Validation of a Novel Adaptive Inner EAR Scale to Intelligently Quantify the Impact of Hearing Loss

ABSTRACT

Objectives
To develop and validate a novel adaptive version of the Inner EAR scale, which efficiently quantifies the patient‐centered impact of hearing loss. Adaptive testing is a vetted, established means to provide targeted questions that assess each individual to achieve increased accuracy with less work for respondents.


Methods

A prospective validation study was performed. The adaptive test was developed through factor analysis, item response theory assessments, and evaluation of internal consistency (
n
 = 2200). Convergent and discriminant validity were measured in relation to standard static testing and measured audiometry (
n
 = 513). Assessments of intra‐rater reliability and responsiveness to change were also performed.



Results
Factor analysis demonstrated that items reflected one domain (hearing ability). Internal consistency was strong (Cronbach alpha 0.91, 95% CI: > 0.89). Convergent validity was also demonstrated, with positive associations between adaptive scale scores and audiogram results (Spearman rho 0.30, 95% CI: 0.19–0.41), overall PROMIS physical health (Spearman rho 0.29, 95% CI: 0.17–0.40), social health scores, and global overview scores. Intra‐rater reliability was also demonstrated (Cohen kappa 0.6, 95% CI: 0.5–0.7). Responsiveness to change and discriminant validity (an increase in adaptive test score of 10 was associated with 10.4‐fold increase in odds of normal hearing) were also observed. The adaptive scale had comparable internal consistency, validity, and responsiveness to change, and higher intra‐rater reliability than the standard static scale.


Conclusions
This novel adaptive validated instrument is clinically applicable, internally consistent, reliable, responsive, aligns with audiometry, and has higher reliability than standard static testing.


Level of Evidence
2 (diagnostic or monitoring test).