Evaluation of Remote Check: A Clinical Tool for Asynchronous Monitoring and Triage of Cochlear Implant Recipients

Abstract

Background: A new Remote Check App permits remote self-testing of hearing function for Nucleus cochlear implant (CI) recipients and enables asynchronous review by their clinician to support patient-management decisions.

Objectives: To evaluate the Remote Check App for: (1) ease of use; (2) overall acceptance of the test battery by CI recipient or their carer in the home setting; (3) test-retest reliability of audiological threshold and speech recognition measures via wireless streaming; and (4) to compare outcomes from patient-driven measures with conventional clinician-driven measurements of aided-hearing function.

Design: Single-site, prospective, repeated-measures cohort study with 32 experienced CI users (28 adults and 4 children).

Methods: Participants completed self-testing using the Remote Check app at home and in the clinic. Measures include audiological, objective and subjective tests. Self-administered speech recognition in noise, via the digit triplets test (DTT) and aided thresholds, via the aided threshold test (ATT) were reassessed in free-field and by clinicians following conventional clinical protocols. Results of ATT and DTT were compared across test conditions. Completion time and perceived ease of self-driven assessments were documented. Insights from subsequent real-world experience with Remote Check are summarized and compared to the study findings.

Results: Remote Check was rated as easy to use by the majority (87%) of subjects. Mean group test-retest score differences for self-administered testing within the clinic versus at-home environments were nonsignificant (p > 0.05): 1.4 dB (SD = 1.97) for ATT and 1.6 dB (SD = 1.54) for DTT. Mean group test-retest score difference for patient-driven DTT in streamed versus the free-field condition was 1.8 dB (SD = 2.02). Self-administered, streamed, ATT via Remote Check, resulted in significantly lower thresholds compared to clinician-driven warble-tone thresholds in the free-field by 6.7 dB (SD = 6.8) (p < 0.001). ATT thresholds via Remote Check were not significantly different from predicted thresholds based on the Threshold Sound Pressure Level of the sound processor.

Conclusion: Remote Check is the first CI telehealth assessment tool that uses wireless streaming to enable comprehensive, easy and reliable self-testing of hearing function by the CI recipient or their carer, in the comfort of their home. Asynchronous access to test results can assist clinicians in monitoring and triaging individuals for appropriate patient-management based on their needs. Use of remote monitoring may also help to reduce the burden of unnecessary clinic visits on clinic resources, patient travel time and associated costs. Remote Check is an important step toward addressing the current growing need for asynchronous audiological telepractice to support long-term care of CI recipients.

Fig. 1.

Diagram of Remote Check. (1) Clinician schedules Remote Check; (2) check available at scheduled time; (3) recipient complete Remote Check; (4) results uploaded; and (5) clinician reviews results on mCP.

Fig. 2.

Individual speech reception thresholds with digit triplet test for 32 participants (52 ears) via Remote Check. The scores for children (C), minimum, maximum, 25th (P₂₅), 50th (P₅₀), and 75th (P₇₅) percentile points are highlighted.

Fig. 3.

Grouped mean aided thresholds with self-tested aided threshold test, clinician-driven audiometry compared to the predicted thresholds based on threshold sound pressure level of the sound processor.