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Author's personal copy Journal of the Formosan Medical Association (2014) 113, 477e480
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BRIEF COMMUNICATION
A web-based audiometry database system Chung-Hui Yeh a, Sung-Tai Wei b, Tsung-Wen Chen c, Ching-Yuang Wang a, Ming-Hsui Tsai a,d, Chia-Der Lin a,d,* a
Department of Otorhinolaryngology, China Medical University and Hospital, Taichung, Taiwan Department of Neurosurgery, China Medical University and Hospital, Taichung, Taiwan c Department of Information Technology, China Medical University Hospital, Taichung, Taiwan d Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan b
Received 23 July 2013; received in revised form 1 September 2013; accepted 4 October 2013
KEYWORDS audiometry; database system; pure tone audiometry
To establish a real-time, web-based, customized audiometry database system, we worked in cooperation with the departments of medical records, information technology, and otorhinolaryngology at our hospital. This system includes an audiometry data entry system, retrieval and display system, patient information incorporation system, audiometry data transmission program, and audiometry data integration. Compared with commercial audiometry systems and traditional hand-drawn audiometry data, this web-based system saves time and money and is convenient for statistics research. Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
Introduction Audiometry is the most widely used quantitative method for diagnosing hearing loss by degree and type. The clinical audiometer emits a pure tone by means of a fixedfrequency oscillator, allowing the examination of air and bone conduction. These parameters are used to measure hearing thresholds. Pure tone audiometry is one of the most common tests used in otorhinolaryngology clinical practice. Most of the hospitals in Taiwan use commercial devices that
* Corresponding author. Department of Otolaryngology, China Medical University and Hospital, Number 2 Yuh-Der Road, Taichung City 404, Taiwan. E-mail address:
[email protected] (C.-D. Lin).
are limited to use on specifically designated computers. Traditional audiometers have a thermal printer, and most of the data are stored as graphs printed onto paper by the machine. When the audiometer is turned off or when new patient data are introduced, the information from the previous test is lost, as there are no hardcopy backups. Computerized audiometers have been developed and are now commercially available. However, problems with these systems remain. Because the software is designed abroad, the computerized audiometer usually fails to integrate with the local hospital intranet. In addition, these machines are expensive, and there is no Chinese version available. Hence, we worked in cooperation with our departments of medical records, information technology, and otorhinolaryngology to develop a digital audiometry database system. The purpose of our paper is to describe the development,
0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved. http://dx.doi.org/10.1016/j.jfma.2013.10.006
Author's personal copy 478 implementation, and effectiveness of this web-based audiometry database system.
Methods To establish a real-time, web-based, customized audiometry database system, we worked in cooperation with the departments of medical records, information technology, and otorhinolaryngology at our hospital. Computer program designers wrote the program and set up this system (Fig. 1A), which was connected to our electronic medical
C.-H. Yeh et al. chart system. The patient’s Chinese name, chart number, date of birth, age, sex, and ward number were displayed when the chart number was keyed into this system. Audiologists used the interface in this database system as follows (Fig. 1B): 1. Choose the symbol to indicate the right or left ear, air conduction or bone conduction, masked or unmasked. 2. Click the threshold at different frequencies on the audiogram on the screen, which can be obtained as a number in the corresponding tabulation cell below.
Figure 1 (A) Overview of the audiometry database system. (B) The interface used for this system. The audiologist clicks the threshold at different frequencies on the screen and then clicks save. The data are saved into the hospital information system. (C) Audiogram, tailor-made in our hospital, that can be adjusted to accommodate needs for clinical use and the government policy of hearing disability authentication.
Author's personal copy A web-based audiometry database system 3. After finishing the audiogram, click save. The data were saved into the hospital information system, where they were stored as an Excel file, processed, and then transformed into PDF format automatically (Fig. 1C). 4. For statistical analysis, click data export. The statistical parameters can be retrieved using Microsoft Excel. This system (Fig. 1A) included an audiometry data entry system, retrieval and display system, patient information incorporation system, audiometry data transmission program, and an audiometry data integration system. The audiometry data can be easily retrieved at any time, from any place that our website can be accessed, and used in statistical analyses. Two clinical examples (distribution of hearing level characteristics at different ages and hearing improvement in patients with otitis media after ventilation tubes insertion) are used to illustrate the use of data retrieval and analysis in this study.
Results From January 1, 2010 to June 30, 2011, we collected audiometric records from 15,528 patients using this database. Of these patients, 7507 were male (48.3%) and 8021 female (51.7%). The average age was 47 years, with 20.5% being aged 51e60 years (20.5%). The mean hearing level (in decibels, dB) is reported for frequencies of 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. The mean hearing level for all patients was 34.9 dB (24.1) in the right ear and 33.8 dB (24.1) in the left. Using this tailor-made audiometry database, the raw data can be retrieved and used with statistics software. For example, the distribution of the mean hearing levels at different age groups can be calculated in a short time (Fig. 2). Audiograms typical of hearing decline were observed with increasing age. The mean hearing levels for different age groups in Taiwan have rarely been collected and reported. The distribution characteristics of the mean hearing levels in our medical center could be used as a reference for the Taiwanese people. We propose that our web-based data collection system could also be used to assess procedures used in clinical practice. To test this proposal, we examined hearing gain in patients with otitis media with effusion after ventilation tube insertion Excluding patients with tympanoplasty, hyperbaric oxygen therapy, or incomplete data, there were
479 404 audiometric data records in a total of 160 otitis media with effusion patients receiving ventilation tube insertion from January 1, 2010 to June 30, 2011. The mean hearing improvement after the operation was 6.6 dB in the right ear and 6.9 dB in the left ear. Of these patients, 69 (43%) were children from newborn to age 10 years. The hearing level improved by 8.6 dB in the right ear, and 9.5 dB in the left ear, which was comparable to a previous report that children with otitis media with effusion improved by 6e9 dB after grommet tube insertion.1
Discussion Traditional commercial audiometric devices record data by thermal printer drawings, and these audiometric data are stored as paper sheets in the medical records. Using such a system, communication between departments regarding patients’ hearing levels may be inconvenient, because not all parties can see the audiometric data in the medical records. The transfer of medical records between different departments is usually costly in terms of both time and labor. Mizukami et al have reported on the linking of several audiometers to a personal computer to prepare a standard pure-tone audiometric database system using a local area network2 to store and retrieve data from a small number of hard disks. Josefina et al developed an interface to compensate for the limitations of commercial audiometers, including storing, transferring, processing, and printing data.3 This interface is limited to use in English only. Using our web-based audiometry database system, data can be stored in the database, processed to yield average hearing levels, and retrieved any time at any location that our website is accessible. Additionally, this system has a traditional Chinese version; the patient’s name can be recorded in Chinese, added to the patient’s chart number, along with the birth date, sex, and date of tests, and then transformed into a tailor-made audiogram. We can adjust the contents of the audiograms to accommodate the demands of clinical practice or government regulations. For example, new regulations for authentication of hearing handicaps were introduced by the government in July 2012.4 The new hearing authentication must include monaural impairment and overall hearing handicap estimations, which demand complicated calculations using a mathematical formula and data on hearing levels at different frequencies (500 Hz, 1000 Hz, 2000 Hz, and
Figure 2 (A) Distribution of hearing level characteristics in our medical center. Right, pure tone audiogram of right ear at different ages; left, pure tone audiogram of left ear at different ages; X-axis, frequency (kHz); Y-axis, decibels (dB). (B) The mean hearing levels in Taiwan for different age groups.
Author's personal copy 480 4000 Hz) in both ears. Such calculations are usually time consuming. We easily integrated this calculation into the web-based, digital audiometric system. The degree of functional hearing impairment was displayed on the tailormade audiogram. Using such a system, clinical physicians could save the time required for these complicated calculations and have more time for clinical practice and communication with patients. Because the audiometry data are accessible through the website, the retrieval of hearing level data for medical research and statistical applications is easy and less time consuming. In the past, we collected such hearing data from medical charts, which can take up to several months. Now, we use keywords to select specific data from our audiometric database, as with the two practice examples mentioned above. Less than an hour was required for the collection and analysis of 16,235 records. Using this web-based audiometry database system, clinicians could retrieve and display hearing data at any station or ward in a hospital, out-patient department, or anywhere else that can access our website. These audiometry data could be stored easily for years or even decades. Our system also provides a tool to quickly research and analyze specific audiometry-related variables.
C.-H. Yeh et al.
Acknowledgments This study was supported by a research grant (CMU98-NTU13, DMR-100-043) from the Department of Medical Research at China Medical University Hospital, Taiwan, and Clinical Trial and Research Center of Excellence Funds (DOH102-TDB-111-004) from the Taiwanese Department of Health. The authors would also like to thank Hsiu-Chen Lu for the illustrations.
References 1. Lous J, Burton MJ, Felding J, Ovesen T, Rovers M, Williamson I. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev 2005:CD001801. 2. Mizukami C, Yamamoto E. Audiometry database system using a local area network. Acta Otolaryngol Suppl 1994;510:48e51. 3. Gutie ´rrez Martinez J, Barraza Lo ´pez F, Guadarrama Lara A, Nu ˜ez Gaona MA, Delgado Esquerra R, Gutie ´rrez Farfa ´n I. ´n Communication interface and graphic module for audiometry equipment. Biomed Instrum Technol 2009;43:484e8. 4. International classification of functioning disability and health: ICF. Geneva: World Health Organization; 2001.
