Improving Measurement Efficiency of the Inner EAR Scale with Item Response Theory

Annika Jessen, Andrew D. Ho, C. Eduardo Corrales, Bevan Yueh, Jennifer J. Shin

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objectives: (1) To assess the 11-item Inner Effectiveness of Auditory Rehabilitation (Inner EAR) instrument with item response theory (IRT). (2) To determine whether the underlying latent ability could also be accurately represented by a subset of the items for use in high-volume clinical scenarios. (3) To determine whether the Inner EAR instrument correlates with pure tone thresholds and word recognition scores. Design: IRT evaluation of prospective cohort data. Setting: Tertiary care academic ambulatory otolaryngology clinic. Subjects and Methods: Modern psychometric methods, including factor analysis and IRT, were used to assess unidimensionality and item properties. Regression methods were used to assess prediction of word recognition and pure tone audiometry scores. Results: The Inner EAR scale is unidimensional, and items varied in their location and information. Information parameter estimates ranged from 1.63 to 4.52, with higher values indicating more useful items. The IRT model provided a basis for identifying 2 sets of items with relatively lower information parameters. Item information functions demonstrated which items added insubstantial value over and above other items and were removed in stages, creating a 8- and 3-item Inner EAR scale for more efficient assessment. The 8-item version accurately reflected the underlying construct. All versions correlated moderately with word recognition scores and pure tone averages. Conclusion: The 11-, 8-, and 3-item versions of the Inner EAR scale have strong psychometric properties, and there is correlational validity evidence for the observed scores. Modern psychometric methods can help streamline care delivery by maximizing relevant information per item administered.

Original languageEnglish (US)
Pages (from-to)1093-1100
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number6
StatePublished - Jun 1 2018

Bibliographical note

Funding Information:
Competing interests: J.J.S. receives textbook royalties from Evidence-Based Otolaryngology (Springer) and Otolaryngology Prep and Practice (Plural Publishing) and is a recipient of a Harvard Medical School Shore Foundation / Center for Faculty Development Grant and a Brigham Care Redesign Program Award. Sponsorships: None.

Publisher Copyright:
© 2018, © American Academy of Otolaryngology–Head and Neck Surgery Foundation 2018.


  • audiometry
  • clinical care
  • factor analysis
  • health status
  • hearing
  • hearing loss
  • inner ear
  • item response theory
  • psychometrics
  • pure tone averages
  • quality of life
  • validated instrument
  • word recognition scores


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