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

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).