A Prospective Study on the Diagnostic Accuracy of the Smartphone Weber Test in Unilateral Hearing Loss.

AIM: This study aimed to evaluate the diagnostic accuracy of the smartphone Weber test compared with the traditional tuning fork Weber test (TFWT) in patients with unilateral conductive and sensorineural hearing loss, and to determine whether the smartphone-based method can serve as a practical screening tool in clinical and remote settings.

METHODS

This prospective study was conducted at the Otorhinolaryngology Clinic of Ankara Bilkent City Hospital between April 2023 and March 2024. A total of 150 participants were enrolled, including patients with conductive hearing loss (n = 50), sensorineural hearing loss (n = 50), and healthy controls (n = 50). Both the TFWT and a smartphone vibration test (iPhone 13, 512 Hz equivalent) were performed. The smartphone vibration was validated for functional comparability, rather than acoustic identity, using accelerometer measurements. Diagnostic performance was evaluated by accuracy, sensitivity, specificity, Cohen's Kappa coefficient, and receiver operating characteristic analysis with 95% confidence intervals (CIs). A binary logistic regression identified independent predictors of test accuracy.

RESULTS

The smartphone Weber test demonstrated an overall accuracy of 83.3% (95% CI: 76.8-89.7%), comparable to the TFWT (84.0% [95% CI: 78.1-90.2%]). Agreement between tests was "moderate" (κ = 0.488, 95% CI: 0.39-0.57, p < 0.001). The smartphone test showed an area under the curve of 0.74 (95% CI: 0.67-0.81), while the TFWT had 0.78 (95% CI: 0.71-0.84), with no significant difference between them (p = 0.34). Logistic regression identified interaural difference as the only independent predictor of correct smartphone test results (p = 0.009).

CONCLUSION

The smartphone Weber test shows moderate diagnostic accuracy and comparable, but not statistically superior, performance to the traditional tuning fork. While not a replacement for audiometry, it may serve as a convenient preliminary screening tool in primary care, emergency, and telemedicine settings. Further multicenter research should standardize calibration, improve specificity, and validate its clinical utility across devices and populations.