Validation of Portable Screening Audiometry (PSA) Test for Screening of Hearing Impairment among Elders in an Urban Setting, Sri Lanka

Introduction: Hearing impairment is the fourth leading cause of disability among the elderly worldwide. It is defined as the inability to perceive sounds below 25 dB in one or both ears. Often, individuals do not recognize the condition until it affects daily activities. In Sri Lanka, early identification through national programs is limited due to the lack of resources, specially screening tools at the community level.  
Objectives: To validate the Portable Screening Audiometry (PSA) test for screening hearing impairment in elderly individuals aged 65 years and above in Sri Lanka
Methods: A clinic-based, descriptive cross-sectional study was conducted at the National Hospital of Sri Lanka. The study included 103 elderly participants. The PSA test was administered by a trained data collector, and its results were compared with Pure Tone Audiometry (PTA) performed by an audiology technician, which served as the gold standard. Reliability was assessed using the test-retest method.
Results: The mean age of participants was 75.0 years (SD=6.28). At 60 dB, the PSA test showed the highest validity, with a sensitivity of 88.3% (95% CI: 82.2, 93.0) and specificity of 64.7% (95% CI: 50.1, 77.6) against PTA. Test-retest reliability showed a Cohen's kappa of 0.81.
Conclusions & Recommendations: The PSA is a valid and reliable test for detecting hearing impairment in the elderly. Integrating PSA testing into primary healthcare settings (Health and Lifestyle Clinics) could enhance early detection and referral.