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 to the traditional TFWT in patients with unilateral conductive and sensorineural hearing loss. The study investigates whether the smartphone Weber test can serve as a viable 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 patients were enrolled, including conductive hearing loss (n=50), sensorineural hearing loss (n=50), and healthy controls (n=50). The Weber test was performed using both a 512 Hz tuning fork and a smartphone vibration function. Accuracy, sensitivity, and specificity of the smartphone Weber test were compared to the TFWT, with agreement assessed using Cohen’s Kappa coefficient. Receiver operating characteristic curve analysis was conducted to determine diagnostic performance. Results: The smartphone Weber test demonstrated an overall accuracy of 83.3 percent (95% CI: 76.8–89.7), with 82 percent accuracy for conductive hearing loss, 88 percent for sensorineural hearing loss, and 80 percent for healthy controls. The TFWT had an accuracy of 84 percent (95% CI: 78.1–90.2), with 80 percent accuracy for conductive hearing loss, 92 percent for sensorineural hearing loss, and 80 percent for healthy controls. Agreement between the smartphone Weber test and the TFWT was moderate to good (Cohen’s Kappa, κ=0.488, 95% CI: 0.39–0.57, p<0.001). Sensitivity and specificity were 72 percent and 68 percent, respectively, with an area under the receiver operating characteristic curve of 0.74, indicating moderate diagnostic capability. Conclusion: The smartphone Weber test shows moderate diagnostic accuracy and agreement with the TFWT. While not a replacement for audiometry, it may serve as a screening tool in primary care, emergency settings, and telemedicine applications. Further research should focus on standardization, improving specificity, and validating its use across different populations and smartphone models.