Objective: To investigate the validity of diagnostic pure-tone audiometry in a natural environment using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. Design: A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in retirement facilities with thresholds measured in a sound-treated booth. Study sample:

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... 147 adults (average age 76 ± 5.7 years) were evaluated. Pure-tone averages were normal in 59%, mildly (>40 dB) elevated in 23% and moderately (>55 dB) elevated in 6% of ears. Results: Air-conduction Validity of diagnostic pure tone audiometry without a sound-treated.../ 2 thresholds (n=2259) corresponded within 0 to 5 dB in 95% of all comparisons between the two test environments. Bone-conduction thresholds (n=1669) corresponded within 0 to 5 dB in 86% of comparisons. Average threshold differences (-0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Thresholds recorded showed no statistically significant differences (Paired Samples T-test:p˃0.01) except at 8000 Hz in the left ear. Conclusion: Valid diagnostic pure-tone audiometry can be performed in a natural environment with recently developed technology, offering the possibility of access to diagnostic audiometry in communities where sound-treated booths are unavailable.