Telehealth in Audiology: Where Does Validity Really Live?

For most audiologists, there is an unspoken line in the sand: If it is not done in a sound booth, it cannot be trusted.

It is a rule that has shaped training, clinical protocols, and professional identity for decades. In many areas of audiology, it is entirely justified. The booth provides control, standardization, and confidence that what we are measuring is not being distorted by the environment.

But the problem emerges when that rule is applied universally.

Not every audiological measure depends on acoustic perfection. Not every patient benefits from being placed in an unfamiliar, highly controlled environment to understand how they hear in the real world. In some areas of practice, the very conditions we impose to ensure control may interfere with what we are trying to measure.

When the Testing Environment Shapes the Results

This tension is especially clear in auditory processing disorder (APD), tinnitus, hyperacusis, and misophonia, where attention, arousal, and sensory regulation are central to performance. In these cases, the testing environment is not neutral; it can actively shape the outcome.

Telehealth in these areas is often framed as a COVID-era workaround: something improvised or temporary. But that framing misses what actually shifted. What emerged was not just feasibility but a more uncomfortable realization: in some areas of audiology, the sound booth may not be essential for validity.

How Telehealth APD Testing Can Work

If you strip away assumptions, APD assessments delivered via telehealth are conceptually straightforward:

• A stable internet connection.
• Standardized stimulus delivery.
• Wired headphones.
• A patient in a quiet environment.

During COVID-era adaptations of the Central Test Battery, the core requirement was not perfect acoustic calibration in the traditional sense. It was controlled bilateral delivery, consistent presentation, and reliable patient engagement.

The key question quietly shifted: not whether the environment was booth-calibrated, but whether the stimulus was equally accessible to both ears and whether the task was performed under stable conditions.

Once that shift is made, the perceived barrier to telehealth becomes much smaller.

This matters even more when considering the populations involved. Patients with APD, tinnitus, hyperacusis, and misophonia often experience comorbid neurodivergent traits. For many, the clinic itself is not a neutral environment. The act of entering a sound booth or even a clinic can introduce sensory load, cognitive strain, or physiological arousal that directly affects performance. For some patients, that added burden is the difference between meaningful participation and overload.

Telehealth does not remove structure. It changes it. Patients remain in familiar environments, with access to their own sensory regulation strategies. They are not navigating unfamiliar lighting, seating, or clinical pressure. In some cases, this could allow for a more representative measure of functional ability than clinic-based testing.

Rethinking Clinical Validity in Teleaudiology

This is where the most common objection arises. It is not emotional or philosophical. It is methodological.

It is not calibrated.

Calibration, standardization, and acoustic control are foundational to audiology. In procedures such as hearing aid verification, threshold testing, and electroacoustic measures, testing requires a sound booth, calibrated equipment, or both. Removing these controls would compromise the validity and reliability of the results.

But APD testing sits in a different category. Auditory processing measures are less about absolute acoustic precision and more about relative performance under controlled conditions. When stimuli are delivered symmetrically, when listening levels are set to comfortable ranges, and when known asymmetries are accounted for, the clinical signal remains intact.

There are edge cases, particularly in asymmetric hearing loss, but these are manageable clinical variables rather than fundamental barriers to validity.