A Hearing Mission to the Dominican Republic with SHOEBOX Audiometry

In the summer of 2016, Dylan Levy — a second-year medical student at the Frank H. Netter MD School of Medicine — travelled to the Dominican Republic for six weeks to perform an independent hearing study funded by his university.

Background research revealed that the D.R. has no national hearing screening protocol, suggesting that many children are left with undetected hearing loss. Although the capital city of Santo Domingo has a newly established audiology-training program that has started to provide substantial improvements in resources for individuals with hearing loss, resources outside of the capital city for hearing health remain scarce.


Dylan Levy is a second-year medical student at the Frank H. Netter MD School of Medicine.

Dylan’s project centered on testing the hearing of children living in the underserved and impoverished bateys — settlements around sugar plantations. Each day he traveled to a different batey on a bus with volunteers working to build schools, churches, or to set up mobile medical clinics.

He brought SHOEBOX Audiometry with him. SHOEBOX is the first clinically validated iPad audiometer providing diagnostic threshold accuracy in a small, mobile form factor. Its portability, reasonable price, and ease of use made SHOEBOX an ideal tool for this project.

SHOEBOX offers an interactive game-play interface that lets the children test their hearing while essentially playing a game. They select and drag an image on the screen based on whether or not they hear tones presented at different frequencies. The children enjoyed being tested so much that they would often ask if they could keep playing the game even after the test was complete.

SHOEBOX Audiometry also offers smart ambient noise monitoring that makes it possible to perform hearing tests outside of a conventional sound booth. Dylan would seek out the quietest locations available, but often found himself testing in a variety of environments depending on what was available in each batey; small classrooms, an individual’s home, on a school bus, or even outside under a tree.

Over the course of his mission trip, Dylan tested the hearing of approximately 430 children aged 5–18. Of those who failed the screening, the most common cause was impacted cerumen, followed by tympanic membrane perforation and otitis media. Talking with the children and their families, Dylan quickly discovered that it was common to use objects such as hairpins and matchsticks to try to remove earwax from the outer ear canal. Once discovered, each hearing screening was supplemented by recommendations for proper ear health practices.

Dylan found 24 children whose test results indicated the need for further follow-up. If a failed test was not attributable to an ear infection or cerumen impaction, each child was then referred for further testing at the Good Samaritan Hospital in La Romana, the seventh largest city in the D.R. Dylan also plans to donate his SHOEBOX Audiometer to the hospital so that they can continue to provide hearing screening services to the children of Hispaniola.

Dylan has since returned to the U.S. and is now working on developing a protocol for using SHOEBOX Audiometry in the Bobcat Community Clinic, a student-run clinic that was established to serve the needs of underserved populations throughout Bridgeport, Connecticut.

“I am grateful for the experience, and thankful that SHOEBOX Audiometry helped me achieve my goals. While the testing phase of this project is complete, I hope we can continue to collaborate to advance SHOEBOX Audiometry and to improve the lives of those in need,” Dylan Levy.