Consumer Earbuds Completed Hearing Screening in USH2A Retinal Disease Without Technical Failure
A consumer wireless earbud may not look like a medical device, but in this pilot study it functioned as one at the point of care. Investigators at the Singapore National Eye Centre used AirPods Pro 2 to estimate air-conduction thresholds in patients with USH2A-associated retinal disease, a group in which Usher syndrome type 2 can be missed because hearing loss varies so widely and formal audiometry is not always available in ophthalmic clinics. Every participant completed the procedure without failure, repetition, or technical error.
The study enrolled 13 patients with biallelic USH2A pathogenic variants and 13 age- and sex-matched comparison participants between November 2024 and February 2025. Median age among the patients was 45 years, with a range from 29 to 81. Supervised testing was brief: median duration was 4.5 minutes, ranging from 3.6 to 5.1 minutes, and three participants needed physical guidance during the test. Those operational details matter because a screening tool that cannot be completed reliably in a busy eye clinic has little chance of changing referral behavior, even if the underlying signal is sound.
The screen itself was designed to estimate hearing thresholds through consumer earbuds rather than a traditional audiology setup. In this cohort, the threshold configurations resembled previously described USH2A-associated patterns, but the study stopped short of comparing the earbud results against calibrated clinical audiometry. Without that head-to-head validation, the device can be described as feasible and promising for screening, not interchangeable with diagnostic hearing assessment.
Hearing Metrics Tracked With Retinal Structure and Visual Acuity
The investigators also examined cross-sectional relationships between hearing and eye disease severity. Among patients, right-ear pure-tone average, or PTA4-R, ranged from 13.00 to 84.25 dB HL, with a median of 48.25 dB HL. Ellipsoid zone width ranged from 0 to 7,972 μm, with a median of 1,037 μm. Best-corrected visual acuity was also analyzed in logMAR units, allowing a direct look at how auditory decline and retinal degeneration might move together in this inherited disorder.
After adjustment for age, higher PTA4-R showed a negative association estimate with ellipsoid zone width, with β = −57.36 μm/dB and a 95% confidence interval from −117.56 to 2.83. The nominal p value was 0.0597. In parallel, higher PTA4-R showed a positive association estimate with best-corrected visual acuity in logMAR units, with β = 0.02793 logMAR/dB and a 95% confidence interval from 0.00429 to 0.05156; the nominal p value was 0.0251. Neither estimate met the Bonferroni-adjusted significance threshold, which came out to adjusted p values of 0.1194 and 0.0501, respectively.
The biologic logic behind those paired trends is straightforward. USH2A disease affects both cochlear and retinal structures, so a patient with more severe sensory impairment in one system may often have more advanced involvement in the other. The retinal ellipsoid zone reflects photoreceptor integrity, and shrinking width tracks progressive outer retinal damage. When hearing thresholds worsen alongside retinal structural loss, clinicians are seeing two organ systems shaped by the same inherited defect rather than unrelated disease processes.
The signal is suggestive, not definitive. Small numbers, cross-sectional sampling, and the Bonferroni correction all limit how far these associations can be pushed. Still, the direction of effect fits the expected clinical pattern in Usher syndrome type 2 and supports the idea that ophthalmology clinics may be in a better position than they realize to identify patients who also need hearing evaluation.
Why a Brief Earbud Screen Could Matter in Eye Clinics
Usher syndrome type 2 is easy to under-recognize when hearing loss is mild, variable, or compensated for by patient adaptation. In many retina practices, patients focus on vision loss because that is the dominant complaint, and subtle auditory decline never reaches the threshold for formal discussion. A rapid in-clinic hearing screen offers a way to surface that second diagnosis without requiring a separate audiology appointment first.
The present study shows that the workflow is realistic. Supervised testing took only minutes, and no participant was lost to device failure or repeat attempts. That makes the platform attractive for research settings and for preliminary case detection, especially where point-of-care audiometry is limited. It also hints at a broader clinical use case: inherited retinal disease clinics could screen for concurrent hearing loss during routine visits, then refer positive patients for full audiologic workup.
Even so, this should not be mistaken for a replacement for standard hearing care. The investigation did not assess agreement with calibrated audiometry, so diagnostic accuracy remains unproven. The authors also relied on a small pilot sample, which is enough to test feasibility but not enough to define sensitivity, specificity, or clinical cutoffs. Formal audiological evaluation remains necessary for diagnosis and management.
What the study does establish is more practical and more immediate: consumer wireless earbuds can be adapted into a workable screening tool in a specialized retinal cohort, and the resulting threshold patterns align with known USH2A-associated hearing loss. For an inherited disease that spans the eye and ear, that kind of bedside accessibility can change who gets identified, who gets referred, and when the second diagnosis enters the chart.