NORTHERN CONTACT — ShoeBOX: A perfect fit for the North

NORTHERN CONTACT — ShoeBOX: A perfect fit for the North

This series first appeared in the print edition of the Winter 2014 issue of Ottawa Magazine.


The ShoeBOX hearing-testing device. Photo by Dr. Ryan Rourke

More than 60 children from Iqaluit are flown to Ottawa every year to get their hearing tested at CHEO — at a high cost to the Nunavut government. Now, thanks to an iPad-based tool invented by CHEO physician Dr. Matthew Bromwich, some of those children can skip the 3½-hour plane ride. The interactive app asks users to drag an icon (e.g., an egg) into different containers (egg carton, barn, etc.) depending on whether or not they heard a tone. A simple screening test takes five minutes or less and can be done with children as young as three. Dr. Bromwich talked about how this Ottawa invention is changing the game for Northerners and others in remote locations.

The device is called ShoeBOX. I know it’s not for your feet, so why call it that?
ShoeBOX is so named because it is portable and small enough to fit in a shoebox. It consists of an iPad specially calibrated to produce specific tones, headphones, and an interactive game app.

Where did the idea for ShoeBOX come from?
It came from a problem: only 20 percent of the world has access to audiometric testing. If you are outside an urban centre or are outside the First World, you really don’t have much access at all. We [CHEO] kept on having kids fly down from Iqaluit for hearing testing. It is a $40 test, and yet it costs $7,500 [per person] to do. Part of the story here is being smart about where we spend our health-care dollars. We were trying to address the question: how do you bring the testing to them instead of bringing them to the test?

Inuit child playing a game, which tests her hearing. Photo by Dr. Ryan Rourke

How much does ShoeBOX cost?
The simplest but complete ShoeBOX audiometer is a few thousand dollars, which is less expensive than most traditional audiometers.

When did you first use ShoeBOX?
We took ShoeBOX up to Iqaluit in January 2014. Dr. Ryan Rourke, a resident physician at CHEO, and I took three iPads with us, and over seven days, we tested 209 children. These are young children, in Grades 1 or 2. There were 24 children who had results showing some hearing problems. Some have follow-up appointments in Iqaluit, and some will be flown to Ottawa.

How did the children react?
They focused well on it. This [device] is so simple that essentially children can screen themselves. Apparently word spread around the school about the testing, and the kids all wanted to have a turn playing the “hearing game” — there were even high-fives exchanged!

ShoeBOX’s inventor, Dr. Matthew Bromwich. Photo by Dr. Ryan Rourke

Do Inuit children experience greater hearing loss than non-Inuit children in Canada?
There is a greater incidence of hearing loss in northern communities. In the rest of Canada, about three percent of people have hearing problems, but up there, it is about 15 percent. There is a genetic disposition to middle-ear problems — what we call Eustachian tube dysfunction. They can’t clear their ears well and, as a result, get perforations and infections that can lead to hearing loss.

What happens when hearing problems in children are not detected?
They don’t do well in school, get labelled as under-performers, have trouble getting into higher education, and incomes and socioeconomic status as an adult are lower. All these things are reversible if you address the hearing loss. The cost of rehabilitating someone later in life, in terms of speech therapy and special programs, gets higher the later they’re identified. If we can deal with it early, it is cheaper for the health-care system and much better for that individual’s future.

A child testing their hearing using the ShoeBOX device. Photo by Dr. Ryan Rourke

Has ShoeBOX been used in any other remote places?
A team of ear, nose, and throat specialists took ShoeBOX to Uganda earlier this year and screened 639 students. Now this team is working on a grant to help Guyana develop an audiology program. It’s all about taking this homegrown technology and sharing it to democratize access to hearing tests.


Also in this series:

PROFILE: Arctic inspires new Art by Leslie Reid


Renowned for her landscape paintings that evoke emotional responses, Leslie Reid reveals the sublime, fragile nature of the North in her latest series, Mapping Time.


PROFILE: Ottawa’s Inuit centre ignites cultural pride


From women’s healing circles and drop-in baby playtime to book-making workshops and throat-singing lessons, the Ottawa Inuit Children’s Centre is a “hub for celebrating Inuit culture.”