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We evaluated these as separate modules in 155 de-identified outpatient records representing 151 patients. In Module 1, schema-only and audiologist-skill prompts were compared in 50 development records; the locked skill was then tested with a Codex GPT5.5 agentic workflow in 101 independent patients. A post hoc robustness analysis tested matched schema-only and skill-assisted direct-API conditions with DeepSeek-V4-Flash-Vision-Exp in the same 101 patients. The skill increased hearing-loss-type agreement from 85.0% to 94.0% and acoustic-reflex agreement from 70.4% to 98.4% in development. Codex validation yielded 1809\/1820 (99.4%) exact numeric thresholds, but only 9\/15 (60.0%) no-response entries were correct. In the DeepSeek robustness analysis, the skill increased type agreement from 37.6% to 70.3%, while exact numeric-threshold agreement remained 72.1% and no-response agreement remained 0%. In Module 2, AI workflows received adjudicated structured values, not Module 1 outputs. After two audiologists refined reports using 60 records, 91 independent patients were evaluated. All 25 rule-derived fields were correct in 91\/91 Codex and 87\/91 DeepSeek cases; both audiologists rated all Chinese reports accurate or basically accurate. These were different operational workflows, not a matched foundation-model comparison. The findings support prospective evaluation of modular, auditable clinician assistance, not autonomous diagnosis, end-to-end performance, or patient usability.<\/jats:p>","DOI":"10.1007\/s10916-026-02463-5","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:09:06Z","timestamp":1790838546000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Audiologist-Guided Multimodal AI for Pure-Tone Audiometry and Tympanometry Interpretation and Reporting"],"prefix":"10.1007","volume":"50","author":[{"given":"Xia","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6524-9071","authenticated-orcid":false,"given":"Xiaoli","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changgeng","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengyan","family":"Shao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6356-9604","authenticated-orcid":false,"given":"Shangqiguo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"2463_CR1","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1044\/2020_AJA-19-00040","volume":"29","author":"V Manchaiah","year":"2020","unstructured":"Manchaiah V, Kelly-Campbell RJ, Bellon-Harn ML, Beukes EW (2020) Quality, readability, and suitability of hearing health-related materials: a descriptive review. 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The Ningbo Hospital approval and applicable institutional and hospital data-governance requirements permitted transmission and processing of fully de-identified clinical records and images through OpenRouter and downstream AI providers under the retention arrangements actually used in this study. Individual patient consent was waived for retrospective secondary use of the clinical records under the hospital\u2019s data-governance framework.","order":1,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All expert and lay raters provided written informed consent using the University of Hong Kong HREC-approved consent form. Individual patient consent was waived for retrospective secondary use. Clinical records and audiological test images were de-identified before research use.","order":2,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript contains no identifiable individual participant information.","order":3,"name":"Ethics","label":"Consent to Publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"OpenAI Codex was used to assist with code generation, language editing, reference-format checks, and manuscript formatting. All analyses, interpretations, citations, and manuscript text were reviewed and approved by the authors, who take full responsibility for the content.","order":4,"name":"Ethics","label":"Generative AI and AI-Assisted Technologies in the Writing Process","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","label":"Competing Interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Clinical trial number: not applicable.","order":6,"name":"Ethics","label":"Trial Registration","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"140"}}