Purpose: To describe the readability of hearing-related information on the Internet in the German language and compare the readability between webpage origins (by country), type of organisation (i.e., government, non-profit, and commercial), and with and without Health on the Net Foundation (HONcode) certification.

Method: Hearing-related search terms were identified using native German-speaking informants. The three keywords, Schwerhörigkeit [hard of hearing], Hörtest [hearing test], and Hörgerät [hearing aid], were checked with Google Trends and then entered into five country code top-level domain (ccTLD) versions of the Google search engine (Google.de; Google.at; Google.ch; Google.li; and Google.hu). The first 10 retrieved webpages, that matched the inclusion criteria, were documented for each key word along with their webpage origins, type of organisation, date of last update, and HONcode certification. After removing duplicates, from the total of 150 webpages, 39 webpages remained from four ccTLDs. These webpages were analysed for readability using the Läsbarhetsindex 1 (LIX 1) [readability index 1], Läsbarhetsindex 2 - German technical literature (LIX 2) [readability index 2]; Quadratwurzelverfahren (Qu) [square root process], Rate index 1 (RIX 1), and Rate index 2 - German non-fiction (RIX 2); and the Simple Measure of Gobbledygook 1 (SMOG 1) readability formulas (RFs) provided by the Readability Studio software 2012.1 that generated the reading grade levels (RGLs). Descriptive statistics were computed to describe the readability of hearing-related information on the Internet in the German language, and any differences between readability formulas. Univariate and non-parametric ANOVA were used to determine whether there are significant differences in hearing-related information between webpages with, and without, HONcode certification.

Results: The different RFs consistently showed that readability levels for the assessed webpages exceeded the recommended 6th RGL. All webpages analysed in this study had a mean RGL of 12 which was not significantly different based on location and type of organisation. Seventy-seven percent of the webpages were of commercial origin and 23% nonprofit. No government webpages were retrieved by the ccTLDs. The date of last update on 67% of the webpages was not documented. The location of organisation for most webpages was in Germany. Eighty-two percent of the assessed webpages did not have HONcode certification but, most of the webpages that did have HONcode certification were of commercial origin. RGLs did not significantly differ based on HONcode certification.

Conclusion: The readability of hearing-related information on the Internet in the German language is above the 12th grade level, that is, readers need on average 12 years of education to be able to comprehend the information: however, the limitations of the different RFs, and the software used for the analysis, need to be kept in mind when interpreting results because they can artificially influence the RGL results. Due to the increasing number of people who seek health information online, further studies are needed to investigate whether the online health information in the German language informs or misinforms adults with hearing impairment (HI). The clinical implications of poor readability for audiologists and other stakeholders are discussed.