Assessing Sensorineural Hearing Loss Using Various Transient-Evoked Otoacoustic Emission Stimulus Conditions.
Daniel B Putterman, Douglas H Keefe, Lisa L Hunter and 4 others
PMID 28437273WHAT IT FOUND
Chirp otoacoustic emission tests accurately identified sensorineural hearing loss from 1 to 8 kHz, except at 5.7 kHz.
Power-weighted and peak middle-ear pressure conditions offered little clear advantage over ambient in adults with normal middle-ear function.
Key findings
01SNR-based chirp TEOAE tests classified ears as having normal hearing or sensorineural hearing loss with AUCs of at least 0.85 at 1, 2.8, 4 and 8 kHz, and 0.77 to 0.81 at 5.7 kHz.
02Power-weighted and peak-pressure TEOAE conditions improved classification over ambient only at 2 or 2.8 kHz, and they did not differ from each other at any frequency.
03When tests were repeated between one and two months after initial measurements, SNR reliability was 4.3 dB or less and CSM reliability was 0.035 to 0.15 for both hearing groups and all three stimulus conditions.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included adults with normal otoscopy, normal 226-Hz tympanometry and air-bone gaps of 10 dB HL or less, so it does not show how these tests perform in patients with conductive or mixed hearing loss or varied middle-ear pressure and absorbance. At 1 and 2 kHz there were only 16 and 22 ears in the sensorineural hearing loss group compared with 140 and 134 ears in the normal-hearing group, so low-frequency contrasts are unstable. The probe could create distortion near 5.7 kHz, and this may explain the lower classification accuracy at that frequency. TEOAE half-octave measures were compared with the nearest audiometric frequency, so the test and reference standard may not reflect exactly the same cochlear region. The power-weighted stimulus had a mean SPL about 2 dB higher than the other stimulus conditions, which may account for some of its larger TEOAE responses. This was a single study with a modest dataset and no replication, so the findings are not yet established for clinical use.
Declared interests
One author is involved in commercializing technology for screening and diagnosis of middle-ear and cochlear disorders. The work was funded by the National Institute on Deafness and other Communication Disorders of the National Institutes of Health and by resources and facilities at the VA Portland Health Care System.
The easy way to misread this
Do not choose the power-weighted stimulus because it gives larger TEOAE responses. Those responses were also larger in ears with hearing loss, and classification accuracy improved over ambient only at 2 or 2.8 kHz. Power-weighted and peak-pressure conditions did not differ significantly at any frequency.