A ROLE FOR OTOACOUSTIC EMISSIONS IN SCREENING FOR HEARING IMPAIRMENT AND MIDDLE-EAR DISORDERS IN SCHOOL-AGE-CHILDREN

Objective: The primary purpose of this study was to investigate the po tential role of transient-evoked otoacoustic emissions (TEOAEs) for sc reening for hearing impairment and middle ear disorders in school-age children. Because TEOAEs are present in ears with normal cochlear and middle ear function and typically are absent or reduced in ears with c ochlear and/or middle ear disorders of even mild degree, TEOAE screeni ng could serve as a first-stage screening to separate from the general population of school-age children those at greater risk for hearing i mpairment and/or middle ear disorder. There were two secondary objecti ves. First, the relationship between TEOAE measurement variables and m easures of middle ear immittance in ears declared clinically normal wa s investigated. Second, the performance of TEOAEs in screening was com pared with the performance of the pure-tone hearing and tympanometric screening protocol commonly used in the schools. Design: Sixty-six chi ldren (ages 5 to 10 yr) participated. TEOAEs, pure-tone hearing screen ing, acoustic immittance (single-frequency and multifrequency tympanom etry), and an otoscopic exam by a pediatrician, who previously had bee n ''validated'' for identification of middle ear effusion, were done o n each child under typical school hearing screening conditions. Perfor mance of the TEOAE screening was determined based on the pediatrician' s determination of middle ear status and the pure-tone hearing screeni ng as the gold standards. Results: Of the 66 subjects, 61 completed th e study. Fifty-six children passed the hearing and otoscopic screening s bilaterally, and five children did not pass either or both the heari ng screenings or otoscopic examination in at least one ear. A variety of TEOAE criteria were examined with respect to their ability to ident ify ears with either hearing impairment and/or middle ear disease. Sev eral different otoacoustic emission criteria performed well according to our diagnostic criteria. Correlations between TEOAE variables and i mmittance measures of middle ear function were all low. In addition, t ympanometric data were used to compare the TEOAE screening with the Am erican Speech-Language-Hearing Association's (ASHA) recommended protoc ol for the same ears. The ASHA protocol, as recommended, did not do as well as the TEOAE screening. Using slightly modified criteria, the AS HA protocol did as well as TEOAEs. Conclusion: There were some screeni ng criteria based on TEOAE measurement that produced good sensitivity and specificity. A TEOAE screening for hearing impairment and middle e ar disease performed as well as or better than the ASHA-recommended pr otocol, which requires a minimum of two different tests, even when the ASHA protocol was modified to optimize performance. The results sugge st that the TEOAE test has the potential to be incorporated successful ly into hearing screening programs for school-age children and may hav e advantages over current screening protocols. Finally, no relationshi p between TEOAEs and middle ear function, as measured using single-fre quency and multifrequency tympanometry, could be determined in ears wi th normal hearing and normal middle ear function.