Outcomes of transient evoked otoacoustic emission testing in 6-year-old school children: a comparison with pure tone screening and tympanometry

Objectives: (1) To establish test performance measures for Transient Evoked Otoacoustic Emission testing of 6-year-old children in a school setting; ( 2) To investigate whether Transient Evoked Otoacoustic Emission testing pro vides a more accurate and effective alternative to a pure tone screening pl us tympanometry protocol. Methods: Pure tone screening, tympanometry and tr ansient evoked otoacoustic emission data were collected from 940 subjects ( 1880 ears), with a mean age of 6.2 years. Subjects were tested in non-sound -treated rooms within 22 schools. Receiver operating characteristics curves along with specificity, sensitivity, accuracy and efficiency values were d etermined for a variety of transient evoked otoacoustic emission/pure tone screening/tympanometry comparisons. Results: The Transient Evoked Otoacoust ic Emission failure rate for the group was 20.3%. The failure rate for pure tone screening was found to be 8.9%, whilst 18.6% of subjects failed a pro tocol consisting of combined pure tone screening and tympanometry results. In essence, findings from the comparison of overall Transient Evoked Otoaco ustic Emission pass/fail with overall pure tone screening pass/fail suggest ed that use of a modified Rhode Island Hearing Assessment Project criterion would result in a very high probability that a child with a pass result ha s normal hearing (true negative). However, the hit rate was only moderate. Selection of a signal-to-noise ratio (SNR) criterion set at greater than or equal to 1 dB appeared to provide the best test performance measures for t he range of SNR values investigated. Test performance measures generally de clined when tympanometry results were included, with the exception of lower false alarm rates and higher positive predictive values. The exclusion of low frequency data from the Transient Evoked Otoacoustic Emission SNR versu s pure tone screening analysis resulted in improved performance measures. C onclusions: The present study poses several implications for the clinical i mplementation of Transient Evoked Otoacoustic Emission screening for entry level school children. Transient Evoked Otoacoustic Emission pass/fail crit eria will require revision. The findings of the current investigation offer support to the possible replacement of pure tone screening with Transient Evoked Otoacoustic Emission testing for 6-year-old children. However, they do not suggest the replacement of the pure tone screening plus tympanometry battery. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.