Prieve Beth A, Calandruccio Lauren, Fitzgerald Tracy, Mazevski Annette, Georgantas Lea M
Department of Communication Sciences and Disorders, Institute for Sensory Research, Syracuse University, Syracuse, New York 13244-5290, USA.
Ear Hear. 2008 Aug;29(4):533-42. doi: 10.1097/AUD.0b013e3181731e3e.
Otoacoustic emission (OAE) testing is now a standard component of the diagnostic audiology protocol for infants and toddlers and is an excellent tool for detecting moderate-to-profound cochlear hearing loss. Detection of hearing loss is especially important in infants and toddlers. Unfortunately, middle-ear dysfunction has a high incidence in this age range and can confound interpretation of OAEs. The goal of the study was to determine how transient-evoked otoacoustic emission (TEOAE) and noise levels were different when tympanometric peak pressures (TPP) measured from tympanograms were normal versus negative in the same individual. Another goal was to determine how TEOAE screening pass rates using a priori pass criteria were affected on days when TPP was negative.
TEOAE and noise levels were collected in 18 cases under 2 conditions: on a day when the tympanogram TPP was normal and on a day when the tympanogram TPP was negative. Data were collected from 11 children aged 3 to 39 mo, some of whom were tested more than once. Paired t tests were performed to determine whether there were changes in overall TEOAE and noise levels and TEOAE and noise levels analyzed into half-octave bands. A one-way ANOVA was performed on differences across half-octave bands to determine whether TPP affected TEOAE levels for some frequency bands more than others. Equality-of-proportion Z tests were run to determine whether there were significant differences in the percentage of "passes" on days when TPP was negative and TPP was normal.
Mean TEOAE level was lower when TPP was negative, but noise levels did not change between the 2 conditions. Mean TEOAE levels were lower for all frequency bands from 1000 to 4000 Hz and no significant differences were found among the mean reduction across frequency bands. There were no significant differences in the percentage of passes between TEOAEs collected on days when TPP was normal and when TPP was negative.
Mean data indicated that when tympanograms had negative TPP, TEOAE level was lower by approximately 4 dB across all frequency bands. However, this affected the pass rate in only 5% to 6% of cases. Although the number of participants in the current study was small, the data suggest that it is possible to measure TEOAEs in children with negative TPP. If emission-to-noise ratio is used to identify hearing loss in mid-to-high frequency bands, the majority of children will still have TEOAEs that meet clinical criteria, this providing the clinician with important information about cochlear status.
耳声发射（OAE）测试现已成为婴幼儿诊断听力学方案的标准组成部分，是检测中度至重度耳蜗性听力损失的优秀工具。在婴幼儿中，听力损失的检测尤为重要。不幸的是，中耳功能障碍在这个年龄段发病率很高，可能会混淆耳声发射的解读。本研究的目的是确定在同一个体中，当从鼓室图测量的鼓室压峰值（TPP）正常与异常时，瞬态诱发耳声发射（TEOAE）和噪声水平有何不同。另一个目的是确定当TPP异常时，使用先验通过标准的TEOAE筛查通过率会受到怎样的影响。
在两种情况下收集了18例患者的TEOAE和噪声水平：鼓室图TPP正常的一天和鼓室图TPP异常的一天。收集了11名年龄在3至39个月的儿童的数据，其中一些儿童接受了多次测试。进行配对t检验以确定总体TEOAE和噪声水平以及分析为倍频程带的TEOAE和噪声水平是否有变化。对倍频程带的差异进行单因素方差分析，以确定TPP对某些频段的TEOAE水平的影响是否大于其他频段。进行比例相等Z检验以确定TPP异常和正常时“通过”百分比是否存在显著差异。
当TPP异常时，平均TEOAE水平较低，但两种情况下噪声水平没有变化。1000至4000Hz所有频段的平均TEOAE水平较低，各频段平均降低幅度之间未发现显著差异。TPP正常和异常时收集的TEOAE之间的通过率百分比没有显著差异。
均值数据表明，当鼓室图TPP异常时，所有频段的TEOAE水平大约降低4dB。然而，这仅在5%至6%的病例中影响通过率。尽管本研究的参与者数量较少，但数据表明在TPP异常的儿童中测量TEOAE是可行的。如果使用发射噪声比来识别中高频段的听力损失，大多数儿童的TEOAE仍将符合临床标准，这为临床医生提供了有关耳蜗状态的重要信息。
