Wideband Power Reflectance and Power Transmittance as Tools for Assessing Middle-Ear Function

2008 ◽  
Vol 18 (2) ◽  
pp. 44-57 ◽  
Author(s):  
Patricia S. Jeng ◽  
Jont B. Allen ◽  
Judi A. Lapsley Miller ◽  
Harry Levitt
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Power Flow ◽  
Acoustic Power ◽  
Hearing Screening ◽  
Flow Measurements ◽  
Case Examples ◽  
Screening Programs ◽  
Adults And Children ◽  
Infants And Young Children

Abstract Hearing screening programs using otoacoustic emissions can have high false positive rates, due to temporary middle-ear and outer-ear disorders. This is especially the case for newborns, infants, and young children. Standard tympanometry is limited, uncomfortable, and unreliable in young ears. By incorporating wideband acoustic power flow measurements into hearing screening (using the same equipment), middle-ear and outer-ear disorders can be detected, thus allowing for rescreening rather than more expensive audiological referrals. Wideband acoustic power flow is described in detail and four case examples are provided for adults and children.

scholarly journals Finding out incidence of deafness among neonates at a tertiary care centre of western Rajasthan, India using otoacoustic emission

2019 ◽  
Vol 6 (2) ◽  
pp. 338
Author(s):  
Ashish Gupta ◽  
Vinod Kumar
Keyword(s):  
Hearing Loss ◽  
Otoacoustic Emissions ◽  
Large Scale ◽  
Tertiary Care ◽  
Screening Method ◽  
Hearing Screening ◽  
Distortion Product Otoacoustic Emissions ◽  
Research Association ◽  
Screening Programs ◽  
Distortion Product

Background: Newborn hearing screening is conducted to identify suspected hearing loss and not to confirm the presence/absence of hearing loss or define features of the loss. Speech and hearing are interrelated, i.e., a problem with one could mean a problem with the other as speech and language is acquired normally through auditory system.Methods: A descriptive study conducted in the Department of Paediatrics, Dr. S. N. Medical College, Jodhpur, from June 2016 to December 2017. 5000 neonates were screened using otoacoustic emissions (OAE) in 2 stages at birth during 3rd to 7th day and 15-30 days respectively, followed by BERA at 3 months of age.Results: 1.4 infants per thousand infants had hearing loss. Presence of high-risk factors was seen to be associated be associated with hearing loss more than normal infants on screening with distortion product otoacoustic emissions (DPOAE) tests. However, on testing with BERA no such association was seen.Conclusions: 1.4 per 1000 infants had hearing loss. This study has shown that two stage distortion product otoacoustic emissions (DPOAE) hearing screening followed by british educational research association  (BERA) to confirm the hearing deficit, can be successfully implemented as new born hearing screening method in a hospital set-up, for early detection of hearing impaired, on a large scale, to achieve the high-quality standard of screening programs in a resource limited and developing nation like India.

Otoacoustic Emissions

1991 ◽  
Vol 1 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Theodore J. Glattke ◽  
Sharon G. Kujawa
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Great Promise ◽  
Ear Canal ◽  
Auditory Periphery ◽  
Screening Programs ◽  
The Status ◽  
Cochlear Partition ◽  
Tonal Stimuli

Otoacoustic emissions are low-intensity sounds that are produced in the cochlea and transmitted through the middle ear apparatus to the ear canal. They can be detected and extracted from the background noise in the ear canal through the use of a sensitive microphone and selective filtering or averaging techniques. The technical aspects of emission recording are very similar to those associated with the detection and capture of auditory evoked potentials. Emissions provide an acoustic link to a physiological window through which we can view the auditory periphery using frequency-specific stimuli that are presented at low and moderate intensities. The window provides an opportunity to examine cochlear activity that occurs prior to stimulation of the nervous system. Tonal emissions occur spontaneously in approximately 40% of people who have normal thresholds for pure-tone stimuli. SOAE and other types of emissions may be influenced by both ipsilateral and contralateral stimuli. One form of interaction results in suppression of the emission, and the tuning patterns associated with suppression of emissions by ipsilateral stimuli have characteristics that are similar to tuning patterns associated with single cochlear hair cells and individual neurons of the auditory nerve. These findings and other lines of evidence support the conclusion that an emission having tonal characteristics is produced from a very restricted region of the cochlear partition. Emissions may be evoked by brief click or tonal stimuli, and by continuous tonal stimuli, in virtually all individuals who have normal pure-tone thresholds and uncompromised middle ear systems. The EOAE are compromised by conditions that compromise the function of the cochlea, and they hold promise as tools that might be employed in screening for hearing loss. Preliminary findings suggest that screening employing TEOAE produces a yield that is similar to that produced by screening programs based on auditory brainstem responses. Emissions may offer advantages over current screening methods because of the ease with which they can be recorded and their apparent independence from neurological influence. Many questions regarding the origin and nature of emissions remain unanswered, but they appear to offer great sensitivity to the status of the auditory periphery. DPOAE provide an opportunity to scan the cochlear partition from base to apex with frequency-specific stimuli, and give the examiner a detailed view of the status of the end organ. The study of DPOAE holds great promise in refinement of site of lesion identification. It is exciting to witness the development of a tool to help clinical examiners probe the function of the previously inaccessible cochlea.

Universal Neonatal Hearing Screening

2001 ◽  
Vol 10 (1) ◽  
pp. 3-12 ◽  
Author(s):  
George T. Mencher ◽  
Adrian C. Davis ◽  
Shirley J. DeVoe ◽  
Dee Beresford ◽  
John M. Bamford
Keyword(s):  
Otoacoustic Emissions ◽  
Target Population ◽  
Testing Procedure ◽  
The United States ◽  
Hearing Screening ◽  
Screening Programs ◽  
Newborn Hearing ◽  
Key Issues ◽  
Universal Hearing Screening ◽  
Universal Neonatal Hearing Screening

After a brief review of the history of newborn hearing screening including the Downs behavioral testing procedure, the Crib-o-gram and similar devices, and the use of auropalpebral reflex and otoacoustic emissions, there is a discussion of key issues that need to be resolved before universal hearing screening is introduced. Included are questions regarding the target population(s) of screening programs, well baby versus NICU screening, dealing with false-positives and the effects on parent-child relationships, and finally, the availability of resources for screening and follow-up. The results of a recent study in the United Kingdom that assessed the current state of audiology services and found there is a difference between existing standards and what is actually being done in practice, are presented and considered in terms of current trends in the United States to move ahead with universal screening without a solid database of information regarding the preparedness of clinical centers to deal with the need for services that will result from the initiation of universal programs. Caution is urged.

External and middle ear effects on infant hearing screening test results

2000 ◽  
Vol 122 (4) ◽  
pp. 477-481 ◽  
Author(s):  
Karen Jo Doyle ◽  
Paula Rodgers ◽  
Sharon Fujikawa ◽  
Erin Newman
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Hearing Screening ◽  
Pass Rates ◽  
Auditory Brain Stem Response ◽  
Membrane Cleaning ◽  
Auditory Brain Stem ◽  
Newborn Hearing ◽  
Otoscopic Examination

This study investigated the relationship between external and middle ear factors and hearing screening results by automated auditory brain stem response (ABR) and transient-evoked otoacoustic emissions (EOAEs). The ears of 200 healthy new-borns aged 5 to 48 hours underwent screening by ABR and EOAE, followed by otoscopic examination. The pass rates for ABR and EOAE were 91% and 58.5%, respectively. On otoscopic examination, 28% (112/400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was successfully performed in all but 2 ears that had occluding vernix. Cleaning of vernix significantly increased the pass rates of all 400 ears for ABR and EOAE to 96% and 69%. Decreased tympanic membrane mobility was found in 22.7% (90/396) of ears that were evaluated otoscopically. Decreased tympanic membrane mobility had a significant effect on EOAE screening; only 33.4% of ears passed EOAE testing. Decreased tympanic membrane mobility did not significantly affect pass rates for ABR screening; 95% of these ears passed the automated ABR screen. Implications for newborn hearing screening are discussed.

Neonatal Hearing Screening with Otoscopy, Auditory Brain Stem Response, and Otoacoustic Emissions

1997 ◽  
Vol 116 (6) ◽  
pp. 597-603 ◽  
Author(s):  
Karen Jo Doyle ◽  
Barbara Burggraaff ◽  
Sharon Fujikawa ◽  
Ju Kim ◽  
Carol J. Macarthur
Keyword(s):  
Brain Stem ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Hearing Screening ◽  
Pass Rates ◽  
Auditory Brain Stem Response ◽  
Auditory Brain Stem ◽  
Brain Stem Response ◽  
Otoscopic Examination

A study was performed to investigate the relationship between external and middle ear factors and hearing screening results by auditory brain stem response (ABR) and transient evoked otoacoustic emissions (EOAEs). The ears of 200 well newborns aged 5 hours to 48 hours underwent screening by ABR and EOAEs, followed by otoscopic examination. The pass rates for ABR and EOAE screening were 88.5% and 79%, respectively. On otoscopic examination, 13% (53 of 400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was attempted in ears that failed ABR or EOAE screening. Seventeen ears that failed ABR were cleaned, and 12 (71%) of them passed repeat ABR. Thirty-three ears that failed EOAE screening were cleaned, and 22 (67%) of them passed repeat emissions testing. Cleaning vernix increased the pass rates for ABR and EOAE screening to 91.5% and 84%, respectively. Decreased tympanic membrane mobility was found in 9% of ears that could be evaluated otoscopically. Increased failure rates for both ABR and EOAE screening were found in infant ears with decreased tympanic membrane mobility, but significance testing could not be performed because of inadequate sample size. Prevalence of occluding external canal vernix and middle ear effusion as a function of increasing infant age were studied. Implications for newborn hearing screening are discussed.

Absent or Elevated Middle Ear Muscle Reflexes in the Presence of Normal Otoacoustic Emissions: A Universal Finding in 136 Cases of Auditory Neuropathy/Dys-synchrony

2005 ◽  
Vol 16 (08) ◽  
pp. 546-553 ◽  
Author(s):  
Charles I. Berlin ◽  
Linda J. Hood ◽  
Thierry Morlet ◽  
Diane Wilensky ◽  
Patti St. John ◽  
...  
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Hearing Screening ◽  
Auditory Neuropathy ◽  
The Other ◽  
Frequency Bands ◽  
Behavioral Audiogram ◽  
Muscle Reflex ◽  
Muscle Reflexes

We extracted a subpopulation of 136 patients (from our database of 257 AN/AD subjects) in whom middle ear muscle reflexes had been measured. None showed normal reflexes at all frequencies tested. Only three subjects showed any reflexes at 95 dB HL or below, but never at both 1 and 2 kHz in both ears whether ipsilaterally or contralaterally elicited. All the other reflex measures in these remaining 133 patients were either absent or observed above 100 dB HL, which is incongruous with their normal otoacoustic emissions throughout the frequency bands.Therefore, we urge colleagues to test ipsilateral middle ear muscle reflex at least at 1 kHz and 2 kHz in any perinatal hearing screening that depends solely on otoacoustic emissions. If the emissions are present and the reflexes are absent or elevated, an ABR may be required to properly intervene, because the management of AN/AD patients often differs drastically from what the behavioral audiogram or the ABR suggest.

scholarly journals Referral and Lost to System Rates of Two Newborn Hearing Screening Programs in Saudi Arabia

2020 ◽  
Vol 6 (3) ◽  
pp. 50
Author(s):  
Ahmad A. Alanazi
Keyword(s):  
Hearing Loss ◽  
Saudi Arabia ◽  
Otoacoustic Emissions ◽  
Auditory Brainstem ◽  
Hearing Screening ◽  
Newborn Hearing Screening ◽  
Two Stage ◽  
Screening Programs ◽  
Newborn Hearing ◽  
Brainstem Response

Congenital hearing loss has been commonly reported as a significant health problem. Lost to system (LTS) is a major challenge facing newborn hearing screening (NHS) programs. This retrospective cross-sectional descriptive study aimed to determine the referral and LTS rates after the two-stage NHS based on transient evoked otoacoustic emissions (TEOAEs) in two main hospitals in Riyadh, Saudi Arabia (SA). NHS was performed on newborns before hospital discharge. Newborns were only rescreened if NHS initially revealed a fail/refer outcome in one or both ears. Those who failed the first and second screenings or had risk factors were referred for auditory brainstem response (ABR) testing to confirm or exclude hearing loss. In total, 20,171 newborns (40,342 ears; 52% males; 48% females) were screened, of whom 19,498 (96.66%) passed the initial screening, while 673 (3.34%) failed. Of the 673 newborns, 235 (34.92%) were LTS, and 438 (65.08%) were rescreened, of whom 269 (61.42%) failed and were referred for a comprehensive audiological assessment to confirm the existence of hearing loss. The referral rate after the initial two-stage screening was equal to 1.33%. The lack of awareness of the importance of NHS among parents seems to be the major cause behind the LTS rate. The stakeholders have to work efficiently to reduce the LTS rate.

Practicality, Validity, and Cost-Efficiency of Universal Newborn Hearing Screening Using Transient Evoked Otoacoustic Emissions

1995 ◽  
Vol 17 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Karl R. White ◽  
Thomas R. Behrens ◽  
Bonnie Strickland
Keyword(s):  
Hearing Loss ◽  
Otoacoustic Emissions ◽  
Screening Program ◽  
The United States ◽  
Hearing Screening ◽  
Newborn Hearing Screening ◽  
Transient Evoked Otoacoustic Emissions ◽  
Screening Programs ◽  
Universal Newborn Hearing Screening ◽  
Newborn Hearing

Although the importance of identifying significant hearing loss at an early age has long been recognized, it is generally acknowledged that newborn hearing screening programs in the United States have not been very successful. The problem has been that available techniques were impractical, too expensive, or invalid. This article summarizes the data regarding the use of transient evoked otoacoustic emissions (TEOAE) in a universal newborn hearing screening program and describes various facets of program implementation. It is concluded that available data provide clear evidence that TEOAE can be used to significantly reduce the average age of identification for hearing loss in the U.S.

Impedance Screening

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 233-235 ◽  
Author(s):  
Jerry L. Northern
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Early Identification ◽  
Hearing Screening ◽  
Additional Research ◽  
Medical Complications ◽  
Research Information ◽  
Screening Programs ◽  
Middle Ear Disease ◽  
Otoscopic Examination

Rationale is presented for including tympanometry as an integral part of all hearing screening programs. Impedance screening will yield more accurate screening results in the identification of middle ear disease than traditional hearing testing or otoscopic examination. Medical complications often result from unidentified otitis media which also contributes to speech, language, and educational delays in children. Although additional research information is needed on the significance of early identification of children with otitis media, it is argued that tympanometry will foster such research efforts, while providing improved identification and potential management of middle ear disease in screening programs.

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