International Journal of Pediatric Otorhinolaryngology
Criteria for detection of transiently evoked otoacoustic emissions in schoolchildren
Introduction
Universal newborn hearing screening (UNHS) programs are nowadays performed in many countries and are usually based on otoacoustic emission (OAE) testing [1], [2], [3]. Some organizations recommend extending hearing screening to young children, especially schoolchildren [4]. Although pure tone audiometry may be effectively used as a method for auditory screening of children older than 4 [5] (i.e. schoolchildren), there are several limitations. The idea behind hearing screening is that it is performed by nonaudiological staff. However, screening by pure tone audiometry performed by nonaudiological personnel has low sensitivity and low specificity, and can be time-consuming [6]. Also, some groups of subjects (e.g. noncooperating) cannot be tested this way. In such cases, fast, objective, and easy-to-use methods such as OAEs might be a better option. Furthermore, some authors have suggested that OAEs can indicate an increased risk of hearing loss [7], [8] and the method is more sensitive to the early stages of hearing damage from noise exposure than is pure tone audiometry [9], [10]. The screening procedure usually has several steps, involving at least two OAE tests or sometimes a combination of OAE and auditory brainstem responses (ABRs), depending on country. One of the crucial steps in such a procedure is the criterion used for detection of the signal.
Because of the great success of UNHS, OAE equipment and detection criteria are prepared specifically with newborns in mind. However, it is known that OAE properties change with age [11], [12]: OAE amplitude decreases with age and there is also a change in the dominant response frequency. In the case of transiently evoked OAEs (TEOAEs) in newborns, the major peak is at 2–4 kHz [13], [14], [15]; in schoolchildren it is more uniformly spread over 1–4 kHz [16], [17]. This means that criteria prepared for newborns might not be effective in schoolchildren. In addition, there are many different criteria for detecting TEOAEs: different systems usually have different default settings for pass/refer, and sometimes it is impossible to change the settings. This high variability in system performance may explain the controversy about which method is more effective for screening the hearing of schoolchildren, OAEs [18] or pure tone audiometry [19].
The properties of TEOAEs in schoolchildren have been studied by several researchers and some normative values are available, e.g. [20], [21]. Nevertheless, schoolchildren are a population that is not very easy to test. TEOAEs can be influenced by seasonal disease [22], and schoolchildren are very active and find it difficult to sit still. This can introduce additional noise and affect the test result.
The rationale for the present study is that most researchers test the whole screening procedure, not the process of detecting OAEs [23], [24], [25], [26]. Moreover, criteria for newborns are usually compared with auditory brainstem responses (ABRs) as the gold standard, whereas in schoolchildren pure tone audiometry can be used (in combination with impedance audiometry) [18], [27]. There are only a few studies that have examined TEOAEs in this group using pure tone audiometry as the reference standard. Also, it is unlikely that neonatal criteria for TEOAEs deliver the same test performance as in school-age children.
This study aims to compare, on the same dataset, existing detection criteria for TEOAEs and picks out those that are most suitable for identifying hearing impairment in schoolchildren.
Section snippets
Material and methods
TEOAEs from both ears of 187 schoolchildren (117 male, 70 female) aged 8–10 years old (8 years, 48; 9 years, 70; 10 years, 69) were measured under low-noise ambient conditions with the ILO 292 apparatus (Otodynamics Ltd, Hatfield) running software version 5.6. Middle ear function was evaluated by impedance audiometry (using a Madsen Zodiac 901 tympanometer, GN Otometrics, Denmark), since middle ear status may significantly influence OAE properties [28]. Pure tone audiometry was evaluated at
Tympanometry and audiometry
Tympanometric tests were performed for all subjects for both ears. The tympanogram classification used was a modified version of Jerger's system [33], presented in Appendix A. Type B tympanograms were obtained in 18 ears (4.81%), type C2 in 10 ears (2.67%), and type C1 in 25 ears (6.68%). Type A tympanograms were found in 265 ears (70.86%), As in 54 ears (14.44%), and Ad in 2 ears (0.53%). Overall, 28 ears (tympanograms type B and C2, 7.49%) failed tympanometry.
A total of 28 ears (7.49%) had
Discussion
In summary, 24 criteria sets based on TEOAE responses have been tested. The highest sensitivity was 89.47% (set 21, Table 1; and set 24, Table 3) and the highest specificity was 91.07% (set 3, Table 1). Unfortunately there is an inevitable tradeoff between hit rates and false alarm rates. Three of the criteria sets (6, 10, and 20) had simultaneously high sensitivity and specificity values, with all three sets having both factors above 75%. A criterion set 6 is based on a global reproducibility
Conclusions
The use of TEOAEs, based on an appropriate protocol and criteria set, can be an efficient tool in school-age hearing screening. It is brief, repeatable, and simple for nonaudiological personnel to perform. The present study showed that a particular criteria set (set 24) based on global reproducibility, response level, and signal-to-noise ratio, and using different thresholds across frequency bands, had the lowest number of false negatives. On the other hand it had a relatively high false alarm
Acknowledgments
Preliminary results of this study were presented at the EFAS 2015 meeting. The authors wish to thank A. Piotrowska for help with organization of the measurements and A. Bell and K. Kochanek for comments on earlier versions of the manuscript.
References (41)
- et al.
Newborn hearing screening resources on the Internet
Int. J. Pediatr. Otorhinolaryngol.
(2003) - et al.
The universal newborn hearing screening program at the University Hospital of Ferrara: focus on costs and software solutions
Int. J. Pediatr. Otorhinolaryngol.
(2008) - et al.
Screening for pre-school and school-age hearing problems: European consensus statement
Int. J. Pediatr. Otorhinolaryngol.
(2012) - et al.
A comparison of two methods of hearing screening in the preschool population
J. Commun. Disord.
(2006) - et al.
Developmental changes of distortion product and transient evoked otoacoustic emissions in different age groups
Brain
(2000) - et al.
Otoacoustic emissions in neonates measured with different acquisition protocols
Int. J. Pediatr. Otorhinolaryngol.
(2012) - et al.
Low-frequency otoacoustic emissions in schoolchildren measured by two commercial devices
Int. J. Pediatr. Otorhinolaryngol.
(2013) - et al.
Outcomes of transient evoked otoacoustic emission testing in 6-year-old school children: a comparison with pure tone screening and tympanometry
Int. J. Pediatr. Otorhinolaryngol.
(2001) - et al.
A comparison of audiometric and objective methods in hearing screening of school children. A preliminary study
Int. J. Pediatr. Otorhinolaryngol.
(2011) - et al.
A normative study of otoacoustic emissions, ear asymmetry, and gender effect in healthy schoolchildren in Slovakia
Int. J. Pediatr. Otorhinolaryngol.
(2010)
Otoacoustic emission-based hearing screening of a Greek NICU population
Int. J. Pediatr. Otorhinolaryngol.
Methodological factors involved in neonatal screening using transient-evoked otoacoustic emissions and automated auditory brainstem response testing
Hear. Res.
Success rate of newborn and follow-up screening of hearing using otoacoustic emissions
Int. J. Pediatr. Otorhinolaryngol.
Transient evoked otoacoustic emissions in hearing screening programs: protocol for developing countries
Int. J. Pediatr. Otorhinolaryngol.
The effect of the number of averaged responses on the measurement of transiently evoked otoacoustic emissions in newborns
Int. J. Pediatr. Otorhinolaryngol.
Neonatal hearing screening: a combined click evoked and tone burst otoacoustic emission approach
Int. J. Pediatr. Otorhinolaryngol.
Otoacoustic emission criteria for neonatal hearing screening
Int. J. Pediatr. Otorhinolaryngol.
Transient evoked otoacoustic emissions and cochlear dysfunction
Egypt. J. Ear Nose, Throat Allied Sci.
Identification of neonatal hearing impairment: summary and recommendations
Ear Hear.
Validity of pure-tone hearing screening at well-child visits
Arch. Pediatr. Adolesc. Med.
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