Changes in transient-evoked otoacoustic emission levels with negative tympanometric peak pressure in infants and toddlers.

OBJECTIVES 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. DESIGN 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. RESULTS 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. CONCLUSIONS 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.