Subclinical conductive hearing loss significantly reduces otoacoustic emission amplitude: Implications for test performance. 2019

Christoph Kreitmayer, and Steven C Marcrum, and Erin M Picou, and Thomas Steffens, and Peter Kummer
Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany.

OBJECTIVE Distortion product otoacoustic emissions (DPOAEs) are a time-efficient, non-invasive means of assessing the integrity of active inner ear mechanics. Unfortunately, the presence of even relatively minor conductive hearing loss (CHL) has been suggested to reduce the clinical utility of DPOAEs significantly. The primary aims of this study were to systematically evaluate the impact of CHL on DPOAE amplitude and to determine if ear-specific primary tone level manipulations can be used to mitigate CHL impact and recover DPOAE measurability. METHODS For 30 young adults (57 ears) with normal hearing, DPOAEs were obtained for f2 = 1-6 kHz. Observed DPOAE amplitudes were used to generate ear- and frequency-specific models with the primary tone levels, L1 and L2, as inputs and predicted DPOAE amplitude, LDP, as output. These models were then used to simulate the effect of CHL (0-15 dB), as well as L1 manipulations (0-15 dB), on DPOAE measurability. RESULTS Mean LDP for every CHL condition was significantly different from that for all other conditions (p = <.001), with a mean LDP attenuation of 8.7 dB for every 5 dB increase in CHL. Mean DPOAE measurability in response to a standard clinical stimulation paradigm of L1/L2 = 65/55 (dB SPL) was determined to be 99%, 84%, 37%, and 9% in the presence of 0, 5, 10, and 15 dB CHL, respectively. In the presence of 10 dB CHL, altering L1 resulted in an approximately 25% increase in DPOAE responses. CONCLUSIONS Subclinical CHL loss is sufficient to significantly impair DPOAE measurability in a meaningful proportion of otherwise healthy ears. However, through strategic alteration of primary tone levels, the clinician can mitigate CHL impact and at least partially recover DPOAE measurability.

UI MeSH Term Description Entries
D007758 Ear, Inner The essential part of the hearing organ consists of two labyrinthine compartments: the bony labyrinthine and the membranous labyrinth. The bony labyrinth is a complex of three interconnecting cavities or spaces (COCHLEA; VESTIBULAR LABYRINTH; and SEMICIRCULAR CANALS) in the TEMPORAL BONE. Within the bony labyrinth lies the membranous labyrinth which is a complex of sacs and tubules (COCHLEAR DUCT; SACCULE AND UTRICLE; and SEMICIRCULAR DUCTS) forming a continuous space enclosed by EPITHELIUM and connective tissue. These spaces are filled with LABYRINTHINE FLUIDS of various compositions. Labyrinth,Bony Labyrinth,Ear, Internal,Inner Ear,Membranous Labyrinth,Bony Labyrinths,Ears, Inner,Ears, Internal,Inner Ears,Internal Ear,Internal Ears,Labyrinth, Bony,Labyrinth, Membranous,Labyrinths,Labyrinths, Bony,Labyrinths, Membranous,Membranous Labyrinths
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D005260 Female Females
D006314 Hearing Loss, Conductive Hearing loss due to interference with the mechanical reception or amplification of sound to the COCHLEA. The interference is in the outer or middle ear involving the EAR CANAL; TYMPANIC MEMBRANE; or EAR OSSICLES. Conductive Hearing Loss
D006320 Hearing Tests Part of an ear examination that measures the ability of sound to reach the brain. Hearing in Noise Test,Quick Speech-in Noise Test (QuickSIN),Real Ear Measurement,Speech in Noise Hearing Test,Ear Measurement, Real,Ear Measurements, Real,Hearing Test,Measurement, Real Ear,Measurements, Real Ear,Quick Speech in Noise Test (QuickSIN),Real Ear Measurements,Test, Hearing,Tests, Hearing
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000161 Acoustic Stimulation Use of sound to elicit a response in the nervous system. Auditory Stimulation,Stimulation, Acoustic,Stimulation, Auditory
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D001309 Auditory Threshold The audibility limit of discriminating sound intensity and pitch. Auditory Thresholds,Threshold, Auditory,Thresholds, Auditory

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