Transient evoked otoacoustic emission measurement in infants

Transient evoked otoacoustic emissions (TEOAEs) were measured and evaluated in 194 ears of 101 subjects under 4 years old who were suspected of hearing loss, using a ILO88 Otoacoustic Emission Analyzer, to study the basic characteristics of this measure and its utility for hearing screening. The mean time necessary to record TEOAEs in both ears was short, about 3 minutes. In 58 ears judged as normal hearing within 30 dB in ABR, TEOAE levels in infants aged less than 2 months were significantly higher than in those aged more than 1 year, especially in the high frequency bands (4-kHz and 5-kHz bands). One case which had been judged as bilateral moderate-to-profound hearing impairment in initial ABR testing showed good responses in TEOAEs, indicating normal cochlear function, and obvious wave Vs in follow-up ABRs recorded at 30 dB nHL confirmed normal auditory function. Therefore, in a case like this one, suspected of retardation in brain stem maturation, TEOAE is more useful than ABR as a hearing screening technique. Since external and middle-ear factors caused poor TEOAE responses in some cases which had been judged as normal hearing by ABR. TEOAE seems to be more sensitive in detecting external and middle ear problems than ABR. Moreover, TEOAE measurement of infants was easy and noninvasive. We conclude that TEOAE is an excellent tool for screening auditory function in infants.     

Hearing devices for children with unilateral hearing loss: Patient- and parent-reported perspectives

ObjectiveManagement of children with unilateral hearing loss is not standardized. The primary goal of this study was to elicit patient- and parent-reported perspectives regarding usage of hearing devices in pediatric UHL and to suggest a basic algorithmic approach to management.MethodsOur tertiary care center recruited families of youth ages 5–19 years with unilateral hearing loss from January 2014 through October 2015. Parents of all youths completed a 36-item survey, and some youth ages 11–19 years participated in hour-long interviews. We assessed patterns of hearing device usage among participants, and performed qualitative data analysis to understand factors considered by youths when deciding whether or not to use a hearing device.ResultsSurvey information was collected for 50 patients. Distribution of hearing loss severity in affected ear was mild 14%, moderate 26%, severe 22%, and profound 38%. The majority of children had sensorineural hearing loss (57%), followed by mixed (32%), and then conductive (11%). 34 children (68%) had tried a hearing device; 20 continued to use the device. Retention rates were similar among children with different degrees of hearing loss: mild 66%, moderate 50%, severe 60%, profound 64%. Sixteen children tried a wireless contralateral routing of signal (CROS) device, and 15 tried a behind-the-ear (BTE) hearing aid. Retention rates for CROS and BTE devices were 69% and 47%, respectively. The most common reason for cessation of use was discomfort, followed by lack of benefit.ConclusionA majority of children with unilateral hearing loss who tried a hearing device continued to use it, and retention rates were similar across all degrees of hearing loss. These findings suggest that personal hearing devices should be included in management protocols.     

Comparison of TEOAE with Play audiometry for screening hearing problems in children

To evaluate the usefulness of transiently evoked otoacoustic emissions (TEOAEs) for hearing screening of children at around 3 years of age, measurements were done together with Peep show test in a group of 47 children (n=93 ears). A stimulus sound of 30 dB nHL was used as the screening intensity for the TEOAE measurement. All measurements were done with awake subjects. Twenty seven ears, all of which were revealed to have normal hearing (within 20 dB HL, assessed by Peep show test) and tympanograms, showed positive TEOAE results. Furthermore, TEOAEs were sensitive to the presence of middle ear conductive impairment, showing negative results. We conclude that, compared with Play audiometry, TEOAE measurements can not yield quantitative results, but can yield qualitative results for determining the presence of hearing impairment without sedative induced sleeping in this critical age of children.     

Auditory brain stem response in newborn infants--masking effect on ipsi- and contralateral recording

Ipsilateral and contralateral auditory brain stem responses (ABR) were recorded in 10 full-term neonates. We investigated the effect of the masking level on the peak latency and amplitude on ipsi- and contralateral recordings. Clicks were presented at 85 dB HL to the ipsilateral ear and the masking white noise was presented at 75, 65, 55, 45 and 0 dB HL on the contralateral one, respectively. Masking had no significant effect on the ipsi- and contralateral recording in regard to latency and amplitude except for wave CVI (contralateral wave VI). In addition, ABR was recorded in an infant with total unilateral hearing loss. Crossover responses on both sides were observed with-out contralateral masking, but these responses were completely eliminated when 45 dB HL contralateral masking masked the 85 dB HL clicks to the dead ear. Therefore, it is suggested that such crossover responses will contribute to the ipsi- and contralaterally recorded ABR waveform when an ABR recording is carried out without contralateral masking. Our results indicate that contralateral masking is necessary and should be used in cases of unilateral hearing loss.     

Characteristics of normal newborn transient-evoked otoacoustic emissions: Ear asymmetries and sex effects

Transient-evoked otoacoustic emissions (TEOAEs) were recorded from more than 30000 newborns over a six year period. Analysis was performed on all the TEOAEs that passed the bedside universal hearing screen (n=60431), in order to characterize the normal properties of neonatal TEOAEs and to study ear and sex effects. Short recording times (median=33 s) were observed in combination with high entire TEOAE level (median=18.8 dB SPL for an 81.8 dB SPL peak stimulus), and high reproducibility (median=86%). Signal-to-noise ratio (S/N) of the TEOAE was highly frequency-dependent, being poorer at low frequencies. Prolonged averaging increased median reproducibility to 97%, but the minor S/N-improvement at low frequencies did not justify the longer test time. Highly significant mean lateral asymmetries (right >left) and sex differences (female >male) existed in entire TEOAE level, S/N TEOAE, and in half-octave frequency bands (700–4000 Hz). Mean lateral and sex entire TEOAE level differences were 1.1 dB and 1.3 dB, respectively. Stimulus levels were not affected by ear or sex. Hence, physiological differences at the level of organ of Corti were demonstrated in newborns.     

Preserved otoacoustic emissions in postparotitis profound unilateral hearing loss: a case report

We report a case of a profound unilateral sensorineural hearing loss following epidemic parotitis, with good response of otoacoustic emissions. The patient was a 12-year-old girl who had developed a unilateral hearing impairment 2 weeks after the onset of mumps. Pure tone audiometry confirmed a profound left sensorineural hearing loss. The affected ear showed an absence of auditory brain stem responses, whereas transient evoked otoacoustic emissions and distortion product otoacoustic emissions were preserved. Epidemic parotitis virus is likely responsible for an impairment of inner hair cells, primary afferent fibers or their synapses, or a combination of these areas, and it does not seem to have a specific tropism for cochlear outer hair cells. Further follow-up will be necessary to differentiate the present case from auditory neuropathy.     

突发性聋预后影响因素

目的对影响突发性聋的预后因素进行分析讨论。方法回顾分析249例突发性聋患者临床资料,包括年龄、初诊时间,初诊时听力损失程度,听力曲线类型,是否伴有眩晕和耳鸣,进行畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)检查结果。结果初诊时间为发病后1～23天,患侧耳初诊时250 Hz～4000 Hz平均听力损失40dB以下31例(12.45%),41 dB～70 dB 80例(32.13%);71 dB～90 dB 74例(29.72%),91 dB以上64例(25.70%)。听力曲线上升型72例,下降型81例,平坦型96例。伴有眩晕96例,伴耳鸣174例。治疗药物包括血管扩张剂、皮质类固醇激素、神经营养剂、抗病毒及能量合剂,疗程2～4周。81例进行畸变耳声发射检查,45例在不同频率被引出,经治疗最终被引出DPOAE的频率听力恢复达痊愈水平。结论高龄患者和年龄小的患者预后不良;初诊时间越早听力恢复越好;听力曲线上升型预后好;伴有眩晕者预后不好;能引出DPOAE者听力恢复好。     

Transient evoked otoacoustic emissions in patients with middle ear disorders

The aim of this study is to investigate the middle ear dynamic characteristics and their influence on TEOAEs in patients with middle ear disorders. The middle ear dynamic characteristics and TEOAE findings were investigated in 89 patients with middle ear disorders using the sweep frequency impedance (SFI) meter and the ILO88 system, respectively. These patients were divided into six subcategories: tympanic membrane aberrations, otitis media with effusion, chronic otitis media, tympanic membrane perforation, otosclerosis, and ossicular chain dislocation. Details of the TEOAE frequency characteristics were compared with the individual's middle ear dynamic characteristics. TEOAE status as a function of hearing threshold and middle ear dynamic characteristics was also examined. The results showed that the middle ear dynamic characteristics in patients with middle ear disorders correlated with the TEOAE frequency characteristics and amplitudes. The hearing level and middle ear mobility were the controlling factors affecting TEOAE status. Using both non-linear and linear stimulus modes, larger TEOAE responses were obtained when the hearing level was better than 20 dB HL, and there was moderately good middle ear mobility. Moreover, TEOAEs were absent using the non-linear mode when the hearing level was worse than 30 dB HL, whereas with the linear mode. TEOAEs were recordable even with hearing losses of up to 40 dB HL in patients with middle ear disorders. A higher incidence of recordable TEOAEs was found in the subgroups with tympanic membrane abnormalities and secretory otitis media when compared with the other subgroups. No TEOAEs were recordable in patients with chronic otitis media.     

黄石市2025例学龄前儿童听力筛查结果分析

目的 探讨学龄前儿童的听力筛查方式及其可行性.方法 采用随机抽样法抽取黄石地区30所幼儿园共2 025例2~6岁儿童,以声导抗、瞬态诱发耳声发射和畸变产物耳声发射检测进行听力初筛,未通过者一个月后同法进行复筛,复筛未通过者行纯音听阈测试或行为测听、听性脑干反应(auditory brain-stem response,ABR)、听性稳态反应(auditory steady-state response,ASSR)及影像学等检查.结果 本组对象听力初、复筛总通过率为94.02%(1 904/2 025),其中初筛通过者1 842例(90.96%,1 842/2 025);183例初筛未通过者进入复筛,其中62例通过复筛(33.88%,62/183),121例未通过2次筛查(5.98%,121/2 025);最终有72例(3.56%,72/2 025)诊断为听力损失,其中,分泌性中耳炎47例;感音神经性聋22例(中度8例,重度4例,极重度10例),单耳18例,双耳4例;单侧外耳道畸形伴不同程度耳道闭锁3例,其中,2例伴双耳大前庭水管综合征.结论 耳声发射及声导抗检测可用于学龄前儿童听力筛查;黄石地区学龄前儿童听力损失的原因主要为分泌性中耳炎和不同程度的感音神经性听力损失.     

TEOAE-based estimation of the auditory threshold in the mid-octave frequencies

The purpose of this study was to estimate the hearing levels, at the mid-frequencies, of 233 ears with sensorineural hearing loss by classifying the corresponding transiently evoked otoacoustic emissions (TEOAE) recordings into three threshold groups. A classification algorithm was based upon a discriminant analysis of fast Fourier transform (FFT) data, evoked by non-linear click stimuli of 80 (+/-2) dB SPL per ear. To validate the efficiency of the proposed methodology TEOAE recordings were initially grouped by mean hearing level values of the 1 kHz and 2 kHz octaves into three threshold ranges according to two strategy schemes: in the first, TEOAE data were assigned into 10-19 dB HL, 20-39 dB HL or > or = 40 dB HL groups. In the second, TEOAE data were assigned into 10-29 > dB H >, 30-39 dB HL or > or = 40 dB HL groups. The most accurate prediction estimates were obtained from the second strategy scheme with a 90.9% accuracy in the 10-29 dB HL group, 82% in the 30-39 dB HL group and 71.4% in the > or = 40 dB HL group.     

Pedaudiologic findings after severe neonatal hyperbilirubinemia

Neonatal hyperbilirubinemia (NHB) above 20 mg/dl (NHB20) has been shown to increase the risk of hearing impairments. Up to now, audiological findings based on behavioural audiometry (BA), otoacoustic emissions (TEOAE) and auditory brainstem responses (ABR) from children after being diagnosed with NHB20 have not been thoroughly compared to those with lower NHB-levels. We, therefore, aimed to assess the presence and characteristics of auditory dysfunction in children with NHB20. The audiological data of 15 children aged 11 months to 9 years with a NHB level between 22.6 and 45.6 mg/dl and/or MRI-confirmed bilirubin encephalopathy (NHBG) were compared retrospectively to 15 children with NHB levels between 12.5 and 19.4 mg/dl (CG). After matching by weeks of gestation at birth, BA, TEOAE and ABR were performed in all the children. Subsequently the groups were compared. Only two children of the NHBG had consistently normal audiologic findings. Hearing function disorders were detected in 87% (13/15) of the NHBG-children, ranging from total deafness to normal BA, including unilateral and bilateral deafness as well as cochlear hearing loss. Auditory neuropathy/dys-synchrony (AN) was found in a total of eight children (53%) of the NHBG. In addition, it was found that after the occurrence of NHB20, initially detected TEOAE can disappear in some cases. In the comparison group (CG) only two children demonstrated a hearing dysfunction, both of which were cochlear hearing impairments, whereas no child had AN. A bias towards hearing impairments has to be taken into account for both groups. Detailed pedaudiologic testing should be mandatory for all children after the occurrence of NHB20 including follow-up during the first 12 months. Audiological diagnostic work-up in the affected children requires objective investigations of hearing functions, while BA is recommended to evaluate the adequate therapeutic procedure. The data was partly presented as a lecture at the 78th Annual Meeting of the German Society of Otolaryngology—Head and Neck Surgery in Munich, Germany in May 2007, as well as at the 24th Annual Meeting of the German Society of Phoniatrics and Pedaudiology in Innsbruck, Austria, in September 2007.     

A longitudinal study of changes in evoked otoacoustic emissions and pure-tone thresholds as measured in a hearing conservation program

Non-linear transient-evoked otoacoustic emissions (TEOAEs) at 74 dB pSPL, distortion-product otoacoustic emissions (DPOAEs) at 65/45 dB SPL and pure-tone audiometry were used to detect noise-induced, inner ear changes in a longitudinal study. Repeated-measures ANOVAs were made on the Noise (n=69) and Quiet (n=42) groups. The Noise group's hearing thresholds increased by 1.2 dB and DPOAE amplitude decreased by ?0.9 dB. For both groups, TEOAE amplitude decreased by approximately ?0.6 dB. Eight of 12 ears with permanent threshold shift (PTS) and 10 of 13 ears with temporary threshold shift (TTS) showed TEOAE decrements or low baseline TEOAE amplitudes. Fewer TTS and PTS ears also showed DPOAE decrements, and there was never a DPOAE decrement without a corresponding TEOAE decrement or low TEOAE baseline. Some TTS ears showed permanent emission decrements. Although otoacoustic emissions show promise in detecting noise-induced inner ear changes, it is premature to use them in hearing conservation programs.     

Hearing assessment in pre-school children with speech delay

OBJECTIVE: The purpose of this study was to detect any underlying hearing loss among the healthy pre-school children with speech delay. METHODS: 76 children, aged from 1 to 5 years, underwent a thorough audiological examination consisting of tympanometry, free field testing, otoacoustic emission recordings and auditory brainstem responses (ABRs). If hearing was normal, then they were evaluated by a child neurologist-psychiatrist. RESULTS: According to our findings, the children were classified into 3 groups; those with normal hearing levels (group I, 52 children, 68.4%), sensorineural hearing loss (group II, 22 children, 28.9%) and conductive hearing loss (group III, 2 children, 2.6%). In group I, speech delay was attributed to pervasive developmental disorder (PDD), which represents high-functioning autistic children (37 cases). Other causes were specific language impairment (SLI)-expressive (3 cases), bilingualism (2 cases), and unknown etiology (10 cases). More than half (59%) of the children diagnosed with PDD evidenced significant language impairment limited to more than two words. Children with SLI-expressive and bilingualism used a maximum of two words. In group II, 13 children suffered from profound hearing loss in both ears, 3 from severe, 3 had profound hearing loss in one ear and severe in the other, 2 from moderate, and 1 had moderate in one ear and severe in the other. No child had mild sensorineural hearing loss. The children with profound hearing loss in at least one ear had total language impairment using no word at all (10 cases), or a maximum of two words (6 cases). When hearing loss was moderate to severe, then the speech vocabulary was confined to several words (more than two words-6 cases). Only two children suffering from conductive hearing loss both presented with complete lack of speech. CONCLUSION: A great number of healthy pre-school children with speech delay were found to have normal hearing. In this case, the otolaryngologist should be aware of the possible underlying clinical entities, especially of psychiatric nature. The children with profound sensorineural hearing loss exhibited more severe speech delay than those with moderate to severe. Regardless of etiology, the early identification and intervention contribute to positive outcome in this critical period of childhood for language development.     

Ausgeprägte beidseitige mesocochleäre Schwerhörigkeit von 40–45 dB bei regelrechten TEOAE, DPOAE und unauffälliger Click-BERA

An objective screening method for assessment of inner ear function of babies and small children can be carried out by measuring TEOAE and DPOAE. In particular, TEOAE can be used as a cheap and quick method to determine, with very high sensitivity and moderate specificity, whether middle to severe peripheral hearing impairment is present. In order to assess the threshold more precisely, the click-BERA is routinely used. We present a case report of a 6 year old girl with regular TEOAE and DPOAE, and who also had bilateral normal thresholds in the click-BERA. With subjective audiometry, the girl could be diagnosed having bilateral mesocochlear hearing impairment (so called cookie-bite audiogram) ranging at 40-45 dB. The child was helped considerably by fitting of hearing aids bilaterally. In order to determine the auditory ability of children and to provide adequate care, subjective as well as objective tests should be used.     

Using otoacoustic emissions to screen for hearing loss in early childhood care settings

OBJECTIVE: Until recently, no objective tool has been available to help health and early childhood education providers screen young children for hearing loss. The aim of this study was to screen underserved children 相似文献   

Identification of hearing loss in newborns by transient otoacoustic emissions

OBJECTIVE: More than 90% of congenital hearing loss cases are of cochlear origin. There are two methods for newborn hearing screening: the transient otoacoustic emission (TEOAE) or (ABR) screening. When TEOAE is used for hearing screening patients, newborn with a neural hearing loss are not discovered. MATERIALS: In the present study TEOAEs were obtained from 3,048 newborns from both ears in patients with and without risk factors for hearing loss in the history. All newborns who did not pass TEOAE in the 2nd screening (uni or bilaterally) underwent additional audiologic tests. RESULTS: In the first screening 150 (4.5%) of the newborns newborn did not pass the screening and 30 (0.98%) did not pass in the second screening. In nine newborns with unilateral absent TEOAE and in two newborns a deafness was confirmed, with one side cochlear and on the other side retrocochlear. Both patients received cochlear implants before the 2nd year of age. In 21 newborns with absent TEOAE bilaterally, five had moderate sensorineural hearing loss bilaterally and in nine patients profound hearing loss (90-100 dB) or deafness was confirmed. Of 3,048 newborns there were 1,355 with a risk of hearing loss and in 12 (0.88%) newborns bilateral hearing loss or deafness was confirmed; of the 1663 newborns without risk of hearing loss in the history, in four (0.24%) newborn deafness or bilateral sensorineural hearing loss in the range of 45-65 dB were confirmed. CONCLUSION: When the newborn has an absent TEOAE uni or bilaterally, we need to inform the parents and to recommend additional screening and other audiologic tests to confirm or exclude hearing loss.     

Effect of Ageing on Otoacoustic Emissions and Efferent Suppression in Humans: Efectos de la edad en las emisiones otoacústicas y (EN LA) supresión eferente en humanos

Transiently evoked otoacoustic emissions (TEOAEs) without and with contralateral acoustical stimulation, were recorded on 52 subjects ranging from 20 to 78 years. Subject selection was based on the hearing levels from 0.5 to 4 kHz being better than 25 dB HL, normal tympanograms and stapedial reflexes, presence of TEOAEs in at least one ear and no history of otological disease, noise exposure, ototoxic drugs, metabolic disease associated with hearing loss or a family history of hearing loss. The ear with better audiological thresholds was selected as the test ear. If there was no difference between the ears, the ear with stronger TEOAEs was selected. Subjects were divided into five age groups: 20–34 years (n=12, mean age 23.7). 35–44 (n=11, mean age 39.7), 45–54 (n=8, mean age 48.1), 55–64 (n=10, mean age 60), 65–78 (n=11, mean age 71). TEOAEs were never absent in the first two groups, but they were absent in two ears in the 45–54 group, and in one ear of the 55–64 and 65–78 groups. Mean TEOAE amplitude decreased with age, but the differences between the five groups were not significant. Contralateral white noise suppressed emission amplitude, but the amount of suppression was not significantly different between the five groups. A linear regression analysis showed a significant correlation between age and hearing levels, and a negative correlation between age and TEOAE amplitude. In addition, a significant negative correlation between hearing threshold and TEOAE amplitude was evident. No effect of age on the amplitude of the efferent suppression was found.     

Task force Guideline of Brazilian Society of Otology – hearing loss in children – Part II — Treatment

ObjectivesTo provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0–18 years.MethodsTask force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.ResultsThe topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children.ConclusionsIn children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.     

Prevalence of auditory neuropathy/synaptopathy in a population of children with profound hearing loss

OBJECTIVE: To examine the prevalence of auditory neuropathy/synaptopathy (AN/AS) in a cohort of children with profound hearing loss. METHODS: From 1997 until 2004, 5190 children, aged 1-15 years, whose hearing ability was uncertain or who had risk factors for hearing impairment were investigated with subjective and objective hearing tests. Three thousand four hundred and fifteen from these children were screened for AN/AS using pure-tone audiometry, impedance measurement, transient evoked otoacoustic emissions (TEOAE) and click-evoked auditory brainstem responses (ABR). RESULTS: From 3415 patients who participated in an ABR and TEOAE assessment, 379 children showed absent or elevated (> or = 80 dB nHL) ABR thresholds. Within this group we found 32 cases with evidence of AN/AS via visible TEOAE and/or cochlear microphonics (CM) coupled with absent ABR. In the remaining 3036 children, AN/AS, could be ruled out by means of detectable ABR-thresholds and coherent findings in pure-tone audiometry and TEOAE assessment. This results in a prevalence of AN/AS of 0.94% within the group at risk for hearing loss, compared to 8.44% among profoundly hearing impaired children. CONCLUSION: This study shows that AN/AS is a common finding in the population of hearing impaired infants. In the majority of our AN/AS children (50%, n=16), an early audiological diagnosis was made under the age of 12 months. Therefore, clinicians and other health care professionals should generally be sensitised for AN/AS in infants, so that an appropriate treatment can promptly be initiated. Further research on clinical and pathophysiological aspects is necessary to better identify and manage patients suffering from AN/AS.     

Changes in otoacoustic emissions with simultaneous acoustic stimulation of the contralateral ear in normal probands and patients with unilateral acoustic neurinoma]

Contralateral white noise alters the amplitude of transitory evoked otoacoustic emissions (TEOAE). 27 students between 20 and 28 years of age with no history of ear disease or dizziness were tested for normal hearing by pure tone audiogram. OAE evoked by nonlinear stimuli were measured with and without contralateral stimulation by 40, 50 and 60 dB white noise. The contralateral stimulation resulted in a statistically significant diminution of the amplitude of the TEOAE under contralateral acoustic stimulation. This diminution is probably caused by the effect of the crossed bundle of the efferent innervation on the outer hair cells resulting in altered vibratory properties of the basilar membrane. In patients with unilateral acoustic neuroma and measurable TEOAE a diminution of the amplitude of the TEOAE under contralateral sound stimulation was not found. The testing can easily be performed with the routine measurement of TEOAE. It could be useful in the diagnostic of lesions of the cerebello pontine angle and the brain stem.