Patients in the neonatal intensive care unit were tested by hearing screening tests including auditory brain stem response (ABR), transient and distortion-product otoacoustic emissions (TEOAEs and DPOAEs), and acoustic stapedius reflex (ASR), and by middle ear function tests including multifrequency tympanometry and pneumatic otoscopy. Pass rates on hearing tests were 75% to 89%. TEOAEs produced the lowest pass rate, and DPOAEs the highest. TEOAE, DPOAE, or ASR testing followed by ABR testing of initial failures produced pass rates of about 90%. The most efficient combination was DPOAEs followed by ABR. Pass rates tended to decrease with age. Of patients who failed 226-Hz and 678-Hz tympanometry, 30% to 67% passed hearing tests, suggesting a high false-positive rate for these immittance tests. The 3 ears that failed the 1000-Hz tympanogram failed all hearing tests. Many ears were abnormal by pneumatic otoscopy but passed hearing tests, suggesting that the usual ear examination criteria may not apply to infants.
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References
1.
National Institutes of Health.Early identification of hearing impairment in infants and young children. Int J Pediatr Otorhinolaryngol1993;27:215–27.
2.
RobinetteMSGlattkeTJ, editors. Otoacoustic emissions: clinical applications. New York: Thieme Medical Publishers; 1997.
3.
MargolisRH. Detection of hearing impairment with the acoustic stapedius reflex. Ear Hear1993;14:3–10.
4.
WeatherbyLABennettMJ. The neonatal acoustic reflex. Scand Audiol1980;9:103–10.
5.
PlinkertPKSesterhennGAroldR et al. Evaluation of otoacoustic emissions in high-risk infants by using an easy and rapid objective auditory screening method. Eur Arch Otorhinolaryngol1990;247:356–60.
6.
HirschJEMargolisRHRykkenJR. A comparison of acoustic reflex and auditory brain stem response screening of high-risk infants. Ear Hear1992;13:181–6.
7.
MargolisRHTrineMB. Influence of middle ear disease on otoacoustic emissions. In: RobinetteMGlattkeT, editors. Otoacoustic emissions: clinical applications. New York: Thieme Medical Publishers; 1997. p. 130–50.
8.
NaeveSLMargolisRHLevineSC et al. Effect of ear-canal air pressure on evoked otoacoustic emissions. J Acoust Soc Am1992;91:2091–5.
9.
TrineMBHirschJEMargolisRH. The effect of middle ear pressure on transient evoked otoacoustic emissions. Ear Hear1993;14:401–7.
10.
ChangKWVohrBRNortonSJ et al. External and middle ear status related to evoked otoacoustic emissions in neonates. Arch Otolaryngol Head Neck Surg1993;119:276–82.
11.
KokMRvan ZantenGABrocaarMP. Growth of evoked otoacoustic emissions during the first days postpartum. A preliminary report. Audiology1992;31:140–9.
12.
SmurzynskiJ. Longitudinal measurements of distortion-product and click-evoked otoacoustic emissions of pre-term infants: Preliminary results. Ear Hear1994;15:210–23.
13.
BalkanyTJBermanSASimmonsMA et al. Middle ear effusion in neonates. Laryngoscope1978;88:398–405.
14.
EaveyRD. Abnormalities of the neonatal ear: Otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid. Laryngoscope1993;103(Suppl 58):1–31.
15.
PaparellaMMSheaDMeyerhoffWL et al. Silent otitis media. Laryngoscope1980;90:1089–98.
16.
DoyleKJNurggraaffBFujikawaS et al. Neonatal hearing screening with otoscopy, auditory brainstem response, and otoacoustic emissions. Otolaryngol Head Neck Surg1997;116:597–603.
17.
NozzaRJBluestoneCDKardatzeD et al. Identification of middle ear effusion by aural acoustic admittance and otoscopy. Ear Hear1994;15:310–23.
18.
HolteLAMargolisRHCavanaughRM. Developmental changes in multifrequency tympanograms. Audiology1991;30:1–24.
19.
ParadiseJLSmithGCBluestoneCD. Tympanometric detection of middle ear effusion in infants and children. Pediatrics1976;58:198–210.
20.
KeefeDHBulenJCArehartKH et al. Ear-canal impedance and reflection coefficient in human infants and adults. J Acoust Soc Am1993;94:2617–38.
21.
HolteLACavanaghRMMargolisRH. Ear canal wall mobility and tympanometric shape in young infants. J Pediatr1990;117:77–80.
22.
MarchantCDMcMillanPMShurinPA et al. Objective diagnosis of otitis media in early infancy by tympanometry and ipsilateral acoustic reflex thresholds. J Pediatr1986;109:590–5.
23.
GorgaMPReilandJKBeauchaneKA et al. Auditory brainstem responses from graduates of an intensive care nursery: Normal patterns of response. J Speech Hear Res1987;30:311–8.
24.
HunterMFKimmLCafarelli-DeesD et al. Feasibility of otoacoustic emission detection followed by ABR as a universal neonatal screening test for hearing impairment. Br J Audiol1994;28:47–51.
25.
HunterLLMargolisRH. Multifrequency tympanometry: Current clinical application. Am J Audiol1992;1:33–43.
26.
MargolisRHHunterLL. Tympanometry—basic principles and clinical applications. In: RintelmannWFMusiekF, editors. Hearing assessment. Boston: Allyn and Bacon. In press 1998.
27.
McKinleyAMGroseJHRoushJ. Multi-frequency tympanometry and evoked otoacoustic emissions in neonates during the first 24 hours of life. J Am Acad Audiol1997;8:218–23.
28.
ThorntonARDKimmLKennedyCR et al. External and middle-ear factors affecting evoked otoacoustic emissions in neonates. Br J Audiol1993;27:319–27.
29.
SuttonGJGleadlePRoweSJ. Tympanometry and otoacoustic emissions in a cohort of special care neonates. Br J Audiol1996;30:9–17.
30.
El-RefaieAParkerDJBamfordJM. Otoacoustic emission versus ABR screening: The effect of external and middle ear abnormalities in a group of SCBU neonates. Br J Audiol1996;30:3–8.
31.
HalpernJHosford-DunnHMalachowskiN. Four factors that accurately predict hearing loss in “high risk” infants. Ear Hear1987;8:21–5.
