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Pediatric Applications of Wideband Acoustic Immittance Measures

Hunter, Lisa L.1; Prieve, Beth A.2; Kei, Joseph3; Sanford, Chris A.4

doi: 10.1097/AUD.0b013e31829d5158

Wideband acoustic immittance (WAI) measures have potential capability to improve newborn hearing screening outcomes and middle ear diagnosis for infants and children. To fully capitalize on these immittance measures for pediatric hearing care, developmental and pathologic effects need to be fully understood. Published literature on wideband immittance (reflectance, absorbance, tympanometry, and acoustic reflexes) is reviewed in this article to determine pathologic effects in newborns, infants, and children relative to standard audiologic tests such as otoacoustic emissions (OAEs), standard tympanometry, air and bone conduction auditory brainstem response, and otoscopy. Infants and children with surgically confirmed otitis media with effusion have lower absorbance in the mid-frequency range (1 to 3 kHz) for the affected ear(s). Newborns that do not pass OAE screening at birth also have lower absorbance for frequencies from 1 to 3 kHz, suggesting that nonpass results are frequently associated with middle ear issues at birth. In Newborn Hearing Screening Programs, WAI may help to interpret hearing screening results. Conclusions are limited by the fact that the true status of the middle ear and cochlea are not known for newborns and infants in studies that use OAE or tympanometry as the reference standard. Likelihood ratios for reflectance against surgery gold standards range from diagnostically suggestive to informative. Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of WAI technologies in infants and children. Additional investigations using stronger gold standard comparisons are needed to determine which tools can most accurately predict middle ear status in the pediatric population.

1Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA; 2Department of Communication Sciences and Disorders, Syracuse University, Syracuse, New York, New York, USA. 3Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia; and 4Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho, USA.

ACKNOWLEDGMENTS: The authors declare no conflict of interest.

Address for correspondence: Lisa L. Hunter, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA. E-mail:

Received February 2, 2013

Accepted May 19, 2013

© 2013 by Lippincott Williams & Wilkins