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Cochlear Reflectance and Otoacoustic Emission Predictions of Hearing Loss

Neely, Stephen T.; Fultz, Sara E.; Kopun, Judy G.; Lenzen, Natalie M.; Rasetshwane, Daniel M.

doi: 10.1097/AUD.0000000000000677
Research Article

Objectives: Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission (OAE) that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to compare wideband CR to distortion-product (DP) OAEs in two ways: (1) in a clinical-screening paradigm where the task is to determine whether an ear is normal or has hearing loss and (2) in the prediction of audiometric thresholds. The goal of the study was to assess the clinical utility of CR.

Design: Data were collected from 32 normal-hearing and 124 hearing-impaired participants. A wideband noise stimulus presented at 3 stimulus levels (30, 40, 50 dB sound pressure level) was used to elicit the CR. DPOAEs were elicited using primary tones spanning a wide frequency range (1 to 16 kHz). Predictions of auditory status (i.e., hearing-threshold category) and predictions of audiometric threshold were based on regression analysis. Test performance (identification of normal versus impaired hearing) was evaluated using clinical decision theory.

Results: When regressions were based only on physiological measurements near the audiometric frequency, the accuracy of CR predictions of auditory status and audiometric threshold was less than reported in previous studies using DPOAE measurements. CR predictions were improved when regressions were based on measurements obtained at many frequencies. CR predictions were further improved when regressions were performed on males and females separately.

Conclusions: Compared with CR measurements, DPOAE measurements have the advantages in a screening paradigm of better test performance and shorter test time. The full potential of CR measurements to predict audiometric thresholds may require further improvements in signal-processing methods to increase its signal to noise ratio. CR measurements have theoretical significance in revealing the number of cycles of delay at each frequency that is most sensitive to hearing loss.

Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA.

This research was supported by grants R01 DC008318 and P30 DC004662 from the National Institute of Health.

The authors have no conflicts of interest to disclose.

Address for correspondence: Stephen T. Neely, Center for Hearing Research, Boys Town National Research Hospital, 555 N 30th St. Omaha, NE 68131, USA. E-mail:

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