Distortion Product Otoacoustic Emission Test of Sensorineural Hearing Loss: Performance Regarding Sensitivity, Specificity and Receiver Operating Characteristics

Abstract

The performance of distortion product otoacoustic emissions (DPOEs) as a frequency-specific test of sensorineural hearing loss was evaluated in 142 ears of human adults with normal middle-ear function. The DPOE was measured with the stimulus levels of the two tones equal to 65 dB SPL (re 20 mu Pa) and the ratio between the two frequencies 1.2. In the DPOE test, the cochlear function of an ear at a test frequency was predicted to be normal or abnormal depending upon whether the DPOE level with the geometric mean of the two stimulus frequencies at the test frequency was greater or less than a criterion. The DPOE test outcomes were evaluated against the pure-tone hearing threshold as the standard. We found the sensitivity, specificity and predictive efficiency of the test to be 85-89% at 6000 and 4000 Hz, 82-83% at 2000 Hz and 78-79% at 1000 Hz, respectively. The performance was also evaluated using decision theory in terms of the area under the receiver operating characteristics. The latter was found to range from 0.90 (for 1000 Hz) to 0.94 (for 6000 Hz). These findings support the conclusion that the DPOEs can form a useful frequency-specific objective test of cochlear function.

A Clinical Study on the Growth of Distortion Product Otoacoustic Emissions and Hearing Loss at 2 kHz in Humans

“…Bonfils et al (1994) used fixed stimulus intensity of 52 dB SPL in 102 ears and found a sensitivity of 0.93 for predicting hearing loss greater than 25 dB HL at 2 kHz. Gorga (1993) reported similar results, while Kim, (1996) using higher stimulus intensities of 65 dB SPL, found a lower sensitivity of 82%. Kimberley et al (1994a) used discriminant analysis and claimed a prediction accuracy of 92% at 2000 Hz.…”

Distribution of standing-wave errors in real-ear sound-level measurements

“…Thus, the results at 4 kHz indicate more variability and, therefore, more frequent occurrence of standing-wave effects at this frequency (compared to the other four octave frequencies). Despite the fact that variability is greater at 4 kHz, DPOAE test performance (identifying normal and impaired ears) is best at this frequency (e.g., Gorga et al, 1993Gorga et al, , 1997Kim et al, 1997;Johnson et al,. 2010;Burke et al, 2010).…”

Distortion product otoacoustic emissions: Cochlear-source contributions and clinical test performance

“…This approach, which is well suited to assessing the accuracy with which diagnostic tests provide dichotomous classifications (i.e., normal or impaired hearing in the present case), has been used previously to evaluate DPOAE test performance (e.g., Gorga et al, 1993Gorga et al, , 1997Gorga et al, , 1999Gorga et al, , 2000Gorga et al, , 2005Kim et al, 1996;Stover et al, 1996a;Dorn et al, 1999). In these applications of CDT, audiometric threshold served as the gold standard to which the results from the experimental measurement (typically DPOAE level) were compared.…”