Wideband Reflectance in Newborns: Normative Regions and Relationship to Hearing-Screening Results

Abstract

Structured Abstract Objectives To develop normative data for wideband middle-ear reflectance in a newborn hearing-screening population, and to compare test performance with 1-kHz tympanometry for prediction of OAE screening outcome. Design Wideband middle-ear reflectance (using both tone and chirp stimuli over 0.2 to 6 kHz), 1-kHz tympanometry, and distortion-product otoacoustic emissions (DPs) were measured in 324 infants at two test sites. Ears were categorized into DP-pass and DP-refer groups. Results Normative reflectance values were defined over various frequency regions for both tone and chirp stimuli in ambient pressure conditions, and for reflectance area indices (RAIs) integrated over various frequency ranges. Receiver-operating-characteristic (ROC) analyses showed that reflectance provides the best discriminability of DP status in frequency ranges involving 2 kHz, and greater discriminability of DP status than 1-kHz tympanometry. Repeated-measures analyses of variance (ANOVA) established that (a) there were significant differences in reflectance as a function of DP status and frequency, but not sex or ear; (b) tone and chirp stimulus reflectance values are essentially indistinguishable, and (c) newborns from two geographic sites had similar reflectance patterns above 1-kHz. Birth type and weight did not contribute to differences in reflectance. Conclusions Referrals in OAE-based infant hearing screening were strongly associated with increased wideband reflectance, suggesting middle-ear dysfunction at birth. Reflectance improved significantly over the first 4 days after birth with normalization of middle-ear function. Reflectance scores can be achieved within seconds using the same equipment used for OAE screening. Newborns with high reflectance scores at Stage I screening should be rescreened within a few hours to a few days, as most middle-ear problems are transient and resolve spontaneously. If reflectance and OAE are not passed upon Stage II screening, referral to an otologist for ear examination is suggested along with diagnostic testing. Newborns with normal reflectance and a refer result for the OAE screen should be referred immediately to an audiologist for diagnostic testing with threshold auditory brainstem response (ABR) due to higher risk for permanent hearing loss.

Medidas de imitância acústica de banda larga com estímulo chirp e tom puro em lactentes com normalidade de orelha média

“…We observed no significant differences in responses obtained with the chirp and pure tone stimuli (Figures 1 and 2). This result is in line with others observed in previous studies evaluating neonates (12,14) and children (27) , showing that both stimuli were equivalent. and suggesting that they may be used for wideband acoustic immittance measurements.…”

“…Evaluation of the parameters gender and ear (right or left) was not part of the objective of this study since previous publications have not demonstrated a significant difference in results when these parameters were included in the analysis (14,27) .…”

Wideband Tympanometry

“…In the neonates, absorbance shows low values at the low frequencies and then a decrease approximately at the frequency of 6.0 kHz [36][37][38]. The latter also depends on the stimulus bandwidth.…”

“…Many references in the literature, i.e., [36][37][38], use and report reflectance values in their WBI assessment. Figure 6(A) and (B) shows normative neonatal data from reflectance and absorbance curves (10-95 percentiles).…”

Assessment of Conductive Dysfunction: Wideband Acoustic Immittance

“…Energy reflectance measure has been shown to provide superior performance in prediction of conductive hearing loss [4] and help improve newborn hearing screening outcomes [5]. The measure could be useful in the diagnosis of middle ear pathologies, e.g., otitis media with effusion [6], otosclerosis [7], and negative middle ear pressure [8].…”