Subclinical conductive hearing loss significantly reduces otoacoustic emission amplitude: Implications for test performance.

Distortion product otoacoustic emissions (DPOAEs) are a time-efficient, non-invasive means of assessing the integrity of active inner ear mechanics. Unfortunately, the presence of even relatively minor conductive hearing loss (CHL) has been suggested to reduce the clinical utility of DPOAEs significantly. The primary aims of this study were to systematically evaluate the impact of CHL on DPOAE amplitude and to determine if ear-specific primary tone level manipulations can be used to mitigate CHL impact and recover DPOAE measurability. For 30 young adults (57 ears) with normal hearing, DPOAEs were obtained for f 2 = 1–6 kHz. Observed DPOAE amplitudes were used to generate ear- and frequency-specific models with the primary tone levels, L 1 and L 2, as inputs and predicted DPOAE amplitude, L DP , as output. These models were then used to simulate the effect of CHL (0–15 dB), as well as L 1 manipulations (0–15 dB), on DPOAE measurability. Mean L DP for every CHL condition was significantly different from that for all other conditions (p = <.001), with a mean L DP attenuation of 8.7 dB for every 5 dB increase in CHL. Mean DPOAE measurability in response to a standard clinical stimulation paradigm of L 1 /L 2 = 65/55 (dB SPL) was determined to be 99%, 84%, 37%, and 9% in the presence of 0, 5, 10, and 15 dB CHL, respectively. In the presence of 10 dB CHL, altering L 1 resulted in an approximately 25% increase in DPOAE responses. Subclinical CHL loss is sufficient to significantly impair DPOAE measurability in a meaningful proportion of otherwise healthy ears. However, through strategic alteration of primary tone levels, the clinician can mitigate CHL impact and at least partially recover DPOAE measurability. [ABSTRACT FROM AUTHOR]