Auditory Brainstem Response and Distortion‐Product Otoacoustic Emission Studies in Neonates at High‐Risk for Hearing Loss

Objectives: 1) Recognize that preterm infants less than 1300g have a well‐described and markedly increased incidence of hearing loss, possibly attributed to reversible early middle ear pathology. 2) Analyze if distortion product oto‐acoustic emissions (DPOAE) and/or auditory brainstem response (ABR) could be useful adjuncts when used in addition to tympanometry and otoendoscopy in evaluation of neonatal hearing and middle ear. Methods: Institutional review board approved prospective study at a tertiary care center neonatal intensive care unit with subjects undergoing ABR, DPAOE, tympanometry, and otoendoscopy studies within 72 hours of birth and in scheduled increments until discharge. From January 2010 to date, 77 neonates have been examined. Results: Our results confirmed that DPOAE could be a reliable and repetitive study from 24 weeks of gestational age and onward. When comparing traditional tympanometry to DPOAE, 85.7% of examinations with type B or C tympanometry also had an abnormal DPOAE result. Conversely, 62.5% of patients with type A tympanometry had a normal DPOAE result. Furthermore, in patients with a clinical diagnosis of AOM or OME, 66.7% percent had an abnormal DPAOE result. Regarding ABR threshold studies, there were several limitations with data acquisition due to incubator interference and background noise; thus, the potential of ABR in this population remains to be determined. Conclusions: This study suggests that DPOAE can be used as a reliable hearing evaluation in the neonatal population. Additionally, it may serve as a useful adjunct and insight into evaluating neonatal middle ear pathology, especially when combined with tympanometry and otoendoscopy.