Transient evoked otoacoustic emissions: Community-based screening of paediatric populations

Driscoll, Carlie Jane. (2002). Transient evoked otoacoustic emissions: Community-based screening of paediatric populations PhD Thesis, School of Health and Rehabilitation Sciences, The University of Queensland.

       
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Author Driscoll, Carlie Jane.
Thesis Title Transient evoked otoacoustic emissions: Community-based screening of paediatric populations
School, Centre or Institute School of Health and Rehabilitation Sciences
Institution The University of Queensland
Publication date 2002
Thesis type PhD Thesis
Supervisor Kei, Joseph
McPherson, Bradley
Total pages 219
Language eng
Subjects 329999 Medical and Health Sciences not elsewhere classified
730111 Hearing, vision, speech and their disorders
Formatted abstract Universal hearing screening during the neonatal period is generally considered to be an important undertaking, in view of the extensive range of adverse sequelae associated with hearing impairment and the potential benefits of early intervention. Transient evoked otoacoustic emissions (TEOAEs) present as a suitable tool for screening due to their reliability, objectivity, time efficiency and non-invasiveness. Despite widespread investigation and utilization of TEOAE hearing screening programs in the neonatal population, very limited research has occurred into the applicability and particulars of TEOAE testing of other paediatric ages. Further consideration must be afforded to screening beyond the neonatal stage, as coverage may not be extended to every child, nor does neonatal screening allow for detection of late-onset or fluctuating hearing impairment. Later, community-based options for hearing screening include the infant period and/or upon entry to primary school, or alternatively, special education settings.

The present research program aimed to: (1) establish TEOAE normative data for 2- month-old infants in a community setting, as well as describe non-pathological effects (i.e., gender, ear asymmetry, activity state) on the results and examine test/retest variability, (2) establish TEOAE normative data for 6-year-old school children, as well as describe non-pathological effects (i.e., gender, ear asymmetry, history of ear infections, handedness) on the results and examine test/retest variability, (3) investigate the test performance of TEOAE as a screening system for 6-year-old school children, (4) estimate the costs associated with TEOAE screening of 2-month-old infants in a community setting and 6-year-old school children {secondary study aim), and (5) explore the feasibility/practicalities of TEOAE screening of children in special schools.

To achieve these aims, TEOAE screening and analyses was performed for 627 subjects in the 2-month-old age group, 940 subjects of school-entry age (6-year-olds) and 489 subjects studying in special education environments. Infants were assessed at child health clinics, in non-sound proof rooms, as they presented for their first round of immunizations. The latter two groups of school children were screened in non –sound treated environments within their respective educational settings. TEOAE testing was conducted using ILO devices, exclusively in Quick screen mode. Tympanometry was also performed for the children in special schools, whilst tympanometry with pure tone screening comprised the supplementary tests performed for the 6-year-old subjects in non-special schools.

The current research program revealed significant non-pathological effects (of gender, ear asymmetry and activity state) upon the TEOAE results of the 2-month-old infants, along with good intra-subject test reliability for some TEOAE test parameters. TEOAE normative data obtained was displayed to account for the variation associated with such effects (refer to Chapter Two). For the group of entry-level school children, TEOAE data were shown to be significantly affected by the factors of gender, ear asymmetry and history of ear infection. Again, TEOAE normative values were obtained, considerate of the associated variation (see Chapter Three). Test performance measures suggested that TEOAE testing displays potential as a replacement for pure tone screening in the 6 –year old group and optimal pass/fail criteria were recommended, to improve the accuracy and efficiency of TEOAE testing (see Chapter Four). Costs associated with conducting a TEOAE screening program for either infants or 6 -year-old school children were shown to be not excessive. Screening at school entry was less expensive, in terms of cost indices, than screening in infancy (refer to Chapter Five). In addition, the present research program demonstrated TEOAE to be a feasible tool for hearing screening of children studying in special education settings, with most subjects able to be tested (as described in Chapter Six).

In essence, through satisfying the aforementioned aims, the current research program was able to greatly enhance the minimal literature available concerning TEOAE screening of community-based paediatric populations. The technical findings presently described lend themselves to a vast array of immediate clinical applications to improve hearing screening of 2-month-old infants, 6-year-old school children and children in special education settings. Ultimately, this thesis contributes to the development of effective hearing screening programs for children beyond the neonatal period.
Keyword Hearing -- Measurement.
Pediatrics.
Otoacoustic emissions.

 
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Created: Fri, 24 Aug 2007, 17:54:41 EST