title: A validation and potential clinical application of multivariate analyses of distortion-product otoacoustic emission data.
abstract: OBJECTIVE
  To test the generalizability of multivariate analyses of distortion-product otoacoustic emission (DPOAE) data. Previously published multivariate solutions were applied to a new set of data to determine if test-performance improvements, evident in previous reports, are retained. An additional objective was to provide an alternative approach for making multivariate dichotomous decisions of hearing status in the clinic, based on DPOAE measurements.
  
  
  METHODS
  DPOAE level and noise were obtained in 345 ears of 187 subjects. Approximately one third of the subjects had normal hearing, whereas the remainder had hearing loss, ranging from 25 to more than 120 dB HL. DPOAE data were collected at each of nine frequencies. After data collection, clinical decision theory, in combination with univariate (DPOAE level and signal-to-noise ratio [SNR]) and multivariate (logistic regression) analyses, was used to construct relative operating characteristic (ROC) curves and to generate ROC curve areas. In addition, test performance was assessed by fixing the false-alarm rate and comparing different approaches to analyses in terms of their failure rates as a function of magnitude of hearing loss. The DPOAE test results were compared with either single-frequency or multifrequency gold standards. The multivariate solutions were taken from previously published work (Dorn et al., 1999; Gorga, et al., 1999).
  
  
  RESULTS
  DPOAE level and SNR resulted in roughly equivalent test performance (ROC curve areas and failure rates among ears with hearing loss), although DPOAE level performed better for frequencies above 1 kHz, and SNR performed better for frequencies at 0.75 and 1 kHz. Multivariate analyses resulted in better test performance for nearly all conditions, compared with the univariate approaches that used either DPOAE level or SNR. The improvements in test performance were greatest for the frequencies at which the univariate analyses performed poorest (0.75 kHz, 1 kHz, and 8 kHz). Less difference was observed between univariate and multivariate approaches when multifrequency gold standards were used; however, even for the multifrequency cases, multivariate analyses generally resulted in better performance. An approach that might facilitate the interpretation of multifrequency DPOAE measurements in the clinic is described.
  
  
  CONCLUSIONS
  Previously described multivariate analyses were robust in that they improved test performance when applied to an entirely new set of DPOAE data. This, in turn, suggests that the previously described multivariate solutions may have clinical utility in that they are expected to improve test performance at no additional cost in terms of data-acquisition or data-analysis time. In addition to demonstrating that these solutions generalized to new data, an alternative approach to interpreting multifrequency DPOAE measurements is provided that includes the advantages of using multivariate analyses. This new metric may be useful when DPOAEs are used for screening purposes.
authors.affiliation: Boys Town National Research Hospital, Omaha, Nebraska 68131, USA. gorga@boystown.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gorga
authors.forename: Darcia M
authors.initials: DM
authors.lastname: Dierking
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Johnson
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Beauchaine
authors.forename: Cassie A
authors.initials: CA
authors.lastname: Garner
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Neely
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006309:Hearing / Q000502:physiology*; D034381:Hearing Loss / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D012372:ROC Curve