title: Transient-evoked otoacoustic emissions in a group of professional singers who have normal pure-tone hearing thresholds.
abstract: OBJECTIVE
  The objective of this study was to determine whether transient-evoked otoacoustic emissions (TEOAEs) measured in a group of normal-hearing professional singers, who were frequently exposed to high-level sound during rehearsals and performances, differed from those measured in age- and gender-matched normal-hearing non-singers, who were at minimal risk of hearing loss resulting from excessive sound exposure or other risk factors.
  
  
  METHODS
  Twenty-three normal-hearing singers (NH-Ss), 23 normal-hearing controls (NH-Cs), and 9 hearing-impaired singers (HI-Ss) were included. Pure-tone audiometry confirmed normal-hearing thresholds (>or=15 dB HL) at 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, and 8.0 kHz in NH-Ss and NH-Cs, and confirmed mild, high frequency, sensorineural hearing loss in HI-Ss (HI-Ss were included only to estimate sensitivity and specificity values for preliminary pass or fail criteria that could be used to help identify NH-Ss at risk for music-induced hearing loss). TEOAEs were measured twice in all ears. TEOAE signal to noise ratio (S/N) and reproducibility were examined for the whole wave response, and for frequency bands centered at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz.
  
  
  RESULTS
  Moderate to high correlations were found between test and retest TEOAE responses for the three groups. However, absolute test-retest differences revealed standard deviations that were two to three times larger than those reported previously, with the majority of the variability occurring for the 1.0 kHz band. As such, only the best TEOAE response (B-TEOAE) from the two measurements in each ear was used in further analyses, with data from the 1.0 kHz band excluded. With one exception, within-group comparisons of B-TEOAE S/N and reproducibility across ears and gender revealed no statistically significant differences for either NH-Ss or NH-Cs. The only significant within-group difference was between left and right ears of NH-C females for S/Ns measured in the 2.0 kHz band, where median responses from right ears were found to be higher than left ears. Across-group comparisons of B-TEOAEs revealed lower median S/N and reproducibility values for NH-Ss compared with NH-Cs for the whole wave response and 1.4 kHz band. For the 2.0 kHz band, reproducibility was similar for the normal-hearing groups but median S/N was found to be lower for NH-Ss. No significant differences in S/N or reproducibility were found between normal-hearing groups for the 2.8 and 4.0 kHz bands. Using data from NH-Cs and HI-Ss to establish sensitivity and specificity values for various TEOAE pass or fail criteria, six preliminary criteria were identified as having sensitivity and specificity values >or=90%. When these criteria were applied to NH-Ss, the number of NH-S ears passing ranged from 57% to 76%, depending on the criteria used to judge the NH-S ears, which translates into 24% to 43% of ears failing.
  
  
  CONCLUSIONS
  Although TEOAE responses were measurable in all singers with normal audiometric thresholds, responses were less robust than those of NH-Cs. The findings suggest that subtle cochlear dysfunction can be detected with TEOAE measurement in a subset of normal-hearing professional singers. Although preliminary, the study findings highlight the importance of pass or fail criterion choice on the number of ears that will be identified as "at risk" for music-induced hearing loss.
authors.affiliation: American University of Beirut Medical Center, Hamra, Beirut, Lebanon. alhamdan@scvlb.com
authors.forename: Abdul-Latif
authors.initials: AL
authors.lastname: Hamdan
authors.forename: Kim S
authors.initials: KS
authors.lastname: Abouchacra
authors.forename: Adina G
authors.initials: AG
authors.lastname: Zeki Al Hazzouri
authors.forename: Georges
authors.initials: G
authors.lastname: Zaytoun
mesh_terms: D000328:Adult; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000502:physiology*; D005260:Female; D006316:Hearing Loss, High-Frequency / Q000175:diagnosis* / Q000503:physiopathology; D006317:Hearing Loss, Noise-Induced / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009146:Music; D009784:Occupational Diseases / Q000175:diagnosis* / Q000503:physiopathology; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D011237:Predictive Value of Tests; D012016:Reference Values; D012680:Sensitivity and Specificity