title: Technical report: distortion product otoacoustic emissions that are not outer hair cell emissions.
abstract: OBJECTIVE
  To present a case study in order to alert clinicians to the possibility of occurrence of intermodulation distortion during otoacoustic emissions testing that arises from the cavity formed by the external auditory meatus and tympanic membrane rather than from the inner ear, compromising the reliability and validity of otoacoustic emissions testing.
  
  
  METHODS
  Prospective case study.
  
  
  METHODS
  A young (26-year-old) female adult with a longstanding, bilateral, essentially moderate to severe sensorineural hearing loss presented with robust distortion product otoacoustic emissions.
  
  
  RESULTS
  Repeat otoacoustic emissions testing with another device of the same model revealed essentially absent distortion product otoacoustic emissions and transient otoacoustic emissions. Calibration of both otoacoustic emissions devices using a 1 cc membranous cavity indicated present intermodulation distortion for the device that yielded robust distortion product otoacoustic emissions for the patient but absent intermodulation distortion for the device that revealed absent distortion product otoacoustic emissions and absent transient evoked otoacoustic emissions for the patient. The calibration findings for the device yielding intermodulation distortion in the cavity were confirmed by an engineer of a technical instrumentation company. The device was shipped back to the manufacturer of the device for repair. The manufacturer's engineers diagnosed the problem as an interruption in the relay system. Following repair, calibration revealed the absence of intermodulation distortion in the 1 cc membranous cavity.
  
  
  CONCLUSIONS
  The findings have implications for the reliability and validity of otoacoustic emissions. Clinicians should routinely calibrate otoacoustic emissions devices using 1.0 and 0.5 cc membranous cavities to rule out intermodulation distortion that could produce artifactual otoacoustic emissions in patients.
authors: Department of Speech Communication Arts and Sciences, Brooklyn College, City University of New York, 2900 Bedford Avenue, Brooklyn, NY 11230, USA. shlomosilman@yahoo.com
authors: Shlomo
authors: S
authors: Silman
authors: Michele B
authors: MB
authors: Emmer
authors: Carol A
authors: CA
authors: Silverman
mesh_terms: D000328:Adult; D001300:Audiometry, Evoked Response / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D018072:Hair Cells, Auditory, Outer / Q000502:physiology*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*