title: Reliability and clinical test performance of cochlear reflectance.
abstract: OBJECTIVE
  Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is equivalent to an otoacoustic emission (OAE) deconvolved by forward pressure in the ear canal. Similar to other OAE measures, CR level is related to cochlear status. When measured using wideband noise stimuli, potential advantages of CR over other types of OAEs include (1) the capability to cover a wider frequency range more efficiently by requiring fewer measurements, (2) minimal influence on the recorded emission from the measurement system and middle ear, (3) lack of entrainment of spontaneous OAEs, and (4) easier interpretation because of the existence of an equivalent linear model, which validates the application of linear systems theory. The purposes of this study were to evaluate the reliability, assess the accuracy in a clinical screening paradigm, and determine the relation of CR to audiometric thresholds. Thus, this study represents an initial assessment of the clinical utility of CR.
  
  
  METHODS
  Data were collected from 32 normal-hearing and 58 hearing-impaired participants. A wideband noise stimulus presented at seven stimulus levels (10 to 70 dB SPL, 10 dB steps) was used to elicit the CR. Reliability of CR was assessed using Cronbach's α, standard error of measurement, and absolute differences between CR data from three separate test sessions. Test performance was evaluated using clinical decision theory. The ability of CR to predict audiometric thresholds was evaluated using regression analysis.
  
  
  RESULTS
  CR repeatability across test sessions was similar to that of other clinical measurements. However, both the accuracy with which CR distinguished normal-hearing from hearing-impaired ears and the accuracy with which CR predicted audiometric thresholds were less than those reported in previous studies using distortion-product OAE measurements.
  
  
  CONCLUSIONS
  CR measurements are repeatable between test sessions, can be used to predict auditory status, and are related to audiometric thresholds. However, under current conditions, CR does not perform as well as other OAE measurements. Further developments in CR measurement and analysis methods may improve performance. CR has theoretical advantages for cochlear modeling, which may lead to improved interpretation of cochlear status.
authors.affiliation: 1Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA; and 2Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Rasetshwane
authors.forename: Sara E
authors.initials: SE
authors.lastname: Fultz
authors.forename: Judy G
authors.initials: JG
authors.lastname: Kopun
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gorga
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Neely
mesh_terms: D000161:Acoustic Stimulation; D000293:Adolescent; D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D016022:Case-Control Studies; D003051:Cochlea / Q000503:physiopathology*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000503:physiopathology; D006320:Hearing Tests; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017084:Otoacoustic Emissions, Spontaneous / Q000502:physiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult