title: Wideband Absorbance Outcomes in Newborns: A Comparison With High-Frequency Tympanometry, Automated Brainstem Response, and Transient Evoked and Distortion Product Otoacoustic Emissions.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the test performance of wideband absorbance (WBA) in terms of its ability to predict the outer and middle ear status as determined by nine reference standards.
  
  
  METHODS
  Automated auditory brainstem response (AABR), high-frequency (1000 Hz) tympanometry (HFT), transient evoked otoacoustic emission (TEOAE), and distortion product otoacoustic emission (DPOAE) tests were performed on 298 ears (144 right, 154 left) of 192 (108 males, 84 females) neonates with a mean age of 43.7 hours (SD = 21.3, range = 8.3 to 152.2 hr). WBA was measured from 0.25 to 8 kHz using clicks under ambient pressure conditions. Test performance of WBA was assessed in terms of its ability to identify conductive conditions in neonates when compared with nine reference standards (including four single tests and five test batteries) using the receiver operating characteristic analysis.
  
  
  RESULTS
  The test performance of WBA against the test battery reference standards was better than that against single test reference standards. The area under the receiver operating characteristic curve reached a high value of 0.78 for HFT + TEOAE + DPOAE and AABR + TEOAE + DPOAE reference standards. Within the ears that passed each of the reference standards, there were no significant differences in WBA. However, for the ears that failed each of the test standards, there were significant differences in WBA. The region between 1 and 4 kHz provided the best discriminability to evaluate the conductive status compared with other frequencies.
  
  
  CONCLUSIONS
  WBA is a desirable measure of conductive conditions in newborns due to its high performance in classifying ears with conductive loss as determined by the best performing surrogate gold standards (HFT + TEOAE + DPOAE and AABR + TEOAE + DPOAE).
authors.affiliation: 1Department of Audiology, The Townsville Hospital, Townsville, QLD, Australia; 2Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, QLD, Australia; and 3Department of ENT, The Townsville Hospital, Douglas, QLD, Australia.
authors.forename: Sreedevi
authors.initials: S
authors.lastname: Aithal
authors.forename: Joseph
authors.initials: J
authors.lastname: Kei
authors.forename: Carlie
authors.initials: C
authors.lastname: Driscoll
authors.forename: Asaduzzaman
authors.initials: A
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Swanston
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods*; D005072:Evoked Potentials, Auditory; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D006314:Hearing Loss, Conductive / Q000175:diagnosis*; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D017084:Otoacoustic Emissions, Spontaneous; D012017:Referral and Consultation