Longitudinal Evaluation of Otoacoustic Emissions as a Screening Tool for High-Frequency Hearing Loss in Adolescents.

Abstract

To investigate the association between distortion product otoacoustic emission (DPOAE) signal-to-noise ratios (SNRs) and pure-tone audiometry (PTA) thresholds in adolescents, both cross-sectionally at age 18 and longitudinally by evaluating whether DPOAE SNRs at age 13 predict high-frequency hearing loss (HFHL) at age 18. Prospective cohort study. The Generation R Study, a population-based birth cohort in Rotterdam, the Netherlands. PTA thresholds and DPOAEs were obtained at ages 13 (April 2016 to September 2019) and 18 (October 2020 to May 2024). Participants with abnormal middle ear function, based on tympanometry, were excluded. HFHL was defined as PTA thresholds ≤ 15 dB HL at 500 and 1000 Hz and >15 dB HL averaged across 3, 4, 6, and 8 kHz. Receiver operating characteristic (ROC) curves were used to evaluate the ability of DPOAE SNRs to distinguish between HFHL and normal hearing. Sensitivity and specificity were calculated for different SNR thresholds. Cross-sectional analysis of 3463 ears at age 18 showed that DPOAE SNRs discriminated between ears with and without HFHL, yielding an area under the curve (AUC) of 0.830. Longitudinally, SNR values at age 13 predicted HFHL at age 18, with an AUC of 0.743. DPOAE SNRs demonstrate good accuracy for detecting HFHL in adolescents and moderate accuracy for predicting future HFHL. These findings support the potential role of DPOAEs as a noninvasive screening tool to enable early detection of high-frequency cochlear dysfunction suggestive of early-stage noise-related hearing damage in youth.