Pediatric applications of wideband acoustic immittance measures

Wideband acoustic immittance (WAI) measures have potential capability to improve newborn hearing screening outcomes and middle ear diagnosis for infants and children. To fully capitalize on these immittance measures for pediatric hearing care, developmental and pathologic effects need to be fully understood. Published literature on wideband immittance (reflectance, absorbance, tympanometry, and acoustic reflexes) is reviewed in this article to determine pathologic effects in newborns, infants, and children relative to standard audiologic tests such as otoacoustic emissions (OAEs), standard tympanometry, air and bone conduction auditory brainstem response, and otoscopy. Infants and children with surgically confirmed otitis media with effusion have lower absorbance in the mid-frequency range (1 to 3 kHz) for the affected ear(s). Newborns that do not pass OAE screening at birth also have lower absorbance for frequencies from 1 to 3 kHz, suggesting that nonpass results are frequently associated with middle ear issues at birth. In Newborn Hearing Screening Programs, WAI may help to interpret hearing screening results. Conclusions are limited by the fact that the true status of the middle ear and cochlea are not known for newborns and infants in studies that use OAE or tympanometry as the reference standard. Likelihood ratios for reflectance against surgery gold standards range from diagnostically suggestive to informative. Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of WAI technologies in infants and children. Additional investigations using stronger gold standard comparisons are needed to determine which tools can most accurately predict middle ear status in the pediatric population.