auditory evoked potentials we use them to assess hearing acuity on patients and particularly pediatric patients but it is not a behavioral hearing test so someone like dr. Krista Reeves who will be here on November 3rd to talk about C APD she might say no no no that's not a real hearing test the only thing that's a true hearing test is a behavioral hearing test like you would do pure tone audiometry but these things are all are used every day to assess hearing and that results are either consistent with hearing loss or consistent with normal hearing even though it's not a behavioral hearing test naturally if there's a finding a behavioral hearing test would be the goal to actually do that as soon as it's possible but if we're testing a newborn it might be a couple of years before we could actually do a behavioral hearing test even if it's the type of behavioral hearing test where VRA is used visual response audiometry like a toddler right okay so the chances of you using some type of auditory evoked potential evoked means that it's evoked by the stimulus the patient didn't do anything the chances of your using one of these is very high o toku sztyc admissions is an auditory evoked potential Auto acoustic emissions and another one is auditory brainstem response we'll talk about both of them but especially about otoacoustic emissions because every school system has Auto kusik emissions equipment your clinic here I believe has utter acoustic emissions if not they will buy that as soon as there's an audiologist but many speech pathologists use this test equipment many pediatricians do as well every school system in metropolitan Atlanta has that type of equipment okay many school systems even if they don't have an audiologist they have that so why would you do koosy commissions the primary purpose of owed acoustic emissions which is abbreviated oae is to determine the status of the cochlea the hearing organ especially the outer hair cells which which are a critical part of the organ of hearing the cochlea right because these outer hair cells actually produce this emission that we're going to measure in the ear canal right and we could use other acoustic emissions to screen hearing in newborn infants neonates it's used very commonly many many hospitals that have newborn nurseries have otoacoustic emissions and that's how they screen the hearing on newborn babies of course you can't do a behavioral hearing test you can't tell a newborn baby in an intensive care nursery to press the button when they hear the tone you have to do something like otoacoustic emissions right so to screen hearing on neonates that's newborns or older infants or individuals with developmental disabilities who can't respond to a behavioral hearing test you would rather do a behavioral hearing test but sometimes you can't you could also partially estimate hearing sensitivity okay so it's not a measurement of hearing acuity but you can have some idea of hearing sensitivity over a limited range right you can differentiate between a hearing loss that is sensory neural a sensory hearing was a dysfunction of the inner ear and some other type of hearing loss might be conductive or it might be it might not it might be beyond the inner ear something wrong with the auditory nervous system to help differentiate between those or to test for a functional hearing loss of functional hearing losses when somebody is faking a hearing loss right so those are the uses of owed acoustic emissions this is a good slide to note and just to explain how it works the normal cochlea that's the organ of hearing doesn't just receive sounds it actually creates the sound so an odor acoustic emission is a sound that was created by the inner ear so when we stimulate the inner ear with the right kind of stimulus and we have a probe in the ear with a not only a speaker in it but it also has a microphone in it we could apply the stimulus through the speaker in the probe and with the microphone we could pick up a sound that the ear makes when it hears this particular stimulus it actually makes and emits another sound a second sound okay so these sounds are produced specifically by the cochlea and within the cochlea by the outer hair cells as they expand and contract as a result of the stimulus we say that the hair cells become motile in other words they move and they dance they vibrate and the vibration of the little tiny hair cells sends a signal and a vibration back through the ossicular chain to the eardrum which becomes like a speaker within the ear canal and this tiny tiny sound can be picked up by the microphone and if that's present that is consistent with normal hearing okay I put this on here because this shows the outer hair cells within the cochlea okay alright so otoacoustic emissions are as abbreviated Oh a es and there are two types of outer acoustic emissions they're spontaneous emissions and evoked otoacoustic emissions the evoked otoacoustic emissions are the ones that are used most commonly but i will tell you about spontaneous otoacoustic emissions the evoked otoacoustic emissions happen when you stimulate the ear they're evoked by the stimulus the spontaneous owner to stay commissions happen on their own there's no stimulus but those hair cells are dancing on their own of the evoked emissions which we're talking about mainly there are two types transient evoked otoacoustic emissions and distortion product evoked otoacoustic emissions that's important to know transient evoked otoacoustic emissions are named transient because the stimulus is a click a click like that is considered a transient stimulus it comes on instantly and goes off instantly a click alright that's why they call it transient evoked otoacoustic emissions or te o AE transient evoked or acoustic emissions the other type is a distortion product otoacoustic emissions and that's called distortion distortion product or acoustic emission or DP oae because it's named after its stimulus we're using a pair of tones to tones that are presented to the ear simultaneously and the emission that comes back is a distortion of those two tones a third frequency okay so we call that distortion product utter acoustic emissions or D P o AE so there are two types of evoked otoacoustic emissions this is simply what spontaneous utterance to commission sounds like some people have this some people don't we put a probe in the ear in the probe as a microphone and simply measures what is in the ear in a very quiet environment like you put the patient in the booth and it's very very quiet and you put the probe in there and you have a spectral analyzer that now looks at what that probe is picking up and this is just background noise all this stuff this black stuff but these Peaks are our actual emissions at different frequencies their spontaneous emissions probably at least 30% of you in this room have spontaneous emissions but you don't hear them because they're a very very low level there are some people that have spontaneous otoacoustic emissions that you could actually hear if you put a these' scope or a microphone in the ear and listen to it you hear a tone coming out from the patient for no reason it's a spontaneous Oh - acoustic emission it's rare that it's loud enough that you can actually hear it but it's common like 30% of young people like yourself may have something like this but look at the levels this is DB SPL - 10 here you know and lower and that's why you don't hear it's actually lower than your hearing sensitivity is even okay so we typically diagnostically don't measure this sometimes if a patient has tinnitus ringing in his ears and an audiologist has equipment that will measure spontaneous aute acoustic emissions they might measure that and they might find a spontaneous emission at a high frequency and that's his tinnitus right but that's rare tinnitus is usually not caused by spontaneous otoacoustic emissions usually it's caused by hair cell damage okay all right or and it could be genetic too it might not be hair cell damage so auto coup stick emissions could be used for screening could be used diagnostically you could use transient otoacoustic emissions or te o AE or distortion product utter acoustic emissions DP o AE right transient utter acoustic emissions is used very commonly for screening especially the screening of infants in hospitals every newborn infant in every hospital in the state of Georgia gets a hearing screening and it is done by either Auto acoustic emissions or auditory brainstem response which we're talking about next or both right so te o AE is the most popular means of screening a newborn to determine whether they pass or fail a hearing screening if the transient otoacoustic emission is present then they pass distortion product Auto acoustic emissions can be used for screening also but they are primarily used by an audiologist for diagnostic purposes because they're more frequency specific and I'll show you why that is are we are we good so far and other coos to Commission's of what it is the two types transient odor acoustic emissions distortion product or acoustic emissions what is the primary physiological mechanism that produces the otoacoustic emission what outer hair cells excellent yes out of hair cells is the answer so when that question is on the test you know the answer the outer hair cells right within the cochlea okay so we've talked about several things we've talked about how you would evaluate the condition of the outer ear canal and you would do that by otoscopy looking in the ear with an otoscope and you would simply see Titus externa right otitis externa would be an infection of the external ear canal we call this tissue here the external meatus right and we would evaluate the condition of the middle ear including the eustachian tube the middle ear cavity the ossicular chain and the eardrum we would evaluate that with a tempo Namit ER as well as doing air and bone conduction audiometry both of those things meant to evaluate the middle ear and assess the ability to conduct find conductive hearing losses and pathologies of the middle ear and we would use otoacoustic emissions an OE evaluation to evaluate the function of the cochlea the inner ear not the auditory nervous system here at this this is the auditory nerve right here it's sometimes called the vi nerve number 6 or the auditory nerve it doesn't evaluate that but it does evaluate the function of the inner ear or the cochlea the organ of hearing and specifically the outer hair cells within the cochlea okay these are some common screening hand-held otoacoustic emissions devices these are used pretty extensively in pediatricians offices in ear nose and throat physicians offices in school systems and in newborn nurseries and I am going to pass around some brochures on some of these Auto acoustic emissions units so that you would be able to see some of the features that these things have just passed that back pass these back and did you get this one No okay so pass those back and pass these back so if you looked over that you would see some of the features and the applications of this type of instrument these are handheld typically screening but they could be screening and diagnostic otoacoustic emissions devices this is what you would find if you went to the hospital right here in Carrollton and you went into the nursery you would find nurses using these every single day to do hearing screenings on newborns right one of the brochures that I pass back there is of this instrument which is called a corty the only reason I put this slide up here is because it has an interesting name the manufacturer is a company called GSI which is just an abbreviation of grace and Stadler incorporated that's the last name of the two founders of the company you don't have to remember that but your equipment in the clinic here at West Georgia is manufactured by grace and Stadler and if they if they get it Oh - acoustic emission device they would probably buy this one because it's the same manufacturer as their audio meter is and they're tympanometry and it's interesting they call it a Corky because you will find the outer hair cells within the cochlea in the organ of Corti right so it was a pretty pretty appropriate name for this handheld screening device this isn't much long much larger than your smartphone is did anybody get a sound level meter app for their iPhone that I talked about last time no well you can get some of them for free others for a dollar ninety-nine an expensive one is 1995 so they're pretty inexpensive and it's a good thing for a speech pathologist to have so if you have an iPhone you can get a sound level meter and you can determine whether a room is appropriate to do it behavioural pure tone hearing screening in a quiet room is about 45 dB if you're an SPL measuring it on a sound pressure level meter all right all right so what acoustic emissions like these typically handheld devices like this are used for hearing screenings on all ages of patients very commonly used on newborns in hospitals it's possible that every hospital in the state of Georgia has some type one maker model or the other of an OEE inhale Oh a screener and of course you can use it on older patients and adults as well and you might use it on an older patient if for some reason they were disabled and couldn't do a behavioral hearing test and you wanted to get an idea whether their hearing was normal or not you might use it if you think they're faking a hearing test what if you your hearing test audiogram shows a hearing loss and you just have a suspicion about this patient for one reason or another and you do o2 acoustic emissions and they're totally normal utter kusik emissions well that doesn't go hand-in-hand and so then you would want to do some further testing because you suspect a functional hearing loss somebody's faking there are also PC based computer-based oae systems and these typically are instead of screening their clinical they do more something an audiologist would use to do diagnostic otoacoustic emissions rather than screening the way this works is there's a probe in the ear and it has a rubber tip on it because it's making a seal in the ear but it doesn't need a pneumatic seal typically like the a pressure seal like the temp Annamma tur did but it needs an acoustic seal so in so there is some type of ear tip and the user would have to use the appropriate ear tip for the size of the ear canal and that is technique sensitive just have to get used to doing it see what sizes you are successful with these systems calibrate to the ear as soon as they start the calibration takes place in a fraction of a second but a message comes up if it can't calibrate because you don't have a good seal a good acoustic seal so you see that inside the probe you have several things you have a microphone that's picking up what's in the ear canal it's a very sensitive microphone because it's going to pick up this auto acoustic emission this is the vibration energy of those outer hair cells being transmitted back through the acicular chain to the eardrum which becomes like a little tiny speaker in the ear canal these are the very smallest sounds that the human body produces and to be able to measure those is is a marvel of modern technology so we have a very sensitive microphone and we also have a speaker in there that is producing the the stimulus if it's a transient owed acoustic emission system we have only one speaker that's producing the clicks the click is the stimulus in a te o AE a click is considered a transient stimuli and we also have a second speaker if it is a distortion product Auto acoustic emissions unit because you need one speaker for each of the two tones that are presented simultaneously in a dissenter DP o AE ok and of course what happens is the outer hair cells are stimulated and when they're stimulated they become motile they move they dance and as they dance they create a very very tiny vibration and that vibration is transmitted back through the acicular change the three bones to the eardrum and the eardrum starts dancing or vibrating creating a sound like a little speaker in the ear canal that can be detected by this very sensitive microphone and the microphone can distinguish between the stimulus and the actual emission ok I'm going to explain that how that works this is an explanation of how distortion product otoacoustic emissions works remember I said that DP oae uses two distinct and different tones as stimulus that are presented simultaneously well here are two tones one is a thousand Hertz and the other is twelve hundred Hertz these two tones are close together they're close together infrequent see the ratio between them is close to 1.2 that's why the first one which is called f1 for the first frequency f1 is a thousand Hertz in this case and f2 is 1200 Hertz and of course we would do numerous frequencies in a DP OAE I'll show you that in a minute but this is the test of just one frequency but we're using two two different tones that are close together the ratio between them is 1.2 we're using them as stimulus and the intensity of them is important to the intensity of f1 is 65 DB the intensity of f2 is 55 DB SPL in the ear canal okay now that doesn't mean we're testing hearing at a 65 DB level we just need that much stimulus to actually evoke this emission okay so those are the only intensity levels we'll use and if an emission happens then we say that is consistent with normal hearing at that frequency right and what frequency would it be well it would be a frequency close to the f2 frequency alright and when you stimulate the ear with those two tones simultaneously you're stimulating certain specific hair cells along the basilar membrane of the cochlea because those hair cells are fine-tuned to different frequencies okay so you're you are stimulating a set of hair cells which start to become motile they dance and as they dance they create a third tone which is a distortion product of these two tones that third tone is a mathematical consequence of these two it's two times f1 minus f2 so two times f1 that's two thousand 1200 is 800 so we would expect a third tone to be present and picked up by this microphone not only the two tones that are the stimulus one is 65 DB one is 55 DB but we expect a third tone that's the oat acoustic emission that's being produced by the motility of the outer hair cells and we know the Machine knows the software knows exactly what frequency that should be two times f1 minus f2 and so it looks there to see if that is present if it is there is normal hearing acuity in the range of a thousand Hertz and in particular at 1200 Hertz but that's close enough that we're not we don't care it's fine so that's how distortion product utter acoustic emissions works here's a screenshot of a piece of equipment I did this on my own ear last week when I was creating this class for today this is showing you what's going on in the ear this horizontal axis is frequency and this is intensity in DB SPL decibels sound pressure level this is what the microphone is measuring in the ear a spectral analysis of it here are the two tones F 1 65 DB and what is it about 3,500 Hertz and here's F 2 maybe around 40 200 Hertz anyway they are being applied this is 55 DB this is 65 TV these are being applied to the ear by the probe simultaneously and then the Machine knows to look right here where this dotted line is which is 2 times f1 minus f2 right and it expects to find this this is just background noise right here but this is an emission because it's occurring exactly at that frequency we expect it to occur at and it is above the overall noise level around it it's higher than a noise level and so we do this at several pairs of frequencies we do it at a pair of frequencies close to 1,000 and 1,500 and 2,000 and 3,000 and 4,000 and in this case 6000 so we did six frequencies here this an audiologist does it's very typically and the Machine plotted the level of the emission how high how strong was this emission now look at this emission it's about seven dB right here in fact what is it exactly I'll tell you oh it's it's below zero this emission is is just point one minus point one DB you see how small this is this smallest weakest detectable sound in existence practically there's very very very very soft sound but it has it was detected and it's above the noise the noise level is plotted down here this at this frequency this is the noise level this stuff right here so it plots the level of the emission that's how high is this many times below zero you know I've had this happen with the phone rings even drawing a Sunday Mass I'm a minister and every and when it did I didn't know what to do all the people are going oh you yell at us for having our cell phones go off during church and yours goes off so I go yes Archbishop well I'm a little busy now could you call back you know they get a kick out of that because I tell them to put their phones on silent headed to them okay so we've plotted the level of the actual emissions here and we've plotted the level of the noise the reason we want to know the level of the background noise because of the patient's making a lot of noise and that background noise is as high or higher than the emission itself now we don't know whether there's an emission or not it is grounded out by the noise level the only way we know there's an emission if it's above the noise if this noise the background noise was way up here we don't know whether there's an emission or not it is hidden in the background noise so to do this test the patient has to be quiet it cannot be done on a noisy patient so if you go into the intensive care nursery and the baby is screaming we don't even put the probe in the ear what we do like to do it is when the baby is sleeping and of course when you put the probe in the ear it wakes the baby up but that's okay once they once they get used to feeling that in their ear they will typically fall asleep again and you can hit start and it's applying these tones of frequencies a pair of tones at this frequency a pair of tones at this frequency a pair at this in this case they tested for frequencies between 1,000 and 6,000 Hertz and they got emissions like that and we knew they were emissions because the noise level which is green here this is the average of the noise down here this stuff it is well below the actual level of the emission there's a there is an adequate signal-to-noise ratio between them and so we say that that is an emission that exists and is normal and it's consistent with normal hearing hearing within a normal range from 1,000 Hertz through 6,000 the patient didn't have to respond whatsoever and we found out something about his hearing acuity not a behavioral test not a true hearing test but it indicates normal function of the cochlea the outer hair cells the middle ear - if there was a middle ear pathology it wouldn't work you know so if we got no emissions we'd have to rule out middle ear pathology that's preventing those slight vibrations in the cochlea being transmitted back through the acicular chain to the eardrum right these dotted lines are just the ranges of normal in this these ranges of normal a dr. James Hall and I did a research study to determine those on graduate students at Vanderbilt University back in the 90s and we came this is just the mean plus two standard deviations these dotted lines so an audiologist said hey if I get admissions that are in between these dotted lines they're normal because that's what we got on our 23 year old students with normal hearing we tested their hearing first and this dotted line here was our average noise level but we did it in a booth when I was doing this it was outside of a booth but I got low enough noise as I said if my noise was way up here because the patient was making noise so there was ambient noise in the room then this test would not be valid I don't know whether there's an omission or not you can only do it under quiet circumstances and here are just a plot of the two levels of the two tones the 65 DB tone and the 55 DB tone and because these lines are flat that tells me that's normal this is just a crazy sound that's used for collaboration when it starts just so it has the levels right in the ear canal okay that make make some kind of sense an audiologist could do this if they wanted to they can map the cochlea this is called cochlea mapping they did Auto Cousteau Commission's at many many frequencies this is done at at least 30 or 40 frequencies all these X's X's is on the left ear circles of the right ear right red is right and round and these are the noise levels there's a good signal to noise level if I was looking at this I'd say this this this means normal hearing between 1000 and 6000 because I have emissions that are above the noise the noise is sufficiently lowly this is valid and those emissions of present and they're not only present there in the normal area which would be between these two lines and I did a lot of frequencies not just one thousand two thousand three thousand or more a naught octaves or half octaves I did many many frequencies an audiologist that's looking for sometimes there's a dead area in the cochlea or there's an area that is of hair cells that are damaged and they're causing tinnitus and you get emissions that drop down a shock drop just in one particular area I'll bet you that's an area with damaged hair cells and it's an area that's causing the patient's tinnitus at that frequency they're ringing in the ears so this is this would be diagnostic distortion product utter acoustic emissions this is what the typical graph would look like it's called ADP Gram distortion product graph DP gram here's a screening this audiologist did a screening while it was just me on my left ear which is my good one anyway this particular screening software said pass here I didn't have to determine that it passed it determined it itself because it's programmed to know that an emission is valid if it is above the noise by at least six DB or more and so it measured the level of the noise at each frequency and the level of the emission that's the level of the emission the peak of that and and each one of the frequencies or at least three out of four that's typically what they do is test for frequencies and three at least three of the four have to be valid emissions the valid emissions means that it is at least six DB above the noise if the noise if the noise level is low and the emission is low it's right down there with the noise then there are no emissions and this would say not pass it would say refer we don't like to say fail tells a bad world its word it's not politically correct so we say refer because we're going to refer for further testing and so that would be a typical screening this is different this is a te o AE the ones we looked at previously where D Poh distortion product other acoustic emissions this is a te o AE transient evoked Auto acoustic emission and what I'll explain what we're seeing here this is the actual response this is what the ear makes this is a graph and you don't see anything down here but it is simply frequency here on the horizontal axis and intensity DB SPL on the vertical axis and they actually did two sets of clicks they put in the first click and save the response in a memory and then put in the next click and save the response in a memory and they would all the patient would hear is a bunch of very rapid clicks click click click click and within a few seconds that would be a few hundred clicks the average is displayed and the there are two memory banks a and B and they're so poor imposed on each other and so a normal response if I looked at this I'd say this is a response because a and P a and B replicate if they didn't Rep like eight you would have to investigate but a and P a and B replicated these are practically superimposed these two waveforms they were simply done by the first click went into one memory the next click went into a second memory the memory is our a and B we do an average of several hundred clicks and this happens in just a couple of seconds and the average is displayed memory a and B superimposed on each other so I could look at this and say that's a response this is the calibration I'm not going to get into that but this is what the click looks like on a time scale this is time across here and this is what it looks like on a spectral analysis it's a broadband stimulus rather than the tones which are frequency specific so it's a broadband stimulus and it's band is about 700 Hertz to about of 3000 Hertz and this graph here is showing this blue for left ear blue is left and red is right as always this blue graph this blue stuff is emissions and this black stuff under it is the actual noise the ambient noise the background noise in the ear canal it's a result of the physiological noise of the patient any vocal ization from the patient and of course whatever outside noise is measured but when this emission exists I see it it's it's and it's well above the noise level then this patient passes and this is a screening instrument so it says pass all right this is a normal transient owed acoustic emission it's normal because I can see it here above the noise it's normal because I can see it here and it replicated these two waves are superimposed on each other and I could hardly tell the difference between a and B and I have a table here that tells me what it did is a spectral analysis on this broadband stimulus the stimulus contained multiple intense multiple frequencies from at least from a thousand to 3,500 and what it did is it did a spectral analysis of each a 1000 Hertz 1,500 Hertz 2000 3000 4000 it did these in half octaves and it analyzed this the frequency component of this response the the emission that came back from those hair cells a broad band of them were vibrating and producing this and when they did the spectrum analysis they're looking at different frequencies at 1000 Hertz the reproducibility between a and B here was 98% at 1,500 Hertz the reproducibility of a and B is 99% when reproducibility is greater than 70% or greater and emission is said to be present okay in te o AE so an emission is present at 1000 1500 2000 and and 3,000 because the reproducibility is greater than 70% and emission is not present at 4000 because the reproducibility is only 19% but the overall reproducibility in the broadband of this stimulus and the broadband of the response the responses of broadband response in the frequencies of 1.2 to 3.5 K Hertz twelve hundred Hertz to 3500 Hertz the overall reproducibility is 37% e7 percent of course that's over 70 well over 70 and the patient is said to pass the emission is present it is consistent with normal hearing acuity within that frequency range that's how transient otoacoustic emissions happens so this is a patient than passes what does one look like that fales here's that table I just explained to you how the reproducibility factors over 70% at each one of these frequencies so they pass here's somebody who failed now the first one I showed you I did in my left ear which is my good ear this I did just in a cavity not in somebody's ear so I was trying to just come up with but this is what it would look like in an ear that had no odor coos to commissions either because there was a conductive disorder a middle ear disorder preventing the vibration from being transmitted or there was a sensory neural hearing loss damaged hair cells right because I don't see an A and B here response that replicates this is just plain background noise that averaged out over several hundred very rapidly applied clicks right within a few seconds I got this this is no response and there's nothing on this graph because there's no response and if I looked at these numbers the reproducibility at these different frequencies zero or very low certainly well below 70 which you would have to have to say an emission exists at that frequency this is basically how transient otoacoustic emissions are analyzed the main range of testing is limited to up from about 1200 Hertz to 3500 Hertz that's why it's used for screening if you want to do frequencies in a wider range DPOs you can actually test from 500 Hertz to 10,000 Hertz if you wanted to and it's frequency specific where this is generally not frequency specific but we make it frequency specific at least within that limited range by doing a spectral analysis of the response and looking specifically mainly at reproducibility I hope that makes sense to you doesn't yes okay all right here's another just another instrument that did the same thing it was doing transient otoacoustic emission product otoacoustic emissions and it's just showing it in a different way with the bar graph instead of a conventional graph and the bar graph is showing this great these gray bars are the background noise and these black bars above it are the actual emissions and here's the numbers at 1,000 Hertz now of course it used two frequencies close to 1,000 Hertz because it's distortion product of acoustic emissions and the the level of the actual emission when those two tones were applied the level of the actual emission was eleven point nine dB okay the noise was minus point 6 dB the signal-to-noise ratio or how high the emission was above the noise was twelve point six dB if these numbers are above six in other words the emission is at least six DB over the noise then that's normal so I can see emissions all these black things are emissions at all these frequencies so this patient has you know in this frequency range which is 1,000 to 8,000 this patient has a a e results DPO ae results that are consistent with normal hearing acuity and the patient didn't have to respond at all the ear responded by itself by producing that emission if the noise levels were too high if these gray bars were up to the top here I then I don't know if there's an emission behind the noise or not I have an invalid test that's too noisy but if the noise level is low like below zero like this and there's no black bar above it my signal-to-noise ratio is close to zero or at least not greater than six then there's no emission there and that is consistent with some type of hearing loss at least a mild loss not normal hearing at that frequency okay so many of the screeners are like this the screener person doing the screening in the hospital to the infants knows less about oat acoustic emissions than you do you know as much as an audiologist knows now about our acoustic emissions but all they know is they see this word pass or refer and they really don't know what these numbers mean or these bars or these waveforms mean but you do because we told you so you know more about otoacoustic emissions tympanometry and audiometry than you ever wanted to know but that's it's very good because then the relationship between speech pathology and audiology is good and you can work together here is another test would you say this was normal transient otoacoustic emissions by looking at it yes certainly because you can see a and B here and you can almost can't tell that there's two waves it's superimposed on one another and up here is an analysis of that the black is emission above the gray which is noise and here's the individual frequencies when they do a spectral analysis and in each one of these frequencies from 1,000 to 5,000 there is at least seven the percent of reproducibility in here when they do a spectral analysis of the response very good so if a newborn is screened with otoacoustic emissions here's what happens if they pass well then they pass and the parent is told to just do routine well-baby checkups and follow-ups and observe their response to noise and in fact many times they'll give them a chart things too four so they can see if the baby is responding to sounds normally as it ages okay but otherwise there is nothing more that would be done if a patient fails then the test is typically repeated after about one week or after the ears are cleared out many times a baby will fail and odor acoustic emission screening in a hospital because there is what's called vernix in their outer ear canal so their outer ear canals are not clear so that measurement can't be made properly and they fail the test but it's a false positive and so if that happens be they don't immediately go to the doctor or an audiologist typically the test is repeated after at least a week could be more than a week could be to three weeks but it's repeated because you give time for the ears to dry up after they were born usually they're only in the hospital for one day you know so sometimes the there's fur necks in the ear canal and so if they pass the rescreening that's that we at least a week after that sometimes the hospital says bring the baby back or they say go to your pediatrician or and every hospital staff the nursing staff knows we're locally they would have the retesting done Carrollton ent which are a group of ear nose and throat doctors here in Carrollton is an example of a facility that would do the retesting and if they pass then you do the same here just well baby follow-up if they fail then there has to be a plan for further testing because they failed the follow-up testing the second test and they would have to go see an audiologist you
