Hearing screening in community centers for the elderly: Efficacy of distortion product otoacoustic emissions

Abstract

Hearing loss occurs most frequently within the elderly population, and having a hearing loss can adversely impact the quality of life of an individual. There is a need for detection of hearing loss at an early stage, and therefore elderly hearing screening programs are important. The efficacy of using distortion product otoacoustic emissions (DPOAEs) as a stand-alone objective hearing screening tool in comparison to conventional, behavioral pure-tone screening in community centers for the elderly in Hong Kong was investigated. Background noise was measured at each center, and the range of overall noise levels was from 42 to 53 dBA. DPOAE results were analyzed using six different pass/refer criteria, having stimuli concentration in the low, mid, or high frequencies, and based upon both absolute distortion product amplitude and signal-to-noise ratio (SNR; stricter criterion) or SNR alone (looser criterion). Kappa statistics of weighted agreement and observed agreement were calculated to compare DPOAE measures with pure-tone screening for 223 elderly participants. The highest observed agreement between pure-tone screening and DPOAE was found for a protocol with a focus on mid-frequency stimuli using a looser criterion. However, the highest agreement obtained was only fair, with agreement occurring at only 14% more than chance. Background noise in community centers for the elderly adversely affected the DPOAE measurements and DPOAE screening could not be considered as an effective stand-alone hearing screening tool for an elderly population attending urban community centers.