Hearing screening in schoolchildren: accuracy of different criteria used to analyze transient evoked otoacoustic emissions

ABSTRACT Purpose: to compare the accuracy of different criteria used to analyze transient evoked otoacoustic emissions in schoolchildren. Methods: an accuracy study, where an audiological assessment (audiometry, logoaudiometry, tympanometry) and transient emissions were performed with 70 schoolchildren, from the first to the fifth grade of a municipal school, in Northeastern Brazil (6-14 years, 9.9 ± 2 years), with four criteria, all with signal-to-noise ratio ≥ 3 dB, being: criterion A, in all frequency bands; B, in three consecutive frequency bands; C, in three of the five non-consecutive frequency bands; D, in 2, 3 and 4 kHz. Sensitivity, specificity, accuracy and predictive values with their respective confidence intervals of 95% were analyzed. Results: criterion A showed higher sensitivity (92.31%, 95% CI: 67-98%) and lower specificity (17.35%, 95% CI: 10-29%); criterion C higher specificity (84.21%, 95% CI: 72-91%) and higher positive predictive value (52.63%; 95% CI: 51.63-54.63). Accuracy was 82.85% (95% CI 78.23-87.47) in criterion C and 70% (95% CI: 65.38-74.62) in criterion B. Conclusion: criterion C, signal-to-noise ratio ≥ 3dB in three non-consecutive frequency bands, showed the best accuracy, being considered the best choice as a criterion for the isolated use of transient emissions as a hearing screening procedure, in schoolchildren.

摘要 研究目的：对比不同判定标准用于分析学龄儿童瞬态诱发耳声发射（transient evoked otoacoustic emissions）的准确性。方法：本研究为准确性评价研究，纳入巴西东北部一所市立学校一至五年级的70名学龄儿童（年龄6~14岁，平均9.9±2岁），对其开展听力学评估（纯音测听、言语测听、鼓室图检查）及瞬态诱发耳声发射检测，采用四种信噪比≥3dB的判定标准：标准A：所有频带均满足要求；标准B：三个连续频带满足要求；标准C：五个非连续频带中的三个满足要求；标准D：2、3、4 kHz频带满足要求。随后分析四种标准的灵敏度、特异度、准确率及预测值，并给出对应的95%置信区间。结果：标准A的灵敏度最高（92.31%，95%CI：67%~98%），但特异度最低（17.35%，95%CI：10%~29%）；标准C的特异度最高（84.21%，95%CI：72%~91%），且阳性预测值最高（52.63%；95%CI：51.63%~54.63%）。标准C的准确率为82.85%（95%CI：78.23%~87.47%），标准B的准确率为70%（95%CI：65.38%~74.62%）。结论：采用信噪比≥3dB、三个非连续频带符合要求的标准C，其准确率最优，可作为学龄儿童群体中单独使用瞬态诱发耳声发射开展听力筛查的最佳判定标准。