Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Dec;69(12):1474-1485.
doi: 10.1111/jir.70043. Epub 2025 Sep 21.

Hearing Threshold Estimation With Distortion Product Otoacoustic Emission Growth Functions in People With Intellectual Disabilities in an Outreach Setting

Eleftherios Savvas  1 , Emmanouela Dimitrakopoulou  1   2   3 , Harald A Euler  1 , Frans Coninx  4 , Felix Bluemel  2 , Anne Krieger  2 , Karolin Schaefer  3   5 , Philipp Mathmann  1 , Corinna Gietmann  1 , Katrin Neumann  1
Affiliations
Observational Study

Hearing Threshold Estimation With Distortion Product Otoacoustic Emission Growth Functions in People With Intellectual Disabilities in an Outreach Setting

Eleftherios Savvas et al. J Intellect Disabil Res. 2025 Dec.

Abstract

Background: People with intellectual disabilities often have undetected hearing loss.

Methods: In this prospective observational study featuring 110 adults with intellectual disabilities, hearing evaluations based on objective hearing threshold estimation using distortion-product otoacoustic emission growth functions (DPOAEgfs) were performed in a sheltered workshop. Results were compared with thresholds obtained by conventional subjective pure-tone audiometry (cPTA) and the adaptive self-test PTA Multiple-Choice-Auditory-Graphical-Interactive-Check (MAGIC).

Results: The differences between the lowest thresholds obtained by cPTA and MAGIC for the frequencies 1, 2, 4 and 6 kHz (LPTATs) and the estimated distortion-product thresholds (EDPTs) were calculated. Four hundred twenty-seven of 880 (48.5%) pairs of measurements did not differ by any more than 5 dB. With LPTATs as reference criterion, for a favourable four-frequency average over 1.0, 2.0, 4.0 and 6.0 kHz with a cutoff of 20 dB HL, the sensitivity of the EDPTs was 92% and the specificity 62%; a cutoff of 30 dB HL increased the respective values to 98% and 77%.

Conclusions: DPOAEgfs are acceptable for estimating hearing thresholds in individuals with intellectual disability who may have limitations in performing conventional audiometry.

Keywords: DPOAE growth functions; audiometry; distortion product otoacoustic emission; hearing loss; hearing screening; intellectual disability.

PubMed Disclaimer

Conflict of interest statement

The authors declared no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Averaged thresholds of MAGIC, cPTA and DPOAEgf for the right and left ears.
FIGURE 2
FIGURE 2
Boxplots of differences of LPTAT minus EDPT for single frequencies for the right and left ears. Lowest differences were obtained for 2.0 and 4.0 kHz.
FIGURE 3
FIGURE 3
ROC curves and corresponding AUC values for 1.0, 2.0, 4.0 and 6.0 kHz and for their averages to visualise optimal fits of EDPT specificities and sensitivities for cutoff hearing thresholds at 20, 30 and 40 dB HL.
FIGURE 4
FIGURE 4
Example audiograms obtained with cPTA, MAGIC and DPOAEgf as representative of poor fit between PTA and DPOAEgf, shown at (a) lower and (b) higher EDPTs for individual frequencies.
See this image and copyright information in PMC

References

    1. Ali, A. , Scior K., Ratti V., Strydom A., King M., and Hassiotis A.. 2013. “Discrimination and Other Barriers to Accessing Health Care: Perspectives of Patients With Mild and Moderate Intellectual Disability and Their Carers.” PLoS ONE 8, no. 8: e70855. - PMC - PubMed
    1. Bader, K. , Dierkes L., Braun L. H., Gummer A. W., Dalhoff E., and Zelle D.. 2021. “Test‐Retest Reliability of Distortion‐Product Thresholds Compared to Behavioral Auditory Thresholds.” Hearing Research 406: 108232. - PubMed
    1. Boege, P. , and Janssen T.. 2002. “Pure‐Tone Threshold Estimation From Extrapolated Distortion Product Otoacoustic Emission I/O‐Functions in Normal and Cochlear Hearing Loss Ears.” Journal of the Acoustical Society of America 111, no. 4: 1810–1818. - PubMed
    1. Bohnert, A. , Müller S., Brantzen P., Keilmann A., and Janssen T.. 2010. “ Hearing Screening in Children Using DPOAE Thresholds and Interactive, Self‐Paced Behavioural Pure‐Tone Thresholds (MAGIC) [Poster presentation].” In NHS 2010 conference Beyond Newborn Hearing Screening: Infant and Childhood Hearing in Science and Clinical Practice. Cernobbio.
    1. Çorbacıoğlu, Ş. K. , and Aksel G.. 2023. “Receiver Operating Characteristic Curve Analysis in Diagnostic Accuracy Studies: A Guide to Interpreting the Area Under the Curve Value.” Turkish Journal of Emergency Medicine 23, no. 4: 195–198. - PMC - PubMed

Publication types

LinkOut - more resources