Transient evoked otoacoustic emissions recorded using maximum length sequences from patients with sensorineural hearing loss

Much research has shown that transient evoked otoacoustic emissions (TEOAEs) can successfully separate normally hearing and hearing impaired populations. However, this finding comes from TEOAEs recorded using conventional averaging at low stimulation rates. Presenting clicks according to maximum length sequences (MLSs) enables TEOAEs to be recorded at very high stimulation rates. This study compares conventional and MLS TEOAEs in normally hearing and hearing impaired adults. Stimulus presentation rates of 40 clicks/s (conventional) and 5000 clicks/s (MLS) were used. The 'linear' TEOAEs (i.e., the directly recorded waveforms), the 'level nonlinear' (LNL) TEOAEs (i.e., those derived from two linear waveforms separated by a known difference in stimulus level) and the 'rate nonlinear' (RNL) TEOAEs (i.e., obtained by subtracting the emission recorded at 5000 clicks/s from that at 40 clicks/s at a fixed stimulus level) were examined to compare how they separated the normally hearing and hearing impaired subjects. When compared to the results for both conventional and MLS linear or LNL TEOAEs, the present study found that the RNL results best reflected the patients' hearing loss, although the conventional linear and LNL responses performed nearly as well. Only two impaired ears (2%), both with a best threshold of 30 dB HL at 1000 Hz, produced RNL responses with amplitude within the range produced by 95% of the normal group.