Reliability of broadband middle-ear power reflectance in younger and older adults: application of generalizability theory.

PURPOSE: To assess the reliability of broadband middle-ear power reflectance (BMEPR) and transmittance profiles for chirp and tonal stimuli using generalizability theory (GT). METHOD: In adults without a history of middle-ear disease, the authors assessed the reliability of BMEPR to chirp and tonal stimuli using a multivariate approach based on an analysis of variance model (GT). For comparisons with other published studies, Pearson's product-moment correlation coefficients (Pearson's r) also were used. RESULTS: Based on GT with chirp stimuli, overall BMEPR measures had good reliability; however, the reliability of individual profiles across frequencies and ears was less than optimal. Lower generalizability coefficients were found when transmittance was evaluated. Test-retest reliability using Pearson's r was better for right versus left ears, and mid-frequencies were generally more reliable than those at either extreme of the frequency range. In contrast, tonal stimuli had higher generalizability coefficients and Pearson's r values than chirps for all frequencies tested; Pearson's r values were also higher for right versus left ears. CONCLUSION: The authors extended the use of GT as a preferred way to evaluate reliability of BMEPR and transmittance profiles for chirps and tones because it allows for a more comprehensive evaluation compared with unidimensional pairwise correlations.

Missing links in some curious auditory phenomena: a tale from the middle ear.

BACKGROUND: Broadband middle ear power reflectance (BMEPR) is an emerging noninvasive electroacoustic measure that evaluates transmission/reflection properties of the middle ear in high resolution. It is applicable over the entire age continuum and is rapid to perform. However, it remains to be determined if BMEPR is just an incremental step in the evolution of middle ear assessment or a major advance in the way middle ear function can be evaluated. PURPOSE: To evaluate effects of age, gender, ear, and frequency on BMEPR measurements in adults without a history of middle ear disease and to assess whether these factors require consideration in test development; to review how these data may influence active physiologic process within the inner ear; to consider how they reconcile with previously published results; and to suggest applications for future research. RESEARCH DESIGN: Prospective, cross-sectional, multivariate analysis to evaluate the effects of age, gender, ear, and frequency on BMEPR in humans without a history of middle ear disease and no air-bone gaps exceeding 10 dB for any frequency. STUDY SAMPLE: Fifty-six adults in two age groups (Group 1: 18-25 yr, n = 28; Group 2: ≥50 and <66 yr, n = 28). Each age group was stratified by ear and gender in a balanced design. DATA COLLECTION AND ANALYSIS: Pure tone air conduction and bone-conduction audiometry was conducted in a commercial sound booth, using a clinical audiometer with standard earphones enclosed in supra-aural ear cushions, and a standard bone-conduction oscillator and headband to evaluate for air-bone gaps. Broadband middle ear power reflectance was measured using a calibrated, commercially available computer-controlled system that incorporated a high quality probe assembly to transduce stimuli and record acoustic responses from the ear canal. Data were analyzed with a four-way (2 × 2 × 2 × 16) repeated measures analysis-of-variance (ANOVA) to evaluate the effects of age group (young vs. old), gender (male vs. female), ear (left vs. right), and frequency (258 to 5040 Hz) on BMEPR. RESULTS: The ANOVA revealed a significant main effect of frequency. There were also gender × ear, gender × frequency, and age × gender × ear interactions. The three-way, age × gender × ear interaction captured the essence of results and revealed lowest power reflectance values in younger females and for right ears. This trend partially reversed in the older age group where higher power reflectance values were observed only in right ears of older females. CONCLUSIONS: The significant effects of age, gender, ear, and frequency on BMEPR parallel ear- and gender-related differences in hearing sensitivity, ear, and gender differences in the prevalence of spontaneous otoacoustic emissions (OAEs), gender differences in the magnitude of transient evoked OAEs, and ear differences in transient evoked contralateral OAE suppression effects reported in the literature. While original discussions of these aforementioned effects focused primarily on endocochlear and olivocochlear mechanisms, the BMEPR measurements reported herein suggest that middle ear transmission characteristics may also play a role.