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Updated: Nov 7, 2025

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Distortion product otoacoustic emissions in very preterm infants: A longitudinal study
Jayashree Seethapathy1, Prakash Boominathan1, Ajith Kumar Uppunda2
1Department of Speech, Language and Hearing Sciences. Sri Ramachandra Institute of Higher Education and Research (DU). Chennai, 600 116, India.
Insights
Preterm infants who pass newborn hearing screening show normal auditory function. Prematurity does not impact Distortion Product Otoacoustic Emissions (DPOAEs) results in these infants.
Area of Science:
- Neonatal audiology
- Neurodevelopmental pediatrics
- Otoacoustic emissions research
Background:
- Very preterm infants face increased risks for neurodevelopmental issues, including hearing deficits.
- Prematurity itself is a known risk factor affecting auditory system development.
- Hearing difficulties in preterm infants can be influenced by co-existing conditions.
Purpose of the Study:
- To compare Distortion Product Otoacoustic Emissions (DPOAEs) in very preterm and term infants.
- To assess DPOAEs at corrected ages of 1, 3, and 6 months.
- To investigate the influence of prematurity on auditory system functioning.
Main Methods:
- DPOAEs were recorded in 72 very preterm and 30 term infants.
- All infants passed newborn hearing screening via Auditory Brainstem Response (ABR).
- DPOAEs were measured at six frequencies (1500-8000 Hz) with specific stimulus parameters; otoscopy and tympanometry confirmed middle ear status.
Main Results:
- No significant differences in DPOAE amplitude were observed between very preterm and term infants from 1 to 6 months.
- DPOAE amplitude and noise floor were comparable between the two groups.
- DPOAE amplitude remained consistent across tested frequencies and time points.
Conclusions:
- Prematurity does not negatively influence DPOAE results in very preterm infants who pass newborn hearing screening.
- A significant reduction or absence of DPOAEs may indicate underlying inner or middle ear pathology, not just developmental factors.
- Effective monitoring is crucial for preterm infants with abnormal DPOAE findings.
Background:
Very preterm infants are at a greater risk of developing neurodevelopmental impairments such as neuro-motor delays, vision and hearing deficits (Roze and Breart, 2004; Saigal and Doyle, 2008) [1,2]. The hearing difficulties in preterm infants vary depending on the co-morbid conditions. However, prematurity itself is considered as a risk factor that influence the functioning of auditory system.
Aim:
The current study aims to compare the DPOAEs in very preterm infants and term infants at 1 month, 3 months and 6 months of age (corrected age in preterm infants).
Method:
DPOAEs were recorded in 72 very preterm infants and 30 term infants at 1 month, 3 months and 6 months of age. All these infants had obtained 'pass' results in newborn hearing screening using ABR. DPOAE f2 test frequency was measured at six frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz and 8000 Hz) with primary tone stimulus intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL with primary tone f2/f1 frequency ratio of 1.2. Otoscopic examination and tympanometry was performed prior to DPOAE testing, to ascertain normal middle ear status.
Results:
DPOAE amplitude did not change significantly between two groups from 1 month till 6 months of age (p > 0.05). DPOAE amplitude and noise floor in very preterm infants were not different from term infants and DPOAE amplitude did not vary significantly across f2 frequencies at various time periods.
Conclusion:
The current study findings provided evidence that prematurity did not constitute as a factor to influence the results of DPOAE in very preterm infants who passed newborn hearing screening test. Any significant reduction in DPOAE amplitude or absence of DPOAE in very preterm infants has to be considered and monitored effectively, as it may not reflect a developmental process of cochlear function; instead it could indicate the presence of inner ear or middle ear pathology.
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