Use of otoacoustic emissions to screen for hearing loss in critically ill patients

As part of a continuing quality improvement program, this project was undertaken to define the frequency of hearing loss in patients admitted to a surgical intensive care unit in order to identify patients at risk for impaired communication. The study evaluated 168 consecutive admissions over a ten week period to a ten bed adult surgical intensive care unit in a university hospital. Patients were screened as close to admission to the ICU as possible with otoscopy, tympanometry, and distortion product otoacoustic emissions. A total of 113 patients (226 ears, mean age 58.0+/-15.8 years) were screened within 1.5+/-1.4 days of ICU admission; 55 of the 168 admissions could not be screened (48 out of 55 due to short ICU stays). Of the 226 ears evaluated, 6.6 per cent had abnormal otoscopy and 43.2 per cent abnormal tympanograms. OAE failure occurred in 58.4 per cent of ears while OAE results were uninterpretable due to high ambient noise in 2.7 per cent of ears, and technical difficulty in 3.5 per cent of ears. Mean time for screening was 9.3 minutes. OAEs provide an efficient screening modality for hearing impairment in critically ill adults. The results suggest a significant prevalence of hearing impairment in the population studied. More definitive testing should be considered when clinically indicated in patients who fail OAE screening.