Using Quality Improvement to Expand and Align State Public Health Long-Term Follow-up Data Collection Across Newborn Screening Conditions.

Context: Despite the undeniable success of newborn screening (NBS), numerous barriers exist regarding long-term follow-up (LTFU) of children with conditions included in NBS. Furthermore, there is a focus on condition-specific follow-up with no national guidelines for standard quality measures collected by state public health LTFU programs.

Program: Minnesota Department of Health (MDH) Longitudinal Follow-up for NBS.

Vestibular Testing: Patient Perceptions, Morbidity, and Opportunity Costs.

Objective: To characterize patient tolerance and nonmonetary cost burdens of vestibular testing. Rigorously acquired data are essential for patient counseling and to determine if proposed additions/modifications to current protocols improve quality, experience, and efficiencies of care.

Study Design: Prospective observational study.

Clinical test performance of distortion-product otoacoustic emissions using new stimulus conditions.

Objectives: To determine whether new stimulus parameters, which have been shown to produce large distortion-product otoacoustic emission (DPOAE) levels in a group of normal-hearing listeners (Neely et al. 2005; Johnson et al. 2006), result in more accurate identification of auditory status and more accurate predictions of behavioral threshold than traditional stimulus conditions.

Distortion-product otoacoustic emission input/output characteristics in normal-hearing and hearing-impaired human ears.

Distortion-product otoacoustic emission (DPOAE) input/output (I/O) functions were measured in 322 ears of 176 subjects at as many as 8 f(2) frequencies per ear for a total of 1779 I/O functions. The f(2) frequencies ranged from 0.7 to 8 kHz in half-octave steps.

Low-frequency and high-frequency distortion product otoacoustic emission suppression in humans.

Distortion product otoacoustic emission suppression (quantified as decrements) was measured for f(2)=500 and 4000 Hz, for a range of primary levels (L(2)), suppressor frequencies (f(3)), and suppressor levels (L(3)) in 19 normal-hearing subjects. Slopes of decrement-versus-L(3) functions were similar at both f(2) frequencies, and decreased as f(3) increased. Suppression tuning curves, constructed from decrement functions, were used to estimate (1) suppression for on- and low-frequency suppressors, (2) tip-to-tail differences, (3) Q(ERB), and (4) best frequency.

Distortion product otoacoustic emissions: cochlear-source contributions and clinical test performance.

It has been proposed that the clinical accuracy of distortion product otoacoustic emissions (DPOAEs) is affected by the interaction of distortion and reflection sources contributing to the response. This study evaluated changes in dichotomous-decision test performance and threshold-prediction accuracy when DPOAE source contribution was controlled. Data were obtained from 205 normal and impaired ears with L(2) ranging from 0 to 80 dB SPL and f(2)=2 and 4 kHz.

Low-frequency and high-frequency cochlear nonlinearity in humans.

Low- and high-frequency cochlear nonlinearity was studied by measuring distortion product otoacoustic emission input/output (DPOAE I/O) functions at 0.5 and 4 kHz in 103 normal-hearing subjects. Behavioral thresholds at both f2's were used to set L2 in dB SL for each subject.

A validation and potential clinical application of multivariate analyses of distortion-product otoacoustic emission data.

Objective: To test the generalizability of multivariate analyses of distortion-product otoacoustic emission (DPOAE) data. Previously published multivariate solutions were applied to a new set of data to determine if test-performance improvements, evident in previous reports, are retained. An additional objective was to provide an alternative approach for making multivariate dichotomous decisions of hearing status in the clinic, based on DPOAE measurements.

An alternate approach to constructing distortion product otoacoustic emission (DPOAE) suppression tuning curves.

DPOAE suppression tuning curves (STCs) typically are constructed using suppression criteria of 3 or 6 dB. This paper describes a technique for generating DPOAE STCs using criteria ranging from 3 dB to complete suppression. The criterion effect was examined at various primary levels (f = 4 kHz) in normal-hearing ears.

Determining the upper limits of stimulation for auditory steady-state response measurements.

Objective: To determine the maximum stimulus levels at which a measured auditory steady-state response (ASSR) can be assumed to be a reliable measure of auditory thresholds.

Design: ASSR thresholds were measured at octave frequencies from 500 to 4000 Hz in 10 subjects with profound hearing loss. These subjects provided no behavioral responses to sound at the limits of pure-tone audiometers and at the limits of the stimulus levels produced by the ASSR device.

Distortion product otoacoustic emission suppression tuning curves in normal-hearing and hearing-impaired human ears.

Distortion product otoacoustic emission (DPOAE) suppression measurements were made in 20 subjects with normal hearing and 21 subjects with mild-to-moderate hearing loss. The probe consisted of two primary tones (f2, f1), with f2 held constant at 4 kHz and f2/f1 = 1.22.