Distortion product otoacoustic emissions in children at school entry: A comparison with pure tone screening and tympanometry results

This study examined the test performance of distortion product otoacoustic emissions (DPOAEs) when used as a screening tool in the school setting. A total of 1003 children (mean age 6.2 years, SD = 0.4) were tested with pure-tone screening, tympanometry, and DPOAE assessment. Optimal DPOAE test performance was determined in comparison with pure-tone screening results using clinical decision analysis. The results showed hit rates of 0.86, 0.89, and 0.90, and false alarm rates of 0.52, 0.19, and 0.22 for criterion signal-to-noise ratio (SNR) values of 4, 5, and 11 dB at 1.1, 1.9, and 3.8 kHz respectively. DPOAE test performance was compromised at 1.1 kHz. In view of the different test performance characteristics across the frequencies, the use of a fixed SNR as a pass criterion for all frequencies in DPOAE assessments is not recommended. When compared to pure tone plus tympanometry results, the DPOAEs showed deterioration in test performance, suggesting that the use of DPOAEs alone might miss children with subtle middle ear dysfunction. However, when the results of a test protocol, which incorporates both DPOAEs and tympanometry, were used in comparison with the gold standard of pure-tone screening plus tympanometry, test performance was enhanced. In view of its high performance, the use of a protocol that includes both DPOAEs and tympanometry holds promise as a useful tool in the hearing screening of schoolchildren, including difficult-to-test children.

Traditional architecture in the Pacific

Architecture of the Pacific covers a region of more than third of the earth’s surface. The sparse Pacific population spreads over some 30 000 islands, which graduate in size from small atolls to the largest island, Australia, a continent. Pacific architecture can be studied as four cultural units: Micronesia, Polynesia, Melanesia, and Australasia (Australia and New Zealand). While many of the islands of Micronesia lie above the Equator, the remaining Pacific islands are in the southern hemisphere. With the exception of Australia, most of the islands have a warm and humid tropical climate with high rainfalls and lush vegetation. Some islands lie in the cyclonic and earthquake belts. Two distinct racial groups settled the region. The indigenous people, the Micronesians, Melanesians, Polynesians, Australian Aborigines and New Zealand Maoris, migrated from Asia thousands of years ago. The second group, the recent immigrants, were Europeans, who occupied the region during the last two centuries, and pockets of Asians brought in by colonial administrations as labourers during the early twentieth century.