Otoacoustic emissions as a cross-check in pediatric hearing assessment: case report.

Audiologic assessment of infants and young children can be confounded by neurologic disorders or neuromaturational delays. In some cases, this results in an inability to assess hearing sensitivity by behavioral measures or by auditory evoked potentials. This case illustrates such an audiologic challenge. Subject DF was born with hydrocephaly, which was treated with repeated shunt surgeries and resulted in seizures and pervasive developmental delays. At 9 months of age, the child was tested by auditory brainstem response (ABR) measurement and found to have no response to sound. Believing that her child had hearing, DF's mother sought a second opinion. Results of an audiologic evaluation at 11 months of age showed no measurable behavioral responses in the sound field and an ABR abnormality that prevented prediction of hearing sensitivity. In contrast, sensitivity prediction by the acoustic reflex and results of both transient-evoked and distortion-product otoacoustic emissions predicted normal peripheral hearing sensitivity. This case illustrates the usefulness of otoacoustic emissions as an additional cross-check measure in pediatric hearing assessment.