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. Data were collected for control conditions (no suppressor, f(3)) and with f(3) presented at three levels that previously had been shown to reduce the reflection-source contribution. The results indicated that controlling source contribution with a suppressor did not improve diagnostic accuracy (as reflected by relative operating characteristic curve area) and frequently resulted in poorer test performance compared to control conditions. Likewise, correlations between DPOAE and behavioral thresholds were not strengthened when using the suppressors to control source contribution. While improvements in test accuracy were observed for a subset of subjects (normal ears with the smallest DPOAEs and impaired ears with the largest DPOAEs), the lack of improvement for the larger, unselected subject group suggests that DPOAEs should be recorded in the clinic without attempting to control the source contribution with a suppressor.