Publications

• Hunter, L. L., Feeney, M. P., Lapsley Miller, J. A., Jeng, P. S.; Bohning, S. (2010). Wideband Reflectance in Newborns: Normative Regions and Relationship to Hearing-Screening Results. Ear & Hearing. , Publish Ahead of Print, 10.1097/AUD.1090b1013e3181e1040ca1097.
  Objectives: To develop normative data for wideband middle-ear reflectance in a newborn hearing-screening population and to compare test performance with 1-kHz tympanometry for prediction of otoacoustic emission (OAE) screening outcome.
  Design: Wideband middle-ear reflectance (using both tone and chirp stimuli from 0.2 to 6 kHz), 1-kHz tympanometry, and distortion-product (DP) OAEs were measured in 324 infants at two test sites. Ears were categorized into DP pass and DP refer groups.
  Results: Normative reflectance values were defined over various frequency regions for both tone and chirp stimuli in ambient pressure conditions, and for reflectance area indices integrated over various frequency ranges. Receiver operating characteristic analyses showed that reflectance provides the best discriminability of DP status in frequency ranges involving 2 kHz and greater discriminability of DP status than 1-kHz tympanometry. Repeated-measures analyses of variance established that (a) there were significant differences in reflectance as a function of DP status and frequency but not sex or ear; (b) tone and chirp stimulus reflectance values are essentially indistinguishable; and (c) newborns from two geographic sites had similar reflectance patterns above 1 kHz. Birth type and weight did not contribute to differences in reflectance.
  Conclusions: Referrals in OAE-based infant hearing screening were strongly associated with increased wideband reflectance, suggesting middle-ear dysfunction at birth. Reflectance improved significantly during the first 4 days after birth with normalization of middle-ear function. Reflectance scores can be achieved within seconds using the same equipment used for OAE screening. Newborns with high reflectance scores at stage I screening should be rescreened within a few hours to a few days, because most middle-ear problems are transient and resolve spontaneously. If reflectance and OAE are not passed upon stage II screening, referral to an otologist for ear examination is suggested along with diagnostic testing. Newborns with normal reflectance and a refer result for the OAE screen should be referred immediately to an audiologist for diagnostic testing with threshold auditory brainstem response because of higher risk for permanent hearing loss.
  
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• Withnell, R. H., Jeng, P. S., Allen, J. B. (2009). An in situ calibration for hearing thresholds. J. Acoust. Am., 125 (3), 1605-11.
  Quantifying how the sound delivered to the ear canal relates to hearing threshold has historically relied on acoustic calibration in physical assemblies with an input impedance intended to match the human ear (e.g., a Zwislocki coupler). The variation in the input impedance of the human ear makes such a method of calibration questionable. It is preferable to calibrate the acoustic signal in each ear individually. By using a calibrated sound source and microphone, the acoustic input impedance of the ear can be determined, and the sound delivered to the ear calibrated in terms of either (i) the incident sound pressure wave or (ii) that portion of the incident sound pressure wave transmitted to the middle ear and cochlea. Hearing thresholds expressed in terms of these quantities are reported, these in situ calibrations not being confounded by ear canal standing waves. Either would serve as a suitable replacement for the current practice of hearing thresholds expressed in terms of sound pressure level calibrated in a 6cc or 2cc coupler.
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• Jeng, P. S., Allen, J. B., Lapsley Miller, J. A., & Levitt, H. (2008). Wideband Power Reflectance and Power Transmittance as Tools for Assessing Middle-Ear Function. Perspectives on Hearing and Hearing Disorders in Childhood, 18(2), 44-57.
  
Hearing screening programs using otoacoustic emissions can have high false positive rates, due to temporary middle-ear and outer-ear disorders. This is especially the case for newborns, infants, and young children. Standard tympanometry is limited, uncomfortable, and unreliable in young ears. By incorporating wideband acoustic power flow measurements into hearing screening (using the same equipment), middle-ear and outer-ear disorders can be detected, thus allowing for rescreening rather than more expensive audiological referrals. Wideband acoustic power flow is described in detail and four case examples are provided for adults and children.
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• Allen, J. B., Jeng, P. S., Levitt, H. (2005). Evaluation of Human Middle Ear Function Via An Acoustic Power Assessment. Journal of Rehabilitation Research & Development 42(4), 63-78.
  Measurements of middle ear (ME) acoustic power flow (power reflectance, power absorption, and transmittance) and normalized impedance (acoustic resistance, acoustic reactance, and impedance magnitude) were compared for their utility in clinical applications. Transmittance, a measure of the acoustic power absorbed by the ME, was found to have several important advantages over other measures of acoustic power flow. In addition to its simple and audiologically relevant physical interpretation (absorbed power), the normal transmittance curve has a simple shape that is visually similar to the ME transfer function. The acoustic impedance measures (resistance and reactance) provided important additional information about ME status and supplemented transmittance measurements. Together these measurements can help identify unusual conditions such as eardrum perforations. While this article is largely a review of the development of a commercial power reflectance measurement system, previously unpublished experimental results are presented.
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• Lapsley Miller, J. A., Boege, P., Marshall, L., & Jeng, P. S. (2004). Transient-evoked otoacoustic emissions: Preliminary results for validity of TEOAEs implemented on Mimosa Acoustics T2K measurement system v3.1.3. (Technical Report No. 1232). Groton, CT.: Naval Submarine Medical Research Laboratory.
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• Lapsley Miller, J. A., Boege, P., Marshall, L., Shera, C., & Jeng, P. S. (2004). Stimulus-frequency otoacoustic emissions: Validity and reliability of SFOAEs implemented on Mimosa Acoustics SFOAE measurement system v2.1.18. (Technical Report No. 1231). Groton, CT.: Naval Submarine Medical Research Laboratory.
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Presentations

• Withnell, R., Miller, G., Pileri, C., and Jeng, P. (2010). Using WBR in the Clinic. Paper presented at the AAS Technology Update Session, Scottsdale, AZ, 4 Mar.
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• Hunter, L. L., Lapsley Miller, J. A., Jeng, P. S., and Feeney, M. P. (2010). "Relationships Between Wideband Middle Ear Power Analysis and Distortion-Product Otoacoustic Emissions in Newborns". Poster presented at ARO 2010.
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• Withnell, R. H., Jeng, P. S., and Parent, P. (2009) "Interpreting WBR in terms of middle ear mechanics and contrasting Tympanometry with WBR." Paper presented at the American Auditory Society Annual Meeting March 5-7, 2009, Scottsdale, AZ.
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• Hunter, L. L., Feeney, M. P., Lapsley Miller, J. A., and Jeng, P. S. (2008). "Wideband Middle Ear Power Measures in Newborns Related to Hearing Screen Result." Paper presented at NHS2008: Beyond Newborn Hearing Screening: Infant and Childhood Hearing in Science and Clinical Practice (Cernobbio (Como Lake), Italy).
• Jeng, P. S., Allen, J. B., Gross, M. (2006). Evaluating ME Function via an Acoustic Power Assessment. Paper presented at AAA.
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• Marshall, L., Jeng, P. S., Lapsley Miller, J. A., and Boege, P. (2004). "Technology Showcase: Otoacoustic emission technology for hearing-conservation programs. Paper presented at the Peer Reviewed Medical Research Program (Department of Defense) Military Health Research Forum (San Juan, Puerto Rico).
• Marshall, L., Lapsley Miller, J. A., Jeng, P. S., and Boege, P. (2004). "Preventing hearing loss using otoacoustic emissions (Poster and Podium)." Paper presented at the Peer Reviewed Medical Research Program (Department of Defense) Military Health Research Forum (San Juan, Puerto Rico).
• Jeng, P. S., Levitt, H., Lee, W. W., and Gravel, J. S. (2001). "Reflectance measures for detecting otitis media with effusion in children: Preliminary findings," in Recent Advances in Otitis Media with Effusion, Proceedings of the Seventh International Symposium (Ft. Lauderdale), pp. 194-199.