Otoacoustic emissions for the preliminary screening of otitis media in children: a systematic review using a diagnostic test accuracy approach

OBJECTIVE: To summarise the accuracy of otoacoustic emissions (OAE) testing relative to other methods used to screen for otitis media and related conditions in children. DESIGN: Systematic review and meta-analysis. STUDY SAMPLE: Six databases were searched (Medline, CINAHL, Embase, PsychINFO, Scopus, and Web of Science) from inception to 2 November 2023, and included terms related to otitis media and otoacoustic emissions testing. The recommended JBI approach to critical appraisal, study selection and data synthesis was used. RESULTS: Of 3183 articles retrieved, nine articles met the inclusion criteria, with seven included in meta-analyses. Screening accuracy was calculated for transiently evoked OAE (TEOAE) vs. a combination audiological assessment (tympanometry, otoscopy, and audiometry) (pooled sensitivity = 67.6% (95%CI = 60.4%-74.1%); pooled specificity = 81.7% (95%CI = 75.3%-86.7%)); TEOAE vs. tympanometry (pooled sensitivity = 85.9% (95%CI = 50.4%-97.3%); pooled specificity = 90.4% (95%CI = 75.0%-96.7%)); and distortion product otoacoustic emissions (DPOAE) vs. tympanometry and otoscopy combined (pooled sensitivity = 54.8% (95%CI = 45.1%-64.2%); pooled specificity = 97.2% (95%CI = 43.8%-99.9%)). CONCLUSIONS: Sensitivity and specificity were highest for TEOAE vs. tympanometry alone, suggesting TEOAE may be a relatively accurate option as a component of preliminary OM screening in children in primary health settings. These findings may be of interest to clinicians. However, due to few studies and considerable heterogeneity further research is warranted to confirm these results. REGISTRATION: PROSPERO (CRD42021274917).