A 6-month-old infant fails newborn hearing screening. Distortion-product OAE (DPOAE) testing is absent bilaterally, but click-ABR shows robust Wave V responses at 35 dB nHL bilaterally. What is the most likely explanation?
- A Bilateral moderate sensorineural hearing loss with preserved cochlear reserves
- B Auditory neuropathy spectrum disorder (present OAEs + absent/abnormal ABR is classic ANSD; this reversed pattern is atypical)
- C Bilateral middle ear effusion causing absent OAEs with normal neural conduction ✓
- D Technical failure of the OAE probe due to small ear canal size in infancy
Explanation
Absent DPOAEs with present click-ABR (normal Wave V at 35 dB nHL) in an infant most likely indicates bilateral middle ear effusion (secretory otitis media). Middle ear effusion attenuates the sound stimuli delivered to the cochlea (and reflects OAE signals returning), causing OAE failure, but if the conductive loss is mild-to-moderate (< ~30-35 dB), the ABR with click stimuli at a higher intensity may still produce a response. Classic auditory neuropathy spectrum disorder (ANSD) shows the OPPOSITE pattern: present OAEs (intact outer hair cells) with absent/abnormal ABR (disrupted neural synchrony). This infant should have tympanometry performed.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.