by the OAE POrtal staff
1. Introduction
The fourth generation devices appeared in 2001 and many new models are expected in 2003. The average response of the OAE community is mixed, others consider these devices as the solution to the EHDI system requirements , others simply consider them as an exaggerated attempt of the industry to create a wider market space. This editorial presents the characteristics of this generation of devices and poses some questions about their clinical utility.
2. Background Information
The OAE devices have come a long way from the devices we have used 14 years ago . It is not that technology has changed in these 14 years, our clinical priorities seemed to follow different objectives. With the booming of the neonatal screening programs and the definition of the goals of EHDI systems, the familiar OAE devices adopted different philosophies. The research of the hearing function was substituted by a routine evaluation of a few frequencies related mostly to speech and time-consuming protocols (DP-Grams of 10 -12 points per octave) were substituted with fast scripts testing 3 -4 frequency points.
The trends we have observed in the OAE market can be characterized by four generations of OAE equipment:
- The first generation started with the releases of ISA-card systems for the PC, such as the ILO-88 from Otodynamics, and for the Macintosh the Virtual 330.
- The second generation started with the release of devices which could be easily connected to portable PCs such as the IL0-292 from Otodynamics and the Capella system from MADSEN.
- We are currently experiencing the third generation of OAE equipment. Most of the devices are small (handheld sizes) and they have appropriate software pre-loaded in order to automate as much as possible neonatal screening. While the sales of the third generation devices have started to peak, new devices (fourth generation) combining OAE and ABR recording facilities (see the Accu-Screen from GN-resound / Fischer Zoth, and the AudioScreener from Everest Biomedical Devices) are becoming available.
3. Characteristics of the 4rth generation
The fourth generation devices are characterized by:
1. A small unit size (handheld devices) .
2. Ergonomically designed software which facilitates the easy flow of tests to conduct (OAE and ABR).
3. Intelligent algorithms to control the position of the probe.
4. Wireless transmission of the data to a central database (this issue was somehow overlooked in the third generation devices)
5. Clear test results (PASS - REFER)
6. Moderate cost (less than OAE + external AABR or OAE + external ABR units)
4. Questions
The positive impact of the fourth generation devices has not been evaluated yet. Although the aim of the fourth generation instrumentation is to offer the user all the tools necessary to conduct a complete universal screening, it is not clear yet how these objectives will be materialized in different clinical realities. It is also to be seen how the clinical OAE community will universally "trust" AABR conducted in the well baby clinic in comparison to the standard procedures of ABR testing (issues of different clinical realities).
From a cost perspective, at the present moment the fourth generation devices offer more service power to the user who might buy a third generation device and an external AABR / ABR unit. But this advantage most probably will decrease significantly in 2003 when most manufacturers will combine their line of OAE and ABR equipment.
The fourth generation devices can undoubtly assist programs who have developed a significant screening experience with OAEs. There is a considerable difference between the practices in the US and in Europe in terms of the qualification of personnel who performs the screening. In the US screening can be performed by general training nursing personnel, or volunteers. For most European realities only professionals in Audiology (i.e technicians) can be involved. The issue is mostly related to the proper conductance of the AABR procedural testing. As the fourth generation testing sites multiply we should expect some significant feedback in mid-2003 on these issues.
The final question of this editorial is related to whether the fourth generation of OAE devices can boost forward the current status of EHDI systems. It is difficult to predict how the community will respond to the "technological panacea" which is presently offered. It is our opinion the EHDI systems are already propelled forwards by the use of the third generation devices. For many professionals the ABR testing is better allocated to the facilities of the Audiology department and not in the un-controlled environment of the well baby clinic or NICU. But it seems that the fourth generation devices are presenting us with a choice and not with an "induced" trend in neonatal screening.
Despite the fact that OAEs and neonatal screening are becoming synonymous, we should not forget that the industry is determining how we use the OAEs as a tool. There are a lot of things we have not clarify yet about OAEs and a number of clinical areas which can greatly benefit from newly designed protocols and devices. In this context, we would like to see in the near future a Universal OAE device with the following characteristics: handheld, intelligent, testing ABR, OAEs and impedance, designed with an open architecture (easily upgradeable) for multiple clinical usages from screening, to sudden hearing loss, noise and ototoxicity monitoring.
