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Real Ear to Coupler Difference Comparing Left to Right Ears


Of course, measured real-ear values are always preferred and are more accurate than estimated real-ear values. However, sometimes measuring the actual real-ear value is very difficult, sometimes it is very time consuming and some may argue that on occasion, acquiring measured values may be nearly impossible to obtain due to crying or squirmy children and a waiting room full of more of the same! Of course, with cooperative patients, obtaining these measures literally takes seconds and measuring is always the first choice for all clinical protocols.
Nonetheless, if it were only possible to measure one ear, one might ask--Is it better to use the measured ear response as an estimate of the un-measured ear, or are the estimated values more accurate?
Munro and Howlin (2010) evaluated 44 people including 16 adults, 17 school-aged children and 11 pre-schoolers, with the Verifit real-ear system. They posed the question regarding which metric is the better predictor of the second ear?
Their participants had cerumen-free ears and normal tympanograms and they were tested via their own ear-molds. Insertion depths measured from the inter-tragal notch were 31 mm for adult males, 28 mm for adult females and 25 mm for younger participants. More important for this particular analysis, was the fact that the probe tube was inserted to the same depth for both ears of each participant. Test re-test data showed a mean difference of approximately 0 dB and the standard deviation was determined to be +/- 1 dB. Using a 5 percent difference between left and right ears as the criteria for a statistical difference, none of the differences found were statistically different. Of the differences found, the biggest differences were in pre-school children at the frequency extremes.
Thus, differences between left and right ears is typically negligible, as has been previously reported in the literature. Therefore, Munro and Howlin concluded that it is better to use the measured RECD from one ear to estimate the unmeasured ear, rather than using predicted data to estimate the unmeasured ear.
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