# Pitfalls in the Detection of Hearing Loss via Otoacoustic Emissions
## 3 Results
### SNR Estimates and the Outcomes of Accu 1 and Accu 2  
SNR estimates were obtained from the ILO-292 recordings. The SNR data related to the three groups (refer-refer, pass-pass, pass-refer) revealed a particular pattern in the pass-pass group. Figure 1B summarizes the patterns. Only the pass-pass group had average SNRs above 0 dB at all frequencies. The average SNRs for the refer-refer group were well below 0 dB, indicating an absence of detectable TEOAEs. For the pass-refer group, average SNRs for 1 and 1.4 kHz were close to 0 dB, while higher frequencies were below 0 dB. Generally, these three groups were well separated, similar to the thresholds in the 1-4 kHz range. Figure 1B indicates that the disagreement between Accu 1 and Accu 2 in the pass-refer group may come from some borderline cases. A slight change in TEOAE  
\begin{table}
\begin{tabular}{c c c c c c c} \hline \hline  & & & \multicolumn{2}{c}{**Accu 2**} & & \\ \hline \multirow{4}{*}{**Accu 1**} & & & Refer & Pass & \(\chi^{2}\) test & [PERSON]’s kappa \\  & Ears with & Refer & 1 (100.0) & 0 (0.0) & \(\chi^{2}=4.62\); & \\  & normal hearing & Pass & 10 (16.7) & 50 (83.3) & \(p=0.032\) & \\  & Ears with & Refer & 45 (100.0) & 0 (0.0) & \(\chi^{2}=43.11\); & \\  & hearing loss & Pass & 32 (40.5) & 47 (59.5) & \(p<0.001\) & \\  & & Refer & 46 (100.0) & 0 (0.0) & \(\chi^{2}=67.48\); & \\  & All ears & Pass & 42 (30.2) & 97 (69.8) & \(p<0.001\) & \\ \hline \multicolumn{6}{c}{**Overall agreement between Accu 1 and Accu 2: (46 + 97)/185 = 0.773**} \\ \hline \hline \multicolumn{6}{c}{**ILO**} \\ \hline \multirow{4}{*}{**Accu 1**} & & & Refer & Pass & \(\chi^{2}\) test & Cohen’s kappa \\  & Ears with & Refer & 1 (100.0) & 0 (0.0) & \(\chi^{2}=14.49\); & \\  & normal hearing & Pass & 3 (5.0) & 57 (95.0) & \(p<0.001\) & \\ \cline{1-1}  & Ears with & Refer & 45 (100.0) & 0 (0.0) & \(\chi^{2}=20.60\); & \\ \cline{1-1}  & hearing loss & Pass & 51 (64.6) & 28 (35.4) & \(p<0.001\) & \\ \cline{1-1}  & All ears & Refer & 46 (100.0) & 0 (0.0) & \(\chi^{2}=52.04\); & \\ \cline{1-1}  & All ears & Pass & 54 (38.8) & 85 (61.2) & \(p<0.001\) & \\ \hline \multicolumn{6}{c}{**Overall agreement between Accu 1 and ILO: (46 + 85)/185 = 0.708**} \\ \hline \hline \multicolumn{6}{c}{**ILO**} \\ \hline \multirow{4}{*}{**Accu 2**} & & & Refer & Pass & \(\chi^{2}\) test & Cohen’s kappa \\  & Ears with & Refer & 3 (27.3) & 8 (72.7) & \(\chi^{2}=9.40\); & \\  & normal hearing & Pass & 1 (2.0) & 49 (98.0) & \(p=0.002\) & \\ \cline{1-1}  & Ears with & Refer & 73 (94.8) & 4 (5.2) & \(\chi^{2}=35.13\); & \\ \cline{1-1}  & hearing loss & Pass & 23 (48.9) & 24 (51.1) & \(p<0.001\) & \\ \cline{1-1}  & All ears & Refer & 76 (86.4) & 12 (13.6) & \(\chi^{2}=70.55\); & \\ \cline{1-1}  & All ears & Pass & 24 (24.7) & 73 (75.3) & \(p<0.001\) & \\ \hline \multicolumn{6}{c}{**Overall agreement between Accu 2 and ILO: (76 + 73)/185 = 0.805**} \\ \hline \hline \end{tabular} Percentages are shown for rows; they are calculated by dividing the count for a cell by the total sample size for the given row. All \(\chi^{2}\) (chi-square) test results were found statistically significant.  
\end{table}
Table 1: Agreement between Accu 1 and Accu 2, and between each of the two devices and ILO. Comparisons show pass/refer rates (number of ears and percent values in brackets), values of chi-square test, and Cohen’s kappa.  
detection criteria might change the classification result for this group from pass-refer to pass-pass or refer-refer. This situation was not observed in ears classified in the other two groups (pass-pass and refer-refer).