Auditory SceneOAE Simulator
Read the ENT note handed to you by the patient or the newborn's parent, carry out the device's daily check before the first measurement of the day, choose a probe tip, insert the probe and start the recording yourself. In the OAE software on the laptop, monitor the probe check, the noise level, the TEOAE band responses and the DP-gram. The patient swallows and talks, the baby sucks or cries; pausing the recording and settling them is your job. When you finish, compare each ear's result, interpretation and recommendation with the expected answers.
Works on computers and tablets · the 3D scene needs an up-to-date browser
- 23 clinical cases
- 5 baby cases
- 3 practice modes
- TEOAE + DPOAE
- Daily check
- Noise and event management
Before you start
Four short notes to help you use the simulator smoothly.
Computer or tablet
The 3D room, the patient and the OAE software on the laptop must be visible at the same time. For this reason, it does not open on a phone screen; hold your tablet in landscape.
The first load takes a few seconds
The patient, parent and clinician models load with the page. 3D rendering needs an up-to-date browser that supports WebGL.
Sound is optional
The click stimulus, DPOAE tones and baby sounds play at a low level; the patient's and audiologist's speech is shown in written speech bubbles with short syllable sounds. You can turn the sound off with the button in the top bar.
For educational use
This is a simulation; it does not replace a clinical diagnostic tool or a calibrated OAE device. The software screen does not represent any particular device; the values are generated from a virtual patient.
How does it work?
The flow of a real OAE session: check the device, prepare the patient, record both tests in both ears, interpret the findings.
- 1
Choose the case and the mode
Choose one of the 23 clinical cases or the blind case. Set the patient's cooperation (good or variable) and the practice mode (Learning, Guided, Field), then go to the ABR and OAE room.
- 2
Prepare the device and the patient
Read the history and the otoscopy finding in the ENT note. Inspect the probe visually and run the cavity test in the test cavity. Give the patient the instructions or inform the parent; choose a probe tip and insert the probe.
- 3
Record
Select the ear and the test and start the recording. The device first checks the probe fit. While recording, watch the noise indicator; sweeps that exceed the rejection level are not included in the average. If needed, pause and remind the patient, or settle the baby.
- 4
Interpret and compare
For each ear, choose the TEOAE and DPOAE result, the likely interpretation, the combined picture and your recommendation. Your answers are compared item by item with the expected answers and can be downloaded as an A4 report.
Cases
Five infant cases specific to OAE have been added to the cases from the audiometry and acoustic immittance simulators. Each time you open a case, a new patient is generated: the values, the affected side and the canal diameter change, so you will not see the same numbers when you repeat a case.
There is also a Blind case is available as an option: the case is chosen at random and the diagnosis is hidden. The blind case runs only in Free mode; you learn the diagnosis when you submit your assessment. Using the Patient file bridge, you can take the same patient to the audiometry, acoustic immittance or ABR simulator.
Preparation and the 3D scene
OAE is a small signal; the quality of the recording is decided before the probe enters the ear and by what happens in the room during recording.
Prepare the device and the patient
- ENT noteThe patient or the baby's parent hands you the note. The otoscopy finding directly affects OAE interpretation; you decide on the tests.
- Daily checkInspect the probe and the tip visually, place the probe in the test cavity and run the cavity test. If the probe channel is dirty, the test does not pass; clean it and repeat.
- Instructions or parent informationAn adult is told not to talk, swallow or move. For a baby, the parent is informed; recording works best when the baby is asleep or calm.
- Probe tipChoose a tip slightly larger than the canal entrance. A small tip leaks, a large tip sits too shallow; the fit shows in the probe check when recording starts.
- NoiseSwallowing, talking, coughing, head movement and, in babies, sucking and crying increase the noise. The recording recovers from brief events; pause for frequent ones.
Infant cases
Newborns and infants are tested in the parent's arms. The baby's state directly affects the recording.
- Sleep and wakefulnessThe baby may be asleep, calm, restless or crying. Dimming the light and the parent rocking the baby help to settle them.
- DummyA dummy settles the baby, but sucking produces rhythmic noise. If the dummy is in the baby's mouth during recording, points are deducted.
- Small tipsA baby's ear canal is narrow; the box has separate small tips for babies. Vernix can block the ear canal.
- Close-up view of the earYou can watch the probe entering the ear canal close up, and when you switch to the OAE screen, you can see the baby in the small window at the bottom left.
OAE software
Diagnostic OAE software running on the laptop on the desk; with its menus, taskbar and clock, it behaves like a real computer screen.
| Section | In the simulator |
|---|---|
| Probe checkFit of the probe in the ear canal | When recording starts, the spectrum and waveform of the stimulus in the ear canal are measured. Good fit, leak, shallow insertion and blocked probe are distinguished. |
| TEOAEClick-evoked emission | 80 µs click, 84 dB peSPL, nonlinear mode; waveforms of the A and B buffers, response, noise and SNR in half-octave bands from 1-4 kHz. Diagnostic (260 sweeps) and quick protocols. |
| DPOAEDistortion product emission | 2f1-f2, L1/L2 65/55 dB SPL, f2/f1 1.22; DP-gram, the response spectrum at the selected frequency and the stimulus levels measured in the ear canal. Three preset protocols; L1, L2, f2/f1 and rejection level in the Advanced settings. |
| Noise and stabilityReliability of the recording | Instantaneous noise level, rejection level and sweep history; stimulus stability for TEOAE. The recording can run accelerated or in real time. |
| Daily checkDaily check of the device | Visual inspection of the probe, the stimulus level in the test cavity and the absence of a response in the cavity. |
| DP-IODP as a function of stimulus level | Visible in the software; will be added in the next update. |
Criteria used by the simulator
The simulator gives results and assesses your interpretation according to the criteria below. Institutional protocols and manufacturers' default settings may differ slightly from these values.
| Criterion | Value |
|---|---|
| TEOAE stimulusClick level and mode | 81-87 dB peSPL (target 84), nonlinear mode, analysis window 2.5-20 ms. |
| TEOAE response presentBand criterion | SNR ≥ 6 dB in at least two half-octave bands and an overall response above 0 dB SPL. Reproducibility (above 70%) is a supporting criterion. |
| Recording qualityAcceptable recording | Stimulus stability ≥ 85%, at least 40 accepted sweeps (260 in the diagnostic protocol). Rejection level about 47 dB SPL. |
| DPOAE response presentFrequency criterion | SNR ≥ 6 dB and a DP level within the normative range. If SNR ≥ 6 dB but the DP level is below the norm: “response present, below norm”. |
| No responseNoise low enough | SNR below 6 dB and a low noise floor: −5 dB SPL or lower in every half-octave band for TEOAE (BSA), ideally below −10 dB SPL for DPOAE. If the noise is high, the result is not “no response” but “inadequate recording”. |
| Relationship with hearing thresholdExpected picture | TEOAEs are almost always present when thresholds are below 20 dB HL, are reduced at 25-35 dB HL and are usually absent above 40 dB HL. DPOAEs decrease between 15 and 40/50 dB HL. |
| Middle earTwo-way transmission | A middle ear problem attenuates both the stimulus going in and the emission coming out; absent OAEs alone do not mean a cochlear loss. |
Modes, score and achievements
You can practise the same case with different levels of support. Your score looks not only at your interpretation but also at how you obtained the recording.
Three practice modes
- LearningYou follow the clinical sequence step by step: ENT note, daily check, instructions or parent information, probe, TEOAE and DPOAE in both ears, assessment. Every step has a “Why?” explanation.
- GuidedYou do the steps in any order you like; hints on the criteria, noise and probe fit appear as they become relevant.
- FieldThere are no hints; you only see warnings for clear errors. The blind case runs in this mode.
How is the score calculated?
- 1Interpretation (70%)TEOAE and DPOAE result for each ear, the interpretation for each ear, the combined picture of both ears and recommendations.
- 2Procedure (30%)Reading the ENT note, doing the daily check before measuring the patient, giving the instructions or parent information at the right time, finding a suitable tip early, not leaving a problematic recording as it is and managing the noise.
- 3Stars and experienceYour total score is converted into 1-3 stars; with experience points you level up and earn achievements such as First Case, Flawless Interpretation, Quiet Recording, Careful Start and Clean Practice.
Your progress is stored only in your own browser; no data is sent to a server. Teachers can view a student's result with the class code.
Frequently asked questions
The outer hair cells in the cochlea vibrate in response to sound. This active process produces a very faint sound that is transmitted back through the middle ear and can be measured with a sensitive microphone placed in the ear canal. This sound is called an otoacoustic emission (OAE).
OAE testing does not require the patient to respond; this is why it is widely used in newborn hearing screening and with patients who cannot cooperate.
TEOAE is evoked by a brief click, and the response across a wide frequency range is split into bands for analysis. DPOAE is evoked by two pure tones (f1 and f2); the cochlea produces a new frequency from the combination of the two (most often 2f1-f2), and this response is shown on the DP-gram against the f2 frequency.
DPOAE samples the high frequencies better, while TEOAE is more sensitive to mild losses. In the clinic, the two are often used together.
No. OAEs only give information about the function of the outer hair cells and the middle ear. With inner hair cell, auditory nerve or brainstem problems, OAEs can be normal. If auditory neuropathy spectrum disorder (ANSD) is suspected, an ABR is needed; if the reported thresholds contradict the OAE result, a functional loss should also be considered.
Not always. Fluid, a perforation or an ossicular chain problem in the middle ear weakens the emission; wax or vernix in the ear canal can block the recording completely. Before interpreting, the otoscopy finding, the probe check and, if needed, tympanometry are considered together.
The emission is a very small signal; a response is only as reliable as its margin above the noise floor. Saying “no response” when the noise is high would be wrong: the result is taken as an “inadequate recording” and the recording is repeated. Frequencies below 1.5 kHz in particular are more affected by room and patient noise.
Sucking, crying and wriggling push the noise level above the rejection level, and most sweeps are rejected. In a sleeping or calm baby, recording is both quick and reliable. Testing works best after a feed, in a room with dimmed lights and with the baby in the parent's arms.
No. The simulator runs entirely in your browser; no measurements are sent to a server. Your level, best scores and achievements are stored only in your own browser's local storage.
The 3D room, the patient and the OAE software must be visible at the same time. At phone width this layout becomes unusable, so small screens have been deliberately blocked. It works on a tablet held in landscape.
No. The person being tested here is a virtual patient, and you are the clinician. If you have concerns about your hearing or your ears, contact an audiology clinic.
Kaynaklar
The simulator's criteria, case models and interpretation key are based on the sources below.
- British Society of Audiology. Practice guidance on otoacoustic emission measurement.
- Kemp, D. T. (1978). Stimulated acoustic emissions from within the human auditory system. Journal of the Acoustical Society of America.
- Kemp, D. T. (2002). Otoacoustic emissions, their origin in cochlear function, and use. British Medical Bulletin.
- Prieve, B. A., Gorga, M. P., Schmidt, A., Neely, S., Peters, J., Schultes, L., & Jesteadt, W. (1993). Analysis of transient-evoked otoacoustic emissions in normal-hearing and hearing-impaired ears. Journal of the Acoustical Society of America.
- Gorga, M. P., Neely, S. T., Ohlrich, B., Hoover, B., Redner, J., & Peters, J. (1997). From laboratory to clinic: a large scale study of distortion product otoacoustic emissions in ears with normal hearing and ears with hearing loss. Ear and Hearing.
- Starr, A., Picton, T. W., Sininger, Y., Hood, L. J., & Berlin, C. I. (1996). Auditory neuropathy. Brain.
- Joint Committee on Infant Hearing (2019). Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. Journal of Early Hearing Detection and Intervention.
- Robinette, M. S., & Glattke, T. J. (Eds.). Otoacoustic Emissions: Clinical Applications. Thieme.
- Hall, J. W. Handbook of Otoacoustic Emissions. Singular.
If you are ready, let's go into the room
If you spot an error, if a criterion does not work correctly or if there is a case you would like us to add, write to us: info@isitmeatolyesi.com. The simulator is an open-ended educational project; it grows with your feedback.