Consistency and Diagnostic Value Assessment of Auditory Steady-State Response and Distortion Product Otoacoustic Emissions Compared with Pure-Tone Audiometry in Occupational Noise-Induced Hearing Loss

Objective: This study aimed to explore the consistency and application value of auditory steady-state response (ASSR) and otoacoustic emissions (OAE) with pure-tone audiometry (PTA) in the diagnosis of occupational noise-induced deafness. Methods: Clinical data from 182 individuals with occupational noise exposure were retrospectively reviewed. After screening, 55 patients comprised the hearing loss group, whereas 55 controls without noise exposure were matched. All participants underwent PTA, ASSR (500–6000 Hz) and OAE (500–6000 Hz). Consistency and diagnostic performance were assessed using Kappa analysis and receiver operating characteristic (ROC) curves. Results: PTA thresholds and ASSR response thresholds at all frequencies were significantly higher in the hearing loss group than in the control group, whereas OAE amplitudes (500–6000 Hz) were significantly lower ( P < 0.05). ASSR demonstrated a diagnostic sensitivity and specificity of 92.70%, with excellent agreement with PTA (Kappa = 0.85). OAE showed a diagnostic sensitivity of 74.50% and specificity of 80.00%, with moderate agreement with PTA (Kappa = 0.54). The area under the ROC curve for ASSR (area under the curve [AUC] = 0.950, 95% confidence interval [CI]: 0.914–0.987) was significantly higher than that for OAE (AUC = 0.891, 95% CI: 0.820–0.962). After multivariable adjustment for age, sex, smoking, alcohol consumption and duration of noise exposure, ASSR abnormality (odds ratio [OR] = 28.64, 95% CI: 10.35–79.12, P < 0.001) and OAE abnormality (OR = 6.73, 95% CI: 2.81–16.10, P < 0.001) remained independent influencing factors for occupational noise-induced deafness. Conclusion: Within the 500–6000 Hz range, ASSR demonstrates strong concordance with PTA and serves as a reliable objective verification tool. OAE provides complementary insights into early cochlear function. Their combined use warrants further prospective validation.