DESCRIPTION (provided by applicant): The goal of newborn hearing screening is to identify infants with sensorineural hearing loss (SNHL), but most neonates who fail screening have conductive hearing loss (CHL) rather than sensorineural hearing loss, resulting in high false positive rate and costly follow-up diagnostic evaluation. The Rhode Island study (1993) has shown that the prevalence of CHL over SNHL to be 17 vs. 3-6 per 1000. While in NICU the prevalence of CHL over SNHL raises to 36 vs. 23 per 1000. The ramifications of SNHL and CHL are different, so an accurate typing of the loss at the time of a newborn hearing screening is essential. This main objective of this proposal is to build a hearing screening device that combines wideband reflectance measurement system (RMS) with DPOAE measurement system into one system, where the former provides diagnostic evaluation for conductive hearing loss and the later provides diagnostic evaluation for the SNHL. So in one test, both conductive path and cochlear status are evaluated. Since both the reflectance measurement and the DPOAE measurement share an identical measurement, the extra time needed to perform hearing screening using the combined screening device will be no more than few minutes. The benefit of the expected outcome is reduced false positive rate, reduce follow up diagnostic cost, and reduced parental concern. The specific aims of Phase I is (1) to demonstrate the feasibility of distinguishing between conductive disorders (CD) and the inner ear pathologies (IEP) by combining the use of distortion product otoacoustic emission (DPOAE) and wide-band power reflectance measurements (WB-PR) in a single instrument used for hearing screening prototype instrument. (2) To develop a prototype instrument that will demonstrate the feasibility of using WB-PR to address the standing wave problem.