Background: Evaluate the impact of patent tympanostomy tubes (TT) on otoacoustic emissions (OAE) in patients with normal pure tone audiometry (PTA).

Methods: Retrospective review of patients who underwent TT placement with paired postoperative audiogram and OAEs at 1, 2, 4, and 8 kHz were included. Frequencies with PTA >20 dB or nonpatent TTs were excluded. OAEs were graded by signal-to-noise ratio and distortion product as "present," "reduced," or "absent."

Results: In total, 124 patients (217 ears) were included with a mean age (SD) of 3.9 (3.2) years and OAE testing occurring 4.5 (4.7) months postoperatively. OAE absence rates were 85% at 1 kHz (n = 165), 57% at 2 kHz (n = 203), 56% at 4 kHz (n = 206), and 83% at 8 kHz (n = 135).

Conclusions: Absent OAEs were the most common result at all frequencies, especially 1 and 8 kHz. Overall, 78.8% of patients failed at least one tested frequency, despite normal PTA and patent TTs, suggesting a potential direct impact of TTs on OAE outcomes. Clinicians may need to exercise caution when interpreting OAEs in patients with patent TTs, and further research may warrant a reevaluation of OAE utility in this context.