The quasi-periodic fluctuations in otoacoustic emission (OAE) amplitude and phase, known as fine structure, provide critical insight into the mechanisms of OAE generation and propagation. Whether fine structure is relevant from the perspective of hearing health remains an open question. Starting with work done under the tutelage of Professor Long, our group has conducted a decade of work investigating the clinical relevance of fine structure in general, and distortion product (DP) OAE components in particular. These studies cover a significant portion of the human lifespan (0 to ∼80 yrs) and the collective results provide insights into the avenues of application that hold promise. Drawing from the results of several studies conducted in our laboratory and those of collaborators and colleagues we will make the case for focused clinical application of the DPOAE components that constitute fine structure. These constituent elements appear to be ideal for monitoring of cochlear status and expose physiological changes prior to their evidence in other measures of auditory function. However, harnessing the information encapsulated in fine structure directly is not without challenge and the examination of the constituent elements of fine structure may prove more profitable for clinical applications.