Outer hair cell electromotility and otoacoustic emissions

Reliability of distortion-product otoacoustic emissions and their relation to loudness

The reliability of distortion-product otoacoustic emission (DPOAE) measurements and their relation to loudness measurements was examined in 16 normal-hearing subjects and 58 subjects with hearing loss. The level of the distortion product (L(d)) was compared across two sessions and resulted in correlations that exceeded 0.90. The reliability of DPOAEs was less when parameters from nonlinear fits to the input/output (I/O) functions were compared across visits. Next, the relationship between DPOAE I/O parameters and the slope of the low-level portion of the categorical loudness scaling (CLS) function (soft slope) was assessed. Correlations of 0.65, 0.74, and 0.81 at 1, 2, and 4 kHz were observed between CLS soft slope and combined DPOAE parameters. Behavioral threshold had correlations of 0.82, 0.83, and 0.88 at 1, 2, and 4 kHz with CLS soft slope. Combining DPOAEs and behavioral threshold provided little additional information. Lastly, a multivariate approach utilizing the entire DPOAE I/O function was used to predict the CLS rating for each input level (dB SPL). Standard error of the estimate when using this method ranged from 2.4 to 3.0 categorical units (CU), suggesting that DPOAE I/O functions can predict CLS measures within the CU step size used in this study (5).

Characteristics of cochlear microphonics in infants and young children with auditory neuropathy

CONCLUSIONS

Cochlear microphonics (CMs) play an important role in the diagnosis of auditory neuropathy (AN). It is necessary and helpful to diagnose the sites-of-lesion in infants and children with AN by analyzing the patterns of CM amplitudes and I/O functions together.

OBJECTIVES

To investigate the characteristics and clinical significance of CMs in the diagnosis of AN among infants and children.

METHODS

A total of 36 infants and children (16 males and 20 females) were divided into two groups. Group A included 15 children (30 ears) with auditory brainstem response (ABR) absent and distortion product otoacoustic emissions (DPOAEs) present and group B included 21 children (30 ears) with ABR absent and DPOAEs absent. Fifteen normal-hearing infants (30 ears) made up the control group. Click eliciting CMs were recorded at stimulus levels of 100, 90, 80, and 70 dB nHL for each ear using a button electrode placed at the top of the forehead. A tube-clamping method was used to distinguish CMs from artifacts, and an averaging algorithm was used to obtain a clear CM waveform. The time delay and amplitude of CMs were measured in both children with AN and normal-hearing infants on (C-R)/2 waveforms, and an I/O function curve for each group was plotted with the stimulating level as input and the CM amplitude as output.

RESULTS

The largest identifiable CMs were generally found between 0.5 and 0.8 ms after stimulation with mean delay of 0.63 ± 0.04 ms in both group A and the control group, and 0.63 ± 0.07 ms in group B. There was no significant difference between the AN group and the control group in CM time delay. There was no significant difference (p > 0.05) between group A (AN with OAEs present, 0.47 ± 0.15 μV) and the control group (0.45 ± 0.13 μV) in CM amplitude, while CM amplitudes in children with AN with DPOAEs absent (0.24 ± 0.08 μV) were significantly lower than those in either the control group or group A (p < 0.01). The amplitude of CMs reduced with stimulus intensity in all the subjects. There was obvious nonlinearity in group A and the control group, while there was a more linear tendency in amplitude increasing on the I/O function curve in group B.

Biophysical mechanisms underlying outer hair cell loss associated with a shortened tectorial membrane

The tectorial membrane (TM) connects to the stereociliary bundles of outer hair cells (OHCs). Humans with an autosomal dominant C1509G mutation in alpha-tectorin, a protein constituent of the TM, are born with a partial hearing loss that worsens over time. The Tecta(C1509/+) transgenic mouse with the same point mutation has partial hearing loss secondary to a shortened TM that only contacts the first row of OHCs. As well, Tecta(C1509G/+) mice have increased expression of the OHC electromotility protein, prestin. We sought to determine whether these changes impact OHC survival. Distortion product otoacoustic emission thresholds in a quiet environment did not change to 6 months of age. However, noise exposure produced acute threshold shifts that fully recovered in Tecta (+/+) mice but only partially recovered in Tecta(C1509G/+) mice. While Tecta(+/+) mice lost OHCs primarily at the base and within all three rows, Tecta(C1509G/+) mice lost most of their OHCs in a more apical region of the cochlea and nearly completely within the first row. In order to estimate the impact of a shorter TM on the forces faced by the stereocilia within the first OHC row, both the wild type and the heterozygous conditions were simulated in a computational model. These analyses predicted that the shear force on the stereocilia is ~50% higher in the heterozygous condition. We then measured electrically induced movements of the reticular lamina in situ and found that while they decreased to the noise floor in prestin null mice, they were increased by 4.58 dB in Tecta(C1509G/+) mice compared to Tecta(+/+) mice. The increased movements were associated with a fourfold increase in OHC death as measured by vital dye staining. Together, these findings indicate that uncoupling the TM from some OHCs leads to partial hearing loss and places the remaining coupled OHCs at higher risk. Both the mechanics of the malformed TM and the increased prestin-related movements of the organ of Corti contribute to this higher risk profile.

Do "optimal" conditions improve distortion product otoacoustic emission test performance?

OBJECTIVES

To determine whether an "optimal" distortion product otoacoustic emission (DPOAE) protocol that (1) used optimal stimulus levels and primary-frequency ratios for each f2, (2) simultaneously measured 2f2 - f1 and 2f1 - f2 distortion products, (3) controlled source contribution, (4) implemented improved calibration techniques, (5) accounted for the influence of middle ear reflectance, and (6) applied multivariate analyses to DPOAE data results in improved accuracy in differentiating between normal-hearing and hearing-impaired ears, compared with a standard clinical protocol.

DESIGN

Data were collected for f2 frequencies ranging from 0.75 to 8 kHz in 28 normal-hearing and 78 hearing-impaired subjects. The protocol included a control condition incorporating standard stimulus levels and primary-frequency ratios calibrated with a standard SPL method and three experimental conditions using optimized stimuli calibrated with an alternative forward pressure level method. The experimental conditions differed with respect to the level of the reflection-source suppressor tone and included conditions referred to as the null suppressor (i.e., no suppressor tone presented), low-level suppressor (i.e., suppressor tone presented at 58 dB SPL), and high-level suppressor (i.e., suppressor tone presented at 68 dB SPL) conditions. The area under receiver operating characteristic (A(ROC)) curves and sensitivities for fixed specificities (and vice versa) were estimated to evaluate test performance in each condition.

RESULTS

A(ROC) analyses indicated (1) improved test performance in all conditions using multivariate analyses, (2) improved performance in the null suppressor and low suppressor experimental conditions compared with the control condition, and (3) poorer performance below 4 kHz with the high-level suppressor. As expected from A(ROC), sensitivities for fixed specificities and specificities for fixed sensitivities were highest for the null suppressor and low suppressor conditions and lowest for standard clinical procedures. The influence of 2f2 - f1 and reflectance on test performance were negligible.

CONCLUSIONS

Predictions of auditory status based on DPOAE measurements in clinical protocols may be improved by the inclusion of (1) optimized stimuli, (2) alternative calibration techniques, (3) low-level suppressors, and (4) multivariate analyses.

Effects of aspirin on distortion product fine structure: interpreted by the two-source model for distortion product otoacoustic emissions generation

Distortion product otoacoustic emission (DPOAE) fine structure is due to the interaction of two major components coming from different places in the cochlea. One component is generated from the region of maximal overlap of the traveling waves generated by the two primaries and is attributed to nonlinear distortion (nonlinear component). The other component arises predominantly from the tonotopic region of the distortion product and is attributed to linear coherent reflection (reflection component). Aspirin (salicylate) ototoxicity can cause reversible hearing loss and reduces otoacoustic emission generation in the cochlea. The two components are expected to be affected differentially by cochlear health. Changes in DPOAE fine structure were recorded longitudinally in three subjects before, during, and after aspirin consumption. Full data sets were analyzed for two subjects, but only partial data could be analyzed from the third subject. Resulting changes in the two components of DPOAE fine structure revealed variability among subjects and differential effects on the two components. For low-intensity primaries, both components were reduced with the reflection component being more vulnerable. For high-intensity primaries, the nonlinear component showed little or no change, but the reflection component was always reduced.

Environmental lead exposure and otoacoustic emissions in Andean children

Studies relating sensory hearing impairment to lead (Pb) exposure in children have presented inconsistent results. The objective of this study was to measure distortion product otoacoustic emissions (DPOAE), sounds emanating from the outer hair cells of the inner ear, in Pb-exposed children to determine the effects of Pb poisoning on the inner ear. DPOAE were recorded for 9 f(2) frequencies from 1187 to 7625 Hz on 102 ears of 53 Pb-exposed children (aged 6-16 yr) residing in Pb-contaminated environments in the Andes Mountains of Ecuador where Pb glazing of ceramics is the primary livelihood. Blood lead (PbB) levels ranged from 4.2 to 94.3 μg/dl (mean: 37.7; SD: 25.7; median: 36.4). The median PbB level was markedly higher than the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) 10-μg/dl action level. Spearman rho correlation analyses of the relation between PbB level and DPOAE amplitude and between PbB level and DPOAE signal-to-noise ratio revealed no significant associations at any of the f(2) frequencies tested. In addition, no significant correlation (Spearman rho) between PbB level and hearing sensitivity for 6 pure-tone test frequencies from 1000 to 8000 Hz was found. Although the study group was found to have abnormally elevated PbB levels, in contrast to some earlier reports, the results of the current study showed no consistent Pb-induced sensory effects on the cochlea of Pb-intoxicated children.

Impact of three hours of discotheque music on pure-tone thresholds and distortion product otoacoustic emissions

The aim of this study was to investigate whether distortion product otoacoustic emissions (DPOAEs) are a suitable means for detecting changes in outer hair cell (OHC) functionality due to exposure to three hours of discotheque music and whether efferent reflex strength of the medial olivocochlear bundle is able to predict the ear's susceptibility to high-level noise. High-resolution DPOAEs (Δf(2)=47 Hz) were recorded between 3.5 and 4.5 kHz at close-to-threshold primary tone levels. For comparison, high-resolution pure-tone audiometry was conducted in the same frequency range. Efferent reflex strength was measured by means of DPOAEs at a specific frequency with and without contralateral acoustic stimulation. A significant deterioration of more than 10 dB was found for pure-tone thresholds and DPOAE levels indicating that three hours of high-level noise exert a considerable influence on hearing capability and OHC functionality. A significant correlation between shifts in pure-tone threshold and shifts in DPOAE level occurred when removing data with differing calibration across measurements. There was no clear correlation between efferent reflex strength and shifts in pure-tone threshold or shifts in DPOAE level suggesting that the applied measures of efferent reflex strength may not be suitable for quantifying individual vulnerability to noise.

Comparison of cochlear morphology and apoptosis in mouse models of presbycusis

Objectives

Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea.

Methods

We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE).

Results

ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression.

Conclusion

These data suggest that the C57 mouse could be an excellent animal model for early onset 'sensory' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.

Murine intracochlear drug delivery: reducing concentration gradients within the cochlea

Direct delivery of compounds to the mammalian inner ear is most commonly achieved by absorption or direct injection through the round window membrane (RWM), or infusion through a basal turn cochleostomy. These methods provide direct access to cochlear structures, but with a strong basal-to-apical concentration gradient consistent with a diffusion-driven distribution. This gradient limits the efficacy of therapeutic approaches for apical structures, and puts constraints on practical therapeutic dose ranges. A surgical approach involving both a basal turn cochleostomy and a posterior semicircular canal canalostomy provides opportunities for facilitated perfusion of cochlear structures to reduce concentration gradients. Infusion of fixed volumes of artificial perilymph (AP) and sodium salicylate were used to evaluate two surgical approaches in the mouse: cochleostomy-only (CO), or cochleostomy-plus-canalostomy (C+C). Cochlear function was evaluated via closed-system distortion product otoacoustic emissions (DPOAE) threshold level measurements from 8 to 49 kHz. AP infusion confirmed no surgical impact to auditory function, while shifts in DPOAE thresholds were measured during infusion of salicylate and AP (washout). Frequency dependent shifts were compared for the CO and C+C approaches. Computer simulations modeling diffusion, volume flow, interscala transport, and clearance mechanisms provided estimates of drug concentration as a function of cochlear position. Simulated concentration profiles were compared to frequency-dependent shifts in measured auditory responses using a cochlear tonotopic map. The impact of flow rate on frequency dependent DPOAE threshold shifts was also evaluated for both surgical approaches. Both the C+C approach and a flow rate increase were found to provide enhanced response for lower frequencies, with evidence suggesting the C+C approach reduces concentration gradients within the cochlea.

Somatic motility and hair bundle mechanics, are both necessary for cochlear amplification?

Hearing organs have evolved to detect sounds across several orders of magnitude of both intensity and frequency. Detection limits are at the atomic level despite the energy associated with sound being limited thermodynamically. Several mechanisms have evolved to account for the remarkable frequency selectivity, dynamic range, and sensitivity of these various hearing organs, together termed the active process or cochlear amplifier. Similarities between hearing organs of disparate species provides insight into the factors driving the development of the cochlear amplifier. These properties include: a tonotopic map, the emergence of a two hair cell system, the separation of efferent and afferent innervations, the role of the tectorial membrane, and the shift from intrinsic tuning and amplification to a more end organ driven process. Two major contributors to the active process are hair bundle mechanics and outer hair cell electromotility, the former present in all hair cell organs tested, the latter only present in mammalian cochlear outer hair cells. Both of these processes have advantages and disadvantages, and how these processes interact to generate the active process in the mammalian system is highly disputed. A hypothesis is put forth suggesting that hair bundle mechanics provides amplification and filtering in most hair cells, while in mammalian cochlea, outer hair cell motility provides the amplification on a cycle by cycle basis driven by the hair bundle that provides frequency selectivity (in concert with the tectorial membrane) and compressive nonlinearity. Separating components of the active process may provide additional sites for regulation of this process.

Quantitative analysis of cochlear active mechanisms in tinnitus subjects with normal hearing sensitivity: multiparametric recording of evoked otoacoustic emissions and contralateral suppression

OBJECTIVE

Aim of this study was to investigate the possible role played by outer hair cells and cochlear efferent system functionality when tinnitus develops in normal hearing ears. A multiparametric approach was used, entailing recording and analysis of a set of otoacoustic emissions (OAEs): distortion product (DPOAEs), transient evoked (TEOAEs) and efferent-mediated TEOAE suppression in the presence of contralateral acoustic stimulation (CAS).

METHODS

Fifty-four subjects with normal hearing sensitivity participated in the study. Twenty-three suffered from chronic subjective tinnitus whereas thirty-one did not have tinnitus and acted as control subjects. DPOAEs were measured with eliciting tones of frequency ratio 1.22 and intensity 65 and 55dB SPL in the frequency range 0.5-8kHz. TEOAEs were recorded with the 'linear' protocol using clicks at 60dB peak SPL both in the absence and in the presence of CAS at two different intensities. DPOAE amplitude, TEOAE amplitude, and TEOAE suppression were analysed as relevant parameters.

RESULTS

Significantly reduced DPOAE amplitude in the frequency range 1.5-8kHz, lower TEOAE amplitude, and slightly decreased TEOAE suppression were measured in tinnitus subjects compared to non-tinnitus controls. In particular, 74% of tinnitus subjects exhibited abnormal DPOAEs, 13% had abnormal TEOAEs, whereas abnormal TEOAE suppression was found in 9% of patients.

CONCLUSION

Overall, the present work revealed the presence of abnormal OAEs, in particular at higher frequencies, in tinnitus subjects with normal hearing sensitivity. A minor (i.e., sub-clinical) outer hair cell dysfunction, particularly in high-frequency cochlear regions, might thus be assumed in normal hearing tinnitus subjects. In order to better put in light the possible role played by outer hair cells in low-frequency cochlear regions, or by the cochlear efferent system, additional analyses would be needed.

[Distortion product otoacoustic emission levels and input/output-growth functions in normal-hearing individuals with tinnitus and/or hyperacusis]

The purpose of this study was to determine whether distortion product otoacoustic emissions (DPOAEs) can be used to distinguish among four groups with audiometrically normal-hearing sensitivity: (1) control adults without tinnitus or hyperacusis, (2) patients with tinnitus alone, (3) patients with hyperacusis alone, and (4) patients with both tinnitus and hyperacusis. Two types of DPOAE measures were evaluated: (1) the distortion product (DP-)gram measured with fixed primary levels as a function of frequency, and (2) DPOAE input/output (I/O) functions for a range of primary levels between 45 and 70 dB sound pressure level (SPL) at 1000, 2000, and 4000 Hz. DP-grams did not clearly distinguish between the control and patient groups. There was, however, a consistent trend for the three patient groups to have decreased average DP levels at 4000 and 6000 Hz; this notch in the DP-gram was not observed in the response configuration for the control group. In the three patient groups, 51 to 74% of these individuals had DP levels that were outside of the 95% confidence range for the control group. The average slopes of the I/O growth functions for each of the patient groups were consistently steeper than those for the control group; however, the slope values were indistinguishable among the patient groups. About 60% of the patients' DPOAE responses (in each group) were categorized as abnormal based on their slope values. Thus, DPOAE measures can be used with at least partial success to distinguish controls from patients with tinnitus, hyperacusis, or both tinnitus and hyperacusis, but not to discriminate among the respective patient groups. These findings suggest that the pathology represented among the patient groups is consistent at the level of the cochlea; however, diagnostic tests targeted at higher centers of processing are needed if the individuals in these groups are to be distinguished among themselves. In all participants, DPOAEs with fixed primary levels as a function of frequency were measured. There was a consistent trend for the three patient groups to have decreased average DP-gram levels at 4000 and 6000 Hz; this notch in the DP-gram was not observed in the response configuration for the control group. In the three patient groups, 51 to 74% of these individuals had DP levels that were outside of the 95% confidence range for the control group. Thus, DPOAE measures can be used with at least partial success to distinguish controls from patients with tinnitus, hyperacusis, or both tinnitus and hyperacusis, but not to discriminate among the respective patient groups. These findings suggest that the pathology represented among the patient groups is consistent at the level of the cochlea; however, diagnostic tests targeted at higher centers of processing are needed if the individuals in these groups are to be distinguished among themselves.

Cochlear outer hair cells in a dominant-negative connexin26 mutant mouse preserve non-linear capacitance in spite of impaired distortion product otoacoustic emission

Mutations in the connexin26 gene (GJB2) are the most common genetic cause of congenital bilateral non-syndromic sensorineural hearing loss. Transgenic mice were established carrying human Cx26 with the R75W mutation that was identified in a deaf family with autosomal dominant negative inheritance [Kudo T et al. (2003) Hum Mol Genet 12:995-1004]. A dominant-negative Gjb2 R75W transgenic mouse model shows incomplete development of the cochlear supporting cells, resulting in profound deafness from birth [Inoshita A et al. (2008) Neuroscience 156:1039-1047]. The Cx26 defect in the Gjb2 R75W transgenic mouse is restricted to the supporting cells; it is unclear why the auditory response is severely disturbed in spite of the presence of outer hair cells (OHCs). The present study was designed to evaluate developmental changes in the in vivo and in vitro function of the OHC, and the fine structure of the OHC and adjacent supporting cells in the R75W transgenic mouse. No detectable distortion product otoacoustic emissions were observed at any frequencies in R75W transgenic mice throughout development. A characteristic phenotype observed in these mice was the absence of the tunnel of Corti, Nuel's space, and spaces surrounding the OHC; the OHC were compressed and squeezed by the surrounding supporting cells. On the other hand, the OHC developed normally. Structural features of the lateral wall, such as the membrane-bound subsurface cisterna beneath the plasma membrane, were intact. Prestin, the voltage-dependent motor protein, was observed by immunohistochemistry in the OHC basolateral membranes of both transgenic and non-transgenic mice. No significant differences in electromotility of isolated OHCs during development was observed between transgenic and control mice. The present study indicates that normal development of the supporting cells is indispensable for proper cellular function of the OHC.

Compartmentalization of the outer hair cell demonstrated by slow diffusion in the extracisternal space

In the outer hair cell (OHC), the extracisternal space (ECiS) is a conduit and reservoir of the molecular and ionic substrates of the lateral wall, including those necessary for electromotility. To determine the mechanisms through which molecules are transported in the ECiS of the OHC, we selectively imaged the time-dependent spatial distribution of fluorescent molecules in a <100 nm layer near the cell/glass interface of the recording chamber after their photolytic activation in a diffraction-limited volume. The effective diffusion coefficient was calculated using the analytical solution of the diffusion equation. It was found that diffusion in the ECiS is isotropic and not affected by depolarizing the OHC. Compared with free solution, the diffusion of 10 kDa dextran was slowed down in both the ECiS and the axial core by a factor of 4.6 and 1.6, respectively.

Auditory measures in clinically depressed individuals. I. Basic measures and transient otoacoustic emissions

This is the first paper in a series of two papers addressing possible differences in auditory function between individuals with and without clinical depression. Clinical depression is a common yet serious medical condition diagnosed based on the patient's symptoms. Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed if the symptoms are determined to be consistent with low serotonin levels. Three groups of individuals were tested: the control group consisted of subjects with no depression; the medicated group consisted of subjects with depression who were on SSRIs for at least a month: the unmedicated group consisted of subjects with depression who were unmedicated for at least a month. The results indicated no significant differences between the groups in pure-tone threshold, uncomfortable loudness levels, dynamic range of hearing, and acoustic reflex thresholds However, the unmedicated group exhibited higher amplitudes of transient otoacoustic emissions compared to the control group, especially in the right ear.

Tinnitus: characteristics, causes, mechanisms, and treatments

Tinnitus-the perception of sound in the absence of an actual external sound-represents a symptom of an underlying condition rather than a single disease. Several theories have been proposed to explain the mechanisms underlying tinnitus. Tinnitus generators are theoretically located in the auditory pathway, and such generators and various mechanisms occurring in the peripheral auditory system have been explained in terms of spontaneous otoacoustic emissions, edge theory, and discordant theory. Those present in the central auditory system have been explained in terms of the dorsal cochlear nucleus, the auditory plasticity theory, the crosstalk theory, the somatosensory system, and the limbic and autonomic nervous systems. Treatments for tinnitus include pharmacotherapy, cognitive and behavioral therapy, sound therapy, music therapy, tinnitus retraining therapy, massage and stretching, and electrical suppression. This paper reviews the characteristics, causes, mechanisms, and treatments of tinnitus.

Analysis of distortion product otoacoustic emission spectra in normal-hearing adults

PURPOSE

To evaluate the ability of distortion product otoacoustic emission (DPOAE) spectral characteristics to distinguish between ears with variable hearing sensitivity within the normal range.

METHOD

Distortion product grams (DP-grams) were acquired with primary tones decremented in 1/8-octave steps and primary-tone levels presented at 65 dB SPL (L1) and 45 dB SPL (L2) across an f2 frequency range of 842-7996 Hz from 22 normal-hearing adults (44 ears). Hearing thresholds of ears classified in Group A (n = 22) were better than ears classified in Group B (n = 22). Examined parameters of the DP-grams included spectral peak occurrence, peak height, peak width, and DPOAE levels. Analyses of variance were conducted to determine whether DP-gram parameters differed between Group A and Group B.

RESULTS

For the low-resolution DP-grams examined in this study, no significant between-group differences in peak occurrence, peak height, and peak width were observed. DPOAE levels were significantly higher in ears classified in Group A compared with ears classified in Group B in individuals with symmetrical hearing.

CONCLUSIONS

Although spectral peaks are evident in DP-grams acquired with low resolution of the primary tones, DPOAE levels are more effective in distinguishing ears with greater hearing sensitivity from less sensitive ears.

On correlating otoacoustic emissions with blood glucose levels

The long term objective of this research is to develop a new means for diabetic patients to painlessly and non-invasively monitor their blood glucose levels. We propose a novel method for noninvasive glucose monitoring based on measurement and analysis of otoacoustic emissions (OAEs). OAEs are low-intensity sounds generated by the cochlea in response to acoustic stimuli. Evoking and measuring OAEs is done using a tiny speaker and microphone that fit snugly inside the ear canal. The OAE response can be partially masked or reduced in amplitude by presenting competing acoustic stimuli contralaterally (opposite ear), ipsilaterally (same ear), or both. This masking effect is caused by activation of neural efferent pathways from the brain. Neural effects, including evoked responses such as auditory brainstem responses and axonal transmission latencies, are known to correlate with glucose. This suggests that masked OAEs may correlate with glucose since masking is a result of neural activity, and neural activity is affected by glucose levels. Prior to our research, no studies have investigated the correlation of masked OAEs with blood glucose. In this paper we present our preliminary findings, including experimental results that suggest a correlation with blood glucose levels.

Salicylate increases the gain of the central auditory system

High doses of salicylate, the anti-inflammatory component of aspirin, induce transient tinnitus and hearing loss. Systemic injection of 250 mg/kg of salicylate, a dose that reliably induces tinnitus in rats, significantly reduced the sound evoked output of the rat cochlea. Paradoxically, salicylate significantly increased the amplitude of the sound-evoked field potential from the auditory cortex (AC) of conscious rats, but not the inferior colliculus (IC). When rats were anesthetized with isoflurane, which increases GABA-mediated inhibition, the salicylate-induced AC amplitude enhancement was abolished, whereas ketamine, which blocks N-methyl-d-aspartate receptors, further increased the salicylate-induced AC amplitude enhancement. Direct application of salicylate to the cochlea, however, reduced the response amplitude of the cochlea, IC and AC, suggesting the AC amplitude enhancement induced by systemic injection of salicylate does not originate from the cochlea. To identify a behavioral correlate of the salicylate-induced AC enhancement, the acoustic startle response was measured before and after salicylate treatment. Salicylate significantly increased the amplitude of the startle response. Collectively, these results suggest that high doses of salicylate increase the gain of the central auditory system, presumably by down-regulating GABA-mediated inhibition, leading to an exaggerated acoustic startle response. The enhanced startle response may be the behavioral correlate of hyperacusis that often accompanies tinnitus and hearing loss.

Detection without deflection? A hypothesis for direct sensing of sound pressure by hair cells

It is widely thought that organisms detect sound by sensing the deflection of hair-like projections, the stereocilia, at the apex of hair cells. In the case of mammals, the standard interpretation is that hair cells in the cochlea respond to deflection of stereocilia induced by motion generated by a hydrodynamic travelling wave. But in the light of persistent anomalies, an alternative hypothesis seems to have some merit: that sensing cells (in particular the outer hair cells) may, at least at low intensities, be reacting to a different stimulus - the rapid pressure wave that sweeps through the cochlear fluids at the speed of sound in water. This would explain why fast responses are sometimes seen before the peak of the travelling wave. Yet how could cells directly sense fluid pressure? Here, a model is constructed of the outer hair cell as a pressure vessel able to sense pressure variations across its cuticular pore, and this 'fontanelle' model, based on the sensing action of the basal body at this compliant spot, could explain the observed anomalies. Moreover, the fontanelle model can be applied to a wide range of other organisms, suggesting that direct pressure detection is a general mode of sensing complementary to stereociliar displacement.

Acquired hearing loss in adolescents

Studies on prevalence of acquired hearing loss across the life span have shown a trend of increase in hearing loss with age. A parallel decline in age of recreational use of loud music and cigarette smoking suggests that these early listening and recreational habits may be major contributing factors to the chronic hearing disability seen in later years. In recognition of these new recreational patterns of adolescents and young adults, Healthy People 2010 has issued a list of objectives for prevention of noise-induced hearing loss and smoking in adolescents and young adults through early education and intervention. In this article, the authors describe the effects of noise- and music-induced and smoking-induced hearing loss and provide guidelines for early identification and hearing conservation. Such an early approach to identification and conservation should ultimately help reduce hearing loss prevalence rates in adults.

Study of distortion-product otoacoustic emissions during hypothermia in humans

Aim

To evaluate the function of cochlear outer hair-cells under the influence of extra-corporeal circulation and moderate hypothermia during cardiac surgery.

Study Design

Prospective clinical study.

Methods

Distortion-product otoacoustic emissions (DPOAE) were registered before surgery, immediately after general anesthesia induction, during extra-corporeal circulation with moderate hypothermia and after the surgical procedure. Results: Comparison of response-amplitudes before and after surgery and before and after general anesthesia initiation did not demonstrate statistical difference. Comparison of amplitudes before and after extra-corporeal circulation with moderate hypothermia demonstrated a statistically significant decrease in responses amplitudes during hypothermia.

Conclusions

The amplitudes of DPOAE decreased during moderate hypothermia induced during extra-corporeal circulation.

Noise levels during aerobics and the potential effects on distortion product otoacoustic emissions

The purpose of this study was to measure noise levels during aerobics classes and to examine how outer hair cell (OHC) function, using distortion product otoacoustic emissions (DPOAEs), may be affected by this exposure. Fifty individuals (48 women and 2 men, ages 19-41 years) participated in 50-min aerobics classes. Noise levels were measured using noise dosimeters placed on the collar near the test ear. The audiometric protocol consisted of a questionnaire, otoscopy, screening tympanometry, and pre- and post-aerobics DPOAEs. The minute-by-minute peak noise levels varied between 90.5 and 99.7dBA. The overall mean noise level for the aerobics classes was 87.1dBA (range=83.4-90.7dBA). Mean post-aerobic DPOAE levels were lower at most frequencies with a statistically significant 1.4dB decrease at 6000Hz. Results of this project, even with limited statistical significance, should be viewed cautiously.

LEARNING OUTCOMES

The reader will be able to (1) identify the approximate dB SPL measured during aerobics classes, (2) describe what effects, if any, these levels had on DPOAEs, and (3) discuss what specific frequency had a significant decrease in DPOAE level after an aerobics class.

Impact of occupational noise on pure-tone threshold and distortion product otoacoustic emissions after one workday

The aim of this study was to investigate whether distortion product otoacoustic emissions (DPOAEs) are a suitable means for detecting small changes in cochlear amplifier functionality due to occupational noise exposure of one workday and whether efferent reflex strength of the medial olivocochlear bundle is able to predict the ear's susceptibility to noise. High-resolution (Deltaf(2)= 47 Hz) DPOAEs were recorded between 3.5 and 4.5 kHz at close-to-threshold primary tone levels. For comparison, pure-tone audiometry was conducted. Efferent reflex strength was measured by means of DPOAEs at a specific frequency with and without contralateral acoustic stimulation. A statistically significant change was found for pure-tone thresholds (DeltaL(ht)=+1.6+/-3.0 dB, n=155) and DPOAE levels (DeltaL(dp)=-1.0+/-2.4 dB, n=646; L(2)=20 dB SPL) in factory workers but not in office workers (DeltaL(ht)=-1.3+/-3.3 dB, n=80; DeltaL(dp)=0.0+/-1.6 dB, n=336) (control group). However, the influence of systematic biases due to, e.g. ear probe calibration or measurement sequence effects, has to be considered. Moreover, there was no significant correlation between efferent reflex strength and shifts in pure-tone thresholds or shifts in DPOAE levels. Thus, the applied measures of efferent reflex strength do not seem to be suitable for predicting temporary changes in hearing capability.

Perilymph osmolality modulates cochlear function

OBJECTIVES/HYPOTHESIS

The cochlear amplifier is required for the exquisite sensitivity of mammalian hearing. Outer hair cells underlie the cochlear amplifier and they are unique in that they maintain an intracellular turgor pressure. Changing the turgor pressure of an isolated outer hair cells through osmotic challenge modulates its ability to produce electromotile force. We sought to determine the effect of osmotic challenge on cochlear function.

STUDY DESIGN

In vivo animal study.

METHODS

Hypotonic and hypertonic artificial perilymph was perfused through the scala tympani of anesthetized guinea pigs. Cochlear function was assessed by measuring the compound action potential, distortion product otoacoustic emissions, the cochlear microphonic, and the endocochlear potential.

RESULTS

Hypotonic perilymph decreased and hypertonic perilymph increased compound action potential and distortion product otoacoustic emission thresholds in a dose-dependent and reversible manner. The cochlear microphonic quadratic distortion product magnitude increased after hypotonic perfusion and decreased with hypertonic perfusion. There were no changes in the stimulus intensity growth curve of the low-frequency cochlear microphonic. The endocochlear potential was not affected by perilymph osmolality.

CONCLUSIONS

These data demonstrate that perilymph osmolality can modulate cochlear function and are consistent with what would be expected if outer hair cells turgor pressure changes the gain of the cochlear amplifier in vivo.

Transient-evoked otoacoustic emissions in a group of professional singers who have normal pure-tone hearing thresholds

OBJECTIVES

The objective of this study was to determine whether transient-evoked otoacoustic emissions (TEOAEs) measured in a group of normal-hearing professional singers, who were frequently exposed to high-level sound during rehearsals and performances, differed from those measured in age- and gender-matched normal-hearing non-singers, who were at minimal risk of hearing loss resulting from excessive sound exposure or other risk factors.

DESIGN

Twenty-three normal-hearing singers (NH-Ss), 23 normal-hearing controls (NH-Cs), and 9 hearing-impaired singers (HI-Ss) were included. Pure-tone audiometry confirmed normal-hearing thresholds (>or=15 dB HL) at 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, and 8.0 kHz in NH-Ss and NH-Cs, and confirmed mild, high frequency, sensorineural hearing loss in HI-Ss (HI-Ss were included only to estimate sensitivity and specificity values for preliminary pass or fail criteria that could be used to help identify NH-Ss at risk for music-induced hearing loss). TEOAEs were measured twice in all ears. TEOAE signal to noise ratio (S/N) and reproducibility were examined for the whole wave response, and for frequency bands centered at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz.

RESULTS

Moderate to high correlations were found between test and retest TEOAE responses for the three groups. However, absolute test-retest differences revealed standard deviations that were two to three times larger than those reported previously, with the majority of the variability occurring for the 1.0 kHz band. As such, only the best TEOAE response (B-TEOAE) from the two measurements in each ear was used in further analyses, with data from the 1.0 kHz band excluded. With one exception, within-group comparisons of B-TEOAE S/N and reproducibility across ears and gender revealed no statistically significant differences for either NH-Ss or NH-Cs. The only significant within-group difference was between left and right ears of NH-C females for S/Ns measured in the 2.0 kHz band, where median responses from right ears were found to be higher than left ears. Across-group comparisons of B-TEOAEs revealed lower median S/N and reproducibility values for NH-Ss compared with NH-Cs for the whole wave response and 1.4 kHz band. For the 2.0 kHz band, reproducibility was similar for the normal-hearing groups but median S/N was found to be lower for NH-Ss. No significant differences in S/N or reproducibility were found between normal-hearing groups for the 2.8 and 4.0 kHz bands. Using data from NH-Cs and HI-Ss to establish sensitivity and specificity values for various TEOAE pass or fail criteria, six preliminary criteria were identified as having sensitivity and specificity values >or=90%. When these criteria were applied to NH-Ss, the number of NH-S ears passing ranged from 57% to 76%, depending on the criteria used to judge the NH-S ears, which translates into 24% to 43% of ears failing.

CONCLUSIONS

Although TEOAE responses were measurable in all singers with normal audiometric thresholds, responses were less robust than those of NH-Cs. The findings suggest that subtle cochlear dysfunction can be detected with TEOAE measurement in a subset of normal-hearing professional singers. Although preliminary, the study findings highlight the importance of pass or fail criterion choice on the number of ears that will be identified as "at risk" for music-induced hearing loss.

Assessment of cochlear function in mice: distortion-product otoacoustic emissions

Distortion-product otoacoustic emissions (DPOAEs) can be measured in the ear canal following the presentation of two tones. These emissions are generated by the outer hair cells (OHCs) of the inner ear and they are reduced or absent when the OHCs are damaged by, for example, exposure to excessive noise or ototoxic drugs. Consequently, DPOAEs provide a powerful and noninvasive means to assess the robustness of OHC function. A detailed method is described for measuring DPOAEs to assess cochlear function in mice. Recommendations are given for the required equipment and instructions are presented for setting up a DPOAE system. Also, a protocol is outlined for measuring DPOAEs in mice and troubleshooting tips are provided. Examples of data analysis procedures following noise exposure in mice are included, as well. These methods are not only applicable to mice, but can be performed using essentially all small laboratory animals.

Distortion product otoacoustic emission fine structure is responsible for variability of distortion product otoacoustic emission contralateral suppression

Alteration of the distortion product otoacoustic emission (DPOAE) level by a contralateral sound, which is known as DPOAE contralateral suppression, has been attributed to the feedback mechanism of the medial olivocochlear efferents. However, the limited dynamic range and large intra- and intersubject variabilities in the outcome of the measurement restrict its application in assessing the efferent function. In this study, the 2f(1)-f(2) DPgram was measured with a high frequency resolution in six human ears, which exhibits a fine structure with the quasiperiodic appearance of peaks and dips. In the presence of contralateral noise, the DPOAE level increased, decreased, or remained unchanged depending on the frequency. At the peaks, DPOAEs were mostly suppressed with a larger change, while those at the dips had greater variance, with increased occurrence of enhancement or no change. The difference between the peak and dip frequencies in the DPOAE-level change was significant. A switch from suppression to enhancement of the DPOAE level or vice versa with a small change in frequency was noted. These results imply that the DPOAE fine structure is a main source of the variability in DPOAE contralateral suppression measurement. The study suggests that the DPOAE contralateral suppression test would be improved if it is conducted for frequencies at major peaks of the DPOAE fine structure.

Sound-evoked deflections of outer hair cell stereocilia arise from tectorial membrane anisotropy

The exceptional performance of mammalian hearing is due to the cochlea's amplification of sound-induced mechanical stimuli. During acoustic stimulation, the vertical motion of the outer hair cells relative to the tectorial membrane (TM) is converted into the lateral motion of their stereocilia. The actual mode of this conversion, which represents a fundamental step in hearing, remains enigmatic, as it is unclear why the stereocilia are deflected when pressed against the TM, rather than penetrating it. In this study we show that deflection of the stereocilia is a direct outcome of the anisotropic material properties of the TM. Using force spectroscopy, we find that the vertical stiffness of the TM is significantly larger than its lateral stiffness. As a result, the TM is more resistant to the vertical motion of stereocilia than to their lateral motion, and so they are deflected laterally when pushed against the TM. Our findings are confirmed by finite element simulations of the mechanical interaction between the TM and stereocilia, which show that the vertical outer hair cells motion is converted into lateral stereocilia motion when the experimentally determined stiffness values are incorporated into the model. Our results thus show that the material properties of the TM play a central and previously unknown role in mammalian hearing.

Cochlear outer hair cell motility

Normal hearing depends on sound amplification within the mammalian cochlea. The amplification, without which the auditory system is effectively deaf, can be traced to the correct functioning of a group of motile sensory hair cells, the outer hair cells of the cochlea. Acting like motor cells, outer hair cells produce forces that are driven by graded changes in membrane potential. The forces depend on the presence of a motor protein in the lateral membrane of the cells. This protein, known as prestin, is a member of a transporter superfamily SLC26. The functional and structural properties of prestin are described in this review. Whether outer hair cell motility might account for sound amplification at all frequencies is also a critical question and is reviewed here.

Lateral wall protein content mediates alterations in cochlear outer hair cell mechanics before and after hearing onset

Specialized outer hair cells (OHCs) housed within the mammalian cochlea exhibit active, nonlinear, mechanical responses to auditory stimulation termed electromotility. The extraordinary frequency resolution capacity of the cochlea requires an exquisitely equilibrated mechanical system of sensory and supporting cells. OHC electromotile length change, stiffness, and force generation are responsible for a 100-fold increase in hearing sensitivity by augmenting vibrational input to non-motile sensory inner hair cells. Characterization of OHC mechanics is crucial for understanding and ultimately preventing permanent functional deficits due to overstimulation or as a consequence of various cochlear pathologies. The OHCs' major structural assembly is a highly-specialized lateral wall. The lateral wall consists of three structures; a plasma membrane highly-enriched with the motor-protein prestin, an actin-spectrin cortical lattice, and one or more layers of subsurface cisternae. Technical difficulties in independently manipulating each lateral wall constituent have constrained previous attempts to analyze the determinants of OHCs' mechanical properties. Temporal separations in the accumulation of each lateral wall constituent during postnatal development permit associations between lateral wall structure and OHC mechanics. We compared developing and adult gerbil OHC axial stiffness using calibrated glass fibers. Alterations in each lateral wall component and OHC stiffness were correlated as a function of age. Reduced F-actin labeling was correlated with reduced OHC stiffness before hearing onset. Prestin incorporation into the PM was correlated with increased OHC stiffness at hearing onset. Our data indicate lateral wall F-actin and prestin are the primary determinants of OHC mechanical properties before and after hearing onset, respectively.

Auditory efferent feedback system deficits precede age-related hearing loss: contralateral suppression of otoacoustic emissions in mice

The C57BL/6J mouse has been a useful model of presbycusis, as it displays an accelerated age-related peripheral hearing loss. The medial olivocochlear efferent feedback (MOC) system plays a role in suppressing cochlear outer hair cell (OHC) responses, particularly for background noise. Neurons of the MOC system are located in the superior olivary complex, particularly in the dorsomedial periolivary nucleus (DMPO) and in the ventral nucleus of the trapezoid body (VNTB). We previously discovered that the function of the MOC system declines with age prior to OHC degeneration, as measured by contralateral suppression (CS) of distortion product otoacoustic emissions (DPOAEs) in humans and CBA mice. The present study aimed to determine the time course of age changes in MOC function in C57s. DPOAE amplitudes and CS of DPOAEs were collected for C57s from 6 to 40 weeks of age. MOC responses were observed at 6 weeks but were gone at middle (15-30 kHz) and high (30-45 kHz) frequencies by 8 weeks. Quantitative stereological analyses of Nissl sections revealed smaller neurons in the DMPO and VNTB of young adult C57s compared with CBAs. These findings suggest that reduced neuron size may underlie part of the noteworthy rapid decline of the C57 efferent system. In conclusion, the C57 mouse has MOC function at 6 weeks, but it declines quickly, preceding the progression of peripheral age-related sensitivity deficits and hearing loss in this mouse strain.

Resonant modes of otoacoustic emissions

Transiently evoked otoacoustic emission (TEOAE) signals were decomposed into basic components by means of the matching pursuit algorithm. The components were characterized by frequency, latency, time span and energy. The resonant modes characteristic for each person/ear were identified. A high time-frequency resolution of the method and the parametric representation of the waveforms made possible estimation of the frequency ratios of the resonant modes. The repetitive occurrence of the 'fifth', 'fourths' and octaves connected with the Pythagorean temperament was found. The significance of the results was confirmed by comparison to Monte Carlo simulations of the null hypothesis of a random distribution of frequency modes. These findings are in agreement with the resonance theory of hearing, which binds musical ratios with the geometrical spacing of outer hair cells in cochlea.

Distortion-product otoacoustic emission: early detection in deferoxamine induced ototoxicity

OBJECTIVE

Deferoxamine therapy in lifelong transfusion-dependent anaemias, as beta-thalassemia major, is associated with an increased risk of ototoxic changes. With increasing survival rates, prevention and/or early detection of ototoxicity are important for providing management options. The predictive value of pure-tone audiometry in early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions appear to be more sensitive to cochlear insult than the conventional pure-tone audiometry. The aim of our study was to compare the efficacy of otoacoustic emissions (distortion-product otoacoustic emissions) with that of pure-tone audiometry as method of audiological monitoring.

METHODS

Baseline audiometric (0.25-8kHz) and otoacoustic emission testing (distortion-product otoacoustic emissions) was conducted in a group of patients with beta-thalassemia major, 60 of whom met the criteria for inclusion in the study. Comparisons were performed between baseline measurements and those recorded after 20 months. Distortion-product otoacoustic emissions were obtained as DP-grams. The DP-gram amplitude was determined for each child.

RESULTS

Threshold changes from baseline were found to be statistically significant from 4 to 8kHz in 68.4% of the subjects (P<0.01). Distortion-product otoacoustic emissions demonstrated a significant threshold shift and a decreased amplitude in the frequencies >3kHz (P<0.05). Furthermore, DP-gram amplitude also reduced significantly at 3kHz (P<0.05) without any similar change in pure-tone audiometry.

CONCLUSIONS

As ototoxicity screening tool DP-gram was extremely sensitive and superior to pure-tone audiometry. Their use is recommended for regular monitoring of cochlear function, aiming in prevention of permanent damage.

Perception of temporally processed speech by listeners with hearing impairment

OBJECTIVES

The purpose of this study was to assess a new signal-processing strategy, Spatiotemporal Pattern Correction (SPC), for a group of listeners with varying degrees of sensorineural hearing loss. SPC is based on a physiological model of the level-dependent temporal response properties of auditory nerve (AN) fibers in normal and impaired ears. SPC attempts to "correct" AN response patterns by introducing time-varying group delays that differ across frequency channels. Listeners' speech intelligibility and preference judgments were obtained at different strengths of SPC processing.

DESIGN

Fifteen listeners, 12 with bilateral sensorineural hearing loss and 3 with normal hearing, participated in this study. Listeners with hearing impairment were separated into 3 groups (mild, moderate, and moderate-to-severe), based on their pure-tone averages at 0.5, 1, 2, and 4 kHz. All preference judgments were made using sentences from the Hearing-In-Noise-Test (HINT). The sentences were processed at five SPC strengths (1.0, 1.1, 1.2, 1.3, and 1.4). At an SPC strength of 1.0, the speech was processed through the SPC signal processor, becoming bandlimited, but no dynamic group delays were added to the signal. On each trial, listeners were presented a single sentence at two different SPC strengths, 1.0 (uncorrected) and a randomly selected SPC strength. Listeners were instructed to identify which of the two sentences they preferred. Sixteen vowel-consonant syllables, a subset of the Nonsense Syllable Test (NST), were used to assess speech intelligibility at three SPC strengths (1.0, 1.1, and 1.2). Listeners were asked to push one of 16 buttons on a response box that corresponded to the vowel-consonant syllable they heard. The moderate-to-severe hearing loss group was also tested using the low-probability sentences of the Speech-Perception-In-Noise (SPIN) test.

RESULTS

Listeners with normal hearing and listeners with mild hearing loss preferred the quality of uncorrected sentences (SPC strength of 1.0) compared with SPC-processed sentences. As the strength of SPC increased, listeners' preference for uncorrected sentences also increased. Listeners with moderate and moderate-to-severe hearing loss had difficulty differentiating between uncorrected and lower strength SPC-processed sentences but strongly preferred the uncorrected sentences as compared with high strength SPC-processed sentences. Vowel-consonant intelligibility was not improved or degraded by SPC. Sentence recognition scores for listeners with moderate-to-severe hearing loss decreased with SPC processing.

CONCLUSIONS

Although SPC-processed speech was not preferred by listeners with hearing loss, the listeners with a more moderate degree of impairment could not differentiate the unprocessed sentences from the SPC processed sentences. Speech intelligibility was not improved by SPC processing.

Auditory Efferent Function Is Affected in Multiple Sclerosis

OBJECTIVE

This study evaluated efferent medial olivocochlear (MOC) function in patients with multiple sclerosis (MS). Various afferent auditory abnormalities have been described in MS, but there is a paucity of data on efferent function. The brain stem is a site of predilection for MS plaques and the efferent MOC pathway may be affected at this level.

METHODS

The study included 30 patients who had normal hearing. According to MRI findings, they were divided into two groups: those with an identifiable brain stem lesion (n = 10) and those with MS lesions in other parts of the central nervous system but without demonstrable MS plaques in the brain stem (n = 20). MOC function was evaluated by the olivocochlear suppression test, using transient evoked otoacoustic emissions. All subjects underwent standard auditory tests, including pure-tone audiometry and recording of auditory brain stem evoked responses. Twenty-two healthy subjects with normal hearing, matched for age and gender, served as a reference group for the auditory data.

RESULTS

The results showed that 66.6% of all patients had reduced MOC function, particularly those (90%) with identified lesions of the brain stem on MRI. Furthermore, abnormal MOC function was found in 55% patients without evidence of a brain stem lesion on MRI.

CONCLUSIONS

This study provides the evidence for a deficit of efferent auditory function in the majority of patients with MS. Taking into consideration the possible roles of the MOC system in processing of auditory information, abnormal MOC suppression in patients with MS may explain a variety of auditory presentations that are currently largely overlooked. This study also highlights the diagnostic value of the MOC suppression test as a site-of-lesion diagnostic test in MS and in identifying subtle brain stem lesions undetected by MRI, suggesting that subtle brain stem lesions may exist and that the MOC suppression test is sufficiently sensitive to detect them. Accordingly, the MOC suppression test may provide a tool for an early diagnosis of MS.

Relations of pitch matching, pitch discrimination, and otoacoustic emission suppression in individuals not formally trained as musicians

Research has yielded a relationship between pitch matching and pitch discrimination. Good pitch matchers tend to be good pitch discriminators and are often judged to be vocally talented. Otoacoustic emission suppression measures the function of the efferent auditory system which may affect accuracy for pitch matching and pitch discrimination. Formally trained musicians show pitch matching and pitch discrimination superior to those of nonmusicians and have greater efferent otoacoustic emission suppression than nonmusicians. This study investigated the relationship among pitch matching, pitch discrimination, and otoacoustic emission suppression in individuals with no formal musical training and who showed varied pitch matching and pitch discrimination. Analysis suggested a significant relationship between pitch matching and pitch discrimination but not between otoacoustic emission suppression and pitch matching and pitch discrimination. Findings are presented in the context of previous research indicating a significant relationship between otoacoustic emission suppression and musical talent in trained musicians.

Physiological effects of auditory nerve myelinopathy in chinchillas

The goals were to study the physiological effects of auditory nerve myelinopathy in chinchillas and to test the hypothesis that myelin abnormalities could account for auditory neuropathy, a hearing disorder characterized by absent auditory brainstem responses (ABRs) with preserved outer hair cell function. Doxorubicin, a cytotoxic drug used as an experimental demyelinating agent, was injected into the auditory nerve bundle of 18 chinchillas; six other chinchillas were injected with vehicle alone. Cochlear microphonics, compound action potentials (CAPs), inferior colliculus evoked potentials (IC-EVPs), cubic distortion product otoacoustic emissions and ABRs were recorded before and up to 2 months after injection. Cochleograms showed no hair cell loss in any of the animals and measures of outer hair cell function were normal (cubic distortion product otoacoustic emissions) or enhanced (cochlear microphonics) after injection. ABR was present in animals with mild myelin damage (n = 10) and absent in animals with severe myelin damage that included the myelin surrounding spiral ganglion cell bodies and fibers in Rosenthal's canal (n = 8). Animals with mild damage had reduced response amplitudes at 1 day, followed by recovery of CAP and enhancement of the IC-EVP. In animals with severe damage, CAP and IC-EVP thresholds were elevated, amplitudes were reduced, and latencies were prolonged at 1 day and thereafter. CAPs deteriorated over time, whereas IC-EVPs partially recovered; latencies remained consistently prolonged despite changes in amplitudes. The results support auditory nerve myelinopathy as a possible pathomechanism of auditory neuropathy but indicate that myelinopathy must be severe before physiological measures are affected.