Synchronized Spontaneous Otoacoustic Emissions Provide a Signal-to-Noise Ratio Advantage in Medial-Olivocochlear Reflex Assays

Magnitude of medial olivocochlear reflex assayed by tone-burst-evoked otoacoustic emissions: reliability and comparison with click-evoked emissions

OBJECTIVE

The purpose of this pilot study was to evaluate the magnitude of the medial olivocochlear reflex (MOCR) estimated by the reduction in tone-burst evoked otoacoustic emissions (TBOAEs) measured at three levels and at three frequencies in response to fixed contralateral white noise. Results were compared with commonly used click-evoked otoacoustic emissions (CEOAEs).

DESIGN

TBOAEs and CEOAEs, with and without contralateral 60 dB SPL white noise, were measured in response to stimulation at 55, 65, and 75 dB peSPL. In each subject, the set of measurements was performed twice. Of particular interest were the MOCR and its repeatability.

STUDY SAMPLE

15 normally hearing persons (13 women, average age 32.3 years, SD = 8.1).

RESULTS

For both CEOAE and TBOAEs, the reliability of the MOCR was much better for broadband measurements than for half-octave-band filtered estimates. At the same time, the reliability of MOCR in half-octave bands was higher for TBOAEs than for CEOAEs, especially at 2 and 4 kHz.

CONCLUSIONS

For general applications where broadband MOCR is of interest, the highest magnitude and reliability is provided by CEOAEs. However, TBOAEs may be better if a particular frequency band is of interest.

A Clinically Viable Medial Olivocochlear Reflex Assay Using Transient-Evoked Otoacoustic Emissions

OBJECTIVES

The contralateral medial olivocochlear reflex (MOCR) strength may indicate various auditory conditions in humans, but a clinically viable assay and equipment are needed for quick, accurate, and reliable measurements. The first experiment compared an earlier version of the assay, which used a nonlinear-mode chirp stimulus, with a new assay using a linear-mode click stimulus, designed to give reliable MOCR measurements in most normal-hearing ears. The second experiment extended the improved assay on a purpose-built binaural hardware platform that used forward-pressure level (FPL) calibration for both the stimulus and the contralateral MOCR elicitor.

DESIGN

Transient-evoked otoacoustic emission (TEOAE) tests were measured with and without a 60-dB SPL MOCR-evoking contralateral broadband noise. The normalized MOCR strength (MOCR%) was derived from the TEOAE responses for each trial pair using the complex pressure difference weighted by the TEOAE magnitude. Experiment 1 compared MOCR% within-subject and across-day using two TEOAE stimuli: nonlinear-mode chirps (50 dB SPL, bandpass 1-5 kHz, 14 ms window delayed by 2 ms) and linear-mode clicks (50 dB SPL, bandpass 0.5-2.5 kHz, 13 ms window delayed by 5 ms). TEOAE responses were analyzed in the 0.5 to 2.5 kHz band. Thirty adult participants with normal hearing (30 ears) completed the study. The TEOAE stimulus was calibrated in situ using spectral flattening, and the contralateral noise was calibrated in a coupler. Twelve TEOAE trial pairs were collected for each participant and condition. Experiment 2 used a purpose-built binaural system. The TEOAE stimuli were linear-mode clicks (50 dB SPL, bandpass 1-3 kHz, 13 ms window delayed by 5 ms), analyzed in the 1 to 3 kHz band over ~12 trial pairs. After a probe refit, an additional trial pair was collected for the two early-stopping signal-to-noise ratio criteria (15 and 20 dB). They were evaluated for single-trial reliability and test time. Nineteen adult participants with normal hearing (38 ears) completed the study. The TEOAE clicks and contralateral elicitor noise were calibrated in situ using FPL and delivered with automated timing.

RESULTS

MOCR% for linear-mode clicks was distinguishable from measurement variability in 98% to 100% of participants' ears (both experiments), compared with only 73% for the nonlinear-mode chirp (experiment 1). MOCR detectability was assessed using the MOCR% across-subject/within-subject variance ratio. The ratio in experiment 1 for linear-mode clicks was higher (8.0) than for nonlinear-mode chirps (6.4). The ratio for linear-mode clicks (8.9) in experiment 2 was slightly higher than for the comparable linear-mode stimulus (8.0) in experiment 1. TEOAEs showed excellent reliability with high signal-to-noise ratios in both experiments, but reliability was higher for linear-mode clicks than nonlinear-mode chirps. MOCR reliability for the two stimuli was comparable. The FPL pressure response retest reliability derived from the SPL at the microphone was higher than the SPL retest reliability across 0.4 to 8 kHz. Stable results required 2 to 3 trial pairs for the linear-mode click (experiments 1 and 2) and three for the nonlinear-mode chirp (experiment 1), taking around 2 min on average.

CONCLUSIONS

The linear-mode click assay produced measurable, reliable, and stable TEOAE and MOCR results on both hardware platforms in around 2 min per ear. The stimulus design and response window ensured that any stimulus artifact in linear mode was unlikely to confound the results. The refined assay is ready to produce high-quality data quickly for clinical and field studies to develop population norms, recognize diagnostic patterns, and determine risk profiles.

Medial Olivocochlear Reflex Strength in Ears With Low-to-Moderate Annual Noise Exposure

PURPOSE

Studies in lower mammals demonstrate enhancement of the medial olivocochlear reflex (MOCR) following noise exposure. A similar effect may occur in humans, and there is some evidence of an individual's acoustic history affecting the MOCR. The current work evaluates the relationship between an individual's annual noise exposure history and their MOCR strength. Given the potential role of the MOCR as a biological hearing protector, it is important to identify factors associated with MOCR strength.

METHOD

Data were collected from 98 normal-hearing young adults. Annual noise exposure history was estimated using the Noise Exposure Questionnaire. MOCR strength was assayed using click-evoked otoacoustic emissions (CEOAEs) measured with and without noise presented to the contralateral ear. MOCR metrics included the MOCR-induced otoacoustic emission (OAE) magnitude shift and phase shift. A CEOAE signal-to-noise ratio (SNR) of at least 12 dB was required for estimation of the MOCR metrics. Linear regression was applied to evaluate the relationship between MOCR metrics and annual noise exposure.

RESULTS

Annual noise exposure was not a statistically significant predictor of the MOCR-induced CEOAE magnitude shift. However, annual noise exposure was a statistically significant predictor of the MOCR-induced CEOAE phase shift-the MOCR-induced phase shift decreased with increasing noise exposure. Additionally, annual noise exposure was a statistically significant predictor of OAE level.

CONCLUSIONS

Findings contrast with recent work that suggests MOCR strength increases with annual noise exposure. Compared with previous work, data for this study were collected using more stringent SNR criteria, which is expected to increase the precision of the MOCR metrics. Additionally, data were collected for a larger subject population with a wider range of noise exposures. Whether findings generalize to other exposure durations and levels is unknown and requires future study.

Medial olivocochlear reflex reliability: The effects of averaging and presence of synchronized spontaneous otoacoustic emissions

The medial olivocochlear reflex (MOCR), usually assessed by the inhibition of transiently evoked otoacoustic emissions (TEOAEs) with contralateral noise, is a very small effect. In understanding the origin of the MOCR, it is crucial to obtain data of the highest accuracy, i.e., with a high signal-to-noise ratio (SNR), which in turn largely depends on the number of signal averages. This study investigates how the reliability of MOCR measures is affected by the number of averages. At the same time, the effect of the presence of synchronized spontaneous otoacoustic emissions (SSOAEs) is taken into account, as it is known that this factor significantly affects TEOAE amplitudes and SNRs. Each recording session consisted of two series of four measurements, allowing comparison of MOCR magnitude based on 250, 500, 750, and 1000 averages. Reliability was based on comparing the two series. The results show that, for a good quality MOCR measure (i.e., intraclass correlation above 0.9), the required number of averages is at least double that obtainable from a standard TEOAE test (i.e., 500 compared to 250). Ears without SSOAEs needed a higher number of averages to reach a correlation of 0.9 than ears with SSOAEs.

Fluctuations of Otoacoustic Emissions and Medial Olivocochlear Reflexes: Tracking One Subject over a Year

The purpose of the study was to measure the variability of transiently evoked otoacoustic emissions (TEOAEs) and the medial olivocochlear reflex (MOCR) over a long period of time in one person. TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured, from which MOCR strength could be derived as either a dB or % change. In this longitudinal case study, measurements were performed on the right and left ears of a young, normally hearing adult female once a week for 1 year. The results showed that TEOAE level and MOCR strength fluctuated over the year but tended to remain close to a baseline level, with standard deviations of around 0.5 dB and 0.05 dB, respectively. The TEOAE latencies at frequencies from 1 to 4 kHz were relatively stable, with maximum changes ranging from 0.5 ms for the 1 kHz band to 0.08 ms for the 4 kHz band. TEOAE levels and MOCR strengths were strongly and negatively correlated, meaning that the higher the TEOAE level, the lower the MOCR. Additionally, comparison of fluctuations between the ears revealed positive correlation, i.e., the higher the TEOAE level or MOCR in one ear, the higher in the second ear.

The Reliability of Contralateral Suppression of Otoacoustic Emissions Is Greater in Women than in Men

The aim of this study was to compare the reliability of the medial olivocochlear reflex (MOCR) between men and women. The strength of the MOCR was measured in terms of the suppression of transiently evoked otoacoustic emissions (TEOAEs) by contralateral acoustic stimulation (CAS). The difference between TEOAEs with and without CAS (white noise) was calculated as raw decibel TEOAE suppression as well as normalized TEOAE suppression expressed in percent. In each subject, sets of measurements were performed twice. Reliability was evaluated by calculating the intraclass correlation coefficient, the standard error of measurement, and the minimum detectable change (MDC). The study included 40 normally hearing subjects (20 men; 20 women). The estimates of MOCR for both genders were similar. Nevertheless, the reliability of the MOCR was poorer in men, with an MDC around twice that of women. This can be only partially attributed to slightly lower signal-to-noise ratios (SNRs) in men, since we used strict procedures calling for high SNRs (around 20 dB on average). Furthermore, even when we compared subgroups with similar SNRs, there was still lower MOCR reliability in men.

A Time-Course-Based Estimation of the Human Medial Olivocochlear Reflex Function Using Clicks

The auditory efferent system, especially the medial olivocochlear reflex (MOCR), is implicated in both typical auditory processing and in auditory disorders in animal models. Despite the significant strides in both basic and translational research on the MOCR, its clinical applicability remains under-utilized in humans due to the lack of a recommended clinical method. Conventional tests employ broadband noise in one ear while monitoring change in otoacoustic emissions (OAEs) in the other ear to index efferent activity. These methods, (1) can only assay the contralateral MOCR pathway and (2) are unable to extract the kinetics of the reflexes. We have developed a method that re-purposes the same OAE-evoking click-train to also concurrently elicit bilateral MOCR activity. Data from click-train presentations at 80 dB peSPL at 62.5 Hz in 13 young normal-hearing adults demonstrate the feasibility of our method. Mean MOCR magnitude (1.7 dB) and activation time-constant (0.2 s) are consistent with prior MOCR reports. The data also suggest several advantages of this method including, (1) the ability to monitor MEMR, (2) obtain both magnitude and kinetics (time constants) of the MOCR, (3) visual and statistical confirmation of MOCR activation.

Does the Presence of Spontaneous Components Affect the Reliability of Contralateral Suppression of Evoked Otoacoustic Emissions?

OBJECTIVES

The function of the medial olivocochlear system can be evaluated by measuring the suppression of otoacoustic emissions (OAEs) by contralateral stimulation. One of the obstacles preventing the clinical use of the OAE suppression is that it has considerable variability across subjects. One feature that tends to differentiate subjects is the presence or absence of spontaneous OAEs (SOAEs). The purpose of the present study was to investigate the reliability of contralateral suppression of transiently evoked OAEs (TEOAEs) measured using a commercial device in ears with and without SOAEs.

DESIGN

OAEs were recorded in a group of 60 women with normal hearing. TEOAEs were recorded with a linear protocol (identical stimuli), a constant stimulus level of 65 dB peSPL, and contralateral broadband noise (60 dB SPL) as a suppressor. Each recording session consisted of three measurements: the first two were made consecutively without taking out the probe (the "no refit" condition); the third measurement was made after taking out and refitting the probe (a "refit" condition). Global (for the whole signal) and half-octave band values of TEOAE response levels, signal-to-noise ratios (SNRs), raw dB TEOAE suppression, and normalized TEOAE suppression, and latency were investigated. Each subject was tested for the presence of SOAEs using the synchronized SOAE (SSOAE) technique. Reliability was evaluated by calculating the intraclass correlation coefficient, standard error of measurement (SEM) and minimum detectable change.

RESULTS

The TEOAE suppression was higher in ears with SSOAEs in terms of normalized percentages. However, when calculated in terms of decibels, the effect was not significant. The reliability of the TEOAE suppression as assessed by SEM was similar for ears with and without SSOAEs. The SEM for the whole dataset (with and without SSOAEs) was 0.08 dB for the no-refit condition and 0.13 dB for the refit condition (equivalent to 1.6% and 2.2%, respectively). SEMs were higher for half-octave bands than for global values. TEOAE SNRs were higher in ears with SSOAEs.

CONCLUSIONS

The effect of SSOAEs on reliability of the TEOAE suppression remains complicated. On the one hand, we found that higher SNRs generally provide lower variability of calculated suppressions, and that the presence of SSOAEs favors high SNRs. On the other hand, reliability estimates were not much different between ears with and without SSOAEs. Therefore, in a clinical setting, the presence of SOAEs does not seem to have an effect on suppression measures, at least when testing involves measuring global or half-octave band response levels.

Medial olivocochlear reflex effects on amplitude growth functions of long- and short-latency components of click-evoked otoacoustic emissions in humans

Functional outcomes of medial olivocochlear reflex (MOCR) activation, such as improved hearing in background noise and protection from noise damage, involve moderate to high sound levels. Previous noninvasive measurements of MOCR in humans focused primarily on otoacoustic emissions (OAEs) evoked at low sound levels. Interpreting MOCR effects on OAEs at higher levels is complicated by the possibility of the middle-ear muscle reflex and by components of OAEs arising from different locations along the length of the cochlear spiral. We overcame these issues by presenting click stimuli at a very slow rate and by time-frequency windowing the resulting click-evoked (CE)OAEs into short-latency (SL) and long-latency (LL) components. We characterized the effects of MOCR on CEOAE components using multiple measures to more comprehensively assess these effects throughout much of the dynamic range of hearing. These measures included CEOAE amplitude attenuation, equivalent input attenuation, phase, and slope of growth functions. Results show that MOCR effects are smaller on SL components than LL components, consistent with SL components being generated slightly basal of the characteristic frequency region. Amplitude attenuation measures showed the largest effects at the lowest stimulus levels, but slope change and equivalent input attenuation measures did not decrease at higher stimulus levels. These latter measures are less commonly reported and may provide insight into the variability in listening performance and noise susceptibility seen across individuals.NEW & NOTEWORTHY The auditory efferent system, operating at moderate to high sound levels, may improve hearing in background noise and provide protection from noise damage. We used otoacoustic emissions to measure these efferent effects across a wide range of sound levels and identified level-dependent and independent effects. Previous reports have focused on level-dependent measures. The level-independent effects identified here may provide new insights into the functional relevance of auditory efferent activity in humans.

Muscles in and around the ear as the source of "physiological noise" during auditory selective attention: A review and novel synthesis

The sensitivity of the auditory system is regulated via two major efferent pathways: the medial olivocochlear system that connects to the outer hair cells, and by the middle ear muscles-the tensor tympani and stapedius. The role of the former system in suppressing otoacoustic emissions has been extensively studied, but that of the complementary network has not. In studies of selective attention, decreases in otoacoustic emissions from contralateral stimulation have been ascribed to the medial olivocochlear system, but the acknowledged problem is that the results can be confounded by parallel muscle activity. Here, the potential role of the muscle system is examined through a wide but not exhaustive review of the selective attention literature, and the unifying hypothesis is made that the prominent "physiological noise" detected in such experiments, which is reduced during attention, is the sound produced by the muscles in proximity to the ear-including the middle ear muscles. All muscles produce low-frequency sound during contraction, but the implications for selective attention experiments-in which muscles near the ear are likely to be active-have not been adequately considered. This review and synthesis suggests that selective attention may reduce physiological noise in the ear canal by reducing the activity of muscles close to the ear. Indeed, such an experiment has already been done, but the significance of its findings have not been widely appreciated. Further sets of experiments are needed in this area.

No Change in Medial Olivocochlear Efferent Activity during an Auditory or Visual Task: Dual Evidence from Otoacoustic Emissions and Event-Related Potentials

The medial olivocochlear (MOC) system is thought to be responsible for modulation of peripheral hearing through descending (efferent) pathways. This study investigated the connection between peripheral hearing function and conscious attention during two different modality tasks, auditory and visual. Peripheral hearing function was evaluated by analyzing the amount of suppression of otoacoustic emissions (OAEs) by contralateral acoustic stimulation (CAS), a well-known effect of the MOC. Simultaneously, attention was evaluated by event-related potentials (ERPs). Although the ERPs showed clear differences in processing of auditory and visual tasks, there were no differences in the levels of OAE suppression. We also analyzed OAEs for the highest magnitude resonant mode signal detected by the matching pursuit method, but again did not find a significant effect of task, and no difference in noise level or number of rejected trials. However, for auditory tasks, the amplitude of the P3 cognitive wave negatively correlated with the level of OAE suppression. We conclude that there seems to be no change in MOC function when performing different modality tasks, although the cortex still remains able to modulate some aspects of MOC activity.

Efferent-induced shifts in synchronized-spontaneous-otoacoustic-emission magnitude and frequency

Synchronized-spontaneous otoacoustic emissions (SSOAEs) present as slow-decaying emission energy that persists after the transient-evoked otoacoustic emission (TEOAE). SSOAEs possess high amplitudes and signal-to-noise ratios, making them potentially ideal candidates to assay the medial-olivocochlear reflex (MOCR). The current work quantified MOCR-induced changes to SSOAEs over a 36-dB stimulus level range and compared MOCR effects between TEOAE- and SSOAE-based assays. Otoacoustic emissions were evoked using band limited clicks from 52 to 88 dB peak sound pressure level (pSPL) with and without contralateral-acoustic stimulation (CAS) in 25 normal-hearing, female adults. The CAS was 50-dB sound pressure level (SPL) broadband noise and served to activate the MOCR. The number of SSOAEs increased with the stimulus level through approximately 70 dB pSPL. The presentation of CAS resulted in fewer SSOAEs. SSOAEs exhibited compressive growth and approached saturation for stimulus levels of 70 dB pSPL. The primary effects of CAS were a reduction in the SSOAE magnitude and an upward shift in the SSOAE frequency. These changes were not strongly affected by the stimulus level. Time-domain analysis of the SSOAE revealed an increase in the CAS-induced magnitude shift during the decay portion of the SSOAE. Compared to CAS-induced TEOAE magnitude shifts, SSOAE magnitude shifts were typically 2-3 dB larger. Findings support SSOAEs as a means to assay the MOCR.

Reliability of contralateral suppression of otoacoustic emissions in children

OBJECTIVE

The purpose of the study was to determine the reliability in children of the medial olivocochlear reflex when measured as decibels of suppression of transiently evoked otoacoustic emissions (TEOAEs) by contralateral acoustic stimulation (CAS).

DESIGN

TEOAEs with and without CAS (white noise) were measured. In each subject, measurements were performed twice. Of particular interest was the suppression of TEOAEs by CAS and its reliability. Reliability was evaluated by calculating the standard error of measurement (SEM) and minimum detectable change (MDC).

STUDY SAMPLE

Fifty-one normally hearing girls aged 3-6 years.

RESULTS

The average global TEOAE suppression was around 0.6 dB. The highest reliability was for global values, with SEM of 0.2 dB and MDC of ±0.55 dB for the standard 2.5-20 ms recording window and slightly higher values for an 8-18 ms window. The worst reliability in the studied group was for the 1 kHz half-octave frequency band. Additionally, ears without spontaneous otoacoustic emissions had higher suppression levels than those with, but they also had lower signal-to-noise ratios, which may limit their clinical utility.

CONCLUSIONS

The current study shows that, under the studied paradigm, TEOAE suppression does not have satisfactory reliability since MDC was similar to the level of suppression.

Contralateral suppression of otoacoustic emissions in pre-school children

BACKGROUND

Contralateral suppression of otoacoustic emissions (OAEs) may serve as an index of the medial olivocochlear (MOC) reflex. To date, this index has been studied in various populations but never in pre-school children. The purpose of this study was to fill this gap and describe how the MOC reflex affects the properties of transiently evoked OAEs (TEOAEs) in this age group. In addition, the influence of the presence of spontaneous OAEs (SOAEs) in the studied ear on the suppression of TEOAEs was also investigated.

METHODS

TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured in 126 normally hearing pre-school children aged 3-6 years. The values of response levels, suppression by CAS, and signal-to-noise ratios (SNRs) of TEOAEs were investigated for the whole signal (global) and for half-octave frequency bands from 1 to 4 kHz. Only ears with SNR >6 dB were used in the analyses. SOAEs were acquired using the so-called synchronized SOAEs (SSOAEs) technique.

RESULTS

Ears with SSOAEs had higher response levels and SNRs than ears without SSOAEs, and suppression was lower (0.58 dB compared to 0.85 dB). Only 22% of all studied ears had an SNR >20 dB, a level recommended in some studies for measuring suppression. There were no significant effects of age or gender on TEOAE suppression.

CONCLUSIONS

Suppression levels for pre-school children did not differ appreciably from those of adults measured under similar conditions in other studies. Taken together with no effect of age in the data studied here, it seems that there is no effect of age on TEOAE suppression. However, we did find that the presence of SSOAEs had an effect on TEOAE suppression, a finding which has not been reported in earlier studies on different populations. We suggest that the presence of SSOAEs might be a crucial factor related to MOC function.

Jittering stimulus onset attenuates short-latency, synchronized-spontaneous otoacoustic emission energy

Synchronized-spontaneous otoacoustic emissions (SSOAEs) are slow-decaying otoacoustic emissions (OAEs) that persist up to several hundred milliseconds following presentation of a transient stimulus. If the inter-stimulus interval is sufficiently short, SSOAEs will contaminate the stimulus window of the adjacent epoch. In medial-olivocochlear reflex (MOCR) assays, SSOAE contamination can present as a change in the stimulus between quiet and noise conditions, since SSOAEs are sensitive to MOCR activation. Traditionally, a change in the stimulus between MOCR conditions implicates acoustic reflex activation by the contralateral noise; however, this interpretation is potentially confounded by SSOAEs. This study examined the utility of jittering stimulus onset to desynchronize and cancel short-latency SSOAE energy. Transient-evoked (TE) OAEs and SSOAEs were measured from 39 subjects in contralateral-quiet and -noise conditions. Clicks were presented at fixed and quasi-random intervals (by introducing up to 8 ms of jitter). For the fixed-interval condition, spectral differences in the stimulus window between quiet and noise conditions mirrored those in the SSOAE analysis window, consistent with SSOAE contamination. In contrast, spectral differences stemming from SSOAEs were attenuated and/or absent in the stimulus window for the jitter conditions. The use of jitter did not have a statistically significant effect on either TEOAE level or the estimated MOCR.

Medial olivocochlear reflex effects on synchronized spontaneous otoacoustic emissions

This study characterized medial olivocochlear (MOC) reflex activity on synchronized spontaneous otoacoustic emissions (SSOAEs) as compared to transient-evoked otoacoustic emissions (TEOAEs) in normal-hearing adults. Using two time windows, changes in TEOAE and SSOAE magnitude and phase due to a MOC reflex elicitor were quantified from 1 to 4 kHz. In lower frequency bands, changes in TEOAE and SSOAE magnitude were significantly correlated and were significantly larger for SSOAEs. Changes in TEOAE and SSOAE phase were not significantly different, nor were they significantly correlated. The larger effects on SSOAE magnitude may improve the sensitivity for detecting the MOC reflex.