Spontaneous otoacoustic emissions in preterm neonates: prevalence and gender effects

Exploring the Differences Between an Immature and a Mature Human Auditory System Through Auditory Late Responses in Quiet and in Noise

Children are disadvantaged compared to adults when they perceive speech in a noisy environment. Noise reduces their ability to extract and understand auditory information. Auditory-Evoked Late Responses (ALRs) offer insight into how the auditory system can process information in noise. This study investigated how noise, signal-to-noise ratio (SNR), and stimulus type affect ALRs in children and adults. Fifteen participants from each group with normal hearing were studied under various conditions. The findings revealed that both groups experienced delayed latencies and reduced amplitudes in noise but that children had fewer identifiable waves than adults. Babble noise had a significant impact on both groups, limiting the analysis to one condition: the /da/ stimulus at +10 dB SNR for the P1 wave. P1 amplitude was greater in quiet for children compared to adults, with no stimulus effect. Children generally exhibited longer latencies. N1 latency was longer in noise, with larger amplitudes in white noise compared to quiet for both groups. P2 latency was shorter with the verbal stimulus in quiet, with larger amplitudes in children than adults. N2 latency was shorter in quiet, with no amplitude differences between the groups. Overall, noise prolonged latencies and reduced amplitudes. Different noise types had varying impacts, with the eight-talker babble noise causing more disruption. Children's auditory system responded similarly to adults but may be more susceptible to noise. This research emphasizes the need to understand noise's impact on children's auditory development, given their exposure to noisy environments, requiring further exploration of noise parameters in children.

Human bony labyrinth as a sex indicator in subadults

Due to the durability and good preservation of the petrous bone in archaeological and forensic contexts, the value of the inner ear as a sex indicator has been evaluated in various studies. Previous findings suggest that the morphology of the bony labyrinth is not stable in the postnatal period. In this study, we aim to assess the sexual dimorphism of the bony labyrinth via analysis of computed tomography (CT) data obtained from 170 subadults (birth to 20 y.o.) and test whether the postnatal changes of the bony labyrinth affect the level of dimorphism in the inner ear. A set of 10 linear measurements of 3D labyrinth models as well as 10 size and shape indices were analyzed. Sexually dimorphic variables were used to produce sex estimation formulae with discriminant function analysis. The produced formulae allowed for the correct classification of up to 75.3 % of individuals aged from birth to 15 years old. Sexual dimorphism was not significant for individuals between 16 and 20 years of age. This study suggests that the morphology of the subadult bony labyrinth exhibits significant sexual dimorphism in individuals under 16 years of age, which can aid the forensic identification process. Although postnatal growth of the temporal bone seems to affect the level of sexual dimorphism present in the inner ear, the formulae created in this study could be used as an additional tool for sex estimation of subadult (<16 y.o.) remains.

The development of auditory temporal processing during the first year of life

OBJECTIVES

The processing of auditory temporal information is important for the extraction of voice pitch, linguistic information, as well as the overall temporal structure of speech. However, many aspects of its early development remain poorly understood. This paper reviews the development of auditory temporal processing during the first year of life when infants are acquiring their native language.

METHODS

First, potential mechanisms of neural immaturity are discussed in the context of neurophysiological studies. Next, what is known about infant auditory capabilities is considered with a focus on psychophysical studies involving non-speech stimuli to investigate the perception of temporal fine structure and envelope cues. This is followed by a review of studies involving speech stimuli, including those that present vocoded signals as a method of degrading the spectro-temporal information available to infant listeners.

RESULTS/CONCLUSION

This review suggests that temporal resolution may be well developed in the first postnatal months, but that the ability to use and process the temporal information in an efficient way along the entire auditory pathway is longer to develop. Those findings have crucial implications for the development of language abilities, especially for infants with hearing impairment who are using cochlear implants.

Sexual Dimorphism in the Functional Development of the Cochlear Amplifier in Humans

OBJECTIVES

Otoacoustic emissions, a byproduct of active cochlear mechanisms, exhibit a higher magnitude in females than in males. The relatively higher levels of androgen exposure in the male fetus are thought to cause this difference. Postnatally, the onset of puberty is also associated with the androgen surge in males. In this study, we investigated sexual dimorphism in age-related changes in stimulus-frequency otoacoustic emissions for children.

DESIGN

In a retrospective design, stimulus-frequency otoacoustic emissions were analyzed from a cross-sectional sample of 170 normal-hearing children (4 to 12 years) and 67 young adults. Wideband acoustic immittance and efferent inhibition measures were analyzed to determine the extent to which middle ear transmission and efferent inhibition can account for potential sex differences in stimulus-frequency otoacoustic emissions.

RESULTS

Male children showed a significant reduction in otoacoustic emission magnitudes with age, whereas female children did not show any such changes. Females showed higher stimulus-frequency otoacoustic emission magnitudes compared with males. However, the effect size of sex differences in young adults was larger compared with children. Unlike the otoacoustic emission magnitude, the noise floor did not show sexual dimorphism; however, it decreased with age. Neither the wideband absorbance nor efferent inhibition could account for the sex differences in stimulus-frequency otoacoustic emissions.

CONCLUSIONS

The cochlear-amplifier function remains robust in female children but diminishes in male children between 4 and 12 years of age. We carefully eliminated lifestyle, middle ear, and efferent factors to conclude that the androgen surge associated with puberty likely caused the observed masculinization of stimulus-frequency otoacoustic emissions in male children. These findings have significant theoretical consequences. The cochlea is considered mature at birth; however, the present findings highlight that functional cochlear maturation, as revealed by otoacoustic emissions, can be postnatally influenced by endogenous hormonal factors, at least in male children. Overall, work reported here demonstrates sexual dimorphism in the functional cochlear maturational processes during childhood.

The duration of intrauterine development influences discrimination of speech prosody in infants

Auditory speech discrimination is essential for normal language development. Children born preterm are at greater risk of language developmental delays. Using functional near-infrared spectroscopy at term-equivalent age, the present study investigated early discrimination of speech prosody in 62 neonates born between week 23 and 41 of gestational age (GA). We found a significant positive correlation between GA at birth and neural discrimination of forward versus backward speech at term-equivalent age. Cluster analysis identified a critical threshold at around week 32 of GA, pointing out the existence of subgroups. Infants born before week 32 of GA exhibited a significantly different pattern of hemodynamic response to speech stimuli compared to infants born at or after week 32 of GA. Thus, children born before the GA of 32 weeks are especially vulnerable to early speech discrimination deficits. To support their early language development, we therefore suggest a close follow-up and additional speech and language therapy especially in the group of children born before week 32 of GA.

Postnatal Effects of Sex Hormones on Click-Evoked Otoacoustic Emissions: A Study of Adolescents with Gender Dysphoria

Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds, generated by the inner ear in response to click-stimuli. A sex difference in emission strength is observed in neonates and adults, with weaker CEOAE amplitudes in males. These differences are assumed to originate from testosterone influences during prenatal male sexual differentiation and to remain stable throughout life. However, recent studies suggested activational, postnatal effects of sex hormones on CEOAEs. Adolescents diagnosed with gender dysphoria (GD) may receive gonadotropin-releasing hormone analogs (GnRHa) in order to suppress endogenous sex hormones and, therefore, pubertal maturation, followed by cross-sex hormone (CSH) treatment. Using a cross-sectional design, we examined whether hormonal interventions in adolescents diagnosed with GD (62 trans boys, assigned female at birth, self-identifying as male; 43 trans girls, assigned male at birth, self-identifying as female), affected their CEOAEs compared to age- and sex-matched controls (44 boys, 37 girls). Sex-typical differences in CEOAE amplitude were observed among cisgender controls and treatment-naïve trans boys but not in other groups with GD. Treatment-naïve trans girls tended to have more female-typical CEOAEs, suggesting hypomasculinized early sexual differentiation, in support of a prominent hypothesis on the etiology of GD. In line with the predicted suppressive effects of androgens, trans boys receiving CSH treatment, i.e., testosterone plus GnRHa, showed significantly weaker right-ear CEOAEs compared with control girls. A similar trend was seen in trans boys treated with GnRHa only. Unexpectedly, trans girls showed CEOAE masculinization with addition of estradiol. Our findings show that CEOAEs may not be used as an unequivocal measure of prenatal androgen exposure as they can be modulated postnatally by sex hormones, in the form of hormonal treatment.

Cochlear shape reveals that the human organ of hearing is sex-typed from birth

Sex differences in behavioral and neural characteristics can be caused by cultural influences but also by sex-based differences in neurophysiological and sensorimotor features. Since signal-response systems influence decision-making, cooperative and collaborative behaviors, the anatomical or physiological bases for any sex-based difference in sensory mechanisms are important to explore. Here, we use uniform scaling and nonparametric representations of the human cochlea, the main organ of hearing that imprints its adult-like morphology within the petrosal bone from birth. We observe a sex-differentiated torsion along the 3D cochlear curve in samples of 94 adults and 22 juvenile skeletons from cross-cultural contexts. The cochlear sexual dimorphism measured in our study allows sex assessment from the human skeleton with a mean accuracy ranging from 0.91 to 0.93 throughout life. We conclude that the human cochlea is sex-typed from an early post-natal age. This, for the first time, allows nondestructive sex determination of juveniles' skeletal remains in which the biomolecules are too degraded for study but in which the petrosal is preserved, one of the most common bone within archaeological assemblages. Our observed sex-typed cochlear shape from birth is likely associated with complex evolutionary processes in modern humans for reasons not yet fully understood.

Neuroprocessing Mechanisms of Music during Fetal and Neonatal Development: A Role in Neuroplasticity and Neurodevelopment

The primary aim of this viewpoint article is to examine recent literature on fetal and neonatal processing of music. In particular, we examine the behavioral, neurophysiological, and neuroimaging literature describing fetal and neonatal music perception and processing to the first days of term equivalent life. Secondly, in light of the recent systematic reviews published on this topic, we discuss the impact of music interventions on the potential neuroplasticity pathways through which the early exposure to music, live or recorded, may impact the fetal, preterm, and full-term infant brain. We conclude with recommendations for music stimuli selection and its role within the framework of early socioemotional development and environmental enrichment.

The human newborn's umwelt: Unexplored pathways and perspectives

Historically, newborns, and especially premature newborns, were thought to "feel nothing." However, over the past decades, a growing body of evidence has shown that newborns are aware of their environment, but the extent and the onset of some sensory capacities remain largely unknown. The goal of this review is to update our current knowledge concerning newborns' perceptual world and how ready they are to cope with an entirely different sensory environment following birth. We aim to establish not only how and when each sensory ability arises during the pre-/postbirth period but also discuss how senses are studied. We conclude that although many studies converge to show that newborns are clearly sentient beings, much is still unknown. Further, we identify a series of internal and external factors that could explain discrepancies between studies, and we propose perspectives for future studies. Finally, through examples from animal studies, we illustrate the importance of this detailed knowledge to pursue the enhancement of newborns' daily living conditions. Indeed, this is a prerequisite for assessing the effects of the physical environment and routine procedures on newborns' welfare.

The 1.06 frequency ratio in the cochlea: evidence and outlook for a natural musical semitone

A frequency ratio of about 1.06 often appears in cochlear mechanics, and the question naturally arises, why? The ratio is close to that of the semitone (1.059) in music, giving reason to think that this aspect of musical perception might have a cochlear basis. Here, data on synchronised spontaneous otoacoustic emissions is presented, and a clustering of ratios between 1.05 and 1.07 is found with a peak at 1.063 ± 0.005. These findings reinforce what has been found from previous sources, which are reviewed and placed alongside the present work. The review establishes that a peak in the vicinity of 1.06 has often been found in human cochlear data. Several possible cochlear models for explaining the findings are described. Irrespective of which model is selected, the fact remains that the cochlea itself appears to be the origin of a ratio remarkably close to an equal-tempered musical semitone, and this close coincidence leads to the suggestion that the inner ear may play a role in constructing a natural theory of music. The outlook for such an enterprise is surveyed.

Characterizing spontaneous otoacoustic emissions across the human lifespan

This study characterizes 1571 archival and newly acquired spontaneous otoacoustic emissions (SOAEs) from 632 human subjects with ages ranging from premature birth through the seventh decade of life. Automated detection and Lorentzian modeling were applied to identify SOAEs and characterize SOAE features throughout the human lifespan. Results confirm higher-level, higher-frequency, and more numerous SOAEs from neonates compared to young adults. Approximately 85% of newborns have measurable SOAEs as compared to 51%-68% for young adults. Newborn SOAEs are also an average of 5 to 6 dB higher in level than those from young-adult ears. These age differences may reflect immature ear-canal acoustics and/or the pristine condition of the neonatal cochlea. In addition, newborns as a group showed broader SOAE bandwidth and increased frequency jitter, possibly due to higher intracochlear noise; additionally, 22% of newborn SOAEs had a different, non-Lorentzian spectral shape. Aging effects were also observed: 40% of elderly ears had SOAEs, and these were greatly reduced in level, likely due to lower power gain in the aging cochlea. For all ages, SOAE bandwidths decreased with frequency in a way that mirrors the frequency dependence of stimulus-frequency otoacoustic emission delays as predicted by the standing-wave model of SOAE generation.

Spontaneous otoacoustic emissions in schoolchildren

OBJECTIVE

Spontaneous otoacoustic emissions (SOAEs) are one of the least studied types of otoacoustic emissions (OAEs). The purpose of this study was twofold: first, to determine the prevalence of SOAEs in schoolchildren, and second to test whether there was dependence between the presence or absence of SOAEs in a subject and the corresponding level of their transiently evoked OAEs (TEOAEs).

METHODS

Measurements were made on a group of normally hearing children of age 7-13 years. A technique which detects synchronized SOAEs (SSOAEs) was used in which the response to repetitive clicks (12.5/s) was analyzed in the 60-80 ms time window following each click. The matching pursuit method was used to detect SSOAEs components above the noise in this window. For comparison, TEOAEs evoked by clicks (40/s) were obtained using the standard nonlinear protocol (20 ms time window).

RESULTS

The prevalence of SOAEs was 37%, and higher in females and right ears. There was an average of 2.3 SOAEs per emitting ear. TEOAE levels were higher for ears that had SOAEs and were lower for ears that did not have any SOAEs.

CONCLUSION

Although not all normal human have SOAEs, they appear to reflect an important aspect of cochlear function. Their presence is strongly related to elevated levels of TEOAEs which are routinely used in audiological tests.

Associations between prenatal and recent postnatal methylmercury exposure and auditory function at age 19 years in the Seychelles Child Development Study

OBJECTIVES

The aim of this study was to determine if prenatal or recent postnatal methylmercury (MeHg) exposure from consuming ocean fish and seafood is associated with auditory deficits in young adults. Some investigators have reported adverse associations while others have found no associations. Ocean fish is an important nutrient source for billions of people around the world. Consequently, determining if there is an adverse association with objective auditory measures is important in assessing whether a risk is present or not.

DESIGN

The peripheral and central auditory function of 534 subjects in the Seychelles Child Development Study (SCDS) Main Cohort was examined at age of 19 years. The auditory test battery included standard pure-tone audiometry, tympanometry, auditory brainstem response (ABR) latencies, and both click-evoked and distortion product otoacoustic emissions (OAE). Associations with MeHg were evaluated with multiple linear regression models, adjusting for sex, recent postnatal MeHg exposure, and hearing loss.

RESULTS

Bilateral hearing loss (defined as a mean pure-tone threshold of greater than 25 dB) was present in 1.1%of the subjects and was not associated with prenatal or recent postnatal MeHg exposure. As expected, absolute and interwave ABR latencies were shorter for women as compared to men, as the stimulus presentation rate decreased from 69.9 to 19.9 clicks/s and as the stimulus intensity increased from 60 to 80 dBnHL. Similarly, larger OAE amplitudes were elicited in women as compared to men and in the right ears as compared to the left. There was no association of prenatal MeHg exposure with hearing loss, ABR absolute and interwave latencies or OAE amplitudes. As recent postnatal MeHg increased, some associations were found with a few ABR absolute and interwave latencies and a few OAE amplitudes. However, the direction of these associations was inconsistent. As recent postnatal MeHg levels increased the wave I absolute latencies were shorter at 80 dBnHL for all three click rates, but the interwave I–V latency was longer for males for the 80 dBnHL 19 clicks/s and for the III–V interwave latencies for males and females for the dBnHL 69 clicks/s. Similarly, smaller OAE amplitudes were found at 1500, 2000, and 4000 Hz for males while larger OAE amplitudes were found for females at 1500 and 2000 Hz as the recent postnatal MeHg levels increased.

CONCLUSIONS

No consistent associations were present in this study between prenatal MeHg exposure from consumption of oceanic fish and seafood during pregnancy and auditory functions at 19 years of age. Given the level of prenatal exposure to MeHg, the number of audiologic measures tested, and the presence of the expected sex, click rate, and level dependent findings, it seems unlikely that an association was present and not detected. As recent postnatal MeHg exposure increased, a few associations with ABR latencies and OAE amplitudes were found. The direction of these associations was inconsistent as some showed improved performance as MeHg exposure levels increased while others showed poorer performance. The presence of the inconsistent postnatal MeHg exposure findings are intriguing and deserve further clarification.

Characterization of spontaneous otoacoustic emissions in full-term newborns

OBJECTIVE

To analyze the characteristics of spontaneous otoacoustic emissions (SOAEs) in full-term newborns.

METHODS

A total of 236 ears from 147 randomly selected full-term Chinese neonates (82 females and 65 males), who had passed the initial newborn hearing screening, were assessed for SOAEs using the Capella OAE equipment (Madsen, Denmark). The test was performed in a sound booth.

RESULTS

(1) The overall prevalence of SOAE was 56.77% of the ears. The prevalence of SOAEs was significantly higher in females (69.23%) than in males (41.51%, p<0.01), as well as in the right ears (64.17%) than in the left ears (49.14%, p<0.05). (2) The overall mean level of SOAE was 11.78±8.36dB SPL, with no significant differences between males (11.73±8.25dB SPL) and females (11.81±8.43dB SPL) or between the left (11.97±8.56dB SPL) and the right ears (11.65±8.22dB SPL). (3) The 25th and 75th percentiles of SOAE frequencies were 2.31 and 4.36kHz in females and 1.93 and 3.94kHz in males, which were statistically significantly different (p<0.01). In contrast, the SOAE frequency was not significantly different between ears (2.22-4.18kHz in the left ears and 2.17-4.14kHz in right ears). (4) The overall mean number of SOAEs was 3.70±2.75, with no significant differences in females (3.62±2.70) and males (3.86±2.87) or in right (3.70±2.55) and left ears (3.70±3.02).

CONCLUSIONS

The prevalence rate of SOAE is significantly higher in females than in males and in the right ears than in the left ears in Chinese newborns. The frequencies of the SOAEs in newborns appeared to be higher than those reported in normal-hearing adults in the literature.

Analysis of otoacoustic emissions in neonates at term and preterm

The transient evoked otoacoustic emissions (TEOAEs) have been widely used in neonatal hearing screening.

Objective

To compare the TEOAEs in newborns at term and preterm vis-à-vis the following variables: ear side, gender, frequency spectrum and gestational age.

Method

By means of a cross-sectional cohort of 66 newborns up to the 28^th day of life (41 newborns at term and 25 premature babies), we recorded TEOAEs. All the individuals did not have risk indicators for hearing loss.

Results

There was a signal/noise ratio improvement with frequency increase. No differences were observed between genders and between the ears, but there were differences among the children born at term and preterm in the frequency bands at 3 kHz and 4 kHz.

Conclusion

The TEOAEs test is important for assessing the peripheral auditory system of newborns at term and preterm, making it possible to have responses regardless of gender and gestational age.

Maturation and aging of the human cochlea: a view through the DPOAE looking glass

Cochlear function changes throughout the human lifespan. Distortion product otoacoustic emissions (DPOAEs) were recorded in 156 ears to examine these changes and speculate as to their mechanistic underpinnings. DPOAEs were analyzed within the context of current OAE generation theory, which recognizes distinct emission mechanisms. Seven age groups including premature newborns through senescent adults were tested with a swept-tone DPOAE protocol to examine magnitude and phase features of both the mixed DPOAE and individual distortion and reflection components. Results indicate (1) 6-8-month-old infants have the most robust DPOAE and component levels for frequencies >1.5 kHz; (2) older adults show a substantial reduction in DPOAE and distortion-component levels combined with a smaller drop in reflection-component levels; (3) all age groups manifest a violation of distortion phase invariance at frequencies below 1.5 kHz consistent with a secular break in cochlear scaling; the apical phase delay is markedly longer in newborns; and (4) phase slope of reflection emissions is most shallow in the older adults. Combined findings suggest that basilar membrane motion in the apical half of the cochlea is immature at birth and that the cochlea of senescent adults shows reduced nonlinearity and relatively shallow reflection-component phase slope, which can be interpreted to suggest degraded tuning.

Otoacoustic emissions in neonates measured with different acquisition protocols

OBJECTIVE

The purpose of the study was to investigate the properties of neonatal transiently evoked otoacoustic emissions (TEOAEs) recorded with three most popular stimulation protocols. Differences between the recorded TEOAEs with and without spontaneous otoacoustic emissions (SOAEs), were also assessed. In addition two more issues were addressed: (i) the effect of windowing on the TEOAE responses; and (ii) the contribution of the TEOAE segment from 12.5 to 20 ms to the overall TEOAE response.

METHODS

TEOAEs and SOAEs were recorded from 50 normal hearing neonates using linear, non-linear, QuickScreen and standard synchronized SOAE stimulation protocols. Global and half-octave-band values of TEOAE reproducibility and response level were used to assess statistical differences in the recorded responses. Furthermore protocol differences were evaluated in different recording windows from 2.5 to 12.5 and 12 to 20 ms.

RESULTS

Data from the linear protocol presented TEOAE parameters with the highest values. The differences between recordings with longer and shorter acquisition windows were especially apparent in 1-1.4 kHz frequency range. Furthermore the data have shown that the low frequency TEOAE components are a significant part of the TEOAE response, especially in ears without SOAEs.

CONCLUSIONS

The results suggest that TEOAE protocols using short recording windows (i.e. QuickScreen) can be used only for a fast detection of a valid TEOAE. For more sophisticated clinical analyses the standard 20 ms TEOAE recording window is more appropriate. The presence of SOAEs significantly influences TEOAEs. Ears with SOAEs presented higher values of TEOAE parameters especially in the 2-4 kHz range. On the other hand, in the ears without SOAEs low frequency components contribute more to the signal.

Sexual orientation and the auditory system

The auditory system exhibits differences by sex and by sexual orientation, and the implication is that relevant auditory structures are altered during prenatal development, possibly by exposure to androgens. The otoacoustic emissions (OAEs) of newborn male infants are weaker than those of newborn females, and these sex differences persist through the lifespan. The OAEs of nonheterosexual females also are weaker than those of heterosexual females, suggesting an atypically strong exposure to androgens some time early in development. Auditory evoked potentials (AEPs) also exhibit sex differences beginning early in life. Some AEPs are different for heterosexual and nonheterosexual females, and other AEPs are different for heterosexual and nonheterosexual males. Research on non-humans treated with androgenic or anti-androgenic agents also suggests that OAEs are masculinized by prenatal exposure to androgens late in gestation. Collectively, the evidence suggests that prenatal androgens, acting globally or locally, affect both nonheterosexuality and the auditory system.

Frequency distribution of synchronized spontaneous otoacoustic emissions showing sex-dependent differences and asymmetry between ears in 2- to 4-day-old neonates

OBJECTIVE

The mature pattern of frequency distribution of synchronized spontaneous otoacoustic emissions (SSOAEs) has been reported to be bimodal in adults and children between 5 and 11 years of age; however, little is known about the distribution in neonates between 2 and 4 days after birth. Furthermore, overall differences in frequency distribution resulting from difference in sex and asymmetry between ears have not been carefully examined. The aim of this study is to determine the frequency distribution of SSOAEs in neonates at 2 to 4 days of age, evaluate the maturity of the pattern of distribution in this age group, and to evaluate the effects of differences in sex and asymmetry between left and right ears on the frequency distribution.

METHODS

We evaluated 224 ears in 112 newborns (59 girls, 53 boys) whose ages ranged from 2 to 4 days. The SSOAEs were measured using ILO96.

RESULTS

Most of the SSOAEs (86.5%) appeared at frequencies between 1.01 and 4.50 kHz. The overall frequency distribution of the SSOAEs showed a 'peak-valley-peak' pattern when plotted. Two peaks with maxima at 1.41-1.60 and 3.01-3.20 kHz were separated by a valley with a minimum at 2.41-2.60 kHz. Both girls and boys had approximate monomodal patterns in the distribution of SSOAEs. Significant sex-dependent differences were noted with more SSOAEs at the lower frequencies (<or=2 kHz) in boys (46.1%) than in girls (32.0%) (P<0.05) and more SSOAEs at the higher frequencies (2.51- 4.50 kHz) in girls (50.9%) than in boys (37.5%) (P<0.05). Both the right and left ears showed the 'peak-valley-peak' pattern that was similar to the overall distribution pattern. But, compared with the peaks measured in the left ears at 1.01-1.50 and 3.01-3.50 kHz, the peaks of the right ears at 1.51-2.00 and 2.51-3.00 kHz were much closer to the valley.

CONCLUSIONS

The overall distribution of frequency of SSOAEs in 2- to 4-day-old neonates had the similar mature 'peak-valley-peak' distribution pattern seen in adults. Significant sex-dependent differences of the SSOAEs frequency distributions have been found. However, only slight ear asymmetries of the SSOAEs frequency distributions can observed in this age group.

Masculinization of the mammalian cochlea

Otoacoustic emissions (OAEs) differ between the sexes in humans, rhesus and marmoset monkeys, and sheep. OAEs also are different in a number of special populations of humans. Those basic findings are reviewed and discussed in the context of possible prenatal-androgen effects on the auditory system. A parsimonious explanation for several outcomes is that prenatal exposure to high levels of androgens can weaken the cochlear amplifiers and thereby weaken otoacoustic emissions (OAEs). Prenatal androgen exposure apparently also can alter auditory evoked potentials (AEPs). Some non-hormonal factors possibly capable of producing sex and group differences are discussed, and some speculations are offered about specific cochlear structures that might differ between the two sexes.

Effect of prenatal androgens on click-evoked otoacoustic emissions in male and female sheep (Ovis aries)

Otoacoustic emissions (OAEs) were measured in male and female Suffolk sheep (Ovis aries). Some sheep had been administered androgens or estrogens during prenatal development, some were gonadectomized after birth, and some were allowed to develop normally. As previously reported for spotted hyenas, gonadectomy did not alter the OAEs for either sex; accordingly, the untreated/intact and the untreated/gonadectomized animals were pooled to form the control groups. The click-evoked otoacoustic emissions (CEOAEs) exhibited by the female control group (N=12) were slightly stronger (effect size=0.42) than those in the male control group (N=15), which is the same direction of effect reported for humans and rhesus monkeys. Females administered testosterone prenatally (N=16) had substantially weaker (masculinized) CEOAEs than control females (effect size=1.15). Both of these outcomes are in accord with the idea that prenatal exposure to androgens weakens the cochlear mechanisms that underlie the production of OAEs. The CEOAEs of males administered testosterone prenatally (N=5) were not different from those of control males, an outcome also seen in similarly treated rhesus monkeys. Males administered dihydrotestosterone (DHT) prenatally (N=3) had slightly stronger (hypo-masculinized) CEOAEs than control males. No spontaneous otoacoustic emissions (SOAEs) were found in any ears, a common finding in non-human species. To our knowledge, this is the first ruminant species measured for OAEs.

Sex differences in distortion-product and transient-evoked otoacoustic emissions compared

Although several studies have documented the existence of sex differences in spontaneous otoacoustic emissions (SOAEs) and transient-evoked OAEs (TEOAEs) in humans, less has been published about sex differences in distortion-product OAEs (DPOAEs). Estimates of sex and ear differences were extracted from a data set of OAE measurements previously collected for other purposes. In accord with past findings, the sex differences for TEOAEs were substantial for both narrowband and wideband measures. By contrast, the sex differences for DPOAEs were about half the size of those for TEOAEs. In this sample, the ear differences were small for TEOAEs in both sexes and absent for DPOAEs. One implication is that the cochlear mechanisms underlying DPOAEs appear to be less susceptible to whatever influences are responsible for producing sex differences in TEOAEs and SOAEs in humans. We discuss the possibility that differences in the effective level of the stimuli may contribute to these outcomes.

Synchronized spontaneous otoacoustic emissions analyzed in a time-frequency domain

A synchronized spontaneous otoacoustic emission paradigm was used to measure the response in time intervals of 80 ms following a click stimulus. The responses obtained were decomposed into basic waveforms by means of adaptive approximations using a matching pursuit algorithm. High-resolution time-frequency distributions of signal energy were calculated and showed three types of component: (1) purely evoked of duration less than 5 ms, (2) longer lasting and decaying, with exponentially decreasing amplitude, and (3) long lasting and stable. The distributions of the frequencies of components of different durations were similar, with most components falling within the 1-2 kHz interval. It is shown that the presence of long-lasting components may influence the estimation of the latency of evoked emissions, especially at higher frequencies where the evoked part has a very short duration.

Transient evoked otoacoustic emission latency and estimates of cochlear tuning in preterm neonates

The latency of transient evoked otoacoustic emissions has been evaluated in a sample of 58 ears from 34 preterm neonates, to understand if the estimates of cochlear tuning based on the otoacoustic emission latency show signs of developmental changes. A previous study on the same otoacoustic emissions analyzed here [Tognola et al. (2005). "Cochlear maturation and otoacoustic emissions in preterm infants: A time-frequency approach," Hear. Res., 199, 71-80] reported indeed a significant change in the otoacoustic emission latency with postconception age. This last result, which would imply a significant decrease of tuning, was partially biased by the presence of spontaneous emissions. In this study, the same neonate data are reanalyzed using a novel time-frequency algorithm, less sensitive to spontaneous emissions. Asymmetry between right and left ears has been found, with the left ears showing no significant change, whereas in the right ears and in the 1.5-2.5 kHz frequency range only, a slow decrease of latency with postconception age (0.1-0.2 ms/week) was observed. The correspondent tuning estimates based on latency decrease by 0.4-0.5/week. Significant differences between neonate and adult latency were confirmed, which could be either cochlear or middle ear in nature. These findings are compared to previous studies on distortion product suppression tuning curves in preterm neonates.

Music as a nursing intervention for preterm infants in the NICU

Although there is general agreement that noise in the neonatal intensive care unit should be reduced, there is controversy about the use of music as a developmental care strategy with prererm infants. Much literature supports using music with preterm infants, indicating that it enhances physiologic and neurobehavioral functioning, but some experts worry that music is overstimulating. This article presents evidence supporting the use of music with preterm infants as well as criticism of same. Recommendations for music interventions with preterm infants are discussed, although fUrther research is needed before specific guidelines can he established.

What Do Sex, Twins, Spotted Hyenas, ADHD, and Sexual Orientation Have in Common?

The otoacoustic emissions (OAEs) measured in a collection of special populations of humans and certain nonhuman species suggest that OAEs may provide a window into some processes of human prenatal development and sexual differentiation. For reasons that are unclear, OAEs appear to be highly sensitive to events occurring during prenatal development that seem to be related to the degree of exposure to androgens a fetus receives. The (largely circumstantial) evidence for a relationship between androgen exposure and OAE strength comes from a series of studies of twins, children with attention-deficit/hyperactivity disorder, people of differing sexual orientations, and spotted hyenas, among others. Some conclusions are bolstered by parallel studies using auditory evoked potentials (AEPs). OAEs and AEPs are simple, objective, noninvasive measures that appear to have potential as tools of value to researchers working on a wide variety of basic and applied topics beyond audition.

Fetal cortical activation to sound at 33 weeks of gestation: a functional MRI study

Hearing already functions before birth, but little is known about the neural basis of fetal life experiences. Recent imaging studies have validated the use of functional magnetic resonance imaging (fMRI) in pregnant women at 38-weeks of gestation. The aim of the present study was to examine fetal brain activation to sound, using fMRI at the beginning of the third trimester of pregnancy. 6 pregnant women between 28- and 34-weeks of gestation were scanned using a magnetic strength of 1.5 T, with an auditory stimulus applied to their abdomen. 3 fetuses with a gestational age of 33 weeks, showed significant activation to sound in the left temporal lobe, measured using a new data-driven approach (Independent Component Analysis for fMRI time series). Only 2 of these fetuses showed left temporal activation, when the standard voxel-wise analysis method was used (p=0.007; p=0.001). Moreover, motion parameters added as predictors of the General Linear Model confirmed that motion cannot account for the signal variance in the fetal temporal cortex (p=0.01). Comparison between the statistical maps obtained from MRI scans of the fetuses with those obtained from adults, made it possible to confirm our hypothesis, that there is brain activation in the primary auditory cortex in response to sound. Measurement of the fetal hemodynamic response revealed an average fMRI signal change of +3.5%. This study shows that it is possible to use fMRI to detect early fetal brain function, but also confirms that sound processing occurs beyond the reflexive sub-cortical level, at the beginning of the third trimester of pregnancy.

Otoacoustic emissions latency difference between full-term and preterm neonates

Transiently evoked otoacoustic emissions (TEOAEs) were recorded from full-term and preterm neonates. The responses were decomposed, by means of an adaptive approximation method, into waveforms of defined frequencies, amplitudes, latencies and time spans. Statistically significant differences in the latency values were found between the tested groups. Differences were also found in the time spans of the TEOAEs components. For the preterm neonates the contribution of long-duration components (i.e. long-time span) was higher. Those components were characterized by narrow frequency band and contrary to the short-time span components their latencies did not depend on frequency. The removal of the long-duration components, from the pool of analyzed data, decreased the latency differences between the tested groups. The results indicate that the origin of the longer latency values for preterm neonates (with a post conceptional age up to 33 weeks) in respect to full-term neonates can be attributed to the presence of long-lasting components. The correspondence, which was found between frequencies of long-duration components and the spectral peaks of spontaneous otoacoustic emissions (SOAEs), suggests that those components may be connected with SOAEs.

Temporal bone study of development of the organ of Corti: correlation between auditory function and anatomical structure

OBJECTIVE

To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function.

MATERIAL AND METHODS

Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term.

RESULTS

By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensen's cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term.

DISCUSSION AND CONCLUSIONS

A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollicker's organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.

Masculinized otoacoustic emissions in female spotted hyenas (Crocuta crocuta)

In humans and rhesus monkeys, click-evoked otoacoustic emissions (CEOAEs) are stronger in females than in males, and there is considerable circumstantial evidence that this sex difference is attributable to the greater exposure to androgens prenatally in males. Because female spotted hyenas are highly androgenized beginning early in prenatal development, we expected an absence of sexual dimorphism in the CEOAEs of this species. The CEOAEs obtained from 9 male and 7 female spotted hyenas confirmed that expectation. The implication is that the marked androgenization to which female spotted hyenas are exposed masculinizes the cochlear mechanism responsible for CEOAEs. The CEOAEs measured in 3 male and 3 female hyenas that had been treated with anti-androgenic agents during prenatal development were stronger than the CEOAEs of the untreated animals, in accord with the implied inverse relationship between prenatal androgen exposure and the strength of the cochlear mechanisms producing CEOAEs. The CEOAEs of three ovariectomized females and two castrated males were essentially the same as those for the untreated females and males, suggesting that there is little or no activational effect of hormones on CEOAE strength in spotted hyenas. Distortion product OAEs (DPOAEs) also were measured. Those sex differences also were generally small (as they are in humans), and the effects of the anti-androgen agents were inconsistent. Thus, prenatal androgen exposure apparently does affect OAEs, but the effects appear to be greater for the reflection-based cochlear mechanism that underlies CEOAEs than for the nonlinear cochlear mechanism underlying DPOAEs.

Resonant modes in transiently evoked otoacoustic emissions and asymmetries between left and right ear

A number of single-frequency resonant modes in click evoked otoacoustic emissions (OAEs) was investigated. The OAE modes were identified by means of an adaptive approximation method based on the matching pursuit (MP) algorithm. The signals were decomposed into basic waveforms coming from a very large and redundant dictionary of Gabor functions. The study was performed on transiently evoked otoacoustic emissions (TEOAEs) from left and right ears of 108 subjects. The correspondence between waveforms found by the procedure and resonant modes was shown (both for simulated noisy data and for single-person TEOAEs). The decomposition of TEOAEs made distinction between short and long-lasting components possible. The number of main resonant modes was studied by means of different criteria and they all led to similar results, indicating that the main features of the signal are explained on average by 10 waveforms. The same number of resonant modes for the right ear accounted for more energy than for the left ear.

Prenatal sex hormone effects on child and adult sex-typed behavior: methods and findings

There is now good evidence that human sex-typed behavior is influenced by sex hormones that are present during prenatal development, confirming studies in other mammalian species. Most of the evidence comes from clinical populations, in which prenatal hormone exposure is atypical for a person's sex, but there is increasing evidence from the normal population for the importance of prenatal hormones. In this paper, we briefly review the evidence, focusing attention on the methods used to study behavioral effects of prenatal hormones. We discuss the promises and pitfalls of various types of studies, including those using clinical populations (concentrating on those most commonly studied, congenital adrenal hyperplasia, androgen insensitivity syndrome, ablatio penis, and cloacal exstrophy), direct measures of hormones in the general population (assayed through umbilical cord blood, amniotic fluid, and maternal serum during pregnancy), and indirect measures of hormones in the general population (inferred from intrauterine position and biomarkers such as otoacoustic emissions, finger length ratios, and dermatoglyphic asymmetries). We conclude with suggestions for interpreting and conducting studies of the behavioral effects of prenatal hormones.

Comparison of fetal behavior in low- and high-risk pregnancies

Meta-analyses were conducted on archival data of human fetal behavior to identify differential behavior among high-risk fetuses in pregnancies complicated by threatened preterm delivery, maternal hypertension or diabetes compared with low-risk fetuses in uneventful pregnancies, delivering as healthy, full-term infants. Data for a total of 493 fetuses (260 high risk, 233 low risk) from 23 weeks' gestation to term who participated in a study using a standardized protocol including observations of spontaneous and auditory-induced behavior were retrieved from our laboratory database. There were no differences in spontaneous behaviors when scored using clinical criteria for the nonstress test and biophysical profile; however, there were differences in the magnitude of the behaviors measured in the tests. Developmental differences were observed between those threatening to deliver early and the fetuses of hypertensive and diabetic mothers. The latter two groups differed little from one another but differed from low-risk fetuses in their response to auditory stimulation. We concluded that differences in behavior among high-risk groups suggest that atypical fetal behaviors may represent adaptation to condition specific insult rather than a generalized response to insult per se. The finding that high-risk fetuses showed atypical responses to auditory stimuli indicates a need to examine the relation between fetal auditory function and later language acquisition.

Cochlear maturation and otoacoustic emissions in preterm infants: a time–frequency approach

Click-evoked otoacoustic emissions (CEOAEs) from preterm infants were analyzed to characterize developmental changes of cochlear active mechanisms. Due to their strong time-varying properties, CEOAEs were studied with a time-frequency approach--the wavelet transform (WT). By means of the WT, CEOAEs were decomposed into 12 frequency bands, spanning the 0.25-6.25 kHz range. For each band, the root-mean-square (RMS) level and latency were studied as functions of both frequency and age. Because CEOAEs were averaged using the non-linear mode of acquisition, the developmental changes in observed in this study are related to the non-linear component (which is actually the most predominant component of the active cochlear response) of CEOAEs, the linear one being mostly canceled out by non-linear averaging. In our study, there was evidence that properties of CEOAE non-linear components are related to the post-conception age (PCA) in that the levels and latency of CEOAE frequency components changed until the age of about 38 weeks post-conception, whereas after 38 weeks, CEOAE features were very similar to those of term newborns. In particular, the CEOAE levels increased and latency decreased with age. The observed changes in CEOAE properties seem to reveal a development of cochlear active mechanisms, although contributions from outer and middle ear development cannot be excluded. Also, in agreement with previous physiological and behavioral findings, our results revealed that the development of CEOAE properties was not the same for all the frequencies, being greater for frequencies 4 kHz, and resembled the development of the cochlear partition, which proceeds from base to apex.

Maturation of fetal responses to music

Maturation of fetal response to music was characterized over the last trimester of pregnancy using a 5-minute piano recording of Brahms' Lullaby, played at an average of 95, 100, 105 or 110 dB (A). Within 30 seconds of the onset of the music, the youngest fetuses (28-32 weeks GA) showed a heart rate increase limited to the two highest dB levels; over gestation, the threshold level decreased and a response shift from acceleration to deceleration was observed for the lower dB levels, indicating attention to the stimulus. Over 5 minutes of music, fetuses older than 33 weeks GA showed a sustained increase in heart rate; body movement changes occurred at 35 weeks GA. These findings suggest a change in processing of complex sounds at around 33 weeks GA, with responding limited to the acoustic properties of the signal in younger fetuses but attention playing a role in older fetuses.

The order of testing effect in otoacoustic emissions and its consequences for sex and ear differences in neonates

The amplitude values of transient-evoked otoacoustic emissions, recorded from a large sample of neonates, were used to examine the asymmetry between ears tested and the differences due to the sex of the subject. Whilst the sex difference, with females having larger responses than males, has been a consistent finding in previous reports, the right/left ear difference, with the right ear giving a larger response than the left, has produced variable results that differed between laboratories. In this study, the sex difference was confirmed with females giving a 1.2 dB greater response than males. It was not affected by the age of the neonate. A significant effect of test order was found. The measured right/left difference was enhanced when the right ear was tested first but was diminished when the left ear was tested first. If the left ear is tested first then the measured right/left difference would be about 0.5 dB whereas, if the right ear is tested first, the measured right/left difference would be about 1.5 dB. When male/female comparisons were made for right and left ears separately and for the same ear tested first, the sex differences were the same for all four conditions. The sex and right/left differences have been confirmed as statistically significant effects and the order effect could explain the discrepancies and variability of the right/left differences reported in the literature.

The interaction between ear and sex differences and stimulus rate

Evoked otoacoustic emissions (EOAEs) are produced by the cochlea in response to acoustic stimuli and provide an objective and non-invasive measure of cochlear function. A new technique, based on maximum length sequences (MLSs), enables stimulus rates of up to 5000 clicks/s to be used. Conventional EOAE amplitude differs between ears and sexes, female subjects having responses of greater amplitude than male subjects and right ears larger responses than left ears. As a prerequisite to clinical use it is necessary to establish if these differences occur with the MLS OAE technique and whether they change with stimulus rate. Eighty ears of normally hearing adults between the ages of 18 and 40 years were tested. MLS OAEs were recorded at eight stimulus rates ranging from 40/s to 5000/s. Two stimulus levels and two recordings were made at each stimulus rate. Female subjects were found to have statistically significantly larger MLS OAEs than male subjects and gave larger amplitude responses in the right ears. The difference was not significant between male right and left ears. A rate effect was also demonstrated with the amplitude of the MLS OAEs decreasing with an increase in rate. The study provides normative data for MLS OAE testing and shows that females have MLS OAEs of larger amplitude than males and that as the click stimulus rate increases the significance of this difference decreases. Female right ears also have MLS OAEs of greater amplitude than female left ears.

Reference data for DPOAE in healthy newborns

Distortion Product Otoacoustic Emissions (DPOAE) can be used as an alternative to Transient Evoked Otoacoustic Emissions (TEOAE). This study aims to establish normal values for DPOAE in healthy newborns. DPOAE were determined with the Madsen Celesta 503 at 0.5, 1, 2, 4 and 8 kHz with an unequal stimulus level of the primaries (L1 = 65 dB SPL, L2 = 50 dB SPL). DPOAE were present in 92.4% of the ears of the 185 babies tested at 4 days after birth. The 5% quantile and the median of the DPOAE of the right and left ears were calculated for the five frequencies tested. At 4 kHz there was a significant sex effect (mean amplitude of DPOAE was higher in female than in male babies) and at 2 kHz a significant interaction effect was found between sex and side. The calculated reference limits are open to comparison with data obtained using other commercial equipment.

Effect of sleep stages on synchronized spontaneous otoacoustic emissions in pre-term neonates

OBJECTIVES

In infants, auditory tests are mainly performed during sleep, since they spend most of their time asleep, and because quiet is required for the duration of the recording session to obtain a precise and reliable response. The aim of this study was to investigate the effect of sleep stages on synchronized spontaneous otoacoustic emissions (sSOAEs) in pre-term neonates at the age where the sleep states begin to be well established and auditory screening can be performed in a neonatology unit before discharge.

METHODS

Synchronized SOAEs were repeatedly recorded during a polygraphic sleep recording using the Otodynamic ILO88 system in 10 pre-term neonates at 36 weeks post-conception.

RESULTS

Variations of sSOAE peak numbers occurred in each subject during the recording session. There was no clear relation between sSOAE peak number fluctuations and the different sleep stages.

CONCLUSIONS

The sSOAE variations appeared to be closely related to experimental conditions, i.e. the mean background noise level. sSOAEs with the highest amplitude were always recorded; however, those with the smallest amplitude were the first to disappear from the recordings with higher background noise.

Development of human cochlear active mechanism asymmetry: involvement of the medial olivocochlear system?

To study the functional development of the medial olivocochlear system, transient-evoked otoacoustic emission suppression experiments were conducted in 73 ears of 38 pre-term and 11 full-term neonates. The continuous contralateral stimulation was a broad band white noise, presented at 70 dB SPL. Efferent suppression was determined by subtracting the without-contralateral stimulation condition from the with-contralateral stimulation condition. Across this population, a mean suppression effect of contralateral stimulation on transient-evoked otoacoustic emissions was found, with most of the suppression effect observed after 8 ms. The amount of suppression is linearly, positively correlated with the conceptional age. In the subgroup of bilaterally tested neonates, the suppression of transient-evoked otoacoustic emissions is similar in the right ear and the left ear in subjects whose conceptional age is less than 36 weeks and significantly higher in the right ear than in the left ear in older neonates. This last observation was seen at frequencies where transient-evoked otoacoustic emission amplitudes became higher in the right ear than in the left ear as the conceptional age increased, a finding already reported in adults. This study shows that the functional adult pattern of the medial efferent system, probably involved in the detection of signals in noise such as speech sounds, seems to appear gradually in neonates and represents one of the several arguments in favor of functional auditory lateralization in humans, with a right ear advantage.

[Precocious maturation of auditory evoked potentials in prematures: influence of gestational age and sex]

In humans, the onset of the auditory function occurs at the beginning of the third trimester of pregnancy. Brainstem auditory evoked potentials (BAEPs) can be recorded in preterm neonates as early as 25-26 weeks of gestational age. The latency of BAEP waves show a significant decrease according to increasing age to achieve adult values at the end of the first month after birth for wave I and near 3 to 5 years old for waves III and V. Auditory evoked responses are influenced by gender, notably with significantly higher wave latencies in males than in females. These gender differences in auditory function appear early in humans, some being observed as soon as 34 weeks of gestational age.

Why do women have rheumatic disease?

If gonadal hormones are responsible for the female predominance (gender discrepancy, sexual dimorphism) that characterizes most autoimmune rheumatic diseases, pregnancy should be a particularly vulnerable period for onset of new disease as well as for exacerbation of established disease. Currently available data support neither the contention: that pregnancy increases incidence nor that it worsens severity of the common illnesses. Moreover, many illnesses pathogenetically similar to rheumatic diseases have the same hormonal background but are not characterized by sexual dimorphism. In nonrheumatic sexually dimorphic illnesses an environmental, behavioral, or genetic reason for gender discrepancy is usually present. To explain sexual dimorphism in the autoimmune rheumatic diseases, the fields of environmental, genetic, chromosomal, and in utero sex differentiation need further exploration.