The use of distortion product otoacoustic emissions in the estimation of hearing and sensory cell loss in noise-damaged cochleas

Noise exposure levels predict blood levels of the inner ear protein prestin

Serological biomarkers of inner ear proteins are a promising new approach for studying human hearing. Here, we focus on the serological measurement of prestin, a protein integral to a human’s highly sensitive hearing, expressed in cochlear outer hair cells (OHCs). Building from recent nonhuman studies that associated noise-induced OHC trauma with reduced serum prestin levels, and studies suggesting subclinical hearing damage in humans regularly engaging in noisy activities, we investigated the relation between serum prestin levels and environmental noise levels in young adults with normal clinical audiograms. We measured prestin protein levels from circulating blood and collected noise level data multiple times over the course of the experiment using body-worn sound recorders. Results indicate that serum prestin levels have a negative relation with noise exposure: individuals with higher routine noise exposure levels tended to have lower prestin levels. Moreover, when grouping participants based on their risk for a clinically-significant noise-induced hearing loss, we found that prestin levels differed significantly between groups, even though behavioral hearing thresholds were similar. We discuss possible interpretations for our findings including whether lower serum levels may reflect subclinical levels of OHC damage, or possibly an adaptive, protective mechanism in which prestin expression is downregulated in response to loud environments.

Nondeterministic nature of sensorineural outcomes following noise trauma

Over 1.1 billion individuals are at risk for noise induced hearing loss yet there is no accepted therapy. A long history of research has demonstrated that excessive noise exposure will kill outer hair cells (OHCs). Such observations have fueled the notion that dead OHCs underlie hearing loss. Therefore, previous and current therapeutic approaches are based on preventing the loss of OHCs. However, the relationship between OHC loss and hearing loss is at best a modest correlation. This suggests that in addition to the death of OHCs, other mechanisms may regulate the type and degree of hearing loss. In the current study, we tested the hypothesis that permanent noise-induced-hearing loss is consequent to additional mechanisms beyond the noise dose and the death of OHCs. Hooded male rats were randomly divided into noise and control groups. Morphological and physiological assessments were conducted on both groups. The combined results suggest that beyond OHC loss, the surviving cochlear elements shape sensorineural outcomes, which can be nondeterministic. These findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead OHCs.

Summary: The current findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead cells.

Non-Monotonic Relation between Noise Exposure Severity and Neuronal Hyperactivity in the Auditory Midbrain

The occurrence of tinnitus can be linked to hearing loss in the majority of cases, but there is nevertheless a large degree of unexplained heterogeneity in the relation between hearing loss and tinnitus. Part of the problem might be that hearing loss is usually quantified in terms of increased hearing thresholds, which only provides limited information about the underlying cochlear damage. Moreover, noise exposure that does not cause hearing threshold loss can still lead to “hidden hearing loss” (HHL), i.e., functional deafferentation of auditory nerve fibers (ANFs) through loss of synaptic ribbons in inner hair cells. While it is known that increased hearing thresholds can trigger increases in spontaneous neural activity in the central auditory system, i.e., a putative neural correlate of tinnitus, the central effects of HHL have not yet been investigated. Here, we exposed mice to octave-band noise at 100 and 105 dB SPL to generate HHL and permanent increases of hearing thresholds, respectively. Deafferentation of ANFs was confirmed through measurement of auditory brainstem responses and cochlear immunohistochemistry. Acute extracellular recordings from the auditory midbrain (inferior colliculus) demonstrated increases in spontaneous neuronal activity (a putative neural correlate of tinnitus) in both groups. Surprisingly, the increase in spontaneous activity was most pronounced in the mice with HHL, suggesting that the relation between hearing loss and neuronal hyperactivity might be more complex than currently understood. Our computational model indicated that these differences in neuronal hyperactivity could arise from different degrees of deafferentation of low-threshold ANFs in the two exposure groups. Our results demonstrate that HHL is sufficient to induce changes in central auditory processing, and they also indicate a non-monotonic relationship between cochlear damage and neuronal hyperactivity, suggesting an explanation for why tinnitus might occur without obvious hearing loss and conversely why hearing loss does not always lead to tinnitus.

Tinnitus in men, mice (as well as other rodents), and machines

The phantom auditory sensation of tinnitus is now studied in humans, animals, and computer models, and our understanding of how tinnitus is triggered and which neural mechanisms give rise to the phantom sensation in the brain has increased considerably. In most cases, tinnitus is associated with hearing loss, and even tinnitus patients with normal hearing thresholds might have cochlear damage that is not detected through conventional audiometry, as has been recently shown through auditory brainstem response measurements. Animals show behavioural signs of tinnitus after induction of hearing loss, indicating a causal relation. Moreover, surgical reduction of hearing loss in otosclerosis can reduce or even abolish tinnitus. However, hearing loss does not always lead to tinnitus. Psychophysical measurements have indicated that certain types of cochlear damage might be more closely linked to tinnitus than others. Recent animal studies have used behavioural testing to distinguish between animals with and without tinnitus after noise exposure. Comparisons between these groups of animals have helped identify neural correlates of tinnitus as well as factors that could represent a predisposition for tinnitus. Human neuroimaging studies have also begun to separate the neural signature of tinnitus from other consequences of hearing loss. The functional mechanisms that could underlie tinnitus development tinnitus have been analysed in computational modelling studies, which indicate that tinnitus could be a side-effect of the brain's attempt to compensate for hearing loss. Even though causal treatments for tinnitus are currently not available, hearing aids can provide considerable benefit when used in conjunction with counselling, tinnitus retraining therapy or cognitive behavioural therapy. Finally, animal studies demonstrate that the development of chronic noise-induced tinnitus might be prevented through timely interventions after noise exposure. This article is part of a Special Issue entitled <Annual Reviews 2014>.

Using a dynamic tracking filter to extract distortion-product otoacoustic emissions evoked with swept-tone signals

Distortion-product otoacoustic emissions (DPOAEs) are sound energy generated by healthy inner ears when stimulated by two tones. Since DPOAEs are physiologically related with the functional status of the inner ear, they have been widely used as a clinical tool in hearing screening and diagnoses. Currently, almost all DPOAEs recording systems use pure tones as the stimuli and can test only one frequency at a time, resulting in low efficiency and insufficient resolution. In this study, conventional pure tones were replaced by swept tones with time-varying frequencies to overcome the limitation of current DPOAEs measurements. A tracking filter with dynamic center frequencies was proposed to extract the swept-tone DPOAEs from recorded signals with stimulus artifacts and background noises. The results of this study showed that the dynamic tracking filter had great performance in effectively extracting the swept-tone DPOAEs under different noise conditions for both the simulation and experimental data. The spectrogram of the extracted swept-tone DPOAEs could provide useful information to examine the functional status of the inner ear and to identify the detailed frequency regions of the hearing loss. These preliminary findings suggested that the swept-tone DPOAEs might be useful for developing a more efficient and accurate tool for hearing loss screening in the clinic.

The effect of impulse noise on distortion product otoacoustic emissions

The aim of this study was the evaluation of distortion product otoacoustic emissions (DPOAEs) before and after noise exposure from shooting, and the comparison of DPOAEs with pure-tone audiometry. Thirteen young male police officers were exposed to impulse noise from shooting, without using earplugs. Standard pure-tone audiometry, tympanometry, and DPOAEs were performed before exposure and at one hour post- and 24 hour post-exposure. In the one hour post-exposure testing mean pure-tone thresholds were elevated in the 1-8 kHz frequency zone and DPOAE levels were reduced at several frequencies. DPOAEs were more affected at 3 kHz or lower, whereas pure-tone thresholds were more affected at higher frequencies. After the final examination, non-significant partial shifts at high frequencies on both tests remained. Pure-tone audiometry was overall more sensitive, but DPOAEs provided additional information about the cochlear status of certain ears. These data suggest that besides behavioral testing, DPOAEs may play a role as a fast, objective, and easy to perform test for monitoring subjects exposed to impulse noise.

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.

Detecting incipient inner-ear damage from impulse noise with otoacoustic emissions

Audiometric thresholds and otoacoustic emissions (OAEs) were measured in 285 U.S. Marine Corps recruits before and three weeks after exposure to impulse-noise sources from weapons' fire and simulated artillery, and in 32 non-noise-exposed controls. At pre-test, audiometric thresholds for all ears were <or=25 dB HL from 0.5 to 3 kHz and <or=30 dB HL at 4 kHz. Ears with low-level or absent OAEs at pre-test were more likely to be classified with significant threshold shifts (STSs) at post-test. A subgroup of 60 noise-exposed volunteers with complete data sets for both ears showed significant decreases in OAE amplitude but no change in audiometric thresholds. STSs and significant emission shifts (SESs) between 2 and 4 kHz in individual ears were identified using criteria based on the standard error of measurement from the control group. There was essentially no association between the occurrence of STS and SES. There were more SESs than STSs, and the group of SES ears had more STS ears than the group of no-SES ears. The increased sensitivity of OAEs in comparison to audiometric thresholds was shown in all analyses, and low-level OAEs indicate an increased risk of future hearing loss by as much as ninefold.

Long term effects of BAPTA in scala media on cochlear function

BAPTA was iontophoresed or allowed to diffuse into the scala media of the first turn of the guinea pig cochlea via pipettes inserted through the round window and basilar membrane. Cochlear action potential (CAP) thresholds for basal turn frequencies were elevated, scala media cochlear microphonic in response to a 207Hz tone were drastically reduced and the distortion products 2f1-f2 and f2-f2 in response to primaries set at 18 and 21.6kHz were eliminated or severely reduced. The animals were recovered and the above measurements repeated between 24 and 240h after the application of BAPTA. In all animals thresholds for basal turn frequencies remained elevated, and the distortion components were severely reduced. The endolymphatic potential (EP), measured through the basilar membrane on recovery, was not significantly different from the values measured before BAPTA was applied. If the effect of BAPTA, in lowering endolymphatic Ca(2+) concentration, is restricted to the destruction of tip links, as has been shown in many other preparations, then these results suggest that this effect has permanent consequences, either because the tip links failed to regenerate or because their destruction precipitated the degeneration of OHCs. These results may have a bearing on the mechanisms behind permanent threshold shift.

The cochleogram of the guinea pig

The cochleogram is an important tool to relate properties of the cochlea (e.g. hair cell loss, damaged hair cells) to their position in the cochlear turns, to calculate the average hair cell density, and to measure the length of the whole cochlea. In this work different methods of plotting cochleograms are compared. We suggest that a sector-wise division of the cochlea for counting a cochleogram has advantages over line diagrams that provide a higher spatial resolution but might lead to misinterpretations of the degree of missing hair cells. The scanning electron microscopic analysis of 171 guinea pig cochleas revealed a mean basilar membrane length of 16.4 +/- 1.4 mm (mean +/- standard deviation) with sector lengths of 6.9, 4.2, 3.2, and 1.9 mm, thus adding relevant information to the morphology of the guinea pig cochlea.

Distortion-product otoacoustic emission suppression growth in normal and noise-exposed rabbits

This study investigated noise-induced changes in suppression growth (SG) of distortion product otoacoustic emissions (DPOAEs). Detailed measurements of SG were obtained in rabbits as a function of f2 frequencies at four primary-tone levels. SG measures were produced by using suppressor tones (STs) presented at two fixed distances from f2. The magnitude of suppression was calculated for each ST level and depicted as contour plots showing the amount of suppression as a function of the f2 frequency. At each f2, SG indices included slope, suppression threshold, and an estimate of the tip-to-tail value. All suppression measures were obtained before and after producing a cochlear dysfunction using a monaural exposure to a 2-h, 110-dB SPL octave-band noise centered at 2 kHz. The noise exposure produced varying amounts of cochlear damage as revealed by changes in DP-grams and auditory brainstem responses. However, average measures of SG slopes, suppression thresholds, and tip-to-tail values failed to mirror the mean DP-gram loss patterns. When suppression-based parameters were correlated with the amount of DPOAE loss, small but significant correlations were observed for some measures. Overall, the findings suggest that measures derived from DPOAE SG are limited in their ability to detect noise-induced cochlear damage.

Distortion-product otoacoustic emission spectra and high-resolution audiometry in noise-induced hearing loss

Distortion product otoacoustic emissions (DPOAE) elicited by 60dB SPL pure tones at f1 and f2 were collected at 2f1-f2, in 1/10th octave steps, in a sample of 36 ears from 27 patients with noise-induced hearing loss (NIHL). They were analyzed in the frequency domain against the outcome of high-resolution pure-tone audiometry, performed with the help of a Békésy sweep-frequency automatic audiometer. The characteristics of DPOAE level plots as a function of frequency (the so-called DP-grams), relative to the DPOAE levels of a control age-matched group, were compared to their alleged counterparts on the audiograms, i.e., the lower and upper frequency boundaries of the interval with hearing loss. Ears with NIHL split into two subgroups, one (n = 25) with a notch in the DP-gram such that its lower boundary matched the lower limit of the audiometric notch (linear regression with a slope of 0.91, r(2) = 0.644, p < 0.001). Likewise, when it existed, its upper boundary matched its upper counterpart on the audiogram (linear regression with a slope of 0.96, r(2) = 0.89, p < 0.001). In this respect, DP-grams performed better than transient-evoked OAE spectra, which exhibited poor correlations with audiogram patterns. The second subgroup (n = 11) exhibited normal DPOAEs at all frequencies despite audiometric losses similar to those of the first subgroup. In all cases, DPOAE levels were poor predictors of the degree of hearing losses. It is hypothesized that NIHL in the second subgroup involves inner hair cells or auditory neurons, instead of outer hair cells in the first subgroup. Provided NIHL affected outer hair cells, DP-grams provided a comparatively accurate predictor of the spectral extent of hearing loss.

Frequency-specific cochlear damage in guinea pig after exposure to different types of realistic industrial noise

For the causal evaluation of occupational hearing damage it is important to identify definitely the noise source. Here we tested, whether recordings of distortion product otoacoustic emissions (DPOAEs) in awake guinea pigs can distinguish the effects of different industrial noises. Six groups of 12 animals each were investigated before and over four months after a single 2 h exposure to specific, played-back industrial noise as well as before and for 2 months after impulse noise exposure. We compared broadband noise (buzz saw, bottle washing machine), low frequency noise (drawing press), and mid-frequency noise (bottle filling machine). All animals had stable DPOAE levels before noise exposure. Frequency specific decreases in DPOAEs were found after exposure to the different noises. Broadband noise diminished mostly all frequencies tested, whereas low- or mid-frequency noise had a greater effect on DPOAE evoked by middle and higher frequencies, respectively. DPOAE evoked by middle and higher frequencies were obliterated after impulse noise. Morphological analysis of the cochleae confirmed these alterations. OHC loss was found in the middle turns of the cochleae corresponding to the diminution of DPOAE. We conclude that different kinds of industrial noise tend to produce typical changes in DPOAE levels.

Sensorineural hearing loss in patients with cerebral palsy after asphyxia and hyperbilirubinemia

The location of lesions causing hearing loss in patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia has remained unclear. We performed behavioral audiometry, distortion product otoacoustic emission (DPOAE) and auditory brainstem evoked response (ABR) in six patients with cerebral palsy due to asphyxia or neonatal hyperbilirubinemia in order to determine the lesion location causing their hearing impairment. In all cases, behavioral audiometry revealed a threshold elevation of 50-75 dB and ABR were no response. DPOAE were totally absent in five patients and normal in one patient. Our study suggests that lesions causing hearing loss potentially include the organ of Corti especially at the outer hair cells and the cochlear nerve.

Predicting severity of cochlear hair cell damage in adult chickens using DPOAE input-output functions

Distortion product otoacoustic emissions (DPOAE) were recorded from the ear canal of aged broiler chickens which have been shown to present with age-related cochlear degeneration [Hear. Res. 166 (2002) 82]. We describe the relationship between the shape of the DPOAE input-output (I/O) function and the type of hair cell damage present at and between the cochlear frequency places of the DPOAE primary tones (f1 and f2). The mid stimulus level compressive growth of the mean DPOAE I/O functions is reduced in a graded fashion relative to the severity of hair cell damage. However, individual DPOAE I/O functions within most hair cell damage groups show large variability from this characteristic. Various least squares regression models were used to predict hair cell density from indices derived from the DPOAE I/O function (area, threshold and slope). The results showed that no simple linear relationship exists between hair cell density and the DPOAE I/O function indices. Multivariate binary logistic regression used DPOAE I/O function indices to predict membership in hair cell damage groups. The logistic model revealed that DPOAE threshold can be used to predict the occurrence of severe/total hair cell damage with good specificity though poor sensitivity.

Effects of 900 MHz electromagnetic fields exposure on cochlear cells' functionality in rats: Evaluation of distortion product otoacoustic emissions

In recent years, the widespread use of mobile phones has been accompanied by public debate about possible adverse consequences on human health. The auditory system is a major target of exposure to electromagnetic fields (EMF) emitted by cellular telephones; the aim of this study was the evaluation of possible effects of cellular phone-like emissions on the functionality of rat's cochlea. Distortion Products OtoAcoustic Emission (DPOAE) amplitude was selected as cochlea's outer hair cells (OHC) status indicator. A number of protocols, including different frequencies (the lower ones in rat's cochlea sensitivity spectrum), intensities and periods of exposure, were used; tests were carried out before, during and after the period of treatment. No significant variation due to exposure to microwaves has been evidenced.

Is there a close relationship between changes in amplitudes of distortion product otoacoustic emissions and hair cell damage after exposure to realistic industrial noise in guinea pigs?

In long-term experiments in awake guinea pigs (n = 12), distortion product otoacoustic emissions (DPOAEs) at various frequencies were measured repeatedly over 6-8 months. About 9 weeks after the first measurement, the animals were exposed to industrial noise (car industry, maximal intensity about 110 dB SPL) for 2 h. The amplitudes of DPOAE were measured prior to noise exposure and 10 min, 70 min, 1 day and 2 days after the noise exposure and then once every week. Three to four months after noise exposure, the animals were killed, and the cochleae were prepared for scanning electron microscopy. The row of inner hair cells (IHCs) was complete in all animals, while the rows of outer hair cells (OHCs) showed a considerable hair cell loss in some of the animals without a correlation to the change in amplitudes of DPOAE. However, a closer relationship between the decline of amplitudes of DPOAE and the number of missing and changed OHCs (fused stereocilia bundles, missing tip links) could be established. The number of lost OHC does not reflect the decline in DPOAE in all cases. This discrepancy must be considered when the degree of hearing loss needs to be established from changed DPOAE.

Progressive Bilateral Sensorineural Hearing Loss Induced by an Antithyroid Drug

We report a patient with antithyroid drug-induced progressive bilateral sensorineural hearing loss associated with myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA). While antithyroid drugs have been linked to MPO-ANCA-associated small-vessel vasculitis, sensorineural hearing loss rarely was noted. A 36-year-old man treated for hyperthyroidism with propylthiouracil (PTU) developed progressive bilateral sensorineural hearing loss accompanied by fever and arthritis. MPO-ANCA were demonstrated in serum. Distortion product otoacoustic emissions test results suggested dysfunction of outer hair cells of the organ of Corti. Inner ear blood flow impairment from ANCA-associated small-vessel vasculitis presumably caused cochlear dysfunction. PTU withdrawal and high-dose methylprednisolone administration greatly improved hearing on both sides.

Temporary DPOAE level shifts, ABR threshold shifts and histopathological damage following below-critical-level noise exposures

DPOAE temporary level shift (TLS) at 2f(1)-f(2) and f(2)-f(1), ABR temporary threshold shift (TTS), and detailed histopathological findings were compared in three groups of chinchillas that were exposed for 24 h to an octave band of noise (OBN) centered at 4 kHz with a sound pressure level (SPL) of 80, 86 or 92 dB (n=3,4,6). DPOAE levels at 39 frequencies from f(1)=0.3 to 16 kHz (f(2)/f(1)=1.23; L(2) and L(1)=55, 65 and 75 dB, equal and differing by 10 dB) and ABR thresholds at 13 frequencies from 0.5 to 20 kHz were collected pre- and immediately post-exposure. The functional data were converted to pre- minus post-exposure shift and overlaid upon the cytocochleogram of cochlear damage using the frequency-place map for the chinchilla. The magnitude and frequency place of components in the 2f(1)-f(2) TLS patterns were determined and group averages for each OBN SPL and L(1), L(2) combination were calculated. The f(2)-f(1) TLS was also examined in ears with focal lesions equal to or greater than 0.4 mm. The 2f(1)-f(2) TLS (plotted at f(1)) and TTS aligned with the extent and location of damaged supporting cells. The TLS patterns over frequency had two features which were unexpected: (1) a peak at about a half octave above the center of the OBN with a valley just above and below it and (2) a peak (often showing enhancement) at the apical boundary of the supporting-cell damage. The magnitudes of the TLS and TTS generally increased with increasing SPL of the exposure. The peaks of the TLS and TTS, as well as the peaks and valleys of the TLS pattern moved apically as the SPL of the OBN was increased. However, there was little consistency in the pattern relations with differing L(1), L(2) combinations. In addition, neither the 2f(1)-f(2) nor f(2)-f(1) TLS for any L(1), L(2) combination reliably detected focal lesions (100% OHC loss) from 0.4 to 1.2 mm in size. Often, the TLS went in the opposite direction from what would be expected at focal lesions. Recovery from TLS and TTS was also examined in seven animals. Both TLS and TTS recovered partially or completely, the magnitude depending upon exposure SPL.