Suppression and enhancement of distortion-product otoacoustic emissions by interference tones above f(2). I. Basic findings in rabbits

Emerging Distortion Product Otoacoustic Emission Techniques to Identify Preclinical Warning Signs of Basal Cochlear Dysfunction Due to Ototoxicity

Hundreds of medications commonly prescribed for anticancer treatments and some infections are known to cause hearing damage, referred to as ototoxicity. Preventing or minimizing ototoxicity is critical in order to preserve quality of life for patients receiving treatment and to reduce the societal burden of hearing loss. Current clinical evaluations are restricted to a limited frequency range (≤8 kHz); however, this approach does not permit the earliest detection of ototoxicity, most likely to be observed at the highest frequencies (9–20 kHz). Distortion product otoacoustic emissions (DPOAEs) offer a noninvasive, objective approach to monitor cochlear health in those unable to respond via conventional methods. The current report analyzes different DPOAE paradigms used in patients undergoing chemotherapy treatments with various platinum derivatives. Individualized serial monitoring protocols were completed at the highest frequencies with measurable DPOAEs. This allowed the exploration of potential clinical translation opportunities for further quantification of the earliest signs of underlying cochlear damage, which may go undetected with conventional methods. Clinical practice has the potential to be enhanced by emerging DPOAE applications, including targeted monitoring protocols and high-frequency stimuli to assess cochlear function, especially at the highest frequencies, and advanced calibration techniques to ensure the stability of serial measurements.

Distributed sources as a cause of abrupt amplitude decrease in cubic distortion-product otoacoustic emissions at high stimulus intensities

The amplitudes of distortion-product otoacoustic emissions (DPOAEs) may abruptly decrease even though the stimulus level is relatively high. These notches observed in the DPOAE input/output functions or distortion-product grams have been hypothesized to be due to destructive interference between wavelets generated by distributed sources of the nonlinear-distortion component of DPOAEs. In this paper, simulations with a smooth cochlear model and its analytical solution support the hypothesis that destructive interference between individual wavelets may lead to the amplitude notches and explain the cause for onset and offset amplitude overshoots in the DPOAE signal measured for intensity pairs in the notches.

Amplification and Suppression of Traveling Waves along the Mouse Organ of Corti: Evidence for Spatial Variation in the Longitudinal Coupling of Outer Hair Cell-Generated Forces

Mammalian hearing sensitivity and frequency selectivity depend on a mechanical amplification process mediated by outer hair cells (OHCs). OHCs are situated within the organ of Corti atop the basilar membrane (BM), which supports sound-evoked traveling waves. It is well established that OHCs generate force to selectively amplify BM traveling waves where they peak, and that amplification accumulates from one location to the next over this narrow cochlear region. However, recent measurements demonstrate that traveling waves along the apical surface of the organ of Corti, the reticular lamina (RL), are amplified over a much broader region. Whether OHC forces accumulate along the length of the RL traveling wave to provide a form of "global" cochlear amplification is unclear. Here we examined the spatial accumulation of RL amplification. In mice of either sex, we used tones to suppress amplification from different cochlear regions and examined the effect on RL vibrations near and far from the traveling-wave peak. We found that although OHC forces amplify the entire RL traveling wave, amplification only accumulates near the peak, over the same region where BM motion is amplified. This contradicts the notion that RL motion is involved in a global amplification mechanism and reveals that the mechanical properties of the BM and organ of Corti tune how OHC forces accumulate spatially. Restricting the spatial buildup of amplification enhances frequency selectivity by sharpening the peaks of cochlear traveling waves and constrains the number of OHCs responsible for mechanical sensitivity at each location.SIGNIFICANCE STATEMENT Outer hair cells generate force to amplify traveling waves within the mammalian cochlea. This force generation is critical to the ability to detect and discriminate sounds. Nevertheless, how these forces couple to the motions of the surrounding structures and integrate along the cochlear length remains poorly understood. Here we demonstrate that outer hair cell-generated forces amplify traveling-wave motion on the organ of Corti throughout the wave's extent, but that these forces only accumulate longitudinally over a region near the wave's peak. The longitudinal coupling of outer hair cell-generated forces is therefore spatially tuned, likely by the mechanical properties of the basilar membrane and organ of Corti. Our findings provide new insight into the mechanical processes that underlie sensitive hearing.

Vibration hotspots reveal longitudinal funneling of sound-evoked motion in the mammalian cochlea

The micromechanical mechanisms that underpin tuning and dynamic range compression in the mammalian inner ear are fundamental to hearing, but poorly understood. Here, we present new, high-resolution optical measurements that directly map sound-evoked vibrations on to anatomical structures in the intact, living gerbil cochlea. The largest vibrations occur in a tightly delineated hotspot centering near the interface between the Deiters' and outer hair cells. Hotspot vibrations are less sharply tuned, but more nonlinear, than basilar membrane vibrations, and behave non-monotonically (exhibiting hyper-compression) near their characteristic frequency. Amplitude and phase differences between hotspot and basilar membrane responses depend on both frequency and measurement angle, and indicate that hotspot vibrations involve longitudinal motion. We hypothesize that structural coupling between the Deiters' and outer hair cells funnels sound-evoked motion into the hotspot region, under the control of the outer hair cells, to optimize cochlear tuning and compression.

Effects of Oxaliplatin, Carboplatin, and Cisplatin Across Treatment on High-Frequency Objective and Subjective Auditory Measures in Adults

Platinum chemotherapies are often ototoxic, initially affecting the basal end of the cochlea. Thus, monitoring high-frequency auditory function is advised to reveal early damage. Objective measures of high-frequency auditory function are repeatable over time, but the sensitivity of these measures for monitoring patients receiving platinum derivatives have not been established. We monitored 13 patients across oxaliplatin, carboplatin, or cisplatin treatment using the highest frequencies with responses for each individual. Behavioral thresholds and distortion product otoacoustic emission (DPOAE) gross frequency (f2=16–2 kHz) and concentrated frequency (1/48 octave steps at the highest frequency with a present DPOAE) sweeps were monitored. DPOAE results indicated changes during treatment within individuals using absolute change criteria, as well as statistically significant differences across trial when analyzing group data. Changes varied depending on the drug administered. Behavioral thresholds changed less often than DPOAE measures and when changes were noted, they initially occurred at the highest frequencies monitored. Often, DPOAE changes occurred at frequencies which conventional equipment could not monitor (>8 kHz). Additionally, some changes were characterized by DPOAE level enhancements at conventional frequencies (<8 kHz), while levels at higher frequencies were reduced. Overall, objective high-frequency measures were sensitive to auditory changes in adults undergoing platinum chemotherapy treatment.

Simultaneous Intracochlear Pressure Measurements from Two Cochlear Locations: Propagation of Distortion Products in Gerbil

Sound energy propagates in the cochlea through a forward-traveling or slow wave supported by the cochlear partition and fluid inertia. Additionally, cochlear models support traveling wave propagation in the reverse direction as the expected mechanism for conveying otoacoustic emissions out of the cochlea. Recently, however, this hypothesis has been questioned, casting doubt on the process by which otoacoustic emissions travel back out through the cochlea. The proposed alternative reverse travel path for emissions is directly through the fluids of the cochlea as a compression pressure in the form of a fast wave. In the present study, a custom-made micro-pressure sensor was used in vivo in the gerbil cochlea to map two-tone-evoked pressure responses at distinct longitudinal and vertical locations in both the scala tympani and scala vestibuli. Analyses of the magnitude and phase of intracochlear pressure responses at the primary tone and distortion product frequencies were used to distinguish between fast and slow waves in both the forward- and reverse-propagation directions. Results demonstrated that distortion products may travel in both forward and reverse directions post-generation and the existence of both traveling and compression waves. The forward-traveling component appeared to duplicate the process of any external tone, tuned to the local characteristic-frequency place, as it increased compressively and nonlinearly with primary-tone levels. A compression wave was evidenced at frequencies above the cutoff of the recording site. In the opposite direction, a reverse-traveling wave played the major role in driving the stapes reversely and contributed to the distortion product otoacoustic emission. The compression wave may also play a role in reverse propagation when distortion products are generated at a region close to the stapes.

Comparing Distortion Product Otoacoustic Emissions to Intracochlear Distortion Products Inferred from a Noninvasive Assay

The behavior of intracochlear distortion products (iDPs) was inferred by interacting a probe tone (f3) with the iDP of interest to produce a "secondary" distortion product otoacoustic emission termed DPOAE(2ry). Measures of the DPOAE(2ry) were then used to deduce the properties of the iDP. This approach was used in alert rabbits and anesthetized gerbils to compare ear-canal 2f1-f2 and 2f2-f1 DPOAE f2/f1 ratio functions, level/phase (L/P) maps, and interference-response areas (IRAs) to their simultaneously collected DPOAE(2ry) counterparts. These same measures were also collected in a human volunteer to demonstrate similarities with their laboratory animal counterparts and their potential applicability to humans. Results showed that DPOAEs and inferred iDPs evidenced distinct behaviors and properties. That is, DPOAE ratio functions elicited by low-level primaries peaked around an f2/f1 = 1.21 or 1.25, depending on species, while the corresponding inferred iDP ratio functions peaked at f2/f1 ratios of ~1. Additionally, L/P maps showed rapid phase variation with DPOAE frequency (fdp) for the narrow-ratio 2f1-f2 and all 2f2-f1 DPOAEs, while the corresponding DPOAE(2ry) measures evidenced relatively constant phases. Common features of narrow-ratio DPOAE IRAs, such as large enhancements for interference tones (ITs) presented above f2, were not present in DPOAE(2ry) IRAs. Finally, based on prior experiments in gerbils, the behavior of the iDP directly measured in intracochlear pressure was compared to the iDP inferred from the DPOAE(2ry) and found to be similar. Together, these findings are consistent with the notion that under certain conditions, ear-canal DPOAEs provide poor representations of iDPs and thus support a "beamforming" hypothesis. According to this concept, distributed emission components directed toward the ear canal from the f2 and basal to f2 regions can be of differing phases and thus cancel, while these same components directed toward fdp add in phase.

Tuning of SFOAEs Evoked by Low-Frequency Tones Is Not Compatible with Localized Emission Generation

Stimulus-frequency otoacoustic emissions (SFOAEs) appear to be well suited for assessing frequency selectivity because, at least on theoretical grounds, they originate over a restricted region of the cochlea near the characteristic place of the evoking tone. In support of this view, we previously found good agreement between SFOAE suppression tuning curves (SF-STCs) and a control measure of frequency selectivity (compound action potential suppression tuning curves (CAP-STC)) for frequencies above 3 kHz in chinchillas. For lower frequencies, however, SF-STCs and were over five times broader than the CAP-STCs and demonstrated more high-pass rather than narrow band-pass filter characteristics. Here, we test the hypothesis that the broad tuning of low-frequency SF-STCs is because emissions originate over a broad region of the cochlea extending basal to the characteristic place of the evoking tone. We removed contributions of the hypothesized basally located SFOAE sources by either pre-suppressing them with a high-frequency interference tone (IT; 4.2, 6.2, or 9.2 kHz at 75 dB sound pressure level (SPL)) or by inducing acoustic trauma at high frequencies (exposures to 8, 5, and lastly 3-kHz tones at 110-115 dB SPL). The 1-kHz SF-STCs and CAP-STCs were measured for baseline, IT present and following the acoustic trauma conditions in anesthetized chinchillas. The IT and acoustic trauma affected SF-STCs in an almost indistinguishable way. The SF-STCs changed progressively from a broad high-pass to narrow band-pass shape as the frequency of the IT was lowered and for subsequent exposures to lower-frequency tones. Both results were in agreement with the "basal sources" hypothesis. In contrast, CAP-STCs were not changed by either manipulation, indicating that neither the IT nor acoustic trauma affected the 1-kHz characteristic place. Thus, unlike CAPs, SFOAEs cannot be considered as a place-specific measure of cochlear function at low frequencies, at least in chinchillas.

Auditory Distortions: Origins and Functions

To enhance weak sounds while compressing the dynamic intensity range, auditory sensory cells amplify sound-induced vibrations in a nonlinear, intensity-dependent manner. In the course of this process, instantaneous waveform distortion is produced, with two conspicuous kinds of interwoven consequences, the introduction of new sound frequencies absent from the original stimuli, which are audible and detectable in the ear canal as otoacoustic emissions, and the possibility for an interfering sound to suppress the response to a probe tone, thereby enhancing contrast among frequency components. We review how the diverse manifestations of auditory nonlinearity originate in the gating principle of their mechanoelectrical transduction channels; how they depend on the coordinated opening of these ion channels ensured by connecting elements; and their links to the dynamic behavior of auditory sensory cells. This paper also reviews how the complex properties of waves traveling through the cochlea shape the manifestations of auditory nonlinearity. Examination methods based on the detection of distortions open noninvasive windows on the modes of activity of mechanosensitive structures in auditory sensory cells and on the distribution of sites of nonlinearity along the cochlear tonotopic axis, helpful for deciphering cochlear molecular physiology in hearing-impaired animal models. Otoacoustic emissions enable fast tests of peripheral sound processing in patients. The study of auditory distortions also contributes to the understanding of the perception of complex sounds.

Time-domain demonstration of distributed distortion-product otoacoustic emission components

Distortion-product otoacoustic emissions (DPOAEs) were measured in rabbits as time waveforms by employing a phase-rotation technique to cancel all components in the final average, except the 2f1-f2 DPOAE. Subsequent filtering allowed the DPOAE waveform to be clearly visualized in the time domain. In most conditions, f2 was turned off for 6 ms, which produced a gap so that the DPOAE was no longer generated. These procedures allowed the DPOAE onset as well as the decay during the gap to be observed in the time domain. DPOAEs were collected with L1 = L2 = 65-dB sound pressure level primary-tone levels for f2/f1 ratios from 1.25 to 1.01 in 0.02 steps. Findings included the appearance of complex onsets and decays for the DPOAE time waveforms as the f2/f1 ratio was decreased and the DPOAE level was reduced. These complexities were unaffected by interference tones (ITs) near the DPOAE frequency place (fdp), but could be removed by ITs presented above f2, which also increased DPOAE levels. Similar outcomes were observed when DPOAEs were measured at a sharp notch in the DPOAE level as a function of the f2 primary tone frequency, i.e., DP-gram. Both findings were consistent with the hypothesis that the DPOAE-ratio function, and some notches in the DP-gram, are caused by interactions of distributed DPOAE components with unique phases.

Characterizing distortion-product otoacoustic emission components across four species

Distortion-product otoacoustic emissions (DPOAEs) were measured as level/phase (L/P) maps in humans, rabbits, chinchillas, and rats with and without an interference tone (IT) placed either near the 2f(1)-f(2) DPOAE frequency place (f(dp)) or at one-third of an octave above the f(2) primary tone (1/3-oct IT). Vector differences between with and without IT conditions were computed to derive a residual composed of the DPOAE components removed by the IT. In humans, a DPOAE component could be extracted with the expected steep phase gradient indicative of reflection emissions by ITs near f(dp). In the laboratory species, ITs near f(dp) failed to produce any conclusive evidence for reflection components. For all species, 1/3-oct ITs extracted large DPOAE components presumably generated at or basal to the IT-frequency place that exhibited both distortion- and reflection-like phase properties. Together, these findings suggested that basal distortion components could assume reflection-like phase behavior when the assumptions of cochlear-scaling symmetry, the basis for shallow phase gradients for constant f(2)/f(1) ratio sweeps, are violated. The present results contradict the common belief that DPOAE components associated with steep or shallow phase slopes are unique signatures for reflection emissions arising from f(dp) or distortion emissions generated near f(2), respectively.

Evidence for basal distortion-product otoacoustic emission components

Distortion-product otoacoustic emissions (DPOAEs) were measured with traditional DP-grams and level/phase (L/P) maps in rabbits with either normal cochlear function or unique sound-induced cochlear losses that were characterized as either low-frequency or notched configurations. To demonstrate that emission generators distributed basal to the f(2) primary-tone contribute, in general, to DPOAE levels and phases, a high-frequency interference tone (IT) was presented at 1/3 of an octave (oct) above the f(2) primary-tone, and DPOAEs were re-measured as "augmented" DP-grams (ADP-grams) and L/P maps. The vector difference between the control and augmented functions was then computed to derive residual DP-grams (RDP-grams) and L/P maps. The resulting RDP-grams and L/P maps, which described the DPOAEs removed by the IT, supported the notion that basal DPOAE components routinely contribute to the generation of standard measures of DPOAEs. Separate experiments demonstrated that these components could not be attributed to the effects of the 1/3-oct IT on f(2), or DPOAEs generated by the addition of a third interfering tone. These basal components can "fill in" the lesion estimated by the commonly employed DP-gram. Thus, ADP-grams more accurately reveal the pattern of cochlear damage and may eventually lead to an improved DP-gram procedure.

Local cochlear damage reduces local nonlinearity and decreases generator-type cochlear emissions while increasing reflector-type emissions

Distortion product otoacoustic emissions (DPOAEs) originate in cochlear nonlinearity and emerge into the ear canal as an apparent sum of emission types, one of which (generator) travels directly out and the other (reflector) travels out following linear reflection. The present study explores intracochlear sources of DPOAEs via simultaneous ear canal and intracochlear pressure measurements in gerbils. A locally damaged cochlea was produced with reduced local intracochlear nonlinearity and significant elevation of the compound action potential thresholds at frequencies represented within the damaged region. In the DPOAE the comparison of healthy to locally damaged cochleae showed the following: (1) In the broad frequency region corresponding to the locally damaged best frequency, DPOAEs evoked by wider f(2)/f(1) stimuli decreased, consistent with the reduction in local nonlinearity. (2) DPOAEs evoked by narrow f(2)/f(1) stimuli often had a bimodal change, decreasing in a lower frequency band and increasing in a band just adjacent and higher, and the DPOAE phase-vs-frequency slope steepened. These changes confirm the complex nature of the DPOAE.

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.

Dissociation between distortion-product and click-evoked otoacoustic emissions in sheep (Ovis aries)

Distortion-product otoacoustic emissions (DPOAEs) were weak or absent in about one-third of sheep (Ovis aries) of both sexes tested for otoacoustic emissions (OAEs) even though their click-evoked OAEs (CEOAEs) seemingly were typical of other sheep of the same sex. Various pieces of evidence suggest that the absence of measurable DPOAEs was unlikely to be attributable to anesthetic effects, a poorly located probe tip, a pressure differential between middle and outer ears, season of the year, body position during testing, temperature effects, or previous medical history. Sheep apparently can exhibit a marked dissociation between DPOAEs and CEOAEs. In those sheep having measurable DPOAEs, the DPOAEs were stronger in males than in females, which is the opposite direction of effect from the CEOAEs measured in these same sheep and in humans. In female sheep exposed to higher-than-normal levels of androgens during gestation, the measurable DPOAEs were stronger than in untreated females. Although this also was the opposite direction of effect from expected, it still was a shift in the male direction, in accord with past findings about the masculinizing effects of androgens on OAEs. In sheep, androgen exposure appears to have different effects on the mechanisms underlying DPOAEs from those underlying CEOAEs.

Otoacoustic emissions in humans, birds, lizards, and frogs: evidence for multiple generation mechanisms

Many non-mammalian ears lack physiological features considered integral to the generation of otoacoustic emissions in mammals, including basilar-membrane traveling waves and hair-cell somatic motility. To help elucidate the mechanisms of emission generation, this study systematically measured and compared evoked emissions in all four classes of tetrapod vertebrates using identical stimulus paradigms. Overall emission levels are largest in the lizard and frog species studied and smallest in the chicken. Emission levels in humans, the only examined species with somatic hair cell motility, were intermediate. Both geckos and frogs exhibit substantially higher levels of high-order intermodulation distortion. Stimulus frequency emission phase-gradient delays are longest in humans but are at least 1 ms in all species. Comparisons between stimulus-frequency emission and distortion-product emission phase gradients for low stimulus levels indicate that representatives from all classes except frog show evidence for two distinct generation mechanisms analogous to the reflection- and distortion-source (i.e., place- and wave-fixed) mechanisms evident in mammals. Despite morphological differences, the results suggest the role of a scaling-symmetric traveling wave in chicken emission generation, similar to that in mammals, and perhaps some analog in the gecko.

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

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

Basilar membrane mechanics in the 6-9 kHz region of sensitive chinchilla cochleae

The vibration of the basilar membrane in the 6-9 kHz region in the chinchilla cochlea has been studied using a displacement sensitive interferometer. Displacements of 0.7-1.4 nm at 0 dB sound pressure level have been obtained. At the characteristic frequency (CF), rate-of-growth (ROG) functions computed as the slope of input-output (IO) functions can be as low as 0.1 dB/dB. IO functions for frequencies > CF have ROGs near 0 dB/dB and can have notches characterized by both negative slopes and expansive ROGs, i.e., > 1 dB/dB. For frequencies < 0.6*CF, ROGs > 1.2 dB/dB were found. Cochlear gain is shown to be greater than 60 dB in sensitive preparations with a single cochlea having nearly 80 dB gain. The compressive nature of the cochlea remains at all levels though it is masked at frequencies > CF when the amplitude of a compression wave exceeds that of the traveling wave. The compression wave produces the plateau region of the mechanical response at high intensities and has a nearly constant phase versus frequency function implying a high velocity. The summation of the traveling and compression waves explains the occurrence of the notches in both the IO and iso-intensity functions. Vibration of the osseous spiral limbus may alter the drive to inner hair cells.

Characteristic findings of auditory brainstem response and otoacoustic emission in the Bronx waltzer mouse

Auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) were evaluated serially from 1 to 22 months in Bronx waltzer homozygotes (bv/bv), heterozygotes (+/bv) and control (+/+) mice, which were differentiated by means of PCR of marker DNA (D5Mit209). The wave IV threshold of the click-evoked ABR was higher than the DPOAE threshold with the DP growth method in each bv/bv, although the two thresholds were almost the same in the +/+ group. The DP value at 2f(1) - f(2) in the bv/bv showed an apparent decrease at 2 to 3 months of age with 80 dB SPL stimulation using f(2) frequency 7996 Hz and frequency ratio f(2)/f(1) = 1.22, compared to control or heterozygote mice. It was characteristic that the 2f(2) - f(1) DP signal-to-noise ratio (SNR) value was more preserved from 80 to 60 dB SPL than the 2f(1) - f(2) DP value at f(2) frequency 7996 Hz in most bv/bv, however, control mice showed almost the same levels of 2f(1) - f(2) and 2f(2) - f(1) SNR value at both f(2) frequencies of 6006 and 7996 Hz. The preservation of a substantial 2f(2) - f(1) DP suggested that it would be generated basal to the primary-tone place on the basilar membrane and there might be a reflection of the unique function of the remaining outer hair cells in the Bronx waltzer mice. These findings suggest that combination of ABR with DPOAE could offer useful information about differentiating the mechanism of hair cell dysfunction of the hereditary hearing impairment in the clinical fields.

In search of basal distortion product generators

The 2f1-f2 distortion product otoacoustic emission (DPOAE) is thought to arise primarily from the complex interaction of components that come from two different cochlear locations. Such distortion has its origin in the nonlinear interaction on the basilar membrane of the excitation patterns resulting from the two stimulus tones, f1 and f2. Here we examine the spatial extent of initial generation of the 2f1-f2 OAE by acoustically traumatizing the base of the cochlea and so eliminating the contribution of the basal region of the cochlea to the generation of 2f1-f2. Explicitly, amplitude-modulated, or continuously varying in level, stimulus tones with f2/f1= 1.2 and f2 =8000-8940 Hz were used to generate the 2f1-f2 DPOAE in guinea pig before and after acoustically traumatizing the basal region of the cochlea (the origin of any basal-to-f2 distortion product generators). It was found, based on correlation analysis, that there does not appear to be a basal-to-f2 distortion product generation mechanism contributing significantly to the guinea pig 2f1-f2 OAE up to L1 = 80 dB sound pressure level (SPL).

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.

Sex differences in otoacoustic emissions measured in rhesus monkeys (Macaca mulatta)

Click-evoked otoacoustic emissions (CEOAEs) and distortion-product OAEs (DPOAEs) were measured in about 60 rhesus monkeys. CEOAE strength was substantially greater in females than in males, just as in humans. DPOAE strength was generally slightly stronger in females, just as in humans. In males, CEOAEs were weaker (more masculine) in the fall breeding season and in winter than in the summer. In females, CEOAEs were slightly stronger (more feminine) in the fall, when sex steroids are elevated in females (and males), than in the summer when rhesus monkeys are reproductively quiescent. Thus, the sex differences in CEOAEs were greater in the fall than in the summer. We presume that the seasonal fluctuations in OAEs reflect activational hormonal effects, while the basic sex differences in OAEs likely reflect organizational effects of prenatal androgen exposure. Some monkeys of both sexes had been treated with additional testosterone or the anti-androgen flutamide during prenatal development. In accord with expectations, prenatal androgen treatment weakened CEOAEs in females, and prenatal flutamide treatment strengthened CEOAEs in males. For DPOAEs, the differences between treated and untreated groups were mostly small and often inconsistent. Taken as a whole, the data from both rhesus monkeys and humans suggest that the linear, reflection-based mechanism of OAE production that underlies CEOAEs is more sensitive to prenatal androgenic processes than is the nonlinear distortion mechanism that underlies DPOAEs.

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.

A model of real time monitoring of the cochlear function during an induced local ischemia

The aim of this study was to investigate the utility of distortion product otoacoustic emissions (DPOAEs) in intraoperative monitoring (IM) of cochlear ischemic episodes in animals during internal auditory artery (IAA) compression. The IAA was exposed using the posterior fossa approach and then compressed for 3 and 5 min intervals to effect ischemia. DPOAE amplitudes and phases were measured at 4, 8, and 12 kHz geometric mean frequency (GMF). In each monitored ear, laser-Doppler cochlear blood flow (CBF) was measured. All IAA compressions resulted in rapid decrease of DPOAE amplitude and CBF, with simultaneous DPOAE phase increase. DPOAE phase changes were found to increase consistently within several seconds of IAA compression, while corresponding DPOAE amplitudes changed more slowly, with up to 30-40 s delays. Following IAA release, DPOAEs at 12 kHz GMF were characterized by longer delays in returning to baseline than those measured at lower frequencies. In some cases, CBF did not return to baseline. In this animal model, DPOAEs were found to be sensitive measures of cochlear function during transient cochlear ischemic episodes, suggesting the utility of DPOAE monitoring of auditory function during surgery of cerebello-pontine angle tumors.

Human efferent adaptation of DPOAEs in the L1,L2 space

The adaptive properties of distortion product otoacoustic emissions (DPOAEs) at 2f(1)-f2 were investigated in 12 ears of normally hearing adults aged 18-30 years using long-lasting 1-s primary-tone on-times. In this manner, DPOAE adaptation at a single f2 of 1.55 kHz (f2/f1=1.21) was evaluated as a function of the levels of the primary tones in a matrix of L1, L2 settings, which varied from 45 to 80 dB SPL, in 5-dB steps. DPOAEs were elicited under both monaural and binaural stimulus-presentation conditions. Adaptation was defined as the difference in DPOAE levels between the initial 92-ms baseline measure using a standard protocol and one obtained during the final 92 ms of the prolonged 1-s primary-tones. These differences were averaged across subjects to create contour plots of mean adaptation in the L1,L2 space. The 2f(1)-f2 DPOAE revealed consistent regions of suppression (-0.5 dB difference) or enhancement (+0.5 dB difference) with respect to baseline measures within the L(1),L(2) matrix for both acoustic-stimulation conditions. Specifically, 2f(1)-f2 DPOAE suppressions of 1-2 dB occurred for both monaural and binaural presentations, typically at level combinations in which L1>L2. In contrast, larger 2f(1)-f2 DPOAE enhancements of 3-4 dB occurred for only the binaural condition, at primary-tone level combinations where L1<L2. Although adaptation activity was also evaluated for the DPOAEs at f(2)-f1, 2f(2)-f1, and 3f(1)-2f2, these emissions were either immeasurable (e.g., f(2)-f1) or only present in a subset of subjects over a narrow range of primary-tone frequencies and levels that did not support a systematic analysis. In summary, the 2f(1)-f2 results suggest that a potentially important area for adaptation measures exists in the L1,L2 space, when L1 is lower than L2. This combination of primary-tone levels can lead to large DPOAE adaptation effects that may be related to a notch in the DPOAE response/growth or input/output (I/O) function.

Suppression tuning in noise-exposed rabbits

Psychophysical, basilar-membrane (BM), and single nerve-fiber tuning curves, as well as suppression of distortion-product otoacoustic emissions (DPOAEs), all give rise to frequency tuning patterns with stereotypical features. Similarities and differences between the behaviors of these tuning functions, both in normal conditions and following various cochlear insults, have been documented. While neural tuning curves (NTCs) and BM tuning curves behave similarly both before and after cochlear insults known to disrupt frequency selectivity, DPOAE suppression tuning curves (STCs) do not necessarily mirror these responses following either administration of ototoxins [Martin et al., J. Acoust. Soc. Am. 104, 972-983 (1998)] or exposure to temporarily damaging noise [Howard et al., J. Acoust. Soc. Am. 111, 285-296 (2002)]. However, changes in STC parameters may be predictive of other changes in cochlear function such as cochlear immaturity in neonatal humans [Abdala, Hear. Res. 121, 125-138 (1998)]. To determine the effects of noise-induced permanent auditory dysfunction on STC parameters, rabbits were exposed to high-level noise that led to permanent reductions in DPOAE level, and comparisons between pre- and postexposure DPOAE levels and STCs were made. Statistical comparisons of pre- and postexposure STC values at CF revealed consistent basal shifts in the frequency region of greatest cochlear damage, whereas thresholds, Q10dB, and tip-to-tail gain values were not reliably altered. Additionally, a large percentage of high-frequency lobes associated with third tone interference phenomena, that were exhibited in some data sets, were dramatically reduced following noise exposure. Thus, previously described areas of DPOAE interference above f2 may also be studied using this type of experimental manipulation [Martin et al., Hear. Res. 136, 105-123 (1999); Mills, J. Acoust. Soc. Am. 107, 2586-2602 (2002)].

Distortion product otoacoustic emission suppression tuning curves in normal-hearing and hearing-impaired human ears

Distortion product otoacoustic emission (DPOAE) suppression measurements were made in 20 subjects with normal hearing and 21 subjects with mild-to-moderate hearing loss. The probe consisted of two primary tones (f2, f1), with f2 held constant at 4 kHz and f2/f1 = 1.22. Primary levels (L1, L2) were set according to the equation L1 = 0.4 L2 + 39 dB [Kummer et al., J. Acoust. Soc. Am. 103, 3431-3444 (1998)], with L2 ranging from 20 to 70 dB SPL (normal-hearing subjects) and 50-70 dB SPL (subjects with hearing loss). Responses elicited by the probe were suppressed by a third tone (f3), varying in frequency from 1 octave below to 1/2 octave above f2. Suppressor level (L3) varied from 5 to 85 dB SPL. Responses in the presence of the suppressor were subtracted from the unsuppressed condition in order to convert the data into decrements (amount of suppression). The slopes of the decrement versus L3 functions were less steep for lower frequency suppressors and more steep for higher frequency suppressors in impaired ears. Suppression tuning curves, constructed by selecting the L3 that resulted in 3 dB of suppression as a function of f3, resulted in tuning curves that were similar in appearance for normal and impaired ears. Although variable, Q10 and Q(ERB) were slightly larger in impaired ears regardless of whether the comparisons were made at equivalent SPL or equivalent sensation levels (SL). Larger tip-to-tail differences were observed in ears with normal hearing when compared at either the same SPL or the same SL, with a much larger effect at similar SL. These results are consistent with the view that subjects with normal hearing and mild-to-moderate hearing loss have similar tuning around a frequency for which the hearing loss exists, but reduced cochlear-amplifier gain.

Suppression and enhancement of distortion-product otoacoustic emissions by interference tones above f(2). II. Findings in humans

Distortion-product otoacoustic emission (DPOAE) suppression tuning curves (STCs) can be obtained in a variety of laboratory animals and humans by sweeping the frequencies and levels of a third tone (f(3)) around a set of f(1) and f(2) primaries. In small laboratory animals, it was previously observed that, when the suppressor tone (f(3)) is above f(2), substantial suppression and or enhancement (suppression/enhancement) could be obtained. In the present study, it was of interest to determine if similar suppression/enhancement phenomena could be observed in humans and to what extent this might influence the interpretation of STC results reported in the literature. To this end, STCs were measured for DPOAEs at 2f(1)-f(2) and 2f(2)-f(1) in human subjects at geometric-mean frequencies (GM) of 1, 2, 3, and 4 kHz, and primary-tone equilevels of 80/80 and 75/75 dB SPL and unequal levels of 65/55 dB SPL. Overall, STC parameters were found to be comparable to those reported in the literature. For the 2f(1)-f(2) DPOAE, STC tip frequencies tuned to the region of the primaries, and tip frequencies were slightly influenced by primary-tone level. STC tip thresholds were typically within 10 dB of the level of L(2), and Q(10dB) values ranged from 1.0 to 2.5, which was consistent with the higher-level primaries employed. The 2f(1)-f(2) DPOAE showed consistent regions of suppression that were approximately an octave above the GM for the 1-kHz, 65/55-dB SPL condition. The 2f(2)-f(1) DPOAE tuned to its characteristic place above f(2) and showed reliable enhancement above the STC tip region for the 1-kHz, 75/75-dB SPL primaries. Overall, the results clearly revealed that human ears also display suppression/enhancement phenomena when f(3) reaches frequencies considerably above f(2). If suppression/enhancement phenomena reflect secondary DPOAE sources, then these sources are present in the ear-canal signal from humans as well as small laboratory animals.

DPOAE level shifts and ABR threshold shifts compared to detailed analysis of histopathological damage from noise

A detailed comparison of 2f(1)-f(2) distortion product otoacoustic emission (DPOAE) level shifts (LS) and auditory brainstem response (ABR) threshold shifts with noise-induced histopathology was conducted in chinchillas. DPOAE levels (i.e., L(1) and L(2)) at f(1) and f(2), respectively, ranged from 55-75 dB sound pressure level (SPL), with f(2)/f(1)=1.23, 6 points/octave, f(2)=0.41-20 kHz, and ABR thresholds at 0.5-20 kHz, 2 points/octave, were determined pre-exposure. The exposure was a 108 dB SPL octave band of noise centered at 4 kHz (1-1.75 h, n=6) or 80-86 dB SPL (24 h, n=5). DPOAE LSs (magnitude pre- minus post-exposure) and ABR threshold shifts (TS) were determined at 0 days and up to 28 days post-exposure. The cochleae were fixed, embedded in plastic and dissected into flat preparations. The length of the organ of Corti (OC) was measured; missing inner (IHC) and outer (OHC) hair cells counted; stereocilia damage rated; and regions of OC and nerve-fiber loss determined. Cytocochleograms were made showing functional loss and structural damage with the LS and TS overlaid. Some unexpected results were obtained. First, the best correlation of LS with histopathology required plotting the DPOAE data at f(1) with respect to the chinchilla-place map. The best correlation of TS was with IHC and nerve-fiber loss. Second, wide regions of up to 10% scattered OHC loss in the apical half of the OC showed little or no LS. Third, with the 108 dB SPL noise, there was 20-40 dB of recovery for DPOAEs at mid-high frequencies (3-10 kHz) in eight of 12 cochleae where there was 70-100% OHC loss in the basal half of the OC. The largest recovery at mid-high frequencies occurred in regions where the OC was entirely missing. Fourth, with the 80-86 dB SPL noise, there was no LS at small focal lesions (100% loss of OHCs over 0.4 mm) when the frequency place of either f(1) or f(2) was within the lesion but not both. There was no correlation of LS with OHC stereocilia loss, fusion or disarray. These results suggest that, after noise exposure, DPOAEs at mid-high frequencies can originate from or be augmented by generators located at someplace other than the frequency place of f(2), possibly the basal 20% of the OC when this region is intact. Also, noise-induced DPOAE LSs seemed to reflect differing mechanisms for temporary and permanent hearing loss.

Evidence of upward spread of suppression in DPOAE measurements

Measurements of DPOAE level in the presence of a suppressor were used to describe a pattern that is qualitatively similar to population studies in the auditory nerve and to behavioral studies of upward spread of masking. DPOAEs were measured in the presence of a suppressor (f3) fixed at either 2.1 or 4.2 kHz, and set to each of seven levels (L3) from 20 to 80 dB SPL. In the presence of a fixed f3 and L3 combination, f2 was varied from about 1 oct below to at least 1/2 oct above f3, while L2 was set to each of 6 values (20-70 dB SPL). L1 was set according to the equation L1 = 0.4L2 + 39 [Janssen et al., J. Acoust. Soc. Am. 103, 3418-3430 (1998)]. At each L2, L1 combination, DPOAE level was measured in a control condition in which no suppressor was presented. Data were converted into decrements (the amount of suppression, in dB) by subtracting the DPOAE level in the presence of each suppressor from the DPOAE level in the corresponding control condition. Plots of DPOAE decrements as a function of f2 showed maximum suppression when f2 approximately = f3. As L3 increased, the suppressive effect spread more towards higher f2 frequencies, with less spread towards lower frequencies relative to f3. DPOAE decrement versus L3 functions had steeper slopes when f2 > f3, compared to the slopes when f2 < f3. These data are consistent with other findings that have shown that response growth for a characteristic place (CP) or frequency (CF) depends on the relation between CP or CF and driver frequency, with steeper slopes when driver frequency is less than CF and shallower slopes when driver frequency is greater than CF. For a fixed amount of suppression (3 dB), L3 and L2 varied nearly linearly for conditions in which f3 approximately = f2, but grew more rapidly for conditions in which f3 < f2, reflecting the basal spread of excitation to the suppressor. The present data are similar in form to the results observed in population studies from the auditory nerve of lower animals and in behavioral masking studies in humans.

Variation in inter-animal susceptibility to noise damage is associated with alpha 9 acetylcholine receptor subunit expression level

Large intersubject variabilities in acoustic injury are known to occur in both humans and animals; however, the mechanisms underlying such differences are poorly understood. The olivocochlear efferent system has been hypothesized to play a significant role in protecting the cochlea from noise overexposure. In this study, we demonstrate that a newly developed test for determining average efferent system strength can predict intersubject variations in acoustic injury. In addition, the intersubject variability in cochlear expression of the alpha9 subunit of the nicotinic acetylcholine receptor was found to be proportional to an animals average efferent strength. Therefore, the inter-animal variability in the alpha9-containing acetylcholine receptor expression may be one mechanism contributing to the inter-animal variability in acoustic injury.

The use of distortion product otoacoustic emission suppression as an estimate of response growth

Distortion product otoacoustic emission (DPOAE) levels in response to primary pairs (f2 = 2 or 4 kHz, L2 ranging from 20 to 60 dB SPL, L1 = 0.4L2 + 39 dB) were measured with and without suppressor tones (f3), which varied from 1 octave below to 1/2 octave above f2, in normal-hearing subjects. Suppressor level (L3) varied from -5 to 85 dB SPL. DPOAE levels were converted into decrements by subtracting the level in the presence of the suppressor from the level in the absence of a suppressor. DPOAE decrement vs L3 functions showed steeper slopes when f3 < f2 and shallower slopes when f3 > f2. This pattern is similar to other measurements of response growth, such as direct measures of basilar-membrane motion, single-unit rate-level functions, suppression of basilar-membrane motion, and discharge-rate suppression from lower animals. As L2 increased, the L3 necessary to maintain 3 dB of suppression increased at a rate of about 1 dB/dB when f3 was approximately equal to f2, but increased more slowly when f3 < f2. Functions relating L3 to L2 in order to maintain a constant 3-dB reduction in DPOAE level were compared for f3 < f2 and for f3 approximately = f2 in order to derive an estimate related to "cochlear-amplifier gain." These results were consistent with the view that "cochlear gain" is greater at lower input levels, decreasing as level increases.

Nonlinear interactions that could explain distortion product interference response areas

Suppression and/or enhancement of third- and fifth-order distortion products by a third tone that can have a frequency more than an octave above and a level more than 40 dB below the primary tones have recently been measured by Martin et al. [Hear. Res. 136, 105-123 (1999)]. Contours of iso-suppression and iso-enhancement that are plotted as a function of third-tone frequency and level are called interference response areas. After ruling out order aliasing, two possible mechanisms for this effect have been developed, a harmonic mechanism and a catalyst mechanism. The harmonic mechanism produces distortion products by mixing a harmonic of one of the primary tones with the other primary tone. The catalyst mechanism produces distortion products by mixing one or more intermediate distortion products that are produced by the third tone with one or more of the input tones. The harmonic mechanism does not need a third tone and the catalyst mechanism does. Because the basilar membrane frequency response is predicted to affect each of these mechanisms differently, it is concluded that the catalyst mechanism will be dominant in the high-frequency regions of the cochlea and the harmonic mechanism will have significant strength in the low-frequency regions of the cochlea. The mechanisms are dependent on the existence of both even- and odd-order distortion, and significant even- and odd-order distortion have been measured in the experimental animals. Furthermore, the nonlinear part of the cochlear mechanical response must be well into saturation when input tones are 50 or more dB SPL.

Frequency responses of two- and three-tone distortion product otoacoustic emissions in Mongolian gerbils

The frequency responses of distortion product otoacoustic emission (DPOAEs) were investigated in adult Mongolian gerbils. The main goal was to investigate in this species the extent to which DPOAE measurements might be useful in estimating cochlear frequency-tuning characteristics. Specifically, this study investigated the parameter space for generation of DPOAEs to determine those regions, if any, where the emission responses gave "simple" frequency responses, i.e., responses similar in form to typical neural responses. At the same time, it was desired to determine in this species the existence, extent, and nature of the more complex three-tone emission frequency responses as observed in some other species [e.g., Martin et al., Hearing Res. 136, 105-123 (1999)]. In the present work, two-tone frequency response curves (f2/f1 ratio functions) were obtained by varying the lower frequency, f1, while holding the f2 frequency and both amplitudes (L1, L2) constant. Only for frequencies, f2, near 8 kHz did the response at the emission frequency, 2 f1-f2, form a simple, relatively broad peak. At all lower frequencies, the two-tone frequency response curve was typically complex and composed of multiple peaks. In comparison, three-tone frequency responses were constructed by fixing the primary stimulus pair (f1, f2) and varying a third tone widely in frequency (f3) and intensity (L3). Points in f3 and L3 which caused a criterion reduction in primary emission amplitude (at 2 f1-f2) were used to construct emission suppression tuning curves (STCs). Only for primary frequencies, f2, at 8 kHz and above were the emission STCs found to be simple, with shapes similar to neural frequency-tuning curves. At lower primary frequencies, particularly for relatively low primary frequency ratios (low f2/f1), three-tone responses were very complex. This complex response usually included a region of anomalous suppression in which very low suppression levels (L3) could result in significant decreases in the primary emission amplitude, often exceeding 12 dB. Regions of such anomalous suppression were typically observed under the following conditions: (1) for all f2 frequencies from 0.5 to 4 kHz; (2) for f3 frequencies between 1.4 and 8 kHz; (3) i.e., for f3 frequencies 1-3 octaves above the primary frequency, f2; (4) at L3 levels often 10 dB lower or more than the usual "best frequency" threshold, i.e., even lower than the relative minimum threshold found near the primary stimulus frequencies; (5) exhibiting sharp amplitude decreases often accompanied by emission phase shifts of about 180 deg; (6) present in both cubic emissions (2 f1-f2 and 2 f2-f1); (7) to be less extreme at larger primary stimulus frequency ratios (larger f2/f1); and (8) less extreme at larger intensity ratios (larger L1/L2). Because of the anomalous behavior at f2 frequencies below 8 kHz, "simple" emission STCs were typically only obtainable, if at all, near the extreme boundaries of the parameter space giving measurable emission amplitudes.

An objective method of analyzing cochlear versus noncochlear patterns of distortion-product otoacoustic emissions in patients with acoustic neuromas

OBJECTIVES

To objectify the effects of retrocochlear disease on distortion-product otoacoustic emissions (DPOAEs) by developing a computer-based software strategy for classifying DPOAE patterns as cochlear or noncochlear and to evaluate the sensitivities of these techniques in a large series of patients with unilateral acoustic neuromas.

STUDY DESIGN

Development of a novel, software-based method of DPOAE analysis, which was evaluated with data obtained from a retrospective review of the results from audiometric tests performed in a series of patients.

METHODS

A computer-based software strategy was developed, using frequency-specific data from normal-hearing adults, for the purpose of distinguishing cochlear from noncochlear patterns of hearing loss, by determining the discrepancies between DPOAEs and behavioral audiometry. Preoperative pure-tone thresholds and DPOAEs from 97 patients with surgically confirmed acoustic neuroma were compared using an objective method and a standard, subjective technique that was considered to be the gold standard. The effects of bilateral hearing losses, such as noise-induced hearing loss and presbycusis, were accounted for during the analysis to isolate the effects of the tumors on hearing thresholds and DPOAEs.

RESULTS

Overall, 55 (57%) of the tumor ears were assigned to the cochlear group (i.e., DPOAEs consistent with hearing thresholds), 40 (41%) to the noncochlear group (i.e., DPOAEs inconsistent with hearing thresholds), and 2 (2%) to an indeterminate group, using the subjective technique for classifying DPOAEs. There was no significant difference in the categorization of the patients with acoustic neuroma when employing the objective strategy. The objective algorithm, when modified to maximize the number of noncochlear identifications, led to assignments of 36 (37%) to the cochlear, 57 (59%) to the noncochlear, and 4 (4%) to the indeterminate categories.

CONCLUSIONS

Subjective analysis of a large series patients with acoustic neuromas showed that the majority of ears with tumors demonstrated cochlear (57%), rather than non-cochlear (41%), patterns of DPOAEs. The computerized, software-based algorithm developed for differentiating cochlear from noncochlear patterns of DPOAEs in patients with retrocochlear disease had a maximum sensitivity of 59%. This value was significantly higher than that reported in previous studies.

Suppression and enhancement of distortion-product otoacoustic emissions by interference tones above f(2). I. Basic findings in rabbits

The present study measured interference-response areas (IRAs) for distortion-product otoacoustic emissions (DPOAEs) at 2f(1)-f(2), 3f(1)-2f(2), and 2f(2)-f(1). The IRAs were obtained in either awake or anesthetized rabbits, or in anesthetized guinea pigs and mice, by sweeping the frequencies and levels of an interference tone (IT) around a set of f(1) and f(2) primary tones, at several fixed frequencies and levels, while plotting the effects of the IT on DPOAE level. An unexpected outcome was the occurrence of regions of suppression and/or enhancement of DPOAE level when the IT was at a frequency slightly less than to more than an octave above f(2). The IRA of the 2f(1)-f(2) DPOAE typically displayed a high-frequency (HF) lobe of suppression, while the 2f(2)-f(1) emission often exhibited considerable amounts of enhancement. Moreover, for the 2f(2)-f(1) DPOAE, when enhancement was absent, its IRA usually tuned to a region above f(2). Whether or not suppression/enhancement was observed depended upon primary-tone level and frequency separation, as well as on the relative levels of the two primaries. Various physiological manipulations involving anesthesia, eighth-nerve section, diuretic administration, or pure-tone overstimulation showed that these phenomena were of cochlear origin, and were not dependent upon the acoustic reflex or cochlear-efferent activity. The aftereffects of applying diuretics or over-exposures revealed that suppression/enhancement required the presence of sensitive, low-level DPOAE-generator sources. Additionally, suppression/enhancement were general effects in that, in addition to rabbits, they were also observed in mice and guinea pigs. Further, corresponding plots of DPOAE phase often revealed areas of differing phase change in the vicinity of the primary tones as compared to regions above f(2). These findings, along with the effects of tonal exposures designed to fatigue regions above f(2), and instances in which DPOAE level was dependent upon the amount of suppression/enhancement, suggested that the interactions of two DPOAE-generator sources contributed, in some manner, to these phenomena.