Reliability of transient-evoked otoacoustic emissions

Visual attention does not affect the reliability of otoacoustic emission or medial olivocochlear reflex

This study investigated whether visual attention affects the reliability (i.e., repeatability) of transiently evoked otoacoustic emission (TEOAE) magnitudes or of medial olivocochlear reflex (MOCR) estimates. TEOAEs were measured during three visual attentional conditions: control (subject were seated with eyes closed); passive (subjects looked at a pattern of squares on a computer screen); and active (subjects silently counted an occasionally inverted pattern). To estimate reliability, the whole recording session was repeated the next day. The results showed that visual attention does not significantly affect TEOAE or MOCR magnitudes-or their reliability. It is therefore possible to employ visual stimuli (e.g., watching a silent movie) during TEOAE experiments, a procedure sometimes used during testing to prevent subjects from falling asleep or to keep children still and quiet.

Reliability of Serological Prestin Levels in Humans and its Relation to Otoacoustic Emissions, a Functional Measure of Outer Hair Cells

OBJECTIVES

Serological biomarkers, common to many areas of medicine, have the potential to inform on the health of the human body and to give early warning of risk of compromised function or illness before symptoms are experienced. Serological measurement of prestin, a motor protein uniquely produced and expressed in outer hair cells, has recently been identified as a potential biomarker to inform on the health of the cochlea. Before any test can be introduced into the clinical toolkit, the reproducibility of the measurement when repeated in the same subject must be considered. The primary objective of this study is to outline the test-retest reliability estimates and normative ranges for serological prestin in healthy young adults with normal hearing. In addition, we examine the relation between serum prestin levels and otoacoustic emissions (OAEs) to compare this OHC-specific protein to the most common measure of OHC function currently used in hearing assessments.

DESIGN

We measured prestin levels serologically from circulating blood in 34 young adults (18 to 24 years old) with clinically normal pure-tone audiometric averages at five different timepoints up to six months apart (average intervals between measurements ranged from <1 week to 7 weeks apart). To guide future studies of clinical populations, we present the standard error of the measurement, reference normative values, and multiple measures of reliability. Additionally, we measured transient evoked OAEs at the same five timepoints and used correlation coefficients to examine the relation between OAEs and prestin levels (pg/mL).

RESULTS

Serum prestin levels demonstrated good to excellent reliability between and across the five different time points, with correlation coefficients and intraclass correlations >0.8. Across sessions, the average serum prestin level was 250.20 pg/mL, with a standard error of measurement of 7.28 pg/mL. Moreover, positive correlations (generally weak to moderate) were found between prestin levels and OAE magnitudes and signal-to-noise ratios.

CONCLUSIONS

Findings characterize serum prestin in healthy young adults with normal hearing and provide initial normative data that may be critical to interpreting results from individuals with sensorineural hearing loss. Our results demonstrate reliability of serum prestin levels in a sample of normal-hearing young adults across five test sessions up to 6 months apart, paving the way for testing larger samples to more accurately estimate test-retest standards for clinical protocols, including those involving serial monitoring. The positive correlations between serum prestin and OAE levels, although weak to moderate, reinforce that the source of serum prestin is likely the outer hair cells in the inner ear, but also that serum prestin and OAEs each may also index aspects of biologic function not common to the other.

Twin study of neonatal transient-evoked otoacoustic emissions

Our knowledge of which physiological mechanisms shape transient evoked otoacoustic emissions (TEOAEs) is incomplete, although thousands of TEOAEs are recorded each day as part of universal newborn hearing-screening (UNHS). TEOAE heritability may explain some of the large TEOAE variability observed in neonates, and give insights into the TEOAE generators and modulators, and why TEOAEs are generally larger in females and right ears. The aim was to estimate TEOAE heritability and describe ear and sex effects in a consecutive subset of all twins that passed UNHS at the same occasion at two hospitals during a six-year period (more than 30 000 neonates screened in total). TEOAEs were studied and TEOAE level correlations compared in twin sets of same-sex (SS, 302 individual twins, 151 twin pairs) and opposite-sex (OS, 152 individual twins, 76 twin pairs). A mathematical model was used to estimate and compare monozygotic (MZ) and dizygotic (DZ) intra-twin pair TEOAE level correlations, based on the data from the SS and OS twin sets. For both SS and OS twin pairs TEOAE levels were significantly higher in right ears and females, compared to left ears and males, as previously demonstrated in young adult twins and large groups of neonates. Neonatal females in OS twin pairs did not demonstrate masculinized TEOAEs, as has been demonstrated for OAEs in young adult females in OS twin pairs. The within-twin pair TEOAE level correlations were higher for SS twin pairs than for OS twin pairs, whereas the within-pair correlation coefficients could not be distinguished from zero when twins were randomly paired. These results reflect heredity as a key factor in TEOAE level variability. Additionally, the estimated MZ within-twin pair TEOAE level correlations were higher than those for DZ twin pairs. The heritability estimates reached up to 100% TEOAE heritability, which is numerically larger than previous estimates of about 75% in young adult twins.

Effect of Contralateral Medial Olivocochlear Feedback on Perceptual Estimates of Cochlear Gain and Compression

The active cochlear mechanism amplifies responses to low-intensity sounds, compresses the range of input sound intensities to a smaller output range, and increases cochlear frequency selectivity. The gain of the active mechanism can be modulated by the medial olivocochlear (MOC) efferent system, creating the possibility of top-down control at the earliest level of auditory processing. In humans, MOC function has mostly been measured by the suppression of otoacoustic emissions (OAEs), typically as a result of MOC activation by a contralateral elicitor sound. The exact relationship between OAE suppression and cochlear gain reduction, however, remains unclear. Here, we measured the effect of a contralateral MOC elicitor on perceptual estimates of cochlear gain and compression, obtained using the established temporal masking curve (TMC) method. The measurements were taken at a signal frequency of 2 kHz and compared with measurements of click-evoked OAE suppression. The elicitor was a broadband noise, set to a sound pressure level of 54 dB to avoid triggering the middle ear muscle reflex. Despite its low level, the elicitor had a significant effect on the TMCs, consistent with a reduction in cochlear gain. The amount of gain reduction was estimated as 4.4 dB on average, corresponding to around 18 % of the without-elicitor gain. As a result, the compression exponent increased from 0.18 to 0.27.

A study of cochlear and auditory pathways in patients with tension-type headache

Background

The purpose of this study was to systematically evaluate the function of cochlear and auditory pathways in patients suffering from tension-type headache (TTH) using various audiological methods.

Methods

Twenty-three TTH patients (46 ears) and 26 healthy controls (52 ears) were included, and routine diagnostic audiometry, extended high-frequency audiometry, acoustic reflex (ASR), transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs) and suppression TEOAEs were tested.

Results

The TTH group showed higher thresholds (P < 0.05) for both pure tone and extended high-frequency audiometry at all frequencies except for 9, 14 and 16 kHz. All ASR thresholds were significantly higher (P < 0.05) in the TTH group compared with the controls, except for the ipsilateral reflex at 1 kHz, but the threshold differences between the ASR and the corresponding pure tone audiometry did not differ (P > 0.05). For the DPOAEs, the detected rates were lower (P < 0.05) in the TTH group compared with the controls at 4 and 6 kHz, and the amplitudes and signal to noise ratio (S/N) were not significantly different between groups. No differences in the TEOAEs (P > 0.05) were observed for the detected rates, amplitudes, S/Ns or contralateral suppression, except for the S/Ns of the 0.5-1 kHz TEOAE responses, which were significantly higher (P < 0.05) in the TTH group.

Conclusions

The results of our study indicate that subclinical changes in cochlear function are associated with TTH.

A new method to estimate sound energy entering the middle ear

Standing waves in the ear canal can cause inaccurate quantification of the sound pressure level (SPL) entering the ear and therefore lead to unreliable results in clinical tests. Since it is impractical to directly measure the SPL at the eardrum position, in this study we proposed a new method to estimate the eardrum SPL by solely making measurement at the entry of the ear canal. To achieve this, the acoustic characteristics of the earphone were calculated using a calculation tube with variable lengths. Then the ear canal impedance was calculated according to the obtained source characteristics. Finally, the eardrum SPL was estimated by the ear-canal impedance and the SPL measured at the entry of the ear canal. The results showed that the eardrum SPL could be reliably estimated for all the five subjects participated in this study. The maximal estimation error was less than 3 dB for all frequencies from 0.5 to 10 kHz. These findings suggested that the proposed method could avoid the standing wave problem and therefore might be a great candidate for accurate calibration of sound pressure in various acoustic measurements.

Otoacoustic-emission-based medial-olivocochlear reflex assays for humans

Otoacoustic emission (OAE) tests of the medial-olivocochlear reflex (MOCR) in humans were assessed for viability as clinical assays. Two reflection-source OAEs [TEOAEs: transient-evoked otoacoustic emissions evoked by a 47 dB sound pressure level (SPL) chirp; and discrete-tone SFOAEs: stimulus-frequency otoacoustic emissions evoked by 40 dB SPL tones, and assessed with a 60 dB SPL suppressor] were compared in 27 normal-hearing adults. The MOCR elicitor was a 60 dB SPL contralateral broadband noise. An estimate of MOCR strength, MOCR%, was defined as the vector difference between OAEs measured with and without the elicitor, normalized by OAE magnitude (without elicitor). An MOCR was reliably detected in most ears. Within subjects, MOCR strength was correlated across frequency bands and across OAE type. The ratio of across-subject variability to within-subject variability ranged from 2 to 15, with wideband TEOAEs and averaged SFOAEs giving the highest ratios. MOCR strength in individual ears was reliably classified into low, normal, and high groups. SFOAEs using 1.5 to 2 kHz tones and TEOAEs in the 0.5 to 2.5 kHz band gave the best statistical results. TEOAEs had more clinical advantages. Both assays could be made faster for clinical applications, such as screening for individual susceptibility to acoustic trauma in a hearing-conservation program.

Reliability and clinical test performance of cochlear reflectance

OBJECTIVE

Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is equivalent to an otoacoustic emission (OAE) deconvolved by forward pressure in the ear canal. Similar to other OAE measures, CR level is related to cochlear status. When measured using wideband noise stimuli, potential advantages of CR over other types of OAEs include (1) the capability to cover a wider frequency range more efficiently by requiring fewer measurements, (2) minimal influence on the recorded emission from the measurement system and middle ear, (3) lack of entrainment of spontaneous OAEs, and (4) easier interpretation because of the existence of an equivalent linear model, which validates the application of linear systems theory. The purposes of this study were to evaluate the reliability, assess the accuracy in a clinical screening paradigm, and determine the relation of CR to audiometric thresholds. Thus, this study represents an initial assessment of the clinical utility of CR.

DESIGN

Data were collected from 32 normal-hearing and 58 hearing-impaired participants. A wideband noise stimulus presented at seven stimulus levels (10 to 70 dB SPL, 10 dB steps) was used to elicit the CR. Reliability of CR was assessed using Cronbach's α, standard error of measurement, and absolute differences between CR data from three separate test sessions. Test performance was evaluated using clinical decision theory. The ability of CR to predict audiometric thresholds was evaluated using regression analysis.

RESULTS

CR repeatability across test sessions was similar to that of other clinical measurements. However, both the accuracy with which CR distinguished normal-hearing from hearing-impaired ears and the accuracy with which CR predicted audiometric thresholds were less than those reported in previous studies using distortion-product OAE measurements.

CONCLUSIONS

CR measurements are repeatable between test sessions, can be used to predict auditory status, and are related to audiometric thresholds. However, under current conditions, CR does not perform as well as other OAE measurements. Further developments in CR measurement and analysis methods may improve performance. CR has theoretical advantages for cochlear modeling, which may lead to improved interpretation of cochlear status.

Persistence of otoacoustic emissions in children with auditory neuropathy spectrum disorders

OBJECTIVES

Many studies confirmed the disappearance of otoacoustic emissions in some of the patients with auditory neuropathy spectrum disorder, yet the data about the incidence rate of such disappearance is scanty or even absent. This study aims to test the persistence of transient evoked otoacoustic emissions in patients with auditory neuropathy spectrum disorder over few years.

METHODS

The study group consisted of 77 subjects (31 females and 46 males). Their ages ranged from 4 to 9 years (5.5 ± 1.5). All the subjects were previously diagnosed to have auditory neuropathy spectrum disorder affecting both ears. Transient evoked otoacoustic emissions test results of the recent follow up sessions were compared with their initial diagnostic evaluation sessions done 3-6 years ago (3.7 ± 0.8), in order to test the persistence of the emissions and the reduction of emissions level.

RESULTS

The transient evoked otoacoustic emissions level was reduced in the follow up visit compared to the initial study group. The transient evoked otoacoustic emissions level showed insignificant reduction (less than 3dB) in 77.3% of the ears in the study group, and significant reduction (i.e. 3dB or more) in 20.8%, and was absent in 1.9%. The transient evoked otoacoustic emissions level reduction in the different study subgroups was homogenous; gender (males versus females) laterality (right versus left ears) incubated to neonatal intensive care unit versus those non incubated all showed no significant differences in transient evoked otoacoustic emissions level reduction. Moreover, the duration of auditory neuropathy spectrum disorder was not correlated to the degree of transient evoked otoacoustic emissions reduction. Those fitted with hearing aids had more reduction in their transient evoked otoacoustic emissions level compared with those not fitted with hearing aids.

CONCLUSIONS

(1) Transient evoked otoacoustic emissions was still detected in 98.1% of patients with auditoryneuropathy spectrum disorder few years after the diagnosis.(2) Those fitted with hearing aids showed the most pronounced reduction in transient evokedotoacoustic emissions level.

Assessment of cochlear and auditory pathways in patients with migraine

PURPOSE

In this study, we aimed to determine the function of the cochlea and peripheral and central auditory pathways with migraine.

MATERIALS AND METHODS

Fifty-eight patients with migraine and 40 healthy subjects were assessed using routine diagnostic audiometry along with transient evoked otoacoustic emissions (TOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brainstem response (ABR) at high and low repetition rate frequencies.

RESULTS

Nearly two thirds of patients with migraine had one or more abnormalities in electrophysiological testing. Compared with control subjects, patients reported significant lowering of TOAEs amplitude at frequencies of 1 kHz (right: P = .0003; left: P = .002), 3 kHz (right: P = .025), and 4 kHz (right: P = .019); prolonged wave III latency (right: P = .009); and I-V interpeak latency (IPL) (left: P = .024) at high repetition rate frequencies. Significant correlations were identified between age, duration of illness and frequency of migraine and TOAEs total response and at amplitude of 4 kHz, amplitudes of DPOAEs at 1, 1.5, 2, 3, and 5 kHz and I, III and wave latencies and I-V IPL of ABR at high rate frequencies.

CONCLUSIONS

These data suggest that subclinical changes in cochlear function and auditory pathways are associated with chronic migraine. It is possible that migraine could be accompanied by compromise of blood supply of auditory system.

Cochlear dysfunction in hyperuricemia: otoacoustic emission analysis

PURPOSE

The objective of this study is to provide evidence that primary hyperuricemia is associated with cochlear dysfunction as other metabolic diseases that interfere with cell metabolism.

MATERIALS AND METHODS

Cochlear function was evaluated in 25 subjects with asymptomatic hyperuricemia using routine diagnostic audiometry along with transient evoked and distortion product otoacoustic emissions (TEOAE and DPOAE, respectively). To support the notion that vascular compromise was a significant underlying factor for such cochlear dysfunction, we assessed vascular anatomical and functional states through measuring the common carotid artery intima-media thickness and flow velocity of the basal intracranial vessels.

RESULTS

Compared with control subjects, reduced response levels of TEOAEs (P < .01) and amplitudes of DPOAEs (P < .001) were detected at higher frequencies. The reduced DPOAE levels at 5 kHz and TEOAEs at 4 kHz correlated significantly with uric acid (P < .05; P < .01), patients' age (P < .06; P < .05), duration since diagnosis of hyperuricemia (P < .05; P < .001), common carotid artery intima-media thickness (P < .05), mean flow velocities of middle cerebral arteries (P < .05), and vertebral arteries (P < .01). Multivariate analysis showed that the abnormalities at higher frequencies were significantly correlated with the duration and degree of hyperuricemia.

CONCLUSIONS

These data suggest that subclinical changes in cochlear function are associated with hyperuricemia. They support the usefulness of otoacoustic emissions in early detection of cochlear dysfunction. It is possible that hyperuricemia could be accompanied by increased stiffness and/or compromise of blood supply of the outer hair cells, which will impair their electromotile response.

Immediate and short-term reliability of distortion-product otoacoustic emissions: Confiabilidad inmediata y a corto plazo de las emisiones otoacústicas por productos de distorsión

This study assessed the test-retest reliability of distortion-product otoacoustic emissions (DPOAEs) at four frequencies (550, 1000, 2000 and 4000 Hz) over three time intervals. The time intervals were: (1) immediate test-retest reliability, in which the retest followed the test without any delay or repositioning of the probe tip; (2) very short-term test-retest reliability, in which the retest followed a 10-20-min break and involved removal and re-insertion of the probe tip; and (3) short-term test-retest reliability, in which the retest was conducted 5-10 days after the test. Fifty normal-hearing women were tested with a commercially available system for measuring DPOAEs (Grason-Stadler, GSI-60), which generated primary tones at 65 dB SPL (L1=L2). Standard errors of measurement at 550 Hz (approximately 4.6 dB) were nearly twice as large as those found for 1000 Hz, 2000 Hz, and 4000 Hz (approximately 2.5 dB). The short-term test-retest data suggest that there is a 95% probability that an individual's true DPOAE will fall within 5 dB of the obtained distortion product at 1000-4000 Hz and within 10 dB at 550 Hz. The standard error of measurement of the difference was calculated to assess whether two or more DPOAE measurements are significantly different (e.g. before versus after administration of an ototoxic drug or noise exposure). The data revealed that short-term differences (probe removed and subject retested on the same day or on different days) between two DPOAEs must exceed approximately 14 dB at 550 Hz and 7 dB at 1000-4000 Hz to be statistically significant at the 0.05 level of confidence.

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.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Low-level otoacoustic emissions may predict susceptibility to noise-induced hearing loss

In a longitudinal study with 338 volunteers, audiometric thresholds and otoacoustic emissions were measured before and after 6 months of noise exposure on an aircraft carrier. While the average amplitudes of the otoacoustic emissions decreased significantly, the average audiometric thresholds did not change. Furthermore, there were no significant correlations between changes in audiometric thresholds and changes in otoacoustic emissions. Changes in transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions were moderately correlated. Eighteen ears acquired permanent audiometric threshold shifts. Only one-third of those ears showed significant otoacoustic emission shifts that mirrored their permanent threshold shifts. A Bayesian analysis indicated that permanent threshold shift status following a deployment was predicted by baseline low-level or absent otoacoustic emissions. The best predictor was transient-evoked otoacoustic emission amplitude in the 4-kHz half-octave frequency band, with risk increasing more than sixfold from approximately 3% to 20% as the emission amplitude decreased. It is possible that the otoacoustic emissions indicated noise-induced changes in the inner ear, undetected by audiometric tests. Otoacoustic emissions may therefore be a diagnostic predictor for noise-induced-hearing-loss risk.

A longitudinal study of changes in evoked otoacoustic emissions and pure-tone thresholds as measured in a hearing conservation program

Non-linear transient-evoked otoacoustic emissions (TEOAEs) at 74dB pSPL, distortion-product otoacoustic emissions (DPOAEs) at 65/45dB SPL and pure-tone audiometry were used to detect noise-induced, inner car changes in a longitudinal study. Repeated-measures ANOVAs were made on the Noise (n=69) and Quiet (n=42) groups. The Noise group's hearing thresholds increased by 1.2 dB and DPOAE amplitude decreased by -0.9 dB. For both groups, TEOAE amplitude decreased by approximately -0.6 dB. Eight of 12 ears with permanent threshold shift (PTS) and 10 of 13 ears with temporary threshold shift (TTS) showed TEOAE decrements or low baseline TEOAE amplitudes. Fewer TTS and PTS ears also showed DPOAE decrements, and there was never a DPOAE decrement without a corresponding TEOAE decrement or low TEOAE baseline. Some TTS ears showed permanent emission decrements. Although otoacoustic emissions show promise in detecting noise-induced inner ear changes, it is premature to use them in hearing conservation programs.

The effect of noise bandwidth on the contralateral suppression of transient evoked otoacoustic emissions

The purpose of this study was to determine whether the bandwidth or loudness of a contralateral stimulus is the most important factor in evoking suppression of transient evoked otoacoustic emissions (TEOAEs). TEOAEs were measured in both ears of 10 women in quiet and in the presence of one of three contralateral noise bands; narrow band (NB), wide band (WB) and equalized (EQ), all centered at 2000 Hz. The NB (100 Hz bandwidth) and WB (2200 Hz bandwidth) noises were presented at 60 dB SPL. The SPL of the EQ (100 Hz bandwidth) noise was adjusted such that it was equal in loudness to the WB noise as determined using a psychoacoustic procedure. Only the WB noise was associated with a significant reduction of TEOAE levels. It is believed that this effect occurred because the WB noise has greater effective energy representation across frequency on the basilar membrane as it may receive more gain from the action of the cochlear amplifier. Results of the present study indicate that noise bandwidth is the most important factor in the contralateral suppression of TEOAEs.

On the detection of early cochlear damage by otoacoustic emission analysis

Theoretical considerations and experimental evidence suggest that otoacoustic emission parameters may be used to reveal early cochlear damage, even before it can be diagnosed by standard audiometric techniques. In this work, the statistical distributions of a set of otoacoustic emission parameters chosen as candidates for the early detection of cochlear damage (global and band reproducibility, response level, signal-to-noise ratio, spectral latency, and long-lasting otoacoustic emission presence) were analyzed in a population of 138 ears. These ears have been divided, according to a standard audiometric test, in three classes: (1) ears of nonexposed bilaterally normal subjects, (2) normal ears of subjects with unilateral noise-induced high-frequency hearing loss, and (3) their hearing impaired ears. For all analyzed parameters, a statistically significant difference was found between classes 1 and 2. This difference largely exceeds the difference observed between classes 2 and 3. This fact suggests that the noise exposure, which was responsible for the unilateral hearing loss, also caused subclinical damage in the contralateral, audiometrically normal, ear. This is a clear indication that otoacoustic emission techniques may be able to early detect subclinical damages.

Spontaneous otoacoustic emissions and relaxation dynamics of long decay time OAEs in audiometrically normal and impaired subjects

The relationship between hearing loss, detected by measuring the audiometric threshold shift, and the presence of long-lasting otoacoustic emissions, has been studied in a population of 66 adult males, by analyzing the cochlear response in the 80 ms following the subministration of a click stimulus. Most long-lasting OAEs are also recognizable as Synchronized Spontaneous OAEs (SSOAEs). The OAE characteristic decay times were evaluated according to the model by Sisto and Moleti [J. Acoust. Soc. Am. 106, 1893 (1999)]. The starting hypothesis, confirmed by the results, is that long decay time and large equilibrium amplitude are both manifestations of the effectiveness of the active feedback mechanism. The prevalence and frequency distribution of long-lasting OAEs, and of their SSOAE subset, have been separately analyzed for normal and impaired ears. No long-lasting OAE was found within the hearing loss frequency range, but several were found in impaired ears outside the hearing loss range, both at lower and higher frequencies. This result suggests that the correlation between the presence of long-lasting OAEs and good cochlear functionality be local in the frequency domain. The monitor of the OAE decay time is proposed as a new possible method for early detecting hearing loss in populations exposed to noise.

Test-retest reliability of tone-burst-evoked otoacoustic emissions

In this study, the short- and long-term test-retest reliabilities of tone-burst-evoked otoacoustic emissions (TBOAEs) with 12 different tone-burst stimuli (4 frequencies [1, 1.5, 2 and 3 kHz] at 3 stimulus levels [approximately 76, approximately 67 and approximately 55 dB pcSPL]) were examined in 30 normal hearing subjects. Click-evoked and spontaneous OAEs were recorded in parallel with TBOAEs to facilitate cross-comparisons and the generalization of results. Findings for click-evoked and spontaneous OAEs were comparable with most literature data. High reliability for TBOAEs was established for high and mid stimulus levels at all frequencies tested with reference to test-retest prevalence rate, test retest occurrence, intra-subject test retest difference and correlation coefficient. Derived half-octave band analysis at the frequency corresponding to the stimulus was found to reflect real TBOAE performance more reliably than broadband analysis. No significant difference between short- and long-term reliabilities was noted from all results. Similar test-retest reliabilities for high-level TBOAEs and click-evoked OAEs was obtained, suggesting that TBOAEs could potentially contribute to clinical assessment.

Methods for early identification of noise-induced hearing loss

An ideal test for identifying shifts in cochlear function would be highly repeatable and sensitive to minor damage. Three types of otoacoustic emission (OAE) test and pure-tone audiometry were evaluated for this purpose. They were compared in terms of test-retest repeatability within subjects and sensitivity to differences between subjects. The OAE measures were transiently evoked either conventionally (TEOAE) or using maximum length sequences (TEOAE-MLS), or continuously evoked as distortion products (DPOAEs). Several stimulus conditions were evaluated for each type. Thirty eight subjects with normal hearing or mild hearing losses were tested on all measures. Test-retest repeatability was rescaled according to the sensitivity of each measure to differences in hearing threshold level, thus allowing a direct comparison across methods. The most repeatable method thus defined was TEOAE-MLS which gave a rescaled standard deviation of 1.8 dB on replication. This was followed by TEOAE and DPOAE which gave rescaled standard deviations of 2.9 and 3.1 dB, respectively. All were more reliable than pure-tone audiometry which had a standard deviation of 4.9 dB. It is concluded that the various OAE measures have the potential to distinguish small changes in cochlear function from measurement uncertainty, and hence show promise for monitoring cochlear function in ears exposed to noise or other hazards.

Transient-evoked otoacoustic emissions as a measure of noise-induced threshold shift

Otoacoustic emissions and behavioral hearing thresholds were measured before and after exposure to a 10-min, 105-dB SPL, half-octave band of noise centered at 1.414 kHz. Along a single recovery function, transient-evoked otoacoustic-emission (TEOAE) measurements made with 74-dB pSPL nonlinear click ensembles were alternated with a Bekesy threshold-tracking procedure. Each of the 14 participants with normal hearing underwent 2 hour-long temporary-threshold shift (TTS) sessions as well as 2 pretest sessions and a posttest session. The Bekesy test frequency was fixed at 2.0 kHz, whereas emissions were analyzed in half-octave bandwidths with center frequencies ranging from 0.707 to 5.656 kHz. Results showed that (a) the maximum temporary emission shifts (TES) were half to 1 octave above the exposure frequency; (b) the 4.7-dB average temporary emission shift magnitude at approximately 2 min postexposure was less than half of the 11.7-dB average TTS; (c) the average recovery times for emissions and hearing thresholds were similar (188 vs. 186 min); and (d) the average TTS magnitude along the recovery function was predictable from TES magnitude. It is concluded that both TEOAEs and Bekesy thresholds reveal the same aspects of postexposure inner-ear changes.

Effect of negative middle-ear pressure on transient-evoked otoacoustic emissions

OBJECTIVE

The purpose of the study was to illustrate the effect of negative middle-ear pressure (MEP) on both the stimulus and response of transient-evoked otoacoustic emissions (TEOAEs) and the effect of compensating for negative pressure in the middle ear by pneumatically introducing pressure into the ear canal. Simulation of negative MEP by introducing positive pressure into the ear canal also was examined.

DESIGN

TEOAEs were measured over 6 mo in a subject who frequently had negative MEP out to -150 daPa. Compensation was done for MEPs of -105, -135, and -165 daPa. Simulation of negative pressure was done for these same pressures. The effect of a pressure differential across the eardrum on the stimulus spectrum was measured at 100, 200, and 300 daPa. All measurements were made on the same subject.

RESULTS

Small amounts of negative MEP significantly affected both stimulus and response spectra. The simulated negative MEP approximated actual MEP at MEPs of -105 and -135 daPa. At -165 daPa, a divergence between the two spectra occurred below 2.0 kHz. Compensation for negative MEP by pneumatically introducing pressure into the ear canal essentially returned both spectra to that seen when the MEP was close to ambient pressure, at least for frequencies above 1.5 to 2.0 kHz. At lower frequencies, compensation resulted in increased TEOAE amplitude relative to the amplitude at ambient pressure.

CONCLUSIONS

Small amounts of negative MEP may affect TEOAE spectra and potentially influence the reliability of the test. For long-term monitoring of TEOAEs, MEPs either should be near ambient pressure or should be compensated for by an equivalent pressure in the ear canal.