1
|
Bader K, Zelle D, Gummer AW, Dalhoff E. Pulsed DPOAEs in serial measurements : Combined analysis paradigm of simultaneously occurring changes in hearing thresholds and DPOAEs. HNO 2024:10.1007/s00106-024-01478-z. [PMID: 38958758 DOI: 10.1007/s00106-024-01478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND To date, there is no consensus on how to standardize the assessment of ototoxicity in serial measurements. For the diagnosis of damage to the cochlear amplifier, measurement methods are required that have the highest possible test-retest reliability and validity for detecting persistent damage. Estimated distortion-product thresholds (LEDPT) based on short-pulse distortion-product otoacoustic emission (DPOAE) level maps use individually optimal DPOAE stimulus levels and allow reliable quantitative estimation of cochlea-related hearing loss. MATERIALS AND METHODS Hearing thresholds were estimated objectively using LEDPT and subjectively using modified Békésy tracking audiometry (LTA). Recordings were performed seven times within three months at 14 frequencies (f2 = 1-14 kHz) in 20 ears (PTA4 (0.5-4 kHz) < 20 dB HL). Reconstruction of the DPOAE growth behavior as a function of the stimulus levels L1, L2 was performed on the basis of 21 DPOAE amplitudes. A numerical fit of a nonlinear mathematical function to the three-dimensional DPOAE growth function yielded LEDPT for each stimulus frequency. For the combined analysis, probability distributions of hearing thresholds (LTA, LEDPT), DPOAE levels (LDP), and combinations thereof were determined. RESULTS LTA and LEDPT each exhibited a test-retest reliability with a median of absolute differences (AD) of 3.2 dB and 3.3 dB, respectively. Combining LEDPT, LDP, and LTA into a single parameter yielded a significantly smaller median AD of 2.0 dB. CONCLUSION It is expected that an analysis paradigm based on a combination of LEDPT, suprathreshold LDP, and fine-structure-reduced LTA would achieve higher test performance (sensitivity and specificity), allowing reliable detection of pathological or regenerative changes in the outer hair cells.
Collapse
Affiliation(s)
- Katharina Bader
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany.
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany.
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
- Earlab GmbH, Tübingen, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Bader K, Dalhoff E, Dierkes L, Braun LH, Gummer AW, Zelle D. Reliable Long-Term Serial Evaluation of Cochlear Function Using Pulsed Distortion-Product Otoacoustic Emissions: Analyzing Levels and Pressure Time Courses. Ear Hear 2024:00003446-990000000-00284. [PMID: 38809242 DOI: 10.1097/aud.0000000000001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVES To date, there is no international standard on how to use distortion-product otoacoustic emissions (DPOAEs) in serial measurements to accurately detect changes in the function of the cochlear amplifier due, for example, to ototoxic therapies, occupational noise, or the development of regenerative therapies. The use of clinically established standard DPOAE protocols for serial monitoring programs appears to be hampered by multiple factors, including probe placement and calibration effects, signal-processing complexities associated with multiple sites of emission generation as well as suboptimal selection of stimulus parameters. DESIGN Pulsed DPOAEs were measured seven times within 3 months for f2 = 1 to 14 kHz and L2 = 25 to 80 dB SPL in 20 ears of 10 healthy participants with normal hearing (mean age = 32.1 ± 9.7 years). L1 values were computed from individual optimal-path parameters derived from the corresponding individual DPOAE level map in the first test session. Three different DPOAE metrics for evaluating the functional state of the cochlear amplifier were investigated with respect to their test-retest reliability: (1) the interference-free, nonlinear-distortion component level (LOD), (2) the time course of the DPOAE-envelope levels, LDP(t), and (3) the squared, zero-lag correlation coefficient () between the time courses of the DPOAE-envelope pressures, pDP(t), measured in two sessions. The latter two metrics include the two main DPOAE components and their state of interference. RESULTS Collated over all sessions and frequencies, the median absolute difference for LOD was 1.93 dB and for LDP(t) was 2.52 dB; the median of was 0.988. For the low (f2 = 1 to 3 kHz), mid (f2 = 4 to 9 kHz), and high (f2 = 10 to 14 kHz) frequency ranges, the test-retest reliability of LOD increased with increasing signal to noise ratio (SNR). CONCLUSIONS On the basis of the knowledge gained from this study on the test-retest reliability of pulsed DPOAE signals and the current literature, we propose a DPOAE protocol for future serial monitoring applications that takes into account the following factors: (1) separation of DPOAE components, (2) use of individually optimal stimulus parameters, (3) SNR of at least 15 dB, (4) accurate pressure calibration, (5) consideration of frequency- and level-dependent test-retest reliabilities and corresponding reference ranges, and (6) stimulus levels L2 that are as low as possible with sufficient SNR to capture the nonlinear functional state of the cochlear amplifier operating at its highest gain.
Collapse
Affiliation(s)
- Katharina Bader
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Linda Dierkes
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Lore Helene Braun
- Department of Radiooncology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Earlab GmbH, Tübingen, Germany
| |
Collapse
|
3
|
Bader K, Zelle D, Gummer AW, Dalhoff E. [Pulsed DPOAEs in serial measurements : Combined analysis paradigm of simultaneously occurring changes in hearing thresholds and DPOAEs. German version]. HNO 2024:10.1007/s00106-024-01477-0. [PMID: 38801424 DOI: 10.1007/s00106-024-01477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND To date, there is no consensus on how to standardize the assessment of ototoxicity in serial measurements. For the diagnosis of damage to the cochlear amplifier, measurement methods are required that have the highest possible test-retest reliability and validity for detecting persistent damage. Estimated distortion-product thresholds (LEDPT) based on short-pulse distortion-product otoacoustic emission (DPOAE) level maps use individually optimal DPOAE stimulus levels and allow reliable quantitative estimation of cochlea-related hearing loss. MATERIALS AND METHODS Hearing thresholds were estimated objectively using LEDPT and subjectively using modified Békésy tracking audiometry (LTA). Recordings were performed seven times within three months at 14 frequencies (f2 = 1-14 kHz) in 20 ears (PTA4 (0.5-4 kHz) < 20 dB HL). Reconstruction of the DPOAE growth behavior as a function of the stimulus levels L1, L2 was performed on the basis of 21 DPOAE amplitudes. A numerical fit of a nonlinear mathematical function to the three-dimensional DPOAE growth function yielded LEDPT for each stimulus frequency. For the combined analysis, probability distributions of hearing thresholds (LTA, LEDPT), DPOAE levels (LDP), and combinations thereof were determined. RESULTS LTA and LEDPT each exhibited a test-retest reliability with a median of absolute differences (AD) of 3.2 dB and 3.3 dB, respectively. Combining LEDPT, LDP, and LTA into a single parameter yielded a significantly smaller median AD of 2.0 dB. CONCLUSION It is expected that an analysis paradigm based on a combination of LEDPT, suprathreshold LDP, and fine-structure-reduced LTA would achieve higher test performance (sensitivity and specificity), allowing reliable detection of pathological or regenerative changes in the outer hair cells.
Collapse
Affiliation(s)
- Katharina Bader
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland.
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland.
| | - Dennis Zelle
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
- Earlab GmbH, Tübingen, Deutschland
| | - Anthony W Gummer
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
| | - Ernst Dalhoff
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
| |
Collapse
|
4
|
Schirmer J, Wolpert S, Dapper K, Rühle M, Wertz J, Wouters M, Eldh T, Bader K, Singer W, Gaudrain E, Başkent D, Verhulst S, Braun C, Rüttiger L, Munk MHJ, Dalhoff E, Knipper M. Neural Adaptation at Stimulus Onset and Speed of Neural Processing as Critical Contributors to Speech Comprehension Independent of Hearing Threshold or Age. J Clin Med 2024; 13:2725. [PMID: 38731254 PMCID: PMC11084258 DOI: 10.3390/jcm13092725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Background: It is assumed that speech comprehension deficits in background noise are caused by age-related or acquired hearing loss. Methods: We examined young, middle-aged, and older individuals with and without hearing threshold loss using pure-tone (PT) audiometry, short-pulsed distortion-product otoacoustic emissions (pDPOAEs), auditory brainstem responses (ABRs), auditory steady-state responses (ASSRs), speech comprehension (OLSA), and syllable discrimination in quiet and noise. Results: A noticeable decline of hearing sensitivity in extended high-frequency regions and its influence on low-frequency-induced ABRs was striking. When testing for differences in OLSA thresholds normalized for PT thresholds (PTTs), marked differences in speech comprehension ability exist not only in noise, but also in quiet, and they exist throughout the whole age range investigated. Listeners with poor speech comprehension in quiet exhibited a relatively lower pDPOAE and, thus, cochlear amplifier performance independent of PTT, smaller and delayed ABRs, and lower performance in vowel-phoneme discrimination below phase-locking limits (/o/-/u/). When OLSA was tested in noise, listeners with poor speech comprehension independent of PTT had larger pDPOAEs and, thus, cochlear amplifier performance, larger ASSR amplitudes, and higher uncomfortable loudness levels, all linked with lower performance of vowel-phoneme discrimination above the phase-locking limit (/i/-/y/). Conslusions: This study indicates that listening in noise in humans has a sizable disadvantage in envelope coding when basilar-membrane compression is compromised. Clearly, and in contrast to previous assumptions, both good and poor speech comprehension can exist independently of differences in PTTs and age, a phenomenon that urgently requires improved techniques to diagnose sound processing at stimulus onset in the clinical routine.
Collapse
Affiliation(s)
- Jakob Schirmer
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Stephan Wolpert
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Konrad Dapper
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
- Department of Biology, Technical University Darmstadt, 64287 Darmstadt, Germany
| | - Moritz Rühle
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Jakob Wertz
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Marjoleen Wouters
- Department of Information Technology, Ghent University, Technologiepark 126, 9052 Zwijnaarde, Belgium; (M.W.); (S.V.)
| | - Therese Eldh
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Katharina Bader
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Wibke Singer
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Etienne Gaudrain
- Lyon Neuroscience Research Center, Centre National de la Recherche Scientifique UMR5292, Inserm U1028, Université Lyon 1, Centre Hospitalier Le Vinatier-Bâtiment 462–Neurocampus, 95 Boulevard Pinel, 69675 Bron CEDEX, France;
- Department of Otorhinolaryngology, University Medical Center Groningen (UMCG), Hanzeplein 1, BB21, 9700 RB Groningen, The Netherlands;
| | - Deniz Başkent
- Department of Otorhinolaryngology, University Medical Center Groningen (UMCG), Hanzeplein 1, BB21, 9700 RB Groningen, The Netherlands;
| | - Sarah Verhulst
- Department of Information Technology, Ghent University, Technologiepark 126, 9052 Zwijnaarde, Belgium; (M.W.); (S.V.)
| | - Christoph Braun
- Magnetoencephalography-Centre and Hertie Institute for Clinical Brain Research, University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany;
- Center for Mind and Brain Research, University of Trento, Palazzo Fedrigotti-corso Bettini 31, 38068 Rovereto, Italy
| | - Lukas Rüttiger
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Matthias H. J. Munk
- Department of Biology, Technical University Darmstadt, 64287 Darmstadt, Germany
- Department of Psychiatry & Psychotherapy, University of Tübingen, Calwerstraße 14, 72076 Tübingen, Germany
| | - Ernst Dalhoff
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| | - Marlies Knipper
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076 Tübingen, Germany; (J.S.); (S.W.); (K.D.); (M.R.); (J.W.); (T.E.); (K.B.); (W.S.); (L.R.)
| |
Collapse
|
5
|
Schilder AGM, Wolpert S, Saeed S, Middelink LM, Edge ASB, Blackshaw H, Pastiadis K, Bibas AG. A phase I/IIa safety and efficacy trial of intratympanic gamma-secretase inhibitor as a regenerative drug treatment for sensorineural hearing loss. Nat Commun 2024; 15:1896. [PMID: 38429256 PMCID: PMC10907343 DOI: 10.1038/s41467-024-45784-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
Inhibition of Notch signalling with a gamma-secretase inhibitor (GSI) induces mammalian hair cell regeneration and partial hearing restoration. In this proof-of-concept Phase I/IIa multiple-ascending dose open-label trial (ISRCTN59733689), adults with mild-moderate sensorineural hearing loss received 3 intratympanic injections of GSI LY3056480, in 1 ear over 2 weeks. Phase I primary outcome was safety and tolerability. Phase lla primary outcome was change from baseline to 12 weeks in average pure-tone air conduction threshold across 2,4,8 kHz. Secondary outcomes included this outcome at 6 weeks and change from baseline to 6 and 12 weeks in pure-tone thresholds at individual frequencies, speech reception thresholds (SRTs), Distortion Product Otoacoustic Emissions (DPOAE) amplitudes, Signal to Noise Ratios (SNRs) and distribution of categories normal, present-abnormal, absent and Hearing Handicap Inventory for Adults/Elderly (HHIA/E). In Phase I (N = 15, 1 site) there were no severe nor serious adverse events. In Phase IIa (N = 44, 3 sites) the average pure-tone threshold across 2,4,8 kHz did not change from baseline to 6 and 12 weeks (estimated change -0.87 dB; 95% CI -2.37 to 0.63; P = 0.252 and -0.46 dB; 95% CI -1.94 to 1.03; P = 0.545, respectively), nor did the means of secondary measures. DPOAE amplitudes, SNRs and distribution of categories did not change from baseline to 6 and 12 weeks, nor did SRTs and HHIA/E scores. Intratympanic delivery of LY3056480 is safe and well-tolerated; the trial's primary endpoint was not met.
Collapse
Affiliation(s)
- Anne G M Schilder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Ear Institute, University College London, London, UK
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals Trust, London, UK
| | - Stephan Wolpert
- Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Tübingen, Germany.
| | - Shakeel Saeed
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Ear Institute, University College London, London, UK
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals Trust, London, UK
| | | | - Albert S B Edge
- Department of Otolaryngology, Harvard Medical School, Boston, USA
| | - Helen Blackshaw
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
- Ear Institute, University College London, London, UK
| | - Kostas Pastiadis
- 1st Department of Otolaryngology, Hippocration Hospital Athens, National & Kapodistrian University of Athens, Athens, Greece
| | - Athanasios G Bibas
- 1st Department of Otolaryngology, Hippocration Hospital Athens, National & Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
6
|
Liu Y, Gong Q. Deep Learning Models for Predicting Hearing Thresholds Based on Swept-Tone Stimulus-Frequency Otoacoustic Emissions. Ear Hear 2024; 45:465-475. [PMID: 37990395 DOI: 10.1097/aud.0000000000001443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVES This study aims to develop deep learning (DL) models for the quantitative prediction of hearing thresholds based on stimulus-frequency otoacoustic emissions (SFOAEs) evoked by swept tones. DESIGN A total of 174 ears with normal hearing and 388 ears with sensorineural hearing loss were studied. SFOAEs in the 0.3 to 4.3 kHz frequency range were recorded using linearly swept tones at a rate of 2 Hz/msec, with stimulus level changing from 40 to 60 dB SPL in 10 dB steps. Four DL models were used to predict hearing thresholds at octave frequencies from 0.5 to 4 kHz. The models-a conventional convolutional neural network (CNN), a hybrid CNN-k-nearest neighbor (KNN), a hybrid CNN-support vector machine (SVM), and a hybrid CNN-random forest (RF)-were individually built for each frequency. The input to the DL models was the measured raw SFOAE amplitude spectra and their corresponding signal to noise ratio spectra. All DL models shared a CNN-based feature self-extractor. They differed in that the conventional CNN utilized a fully connected layer to make the final regression decision, whereas the hybrid CNN-KNN, CNN-SVM, and CNN-RF models were designed by replacing the last fully connected layer of CNN model with a traditional machine learning (ML) regressor, that is, KNN, SVM, and RF, respectively. The model performance was evaluated using mean absolute error and SE averaged over 20 repetitions of 5 × 5 fold nested cross-validation. The performance of the proposed DL models was compared with two types of traditional ML models. RESULTS The proposed SFOAE-based DL models resulted in an optimal mean absolute error of 5.98, 5.22, 5.51, and 6.06 dB at 0.5, 1, 2, and 4 kHz, respectively, superior to that obtained by the traditional ML models. The produced SEs were 8.55, 7.27, 7.58, and 7.95 dB at 0.5, 1, 2, and 4 kHz, respectively. All the DL models outperformed any of the traditional ML models. CONCLUSIONS The proposed swept-tone SFOAE-based DL models were capable of quantitatively predicting hearing thresholds with satisfactory performance. With DL techniques, the underlying relationship between SFOAEs and hearing thresholds at disparate frequencies was explored and captured, potentially improving the diagnostic value of SFOAEs.
Collapse
Affiliation(s)
- Yin Liu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qin Gong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
- School of Medicine, Shanghai University, Shanghai, China
| |
Collapse
|
7
|
Vencovský V, Novak A, Klimeš O, Honzík P, Vetešník A. Distortion-product otoacoustic emissions measured using synchronized swept-sines. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:2586. [PMID: 37129675 DOI: 10.1121/10.0017976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
Swept-sines provide a tool for fast and high-resolution measurement of evoked otoacoustic emissions. During the measurement, a response to swept-sine(s) is recorded by a probe placed in the ear canal. Otoacoustic emissions can then be extracted by various techniques, e.g., Fourier analysis, the heterodyne method, and the least-square-fitting (LSF) technique. This paper employs a technique originally proposed with exponential swept-sines, which allows for direct emission extraction from the measured intermodulation impulse response. It is shown here that the technique can be used to extract distortion-product otoacoustic emissions (DPOAEs) evoked with two simultaneous swept-sines. For proper extraction of the DPOAE phase, the technique employs previously proposed adjusted formulas for exponential swept-sines generating so-called synchronized swept-sines (SSSs). Here, the SSS technique is verified using responses derived from a numerical solution of a cochlear model and responses measured in human subjects. Although computationally much less demanding, the technique yields comparable results to those obtained by the LSF technique, which has been shown in the literature to be the most noise-robust among the emission extraction methods.
Collapse
Affiliation(s)
- Václav Vencovský
- Department of Radioelectronics, Czech Technical University in Prague, Prague, Czech Republic
| | - Antonin Novak
- Laboratoire d'Acoustique de l'Université du Mans (LAUM), UMR 6613, Institut d'Acoustique - Graduate School (IA-GS), CNRS, Le Mans Université, Le Mans, France
| | - Ondřej Klimeš
- Department of Radioelectronics, Czech Technical University in Prague, Prague, Czech Republic
| | - Petr Honzík
- Department of Radioelectronics, Czech Technical University in Prague, Prague, Czech Republic
| | - Aleš Vetešník
- Department of Nuclear Chemistry, Czech Technical University in Prague, Prague, Czech Republic
| |
Collapse
|
8
|
Vetešník A, Vencovský V, Gummer AW. An additional source of distortion-product otoacoustic emissions from perturbation of nonlinear force by reflection from inhomogeneities. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:1660. [PMID: 36182298 DOI: 10.1121/10.0013992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
The basilar membrane in the cochlea can be modeled as an array of fluid coupled segments driven by stapes vibration and by the undamping nonlinear force simulating cochlear amplification. If stimulated with two tones, the model generates additional tones due to nonlinear distortion. These distortion products (DPs) can be transmitted into the ear canal and produce distortion-product otoacoustic emissions (DPOAEs) known to be generated in the healthy ear of various vertebrates. This study presents a solution for DPs in a two-dimensional nonlinear cochlear model with cochlear roughness-small irregularities in the impedance along the basilar membrane, which may produce additional DPs due to coherent reflection. The solution allows for decomposition of various sources of DPs in the model. In addition to the already described nonlinear-distortion and coherent-reflection mechanisms of DP generation, this study identifies a long-latency DPOAE component due to perturbation of nonlinear force. DP wavelets that are coherently reflected due to impedance irregularities travel toward the stapes across the primary generation region of DPs and there evoke perturbation of the nonlinear undamping force. The ensuing DP wavelets have opposite phase to the wavelets arising from coherent reflection, which results in partial cancellation of the coherent-reflection DP wavelets.
Collapse
Affiliation(s)
- Aleš Vetešník
- Department of Nuclear Chemistry, Czech Technical University in Prague, Prague 115 19, Czech Republic
| | - Václav Vencovský
- Department of Radioelectronics, Czech Technical University in Prague, Prague 166 27, Czech Republic
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls University Tübingen, Tübingen 72076, Germany
| |
Collapse
|
9
|
Bader K, Dierkes L, Braun LH, Gummer AW, Dalhoff E, Zelle D. Test-retest reliability of distortion-product thresholds compared to behavioral auditory thresholds. Hear Res 2021; 406:108232. [PMID: 33984603 DOI: 10.1016/j.heares.2021.108232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
When referred to baseline measures, serial monitoring of pure-tone behavioral thresholds and distortion-product otoacoustic emissions (DPOAEs) can be used to detect the progression of cochlear damage. Semi-logarithmic DPOAE input-output (I/O) functions enable the computation of estimated distortion-product thresholds (EDPTs) by means of linear regression, a metric that provides a quantitative estimate of hearing loss due to cochlear-amplifier degradation. DPOAE wave interference and a suboptimal choice of stimulus levels limit the accuracy of EDPTs. This work identifies the test-retest reliability of EDPTs derived from short-pulse DPOAE level maps (EDPTLM), a method that circumvents limitations associated with both wave interference and suboptimal choice of stimulus levels. The test-retest reliability was compared to that of EDPTs derived from semi-logarithmic I/O functions (EDPTI/O) and that of behavioral thresholds acquired with pure-tone audiometry (PTA) and modified Békésy tracking audiometry (TA) to provide a foundation for identifying and interpreting significant threshold shifts. The DPOAE-based auditory thresholds (EDPTLM and EDPTI/O) and behavioral thresholds (PTA and TA) were recorded seven times within three months at 14 frequencies with f2 = 1-14 kHz in 20 ears from ten subjects with normal hearing (4PTA0.5-4kHz < 20 dB HL). To obtain EDPTLM, short-pulse DPOAEs were recorded using 21 L1,L2 pairs. Reconstruction of DPOAE growth behavior as a function of L1 and L2 using nonlinear curve fitting enabled the derivation of EDPTLM for each frequency. Test-retest reliability was determined using three different approaches: 1) centered thresholds, 2) average threshold differences, and 3) average absolute threshold differences, between each possible test session (N = 21). Test-retest reliability based on centered thresholds and average threshold differences showed no statistically significant difference between EDPTLM, EDPTI/O, PTA, and TA for the pooled analysis incorporating all stimulus frequencies. Average absolute threshold differences presented small but significant differences in test-retest reliability with median values of 3.00 dB for PTA, 3.20 dB for TA, 3.34 dB for EDPTLM, and 3.51 dB for EDPTI/O. A considerable frequency dependence of test-retest reliability was found; namely, the highest test-retest reliability was for EDPTLM at f2 = 11 - 14 kHz. Otherwise, at lower frequencies, the highest test-retest reliability was for TA at f2 =1 - 2 kHz. Overall, the test-retest reliability of EDPTLM was better than that of EDPTI/O and was similar to that for behavioral thresholds. Hence, deriving EDPTLM from individual level maps is a promising and sensitive method for objectively monitoring the state of the cochlea. Furthermore, the detection of an equidirectional threshold change at a single frequency in both EDPTLM and TA might allow reducing the threshold shift as indication of a follow-up examination from the clinical standard of 10 dB down to 5 dB. This stricter indicator might be beneficial when monitoring cochlear damage, for example ototoxicity, in the presence of (remnant) cochlear amplification at baseline.
Collapse
Affiliation(s)
- Katharina Bader
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Linda Dierkes
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Lore Helene Braun
- Department of Radiooncology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany; Current address: Department of Radiooncology, Marienhospital Stuttgart, Böheimstraße 37, 70199 Stuttgart, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany; Current address: Redwave Medical GmbH, Hans-Knöll-Str. 6, 07745 Jena, Germany
| |
Collapse
|
10
|
Liu Y, Ji F, Gong Q. Analyzing Stimulus-frequency Otoacoustic Emission Fine Structure Using an Additive Model . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:960-963. [PMID: 33018144 DOI: 10.1109/embc44109.2020.9175491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A good understanding of the origin of stimulus-frequency otoacoustic emission (SFOAE) fine structure in human ears and its probe level-dependency has potential clinical significance. In this study, we develop a two-component additive model, with total SFOAE unmixed into short- and long-latency components (or reflections) using time windowing method, to investigate the origin of SFOAE fine structure in humans from 40 to 70 dB SPL. The two-component additive model predicts that a spectral notch seen in the amplitude fine structure is produced when short- and long-latency components have opposite phases and comparable magnitudes. And the depth of spectral notch is significantly correlated with the amplitude difference between the two separated components, as well as their degree of opposite phase. Our independent evidence for components contributing to SFOAE fine structure suggests that amplitude, phase and delay fine structure in the human SFOAEs are a construct of the complex addition of two or more internal reflections with different phase slops in the cochlea.
Collapse
|
11
|
Zelle D, Bader K, Dierkes L, Gummer AW, Dalhoff E. Derivation of input-output functions from distortion-product otoacoustic emission level maps. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 147:3169. [PMID: 32486784 DOI: 10.1121/10.0001142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Distortion-product otoacoustic emissions (DPOAEs) emerge from the cochlea when elicited with two tones of frequencies f1 and f2. DPOAEs mainly consist of two components, a nonlinear-distortion and a coherent-reflection component. Input-output (I/O) functions of DPOAE pressure at the cubic difference frequency, fDP=2f1-f2, enable the computation of estimated distortion-product thresholds (EDPTs), offering a noninvasive approach to estimate auditory thresholds. However, wave interference between the DPOAE components and suboptimal stimulus-level pairs reduces the accuracy of EDPTs. Here, the amplitude P of the nonlinear-distortion component is extracted from short-pulse DPOAE time signals. DPOAE level maps representing the growth behavior of P in L1,L2 space are recorded for 21 stimulus-level pairs and 14 frequencies with f2=1 to 14 kHz (f2/f1=1.2) from 20 ears. Reproducing DPOAE growth behavior using a least-squares fit approach enables the derivation of ridge-based I/O functions from model level maps. Objective evaluation criteria assess the fit results and provide EDPTs, which correlate significantly with auditory thresholds (p < 0.001). In conclusion, I/O functions derived from model level maps provide EDPTs with high precision but without the need of predefined optimal stimulus-level pairs.
Collapse
Affiliation(s)
- Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Katharina Bader
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn- Straße 5, 72076 Tübingen, Germany
| | - Linda Dierkes
- Department of Otolaryngology, Head and Neck Surgery, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn- Straße 5, 72076 Tübingen, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, Germany
| |
Collapse
|
12
|
Vencovský V, Vetešník A, Dalhoff E, Gummer AW. Distributed sources as a cause of abrupt amplitude decrease in cubic distortion-product otoacoustic emissions at high stimulus intensities. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:EL92. [PMID: 31472590 DOI: 10.1121/1.5119942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Václav Vencovský
- Department of Radioelectronics, Czech Technical University in Prague, Technická 2, 166 27 Prague, Czech
| | - Aleš Vetešník
- Department of Nuclear Chemistry, Czech Technical University in Prague, Břehová 7, 115 19 Prague, Czech
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, ,
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard Karls University Tübingen, Elfriede-Aulhorn-Straße 5, 72076 Tübingen, ,
| |
Collapse
|
13
|
Inner ear function in patients with obstructive sleep apnea. Sleep Breath 2019; 24:65-69. [PMID: 31309465 DOI: 10.1007/s11325-019-01891-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Because of their high metabolic activity and low-resting oxygen tension, the organs of the inner ear are vulnerable to hypoxia, a condition that occurs repetitively in obstructive sleep apnea-hypopnea syndrome (OSAHS). The present study aimed to investigate the inner ear function of patients with OSAHS. METHODS A total of 58 patients with OSAHS (116 ears) and 20 adults without OSAHS were enrolled in the present study. The clinical features, such as air-conduction thresholds, auditory brainstem response (ABR, 11 times/s and 51 times/s stimulation rates), and distorted products otoacoustic emission (DPOAE), were evaluated and compared between these two groups. RESULTS Air-conduction thresholds at 4 kHz and 8 kHz were higher in patients with OSAHS compared with controls (P < 0.001). At the rate of 11 times per second, biauricular wave I latencies and wave V latencies in the OSAHS group were longer than those in the control group (1.51 ± 0.13 vs. 1.33 ± 0.07 ms, P < 0.001; 5.65 ± 0.23 vs. 5.53 ± 0.23 ms, P = 0.0016). At the rate of 51 times per second, biauricular wave I latencies and wave V latencies in the OSAHS group were longer than those in the control group (1.64 ± 0.12 vs. 1.44 ± 0.06 ms, P = 0.0001; 5.92 ± 0.26 vs. 5.80 ± 0.18 ms, P = 0.0077). However, there was no significant difference in the wave I and wave V interval between these two groups (P = 0.10). DPOAE amplitude was significantly reduced in OSAHS patients, although no hearing loss was observed. CONCLUSION High-frequency hearing loss was detected in adults with severe OSAHS, and wave I latencies and wave V latencies of ABR were prolonged.
Collapse
|
14
|
Vencovský V, Zelle D, Dalhoff E, Gummer AW, Vetešník A. The influence of distributed source regions in the formation of the nonlinear distortion component of cubic distortion-product otoacoustic emissions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 145:2909. [PMID: 31153314 DOI: 10.1121/1.5100611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 04/16/2019] [Indexed: 06/09/2023]
Abstract
Distortion product otoacoustic emissions (DPOAEs) are evoked by two stimulus tones with frequency f1 and f2 of ratio f2/f1 in the range between approximately 1.05 and 1.4. This study theoretically and experimentally analyzes the cubic 2f1-f2 DPOAE for different stimulus levels of one of the tones while the other is constant. Simulations for f2/f1 of 1.2 and moderate stimulus levels (30-70 dB sound pressure level) indicate that cubic distortion products are generated along a relatively large length of the basilar membrane, the extent of which increases with stimulus level. However, apical from the place of maximum nonlinear force, the wavelets generated by these distributed sources mutually cancel. Therefore, although the spatial extent of the primary DPOAE sources broadens with increasing stimulus level (up to 1.5 oct), the basilar-membrane region contributing to the DPOAE signal is relatively narrow (0.6 oct) and level independent. The observed dependence of DPOAE amplitude on stimulus level can be well-approximated by a point source at the basilar-membrane place where the largest distortion product (maximum of the nonlinear force) is generated. Onset and offset of the DPOAE signal may contain amplitude overshoots (complexities), which are in most cases asymmetrical. Two-tone suppression was identified as the main cause of these onset and offset complexities. DPOAE measurements in two normal-hearing subjects support the level dependence of the steady-state DPOAE amplitude and the asymmetry in the onset and offset responses predicted by the theoretical analysis.
Collapse
Affiliation(s)
- Václav Vencovský
- Department of Radioelectronics, Czech Technical University in Prague, Technická 2, 166 27 Prague 6, Czech Republic
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany
| | - Aleš Vetešník
- Department of Nuclear Chemistry, Czech Technical University in Prague, Břehová 7, 115 19 Prague, Czech Republic
| |
Collapse
|
15
|
Biswal M, Mishra SK. Comparison of time-frequency methods for analyzing stimulus frequency otoacoustic emissions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 143:626. [PMID: 29495731 PMCID: PMC5796829 DOI: 10.1121/1.5022783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Stimulus frequency otoacoustic emissions (SFOAEs) can have multiple time varying components, including multiple internal reflections. It is, therefore, necessary to study SFOAEs using techniques that can represent their time-frequency behavior. Although various time-frequency schemes can be applied to identify and filter SFOAE components, their accuracy for SFOAE analysis has not been investigated. The relative performance of these methods is important for accurate characterization of SFOAEs that may, in turn, enhance the understanding of SFOAE generation. This study using in silico experiments examined the performance of three linear (short-time Fourier transform, continuous wavelet transform, Stockwell transform) and two nonlinear (empirical mode decomposition and synchrosqueezed wavelet transform) time-frequency approaches for SFOAE analysis. Their performances in terms of phase-gradient delay estimation, frequency specificity, and spectral component extraction are compared, and the relative merits and limitations of each method are discussed. Overall, this paper provides a comparative analysis of various time-frequency methods useful for otoacoustic emission applications.
Collapse
Affiliation(s)
- Milan Biswal
- Department of Communication Disorders, New Mexico State University, Las Cruces, New Mexico 88003, USA
| | - Srikanta K Mishra
- Department of Communication Disorders, New Mexico State University, Las Cruces, New Mexico 88003, USA
| |
Collapse
|
16
|
Zelle D, Dalhoff E, Gummer AW. Comparison of time-domain source-separation techniques for short-pulse distortion-product otoacoustic emissions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 142:EL544. [PMID: 29289117 DOI: 10.1121/1.5016466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Distortion-product otoacoustic emissions (DPOAEs) are presumed to consist mainly of two components, a nonlinear-distortion component and a coherent-reflection component. Wave interference between these two components reduces the accuracy of DPOAEs when used to evaluate cochlear function. Here, short tone pulses are utilized to record DPOAE signals in normal-hearing subjects. DPOAE components are extracted from recordings at discrete frequencies using two different techniques in the time domain. The extracted DPOAE components are compared to recordings obtained with conventional, continuous primary tones.
Collapse
Affiliation(s)
- Dennis Zelle
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany , ,
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany , ,
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Department of Otolaryngology, Eberhard-Karls-University Tübingen, Elfriede-Aulhorn-Strasse 5, 72076 Tübingen, Germany , ,
| |
Collapse
|