Magnitude changes in transient evoked otoacoustic emissions and high-level 2f1-f2 distortion products in man during quinine administration

Congenital Nonprofound Bilateral Sensorineural Hearing Loss in Children: Comprehensive Characterization of Auditory Function and Hearing Aid Benefit

A prospective cross-sectional design was used to characterize congenital bilateral sensorineural hearing loss (SNHL). The underlying material of >30,000 consecutively screened newborns comprised 11 subjects with nonprofound, alleged nonsyndromic, SNHL. Comprehensive audiological testing was performed at ≈11 years of age. Results showed symmetrical sigmoid-like median pure-tone thresholds (PTTs) reaching 50−60 dB HL. The congenital SNHL revealed recruitment, increased upward spread of masking, distortion product otoacoustic emission (DPOAE) dependent on PTT (≤60 dB HL), reduced auditory brainstem response (ABR) amplitude, and normal magnetic resonance imaging. Unaided recognition of speech in spatially separate competing speech (SCS) deteriorated with increasing uncomfortable loudness level (UCL), plausibly linked to reduced afferent signals. Most subjects demonstrated hearing aid (HA) benefit in a demanding laboratory listening situation. Questionnaires revealed HA benefit in real-world listening situations. This functional characterization should be important for the outline of clinical guidelines. The distinct relationship between DPOAE and PTT, up to the theoretical limit of cochlear amplification, and the low ABR amplitude remain to be elucidated. The significant relation between UCL and SCS has implications for HA-fitting. The fitting of HAs based on causes, mechanisms, and functional characterization of the SNHL may be an individualized intervention approach and deserves future research.

A Prospective Study of Etiology and Auditory Profiles in Infants with Congenital Unilateral Sensorineural Hearing Loss

Congenital unilateral sensorineural hearing loss (uSNHL) is associated with speech-language delays and academic difficulties. Yet, controversy exists in the choice of diagnosis and intervention methods. A cross-sectional prospective design was used to study hearing loss cause in twenty infants with congenital uSNHL consecutively recruited from a universal neonatal hearing-screening program. All normal-hearing ears showed ≤20 dB nHL auditory brainstem response (ABR) thresholds (ABRthrs). The impaired ear median ABRthr was 55 dB nHL, where 40% had no recordable ABRthr. None of the subjects tested positive for congenital cytomegalovirus (CMV) infection. Fourteen subjects agreed to participate in magnetic resonance imaging (MRI). Malformations were common for all degrees of uSNHL and found in 64% of all scans. Half of the MRIs demonstrated cochlear nerve aplasia or severe hypoplasia and 29% showed inner ear malformations. Impaired ear and normal-hearing ear ABR input/output functions on a group level for subjects with ABRthrs < 90 dB nHL were parallel shifted. A significant difference in interaural acoustic reflex thresholds (ARTs) existed. In congenital uSNHL, MRI is powerful in finding a possible hearing loss cause, while congenital CMV infection may be relatively uncommon. ABRs and ARTs indicated an absence of loudness recruitment, with implications for further research on hearing devices.

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.

Quinine-induced alterations of electrically evoked otoacoustic emissions and cochlear potentials in guinea pigs

Quinine is a well-known ototoxic drug which may affect portions of the auditory system with different biochemical effects, causing reversible hearing loss and tinnitus. Recent investigations indicate that quinine at high concentrations can act directly on cochlear outer hair cells to affect their motility and the mechanical response of the basilar membrane. This study aimed to investigate the effect of quinine on the electromotility of outer hair cells in vivo by means of measuring the electrically evoked otoacoustic emissions (EEOAEs), and the relationship between EEOAE and hearing sensitivity alterations in guinea pigs. Quinine was infused into the scala tympani with concentrations between 0.05 and 5 mM. An alternating current (35 microA RMS) swept from 400 Hz to 40 kHz was applied to the round window to evoke the EEOAE. The compound action potential (CAP), cochlear microphonic (CM) and summating potential (SP) were also measured. Results show that quinine affects the EEOAE in a dose-dependent manner and that its effects are reversible. Two aspects of the EEOAE were affected by quinine, depending on concentration: (1) the 'fine structure' only for concentrations below 0.1 mM and (2) the overall amplitude and the 'fine structure' for concentrations above 0.1 mM. At 5 mM the fine structure was completely absent and the mean amplitude of the EEOAE greatly decreased. Multiple component analysis shows the short delay component of the EEOAE is related to the mean value of the amplitude spectrum while the long delay component is related to the fine structure. The alterations of the EEOAE are roughly comparable to that of the cochlear potentials. A 'threshold concentration' for quinine's effects was found at 25 microM. CAP was significantly affected at 25 microM while EEOAE, CM and SP were not. Enhancement of the EEOAE amplitude was noticed in five out of 20 animals in the current study. The enhancement appears only related to the EEOAE mean level or short delay component. The results suggest that quinine can affect in vivo electromotility of outer hair cells at low concentration and therefore change the cochlear amplifier performance via an effect on electro-mechanical transduction. Its effects on the cochlear spiral ganglion neurons and/or their presynaptic process are also suggested, and these are speculated to be the primary sites for quinine's effects on the auditory system.

Changes in 2f1 - f2 acoustic distortion products in humans during quinine-induced cochlear dysfunction

Quinine is a suitable model substance for the study of otoacoustic emissions (OAEs) as it reversibly affects the outer hair cells, thus reducing sensitivity, frequency-selectivity and various forms of OAEs. The aim of this experiment was to study quinine-induced changes in the input/output (I/O) function of 2f1 - f2 distortion product OAE (DPOAE; f2/f1 = 1.22; 750-6,000 Hz). Six volunteers with normal hearing (26-39 years old) were intravenously infused to achieve pseudostable quinine plasma concentrations (approximately12 microM) inducing an average pure-tone threshold (PTT; 750-6,000 Hz) shift of 18 dB (5-30 dB) (frequency-independent and reversible). The mean quinine-induced DPOAE shift increased continuously with decreasing equal-level primary tones, e.g. from 1.0 dB at 70 dB sound pressure level (SPL) (n = 42) to 10.5 dB (n = 22) at 40 dB SPL (pooled data, no frequency dependence). According to recruitment, the mean slope of the DPOAE I/O function (at 30-60 dB SPL) increased from 0.86 to 1.35 dB/dB. The lack of correlation between shifts in DPOAE and PTT is in stark contrast to the excellent correlation reported between shifts in transient evoked OAE detection threshold and its corresponding psychoacoustic threshold. The highly vulnerable spontaneous OAEs, in combination with the less vulnerable DPOAEs, fit into a recently proposed taxonomic classification for OAEs.

The effects of quinine on cochlear nerve fibre activity in the guinea pig

The effect of quinine on single cochlear nerve fibre activity (n = 38) was measured in four pigmented guinea pigs, which were given 10-30 mg/kg of quinine intravenously. The frequency tuning curves of these fibres exhibited significant increases in the thresholds of both 'tip' and 'tails' regions of the frequency tuning curve, but these changes did not appear to be accompanied by significant changes in tuning, as measured by the Q'10'dB. In comparison with control fibres (n = 178) from 13 untreated animals, significant changes in the proportion of low:high spontaneous rates (SR) were also seen. Using a boundary criterion of 25 sp/s, this rate changed from 26:74% to 47:53% in control and quinine-poisoned fibres, respectively. Independent of changes in the spontaneous rate, significant increases in the mean absolute refractory period from 0.85 to 1 ms were measured following quinine administration. The absence of a significant effect on fibre tuning whilst threshold was elevated indicates that quinine does not affect the integrity of the cochlear amplifier, though appears to affect cochlear sensitivity.

Identification of noise sources that influence distortion product otoacoustic emission measurements in human neonates

OBJECTIVE

The objective of this study was to identify individual sources of noise and their contribution to the overall noise that influences valid measurement of otoacoustic emissions in neonates. The hypothesis was that careful selection of eliciting signals and signal processing parameters, unique analysis of measured results, and control of certain subject characteristics would allow isolation of these individual noise sources and determine their relative influence.

DESIGN

Eliciting signal parameters were optimized and held constant to minimize equipment noise. Analysis of noise floors in relation to signal level was used to identify equipment-related noise associated with changes in signal parameters. Analysis of noise floor distributions was used to determine whether environmental noise entered the measurements via inadequate coupling of the probe to the ear. The acoustic characteristics of the middle ear were varied via subject selection to determine the influence of middle-ear characteristics on noise floor levels.

RESULTS

The two sources of noise associated with the measurement equipment need not contribute to the noise floor for biologically relevant otoacoustic emissions measurements (eliciting signal levels between 30 and 75 dB SPL). Of the two pathways identified for environmental noise, the pathway resulting from an inadequate seal between the probe and the ear canal can be eliminated. One of the two sources of noise related to the subject, noise resulting from biologic activity unrelated to the ear can be minimized. However, the remaining factor, the status of the middle ear, has been shown to contribute as much as 6 dB to the overall noise floor.

CONCLUSIONS

Careful selection of signal parameters and additional data analyses and procedural variables can isolate or control several sources of noise that influence distortion product otoacoustic emission measurements in neonates. Tight coupling between the probe unit and the external ear canal should be maintained for all measurements. Middle ear abnormalities can increase noise floors up to 6 dB.