Contralateral auditory stimulation and otoacoustic emissions: a review of basic data in humans

Gender differences in contralateral suppression of spontaneous otoacoustic emissions in individuals with auditory neuropathy spectrum disorders

PURPOSE

The current study aims to evaluate gender variations in the efferent auditory system functioning in the ANSD population and compare them to normal hearing persons using contralateral suppression of spontaneous OAE (SOAEs).

METHODS

For the current study, a total of 54 ears were considered prospectively. 27 ears with normal hearing (NH) sensitivity were in group I, while 27 ears with ANSD were in group II. All of the subjects had a regular audiological examination followed by synchronised SOAE recordings with and without broadband noise (in the contralateral ear) at 50 dB SPL and statistical analysis was carried out.

RESULTS

Wilcoxon signed rank test revealed a significant decrease in SOAE amplitude with contralateral noise stimulation in NH, while no such trend was observed in ANSD. However, contralateral SOAE stimulation resulted in significant high-frequency shifts for both the ANSD and NH groups in the noise condition. In the comparison of gender effects on SOAE amplitude and frequency shifts using Mann-Whitney, no significant gender differences were seen. The lack of gender differences in SOAE suppression is explained based on global standing wave theory and local oscillator theory.

CONCLUSIONS

Contralateral effect of noise on SOAE shows frequency shifts, but not amplitude shifts both of which are not affected by gender effects.

Olivocochlear Efferents in Animals and Humans: From Anatomy to Clinical Relevance

Olivocochlear efferents allow the central auditory system to adjust the functioning of the inner ear during active and passive listening. While many aspects of efferent anatomy, physiology and function are well established, others remain controversial. This article reviews the current knowledge on olivocochlear efferents, with emphasis on human medial efferents. The review covers (1) the anatomy and physiology of olivocochlear efferents in animals; (2) the methods used for investigating this auditory feedback system in humans, their limitations and best practices; (3) the characteristics of medial-olivocochlear efferents in humans, with a critical analysis of some discrepancies across human studies and between animal and human studies; (4) the possible roles of olivocochlear efferents in hearing, discussing the evidence in favor and against their role in facilitating the detection of signals in noise and in protecting the auditory system from excessive acoustic stimulation; and (5) the emerging association between abnormal olivocochlear efferent function and several health conditions. Finally, we summarize some open issues and introduce promising approaches for investigating the roles of efferents in human hearing using cochlear implants.

Changing stimulation patterns can change the broadness of contralateral masking functions for bilateral cochlear implant users

Past studies have found that contralateral masking functions are sharper than ipsilateral masking functions for cochlear implant (CI) users. This could suggest that contralateral masking effects are only sensitive to the peak of the masker stimulation for this population. To determine if that is the case, this study investigated whether using broader stimulation patterns affects the broadness of the contralateral masking function. Contralateral masking functions were measured for six bilateral CI users using both a broad and narrow masker. Findings from this study revealed that the broad masker resulted in a broader contralateral masking function. This would suggest that stimulation outside of the peak of the masker affects contralateral masking functions for CI users.

Distortion-product otoacoustic emissions and contralateral suppression findings in children with Asperger's Syndrome

OBJECTIVES

Children with Asperger's Syndrome (AS) often demonstrate auditory behaviors such as hypersensitivity to sounds and poor performance in noisy environments. These auditory behaviors may be related to cochlear dysfunction and abnormal medial olivocochlear bundle (MOCB) activity. The objective of this study was to examine the distortion-product otoacoustic emissions (DPOAEs) with and without contralateral white noise to evaluate outer hair cell activity and MOCB activity in children with AS.

METHODS

A case control study where 18 boys with AS and 18 age-matched control subjects participated in the study. For both groups, DPOAEs were recorded at 4031, 2627, 1969, and 1359 Hz f2 frequencies with and without contralateral white noise at 30 dB SL. DPOAE SNRs and difference scores were analyzed for possible differences between both groups and age subgroups (young and old children).

RESULTS

In the quiet condition, there were no significant group or ear differences in DPOAEs SNR. However, DPOAEs SNR were larger at 4031 Hz than at lower frequencies in both groups, mostly due to negative effect of background noise on low frequency response. Contralateral noise resulted in both suppression and enhancement of the DPOAE SNRs in 93% of the control group and 90% of the AS group. However, there were no significant differences in suppression and enhancement between the two groups or age subgroups. The young controls had right ear advantage and significantly larger suppression at all frequencies except 4031 Hz than old controls. The young children with AS had slight left ear advantage and significantly larger suppression only at 2672 Hz compared to the old children with AS.

CONCLUSIONS

The results, indicating minor differences in DPOAEs and contralateral suppression and enhancement of DPOAEs between both control and AS groups and age subgroups, suggest subtle differences in the function of the outer hair cells and the MOCB activity. Therefore, other central auditory processing in the temporal lobe, limbic system and autonomic nervous system may be involved in the generation of hypersensitivity to sounds and difficulty understanding in noisy environments in children with AS.

Test/retest repeatability of effect contralateral acoustic stimulation on the magnitudes of distortion product ototacoustic emissions

OBJECTIVES/HYPOTHESIS

Contralateral inhibition of distortion product otoacoustic emissions (DPOAE) has become an important tool to assess the functioning of the medial olivocochlear efferents in humans. However, before this measurement can be applied clinically, the test/retest repeatability needs to be established. Therefore, the current study aimed at evaluating intra- and intersession test/retest repeatability of contralateral inhibition of DPOAE at 2f(1) -f(2) .

STUDY DESIGN

Prospective Test/Retest Reliability Study.

METHODS

Contralateral inhibition of DPOAE magnitudes were measured in the right ear of 24 adult male participants. To assess the intrasession repeatability, measurements were repeated without altering the position of the DPOAE probe (single-probe-fit). To assess intersession reliability, measurements were repeated on 8 different days (multiple-probe-fit). Repeatability of inhibition of DPOAE magnitudes was evaluated by Cronbach's alpha, interclass correlations, standard error of measurement, and its 95% confidence interval and smallest detectable difference.

RESULTS

DPOAE magnitudes were highly stable and repeatable across different recording sessions. However, test/retest reliability coefficients of DPOAE inhibition magnitudes were less than satisfactory for all the frequencies, in both single-probe-fit and multiple-probe-fit modes.

CONCLUSIONS

Results of the present study showed that contralateral inhibition magnitudes of DPOAEs varied considerably, even though DPOAEs magnitudes remained essentially the same across different recording sessions. As reliability is an essential aspect of any clinical procedure, it is suggested that at present contralateral inhibition of DPOAEs should not be used clinically to evaluate the medial efferent system. Laryngoscope, 2012.

[Efferent suppression test--sensitivity and specificity]

INTRODUCTION

The amplitude of click evoked otoacoustic emissions can be suppressed (reduced) with contralateral acoustic stimulation (CAS). This is thought to be due to the inhibitory control that the medial efferent auditory nerve exerts on outer hair cell function. One commonly used test of medial olivocochlear (MOC) function in humans involves measuring the degree of suppression of ipsilateral otoacoustic emissions (OAEs) by CAS. This effect is called contralateral suppression, efferent effect or olivocochlear reflex. Aim of the study. The objective of this study was to measure cut-off level of contralateral suppression, sensitivity and specificity of the efferent test.

MATERIAL AND METHODS

To evaluate the function of MOC system click evoked otoacoustic emissions (CEOAEs) with and without continuous contralateral broadband noise (BBN) stimulation were recorded in 14 patients with multiple sclerosis, 16 patients with unilateral cerebello-pontine angle tumor and control group matched for age and gender. BBN was presented at 50 dB SL and otoacoustic emissions were recorded in response to nonlinear clicks at 70 +/- 3 dB SPL.

RESULTS

The cut-off level was established at -1.4 dB. For 1.4 dB cut-off level of contralateral suppression the sensitivity of the efferent test was 90% and specificity was 70%.

CONCLUSIONS

To conclude, assessment of efferent suppression may be a useful addition to the battery test employed in the investigation of multiple sclerosis and cerebello-pontine angle tumors. The MOC suppression test may provide a tool for an early diagnosis of the brainstem pathology.

Pathophysiological Changes of the Central Auditory Pathway after Blunt Trauma of the Head

It is the aim of the present paper to correlate clinical symptoms of auditory dysfunction (tinnitus, hyperacusis, hearing loss) one year on average after a blunt trauma of the head with objective audiological test results (otoacoustic emission and auditory brainstem response testing, impedance audiometry) and to compare these findings to controls without history of head trauma. Thirty-one patients (24-56 years) were included. They were largely female (n = 26). The clinical and otolaryngological examination (including otoscopy) of all patients revealed no pathological abnormalities. Pure-tone audiograms were normal with one exception (pre-existing noise-induced hearing loss) as well as tympanograms. The main auditory symptoms were tinnitus (n = 9), hyperacusis (n = 2) and a reported transient hearing loss immediately after the trauma (n = 16) (which had improved at the time of examination). The results of testing the central auditory pathway showed that the transiently evoked otoacoustic emissions (otoemissions) revealed statistically significant differences between amplitude differences of all patients as well as patients with tinnitus and controls in the linear, but not in the non-linear stimulation mode. A complete loss of stapedial reflex responses was found in 12 of the patients and a partial (irregular) loss (in at least more than two frequencies) in four additional patients. Auditory brainstem responses (ABR) were normal in all patients, but 76% had lowered loudness discomfort levels (LDL). Blunt trauma of the head can lead to auditory dyfunction, probably as a result of diffuse axonal injury of the central auditory pathway. An initial sensorineural hearing loss after the trauma (as a result of the inner ear fluid concussion) was transiently reported only. Auditory symptoms play a minor role in the so-called "postconcussive syndrome," but should be considered and evaluated fully.

The effect of suppression on the periodicity of stimulus frequency otoacoustic emissions: experimental data

In a companion paper [Lineton and Lutman, J. Acoust. Soc. Am. 114, 859-870 (2003)], changes in the spectral period of stimulus frequency otoacoustic emissions (SFOAEs) during self-suppression and two-tone suppression were simulated using a nonlinear cochlear model based on the distributed roughness theory of otoacoustic emission generation [Zweig and Shera, J. Acoust. Soc. Am. 98, 2018-2047 (1995)1. The current paper presents the results of an experimental investigation of SFOAE suppression obtained from 20 human subjects. It was found that, in most subjects, the spectral period increased during self-suppression, but reduced during high-side two-tone suppression. This pattern of results is in close agreement with the predictions of the cochlear model, and therefore strongly supports the distributed roughness theory of Zweig and Shera. In addition, the results suggest that the SFOAE spectral period is sensitive to changes in the state of the cochlear amplifier.

Influence of contralateral stimulation by two-tone complexes, narrow-band and broad-band noise signals on the 2f1-f2 distortion product otoacoustic emission levels in humans

In order to test the frequency specificity of the efferent suppressive effect on otoacoustic emissions, changes in the 2f1-f2 distortion product otoacoustic emission (DPOAE) levels induced by contralateral stimuli of different spectra were measured in 10 normally hearing adults. Three types of contralateral stimuli were used: (i) a set of 6 pairs of pure tones with the same frequencies as used for DPOAE stimulation; (ii) 6 narrow-band noise signals with cut-off frequencies equal to the frequencies of the primary tones used for DPOAE stimulation; and (iii) broad-band noise with a bandwidth of 840-6,000 Hz. A small suppressive effect was observed mainly in the mid-frequency region. Broad-band noise was more effective at suppressing DPOAEs than narrow-band noises and two-tone complexes. Occasionally, small enhancements in DPOAE amplitudes were observed. Based on the results of this study, it is concluded that DPOAE changes induced by contralateral stimuli are not frequency-specific, and are too small to have routine clinical value.

Effects of contralateral white noise stimulation on distortion product otoacoustic emissions in myasthenic patients

Myasthenia gravis (MG) induces a reduction of transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) that reverses partially after administration of an acetylcholinesterase (AChE) inhibitor. In normal subjects a contralateral acoustic stimulation (CAS) produces an amplitude reduction of TEOAEs and DPOAEs. This effect, called contralateral suppression (CS), is mediated by the efferent auditory system. Twenty subjects affected by MG underwent DPOAE recording with and without contralateral white noise in a drug-free baseline period ('basal') and 1 h ('post') after administration of a reversible AChE inhibitor. In 'basal' condition CAS did not induce significant DPOAE amplitude changes but a paradoxical slight increase was observed. After drug administration, CAS produced a significant decrease of DPOAE amplitudes for middle frequencies (f(2) between 1306 and 2600 Hz). In normal controls CAS caused a significant decrease (P<0.001) for all frequencies. The amount of CS in controls and in the MG 'post' condition was not significantly different. The increased acetylcholine (ACh) availability following drug consumption seems to partially restore outer hair cell function and enhances their electromotility; a further influx of ACh due to CAS yields to restoration of the CS. These findings also suggest that DPOAEs may be useful in the diagnosis of MG and for monitoring the effectiveness of treatment.

The influence of hypothermia on outer hair cells of the cochlea and its efferents

Transient evoked otoacoustic emissions (TEOAE) were recorded in 21 guinea-pigs undergoing hypothermia. The minimal average body temperature during cooling was 26 degrees C/24.9 degrees C measured orally or rectally, respectively. The animals were subsequently warmed to normal body temperature. A clear influence of body temperature on TEOAE could be documented. During cooling the amplitude and reproducibilities decreased, disappearing completely at a mean temperature below 28.5 degrees C (oral) and 27.3 degrees C (rectal). The emissions reappeared during rewarming at a mean temperature of 30.1 degrees C (oral) and 30.8 degrees C (rectal). Contralateral auditory stimulation (CAS) led to a decrease of the amplitudes of TEOAE during cooling down to a mean of 33 degrees C/32 degrees C (oral/rectal temperature). During rewarming, influences of the CAS could be recognized, again at an oral temperature above 35 degrees C. The changes to the TEOAE observed in these experiments suggest that hypothermia affects not only the outer hair cells (OHC) of the cochlea but also the efferent supply to the cochlea.

Objective calibration of bone conductors using otoacoustic emissions

OBJECTIVE

To demonstrate a technique for objectively calibrating bone conductors on an individual basis using distortion product otoacoustic emissions (DPOAEs).

DESIGN

Individual calibrations were obtained using DPOAEs recorded from a single ear of 21 normally hearing adults. Validity and robustness of the technique were investigated through subjective phase cancellation measurements and sensitivity analysis.

RESULTS

Calibrations obtained using the DPOAE method were well supported by phase cancellation results. Intersession repeatability was good, and manipulation of the DPOAE data showed that the calculated calibration is relatively insensitive to small variations of emission magnitude. Bilateral stimulation through bone conduction did not display an apparent effect on emission magnitude in a single individual.

CONCLUSION

Bone conductors can be accurately calibrated on an individual basis with good repeatability using DPOAEs. The technique is robust and offers an objective, noninvasive calibration method for research and specialized clinical applications. No training and only passive cooperation are required, making the procedure ideal for special groups such as children. A number of limitations will reduce the clinical utility of this technique. Important audiometric frequencies below 1 kHz cannot be tested because of noise, because individuals with significant hearing loss are unlikely to produce sufficient DPOAEs, and because commercial bone conductors typically have poor high-frequency response above 4 kHz.

Effects of background noise on click-evoked otoacoustic emissions

OBJECTIVE

To investigate the effect of increased levels of background noise on click-evoked otoacoustic emission (CEOAE) recordings and to compare the effectiveness of the default CEOAE program with the QuickScreen CEOAE program in increased levels of noise, using an Otodynamics ILO88 recording device.

DESIGN

The right ears of 40 young adult women with normal hearing were assessed using CEOAEs under four different noise conditions and with two different methods of data collection. The noise conditions were in quiet, 50 dB A, 55 dB A, and 60 dB A of white noise. Data were collected at each noise level in the default mode and also using the ILO88 QuickScreen program.

RESULTS

There was a significant change in a number of important CEOAE output parameters with increased noise. In the default mode, mean whole wave reproducibility was 89.2% in quiet but declined to 85% with 50 dB A of white noise, 65% at 55 dB A and 20% at 60 dB A. The QuickScreen program proved more robust to the effects of noise than the default. In that mode, mean whole wave reproducibility was 91.7% in quiet, 92.5% with 50 dB A of white noise, 82.5% at 55 dB A and 45% at 60 dB A.

CONCLUSIONS

The findings of the study indicate ambient noise levels for accurate CEOAE recording should not exceed 50 to 55 dB A of noise and alternatives to the default program should be considered in non-sound-treated situations.

Distortion product otoacoustic emissions stimulated through bone conduction

OBJECTIVE

To demonstrate the viability of bone conduction as a novel method for stimulation of distortion product otoacoustic emissions (DPOAEs).

DESIGN

DPOAEs were recorded from a single ear of 23 normally hearing adults using bone and air conduction for the delivery of stimulus tones. Exploration of the input-output function was performed by varying stimulus frequency and magnitude.

RESULTS

Bone-stimulated emissions demonstrated similar characteristics to those obtained through standard air transmission techniques. Characteristic nonlinear DPOAE growth was found as the magnitude of the higher frequency stimulus tone, L2, was increased monotonically with other parameters fixed. Bilateral stimulation due to using bone conduction did not saturate the mechanisms of emission suppression. Emission magnitude was not altered substantially by occlusion of the ear canal.

CONCLUSION

Bone conduction can be used successfully to elicit DPOAEs. Absolute comparison of air- and bone-stimulated DPOAEs was difficult because of imprecise calibration of the bone conductors for each individual and particular placement. Properties unique to bone conduction, such as simultaneous bilateral stimulation and reduction of stimulus magnitude in the ear canal, may make bone conduction attractive for clinical measurement of DPOAEs.

Effect of contralateral masking on the latency of otoacoustic emissions elicited by acoustic distortion products

Otoacoustic emissions (OAE) are sound products generated by the outer hair cells (OHC) in the inner ear. The OHC are capable of moving spontaneously or in response to acoustic stimuli (spontaneous otoacoustic emissions and evoked otoacoustic emissions), these movements are known as electromotility. Electromotility is affected when contralateral acoustic stimulation is introduced to the ear. Different types of stimuli may produce this response. Clicks, pure tones, and white masking noise have been used as contralateral stimulation. This effect appears to be mediated by the medial efferent olivocochlear bundle. Contralateral masking produces suppression of OAE, especially on the amplitude. However, the effect of contralateral masking on the latency of distortion product otoacoustic emissions (DPOAE) has not been studied. The purpose of this paper is to investigate whether contralateral masking, with wide band masking noise, may produce a significant change on the latency of the DPOAE. Three different latency measurements of DPOAE measurements were made on low, middle and high frequencies of fl including 574 Hz, 2454 Hz and 4919 Hz. Each one of these frequencies was measured with and without contralateral masking. Twenty-eight ears of 15 subjects were studied. Non-significant differences (P > 0.05) between masked and unmasked conditions were found in all cases. It is concluded that contralateral masking does not appear to affect latency of DPOAE.