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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.
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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
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Lin IF, Tsai PJ, Wu JL, Chin WS, Lin CY, Guo YL. The effect of cumulative noise exposure on distortion product otoacoustic emissions. Int J Audiol 2023; 62:886-892. [PMID: 35968641 DOI: 10.1080/14992027.2022.2106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to identify the characteristics of distortion product otoacoustic emissions (DPOAEs) that can be used to differentiate noise-induced hearing loss (NIHL) from age-related hearing loss. A potential index to detect NIHL was defined in terms of its susceptibility to cumulative noise exposure but not to age. DESIGN In this cross-sectional cohort study, a job-exposure matrix was used to calculate the cumulative noise exposure. Multivariate linear regression models were used to examine how age and cumulative noise exposure associated with DPOAEs at individual frequencies after adjusting for hypertension, dyslipidaemia, tobacco use and alcohol consumption. STUDY SAMPLE The pure-tone audiometry and DPOAEs data collected from 239 male workers in a steel factory. RESULTS DPOAEs and DPOAE signal-to-noise ratios (SNRs) at all frequencies were found to be correlated with age, and those at 2, 3, 4 and 6 kHz were correlated with both age and noise exposure. The difference between DPOAE SNR at 1 and 3 kHz showed significant correlation with noise exposure but not with age. CONCLUSIONS The results showed that this DPOAE index, the DPOAE SNR at 1 kHz minus the DPOAE SNR at 3 kHz, could add values to audiometric evaluation of NIHL.
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Affiliation(s)
- I-Fan Lin
- Department of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Occupational Medicine, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Perng-Jy Tsai
- Department of Environment and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jiunn-Liang Wu
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Shan Chin
- Department of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yue Leon Guo
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Long-Term Variability of Distortion-Product Otoacoustic Emissions in Infants and Children and Its Relation to Pediatric Ototoxicity Monitoring. Ear Hear 2021; 41:239-253. [PMID: 29280917 DOI: 10.1097/aud.0000000000000536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Distortion-product otoacoustic emissions (DPOAEs) provide a rapid, noninvasive measure of outer hair cell damage associated with chemotherapy and are a key component of pediatric ototoxicity monitoring. Serial monitoring of DPOAE levels in reference to baseline measures is one method for detecting ototoxic damage. Interpreting DPOAE findings in this context requires that test-retest differences be considered in relation to normal variability, data which are lacking in children. This study sought to (1) characterize normal test-retest variability in DPOAE level over the long time periods reflective of pediatric chemotherapy regimens for a variety of childhood ages and f2 primary frequencies using common clinical instrumentation and stimulus parameters; (2) develop level-shift reference intervals; and (3) account for any age-related change in DPOAE level or measurement error that may occur as the auditory system undergoes maturational change early in life. DESIGN Serial DPOAE measurements were obtained in 38 healthy children (25 females and 13 males) with normal hearing and ranging in age from one month to 10 years at the initial (baseline) visit. On average, children were tested 5.2 times over an observation period of 6.5 months. Data were collected in the form of DP grams, in which DPOAE level was measured for f2 ranging from 1.4 to 10 kHz, using a fixed f2/f1 ratio of 1.22 and stimulus level of 65/55 dB SPL for L1/L2. Age effects on DPOAE level and measurement error were estimated using Bayesian regression of the longitudinal data. The raw and model-based distribution of DPOAE test-retest differences were characterized using means and standard error of the measurement for several ages and f2's. RESULTS DPOAE test-retest differences for the children in this study are at the high end of those previously observed in adults, as reflected in the associated shift reference intervals. Further, although we observe substantial child-specific variation in DPOAE level, the pattern of age-related changes is highly consistent across children. Across a wide range of f2's, DPOAE level decreases by 3 to 4 dB from 1 to 13 months of age followed by a more gradual decline of <1 dB/year. An f2 of 6 kHz shows the smallest decrease during the early rapid maturation period. DPOAE measurement error is fairly constant with age. It is 3 to 4 dB at most f2's and is greater (indicating poorer reliability) at 1.5, 8, and 10 kHz. CONCLUSIONS DPOAE level decreases with childhood age, with the greatest changes observed in the first year of life. Maturational effects during infancy and greater measurement error at very low and high f2's affect test-retest variability in children. An f2 of 6 kHz shows minimal maturation and measurement error, suggesting it may be an optimal sentinel frequency for ototoxicity monitoring in pediatric patients. Once validated with locally developed normative data, reference intervals provided herein could be used to determine screen fail criteria for serial monitoring using DPOAEs. Employing state-of-the-art calibration techniques might reduce variability, allowing for more sensitive screen fail criteria.
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Brooks CA, Clavier OH, Fellows AM, Rieke CC, Niemczak CE, Gui J, Pryor NJ, Gallagher HL, Murphy SA, Wise SR, Healy-Leavitt C, Allen LV, Buckey JC. Distortion product otoacoustic mapping measured pre- and post-loud sound exposures. Int J Audiol 2021; 61:187-196. [PMID: 34107827 DOI: 10.1080/14992027.2021.1928303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sampling distortion product otoacoustic emissions (DPOAEs) at multiple f2/f1 ratios and f2 frequency values produces a DPOAE "map." This study examined the efficacy of DPOAE mapping compared with pure tone audiometry and standard DPOAEs for detecting noise effects in subjects exposed to loud sound. DESIGN A map significance score was developed as a single measure of map change. Significance scores were evaluated before and after exposure to: loud music (LM), controlled noise (CN), and firing range noise (FR) in three separate sets of subjects. Scores were compared to audiometry and standard DPOAE results in the LM study. STUDY SAMPLE The LM and CN exposure studies involved 22, and 20 healthy young subjects respectively with normal hearing. Eight Marines were studied before and after FR exposure. RESULTS After LM exposure, audiometry showed significant changes at 1, 2, 4, and 6 kHz. Standard DPOAE measures were also significantly different at several frequencies. Map significance scores detected changes more effectively and showed the distribution of DPOAE alterations. CONCLUSIONS Map significance scores detected changes after noise exposure more reliably than audiometry and standard DPOAEs. Additionally, maps showed a diffuse response to sound exposure perhaps explaining why individual DP-grams appear less sensitive.
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Affiliation(s)
| | | | | | | | | | - Jiang Gui
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nina J Pryor
- Air Force Research Laboratory, Wright Patterson Air Force Base, Dayton, OH, USA.,Department of Defense, Hearing Center of Excellence, San Antonio, TX, USA.,zCore Business Solutions, Inc, Round Rock, TX, USA
| | - Hilary L Gallagher
- Air Force Research Laboratory, Wright Patterson Air Force Base, Dayton, OH, USA
| | - Sara A Murphy
- Department of Defense, Hearing Center of Excellence, San Antonio, TX, USA.,Naval Medical Center San Diego, San Diego, CA, USA.,The Geneva Foundation, Tacoma, WA, USA
| | - Sean R Wise
- Creare LLC, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | | | - Jay C Buckey
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Mertes IB. Establishing critical differences in ear-canal stimulus amplitude for detecting middle ear muscle reflex activation during olivocochlear efferent measurements. Int J Audiol 2019; 59:140-147. [DOI: 10.1080/14992027.2019.1673491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ian B. Mertes
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Vaden KI, Matthews LJ, Dubno JR. Transient-Evoked Otoacoustic Emissions Reflect Audiometric Patterns of Age-Related Hearing Loss. Trends Hear 2019; 22:2331216518797848. [PMID: 30198420 PMCID: PMC6131303 DOI: 10.1177/2331216518797848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Distinct forms of age-related hearing loss are hypothesized based on evidence
from animal models of aging, which are identifiable in human audiograms. The
Sensory phenotype results from damage (e.g., excessive noise or ototoxic drugs)
to outer hair cells and sometimes inner hair cells, producing large threshold
increases predominately at high frequencies. The Metabolic phenotype results
from a decline in endocochlear potential that can reduce outer hair cell
motility throughout the cochlea, producing gradually sloping thresholds from
lower to higher frequencies. Finally, the combined Metabolic + Sensory phenotype
results in low-frequency losses similar to the Metabolic phenotype and
high-frequency losses similar to the Sensory phenotype. Because outer hair cell
function appears to be affected differently in each phenotype, this study used
audiograms from 618 adults aged 50 to 93 years (n = 1,208 ears)
to classify phenotypes and characterize differences in transient-evoked
otoacoustic emission (TEOAE) data. Significant phenotype differences were
observed in frequency-band TEOAEs and configuration (intercept and slope),
including large and broadly distributed TEOAE reductions for Metabolic and
Metabolic + Sensory ears and more focused high-frequency TEOAE reductions for
Sensory ears. These findings are consistent with metabolic declines that reduce
cochlear amplification across a broad range of frequencies and more basally
situated, high-frequency declines in sensory hearing loss. The results provide
further validation for the classification of age-related hearing loss phenotypes
based on audiograms and show human TEOAE declines that are highly consistent
with animal models.
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Affiliation(s)
- Kenneth I Vaden
- 1 Hearing Research Program, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Lois J Matthews
- 1 Hearing Research Program, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Judy R Dubno
- 1 Hearing Research Program, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Rosati MV, Tomei F, Loreti B, Casale T, Cianfrone G, Altissimi G, Tomei G, Bernardini A, Di Marzio A, Sacco C, Scala B, Ricci S, Sancini A. Distortion-product otoacoustic emissions in workers exposed to urban stressors. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 73:176-185. [PMID: 28418790 DOI: 10.1080/19338244.2017.1306477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/09/2017] [Indexed: 06/07/2023]
Abstract
The study aimed to compare the distortion-product otoacoustic emissions (DPOAEs) with the pure-tone audiometry and to analyze the changes in participants exposed to noise. The results show a prevalence of participants with impaired DPOAEs higher than the prevalence of participants with impaired audiometries in the total sample, in men, and in outdoor workers and a prevalence of impaired DPOAEs and of impaired audiometries in men higher than in women and in outdoor workers higher than in indoor workers. The comparison of mean values between outdoor and indoor workers shows a significant difference only on some frequencies, in the DP-gram. The results suggest a higher effectiveness of DPOAEs compared with the pure-tone audiometry in identifying the presence of any damage in individuals exposed to noise at an early stage.
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Affiliation(s)
- Maria Valeria Rosati
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Francesco Tomei
- b Spin-off of University of Rome "Sapienza" "Sipro" , Rome , Italy
| | - Beatrice Loreti
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Teodorico Casale
- b Spin-off of University of Rome "Sapienza" "Sipro" , Rome , Italy
| | - Giancarlo Cianfrone
- c Department of Sensory Organs , U.O.C. Audiology, Sapienza University of Rome , Rome , Italy
| | - Giancarlo Altissimi
- c Department of Sensory Organs , U.O.C. Audiology, Sapienza University of Rome , Rome , Italy
| | - Gianfranco Tomei
- d Department of Psychiatric and Psychological Science , Sapienza University of Rome , Rome , Italy
| | - Andrea Bernardini
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Alessandra Di Marzio
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Carmina Sacco
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Barbara Scala
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
| | - Serafino Ricci
- a Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Specialty School of Occupational Medicine, Unit of Occupational Medicine , University of Rome "Sapienza" , Rome , Italy
- e Department of Anatomy, Histology , Legal Medicine and Orthopaedics, Sapienza University of Rome , Rome , Italy
| | - Angela Sancini
- b Spin-off of University of Rome "Sapienza" "Sipro" , Rome , Italy
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Rawool VW, Campbell C. Effectiveness of earmuffs in protecting hearing during shooting practice: a case-study. Int J Audiol 2018; 57:545-552. [PMID: 29490517 DOI: 10.1080/14992027.2018.1441556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Vishakha W. Rawool
- Communication Sciences & Disorders, West Virginia University, Morgantown, WV, USA
| | - Chelsea Campbell
- Communication Sciences & Disorders, West Virginia University, Morgantown, WV, USA
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Meta-Analysis of Distortion Product Otoacoustic Emission Retest Variability for Serial Monitoring of Cochlear Function in Adults. Ear Hear 2016; 36:e251-60. [PMID: 25985018 DOI: 10.1097/aud.0000000000000176] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Distortion product otoacoustic emissions (DPOAEs) have long been heralded as a means to objectively monitor cochlear function and increasingly are becoming a key component in hearing surveillance programs for individuals at risk for ototoxic- and occupational noise-related hearing loss. Yet clinicians are unsure how to define clinically meaningful shifts in DPOAE level. In this study, a meta-analysis approach is used to synthesize the DPOAE level test-retest literature to construct a set of DPOAE level shift reference limits that can be used clinically to define a statistically significant emission change. DESIGN The authors reviewed all published articles identified through a Medline search using the terms "Otoacoustic Emission Variability," "Otoacoustic Emission Reliability," "Otoacoustic Emission Repeatability," and "Otoacoustic Emission Test Retest" restricted to DPOAEs, adults, and English language. Articles with DPOAE level data elicited by moderate stimulus levels for f2 frequencies of 1000, 2000, 4000, or 6000 Hz were selected because these stimulus parameters were relatively well represented in the literature. The authors only included articles that reported the standard error of the measurement (SEM) or from which the SEM could be calculated. Meta-analysis was used to estimate the population mean SEM over the included studies. Models were fit separately for each f2 primary and included days since baseline and study-specific random effects. RESULTS Ten DPOAE test-retest studies met inclusion criteria for this meta-analysis. The SEM values varied widely across published studies (0.57 to 3.9 dB) and were provided for relatively short time intervals (less than 15 days on average). Time, or days since baseline, was statistically significant at higher f2 frequencies (4000 and 6000 Hz). From the model results, 90% reference limits specific to the f2 and elapsed time between baseline and follow-up measurements were established. Reference limits provided correspond to negative (emission decrement) and positive (emission enhancement) shifts indicative of the amount of measurement variability that, using this approach, must be tolerated as "normal" fluctuations over time. Changes larger than the reference limits are considered significant and warrant follow-up testing. CONCLUSIONS The meta-analysis presented provides reference limits that are appropriate for a set of specific f2 frequencies and time intervals. The meta-analysis concerns the SEM statistic directly, so that any preferred reference limit can be computed from the results and should be predicated upon the screening application. The presumed advantage of this meta-analytic approach is increased precision relative to limits suggested by any of the individual studies included in the analysis.
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Basner M, Brink M, Bristow A, de Kluizenaar Y, Finegold L, Hong J, Janssen SA, Klaeboe R, Leroux T, Liebl A, Matsui T, Schwela D, Sliwinska-Kowalska M, Sörqvist P. ICBEN review of research on the biological effects of noise 2011-2014. Noise Health 2015; 17:57-82. [PMID: 25774609 PMCID: PMC4918662 DOI: 10.4103/1463-1741.153373] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The mandate of the International Commission on Biological Effects of Noise (ICBEN) is to promote a high level of scientific research concerning all aspects of noise-induced effects on human beings and animals. In this review, ICBEN team chairs and co-chairs summarize relevant findings, publications, developments, and policies related to the biological effects of noise, with a focus on the period 2011-2014 and for the following topics: Noise-induced hearing loss; nonauditory effects of noise; effects of noise on performance and behavior; effects of noise on sleep; community response to noise; and interactions with other agents and contextual factors. Occupational settings and transport have been identified as the most prominent sources of noise that affect health. These reviews demonstrate that noise is a prevalent and often underestimated threat for both auditory and nonauditory health and that strategies for the prevention of noise and its associated negative health consequences are needed to promote public health.
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Affiliation(s)
- Mathias Basner
- Department of Psychiatry, Division of Sleep and Chronobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Strategies for Evaluating Antioxidant Efficacy in Clinical Trials Assessing Prevention of Noise-Induced Hearing Loss. FREE RADICALS IN ENT PATHOLOGY 2015. [DOI: 10.1007/978-3-319-13473-4_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
OBJECTIVES Audiologists regularly use serial monitoring to evaluate changes in a patient's auditory function over time. Observed changes are compared with reference standards to determine whether further clinical action is necessary. Reference standards are established in a control sample of otherwise healthy subjects to identify the range of auditory shifts that one might reasonably expect to occur in the absence of any pathological insult. Statistical approaches to this seemingly mundane problem typically invoke 1 of 3 approaches: percentiles of the cumulative distribution, the variance of observed shifts, and the "standard error of measurement." In this article, the authors describe the statistical foundation for these approaches, along with a mixed model-based alternative, and identify several necessary, although typically unacknowledged assumptions. Regression to the mean, the phenomenon of an unusual measurement typically followed by a more common one, can seriously bias observed changes in auditory function and clinical expectations. An approach that adjusts for this important effect is also described. DESIGN Distortion product otoacoustic emissions (DPOAEs) elicited at a single primary frequency, f2 of 3175 Hz, were collected from 32 healthy subjects at baseline and 19 to 29 days later. Ninety percent test-retest reference limits were computed from these data using each statistical approach. DPOAE shifts were also collected from a sample of 18 cisplatin patients tested after 120 to 200 mg of cisplatin. Reference limits established according to each of the statistical approaches in the healthy sample were used to identify clinically alarming DPOAE shifts in the cisplatin patient sample. RESULTS Reference limits established with any of the parametric methods were similar. The percentile-based approach gave the widest and least precisely estimated intervals. The highest sensitivity for detecting clinically alarming DPOAE shifts was based on a mixed model approach that adjusts for regression to the mean. CONCLUSIONS Parametric methods give similar serial monitoring criteria as long as certain critical assumptions are met by the data. The most flexible method for estimating test-retest limits is based on the linear mixed model. Clinical sensitivity may be further enhanced by adjusting for regression to the mean.
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Leensen MCJ, Dreschler WA. Longitudinal changes in hearing threshold levels of noise-exposed construction workers. Int Arch Occup Environ Health 2014; 88:45-60. [PMID: 24610168 DOI: 10.1007/s00420-014-0932-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Longitudinal analysis of audiometric data of a large population of noise-exposed workers provides insight into the development of noise-induced hearing loss (NIHL) as a function of noise exposure and age, particularly during the first decade of noise exposure. METHODS Data of pure-tone audiometry of 17,930 construction workers who underwent periodic occupational hearing screening at least twice during a 4-year period were available for analysis. These concerned all follow-up measurements of the baseline cohort described by Leensen et al. (Int Arch Occup Environ Health 84:577-590, 2011). Linear mixed models explored the relationship between the annual rate of change in hearing and noise exposure level, exposure duration, and age. Data of 3,111 workers who were tested on three occasions were used to investigate the pattern of hearing loss development. RESULTS The mean annual deterioration in hearing in this study population was 0.54 dB/yr, and this became larger with increasing noise exposure level and increasing age. Remarkably, during the first decade of noise exposure, an improvement in hearing threshold levels (HTLs) was observed. The change in hearing over three measurements showed a concave development of hearing loss as a function of time, which corresponds to NIHL development. CONCLUSIONS Overall, hearing deteriorated over the measurement period. Because HTLs at follow-up were better than those obtained at baseline, no statement can be made about the NIHL development during the first decade of noise exposure. This improvement in HTLs rather resembles the result of measurement variation in occupational screening audiometry than an actual improvement in hearing ability.
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Affiliation(s)
- Monique C J Leensen
- Clinical and Experimental Audiology, ENT Department, Academic Medical Centre (AMC), P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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A longitudinal study of changes in distortion-product otoacoustic emissions and pure-tone thresholds in an industrial setting. Eur Arch Otorhinolaryngol 2013; 271:2649-60. [PMID: 24114066 DOI: 10.1007/s00405-013-2754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
Abstract
In a longitudinal study of 76 noise-exposed industrial workers, 34 (68 ears) of them were available for final evaluation after 9 years of observation. Distortion-product otoacoustic emissions (DP) at 65/55 dB SPL and pure-tone audiometry were used to detect noise-induced inner ear changes. Repeated measures analyses of variance were made on the subjects and in a control group, whereas significant threshold shifts (STS) and significant emission shifts (SES) were calculated. Both hearing thresholds and DP showed a high-frequency deterioration, but there was absence of statistical correlation between elevation of hearing thresholds and decrease of DP. There was no clear pattern between individual changes in audiometric thresholds and DP, and all combinations were present: ears with only STS, ears with only SES, ears with both STS and SES and ears with absence of STS and SES. Audiometric changes were maximal at 4 and 6 kHz and DP changes at 2 and 3 kHz. Since significant individual emission changes do not necessarily follow the same pattern as the group-averaged results, the use of DP for monitoring of individual subjects is not advised. However, its use in conjunction with audiometry in hearing conservation programs is highly recommended.
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Leensen MCJ, Dreschler WA. The applicability of a speech-in-noise screening test in occupational hearing conservation. Int J Audiol 2013; 52:455-65. [DOI: 10.3109/14992027.2013.790565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Psaltakos V, Balatsouras DG, Sengas I, Ferekidis E, Riga M, Korres SG. Cochlear dysfunction in patients with acute hypothyroidism. Eur Arch Otorhinolaryngol 2012; 270:2839-48. [PMID: 23266870 DOI: 10.1007/s00405-012-2332-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 12/13/2012] [Indexed: 12/26/2022]
Abstract
The effect of acute hypothyroidism on the cochlear function was studied prospectively, in a group of 52 patients with thyroid carcinoma who underwent total thyroidectomy. All patients were examined before surgery and 6-8 weeks postoperatively. During this period there was no replacement with levothyroxine and the magnitude of thyroxin depletion was monitored by serum thyroid-stimulating hormone levels. Pure-tone audiometry, tympanometry and transiently evoked otoacoustic emissions were performed. A group of healthy volunteers of similar age and sex were used as controls. Tympanograms were normal, either on initial or on repeat testing. Audiometry showed elevation of all postoperative hearing thresholds, whereas the thresholds varied significantly across frequency. Transiently evoked otoacoustic emission testing showed response signal-to-noise ratios lower in the postoperative session (hypothyroid state) than in the preoperative session on all measured frequencies. Emission levels varied significantly across frequency, with maximum response observed at 2 kHz. Comparison of significant pure-tone and otoacoustic emission shifts for individual ears showed more ears affected in otoacoustic emission testing, indicating subclinical involvement. Comparing hearing thresholds and otoacoustic emission levels between patients and controls showed significant differences on postoperative testing. It may be thus concluded that acute hypothyroidism causes elevation of hearing thresholds in humans and to a greater degree subclinical damage of the cochlear function.
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Affiliation(s)
- Vassilis Psaltakos
- Ear, Nose and Throat Department, Tzanion General Hospital, Piraeus, Greece
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