Distortion Product Otoacoustic Emissions Responses Research Articles

Effect of Calibration Method on Distortion-Product Otoacoustic Emission Measurements at and Around 4 kHz

Distortion-product otoacoustic emissions (DPOAEs) collected after sound pressure level (SPL) calibration are susceptible to standing waves that affect measurements at the plane of the probe microphone due to overlap of incident and reflected waves. These standing-wave effects can be as large as 20 dB, and may affect frequencies both above and below 4 kHz. It has been shown that forward pressure level (FPL) calibration minimizes standing-wave effects by isolating the forward-propagating component of the stimulus. Yet, previous work has failed to demonstrate more than a small difference in test performance and behavioral-threshold prediction with DPOAEs after SPL and FPL calibration. One potential limitation in prior studies is that measurements were restricted to octave and interoctave frequencies; as a consequence, data were not necessarily collected at the standing-wave null frequency. In the present study, DPOAE responses were measured with f2 set to each participant's standing-wave frequency in an effort to increase the possibility that differences in test performance and threshold prediction would be observed for SPL and FPL calibration methods. Data were collected from 42 normal-hearing participants and 93 participants with hearing loss. DPOAEs were measured with f2 set to 4 kHz and at each participant's notch frequency after SPL and FPL calibration. DPOAE input/output functions were obtained from -10 to 80 dB in 5 dB steps for each calibration/stimulus condition. Test performance was evaluated using clinical decision theory. Both area under receiver operating characteristic curves for all stimulus levels and cumulative distributions when L2 = 50 dB (a level at which the best performance was observed regardless of calibration method) were used to evaluate the accuracy with which auditory status was determined. A bootstrap procedure was used to evaluate the significance of the differences in test performance between SPL and FPL calibrations. DPOAE predictions of behavioral threshold were evaluated by correlating actual behavioral thresholds and predicted thresholds using a multiple linear regression model. First, larger DPOAE levels were measured after SPL calibration than after FPL calibration, which demonstrated the expected impact of standing waves. Second, for both FPL and SPL calibration, test performance was best for moderate stimulus levels. Third, differences in test performance between calibration methods were evident at low- and high-stimulus levels. Fourth, there were small but statistically significant improvements in test performance after FPL calibration for clinically relevant conditions. Fifth, calibration method had no effect on threshold prediction. Standing waves after SPL calibration have an impact on DPOAE levels. Although the effect of calibration method on test performance was small, test performance was better after FPL calibration than after SPL calibration. There was no effect of calibration method on predictions of behavioral threshold.

Determination of hearing levels in patients with Familial Mediterranean Fever

ObjectiveFamilial Mediterranean Fever is the most common congenital, periodic fever condition that affects over 100,000 people worldwide. In the literature, there is limited number of studies about hearing levels in children with Familial Mediterranean Fever. In the present study, we aimed to investigate hearing levels and cochlear functions by using Distortion product Otoacoustic Emission and High Frequency Audiometry (250–20,000Hz) in pediatric patients with Familial Mediterranean Fever. MethodsThe study included 62 children with Familial Mediterranean Fever and 27 healthy children with similar age and gender. After otoscopic examination, both groups underwent audiological evaluation including High Frequency Audiometry (250–20,000Hz) and Distortion product Otoacoustic Emissions. The results obtained were assessed among groups. In addition, these results were compared regarding colchicine use, age at the onset of disease and duration of the diseases in the Familial Mediterranean Fever group. ResultsOf the Familial Mediterranean Fever patients, 93.5% were on colchicine therapy and mean duration of colchicine use was 19.9±13.9 months. The mean age at diagnosis was 6.57±2.86 years (min–max: 2–14) and mean duration of disease was 23±17 months (min–max: 6–84). Pure tone audiometry values, and hearing levels between 9000 and 20,000Hz were similar and within normal range in both groups. The Distortion product Otoacoustic Emissions responses at the frequencies of 1020, 2040, 3000, 4080 and 5040Hz were similar for both groups. ConclusionTo the best of our knowledge, this is the first study evaluating hearing levels at the frequencies of 18kHz and 20kHz in children with Familial Mediterranean Fever in the literature. In children with Familial Mediterranean Fever, Pure tone audiometry values, hearing values obtained at all frequencies from 250 to 20,000Hz, and Distortion product Otoacoustic Emissions levels were within normal range. Furthermore, hearing levels were found to be similar to those in healthy children.

Use of passive hearing protectors and adaptive noise reduction for field recording of otoacoustic emissions in industrial noise

Distortion product otoacoustic emissions (DPOAEs) can detect noise-induced hearing loss in-field, but their data extraction is very sensitive to background noise. This paper investigates how passive and active noise reduction enhance DPOAE recording based on data collected in white noise from 54 dB(A) to 90 dB(A). Despite considerable high-frequency attenuation from a proper placed DPOAE probe, 54 dB(A) background noise deteriorates the test outcome substantially. More low-frequency attenuation by an extra passive earmuff enables measurements in white noise levels of 70 dB(A). The relationship between external sound level and noise recorded by the DPOAE system has been statistically modeled. Additionally, the upper limits of attenuation improvement are analyzed by quantifying residual physiological noise. Furthermore, for an earplug integrating microphone and speakers of the DPOAE measurement probe, adaptive noise reduction processing on the DPOAE signal is used to improve the signal-to-noise ratio. The adaptive noise reduction (ANR) is implemented using the NLMS algorithm to filter out the ambient noise, measured by the first microphone measuring the DPOAE signal, with a second miniature microphone mounted flush with the external faceplate of the isolating DPOAE probe. Simulated data show that DPOAE response extraction is possible in an environment with noise levels exceeding 70 dB(A).

The ototoxic effect of intratympanic terbinafine applied in the middle ear of rats

BackgroundOtomycosis is defined as an infection of the external ear canal with fungal agents. The treatment of the disease is cleansing and drying of the external ear canal, identification and treatment of any predisposing factors and application of topical antifungal agents. Terbinafine is used as an antifungal agent to treat otomycosis. We proposed to investigate the probable ototoxic effect of terbinafine solution on auditory brain stem response (ABR) and distortion product otoacoustic emission (DPOAE) when applied intratympanically in the middle ear of rats.MethodsThe experiment was performed on 30 female Wistar albino rats. Thirty animals were divided into three groups of 10 animals each. 1% terbinafine solution was administered to the first group (group T). The second group (group G) was administered 40 mg/ml gentamicin solution (ototoxic control). The third group (group S) was administered saline solution (negative control). Baseline DPOAE measurements and ABR testing from the left ears were obtained from the animals in all groups under general anesthesia. Ear solutions were applied in the middle ear intratympanically with a dental needle. Treatment was initiated after baseline measurements and repeated once every two days for fifteen days.ResultsPre and post-treatment DPOAE responses for all tested frequencies of group T and Group S showed no statistically significant difference. However, the group G demonstrated a significant change in ABR thresholds and DPOAE responses.ConclusionsTerbinafine solution is a broad spectrum antifungal agent effective in the treatment of otomycosis. The present study demonstrated that its direct administration in the middle ear of rats does not affect inner ear function as measured by ABR and DPOAE responses.

Clinical Usefulness of Otoacoustic Emission Sum in Sudden Sensorineural Hearing Loss Patients

Background and ObjectivesZZSudden hearing loss remain a controversial issue with respect to its prognostic indicators. In a recent study, the change in distortion product otoacoustic emission (DPOAE) has been shown to provide useful information about its prognosis. The purpose of this study is to evaluate the relationship between the changes of DPOAE and hearing improvement in sudden deafness patients. Subjects and MethodZZSixty-one patients underwent pure tone audiometry (PTA) and DPOAE on their first hospital day ; among them 35 patients underwent DPOAE after 2 weeks. These patients were divided into mild (≤40 dB) group, moderate to moderately severe (41-70 dB) group and severe (≥71 dB) group according to their initial hearing thresholds. ResultsZZOf the 22 patients in the moderate to severe group, 11 patients showed a DPOAE response and 5 patients (45%) showed hearing improved. In 11 non-DPOAE response patients, 4 patients (36.4%) had improved. We compared PTA and OAE sum gap results by analyzing 35 patient’s initial thresholds with those measured 2 weeks after the therapy. The correlation coefficient between the two group was 0.547 (p＜0.05). ConclusionZZThe results show that OAE sum is an efficient and non-invasive objective meth od and that it can be used to monitor the effects of treatment in sudden hearing loss patients. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:212-6 Key WordsZZOtoacoustic emissions ㆍPrognosis ㆍSudden hearing loss.

Two-source interference as the major reason for auditory-threshold estimation error based on DPOAE input–output functions in normal-hearing subjects

Fine structure in the frequency response of distortion product otoacoustic emissions (DPOAEs) can severely limit the usefulness of DPOAEs in estimating auditory thresholds. Here, fine structure is removed by extracting the primary-source DPOAE component using the onset-decomposition technique (Vetešník et al., 2009) and auditory threshold estimates are compared to those obtained from DPOAEs in response to conventional, continuous two-tone stimulation. Auditory thresholds are predicted using the estimated distortion product thresholds (EDPTs), obtained from linear regression of input–output (I/O) functions of DPOAE pressure amplitude versus second-tone stimulus level (Boege and Janssen, 2002). The accuracy of the auditory-threshold predictions is derived by comparison with measured auditory thresholds. The parameters of the two primary stimulus tones of frequency f1 and f2 and levels of L1 and L2 are chosen as: f2/f1 = 1.2 with 1.5 ≤ f2 ≤ 2.5 kHz, and L1 = 0.4L2 + 39 dB SPL, with 25 ≤ L2 ≤ 65 dB SPL. Data are from 12 normal-hearing subjects with profound DPOAE fine structure. 255 DPOAE I/O functions were measured for each of the two DPOAE paradigms. An EDPT value was accepted as reliable if: 1) the squared correlation coefficient, r2 ≥ 0.8, 2) the regression slope, sI/O ≥ 0.2 μPa/dB, and 3) the standard deviation of the EDPT, σEDPT ≤ 10 dB. The proportion of rejected I/O functions was 8% for onset-decomposition DPOAEs, and 25% for continuous-tone DPOAEs. Removal of data points from the saturation region of the DPOAE I/O function by an automated algorithm reduced the rejection rate, to zero for onset-decomposition DPOAEs, but to only 13% for continuous-tone DPOAEs. In the absence of saturated DPOAE responses, auditory thresholds were predicted with standard deviation of only 4 dB for onset-decomposition DPOAEs, but 12 dB for continuous-tone DPOAEs. In summary, by extracting the primary-source component of the DPOAE by the method of onset-decomposition it is possible to predict human auditory threshold with hitherto unattainable accuracy.

Protective effect of thymoquinone against cisplatin-induced ototoxicity

The aim of this study was to investigate the potential protective effect of thymoquinone against cisplatin-induced ototoxicity. This study is a prospective, controlled experimental animal study. Experiments were performed on 30 healthy female Sprague-Dawley rats. Thirty animals were divided into three groups of 10 animals each. Group 1 received an intraperitoneal (i.p.) injection of cisplatin 15 mg/kg. Group 2 received i.p. thymoquinone 40 mg/kg/day for 2 days prior to cisplatin injection and third day i.p. cisplatin 15 mg/kg was administered concomitantly. Group 2 continued to receive i.p. thymoquinone until fifth day. Group 3 received i.p. thymoquinone 40 mg/kg/day for 5 days. Pretreatment distortion product otoacoustic emissions (DPOAE) and auditory brain stem responses (ABR) testing from both ears were obtained from the animals in all groups. After the baseline measurements, drugs were injected intraperitonally. After an observation period of 3 days, DPOAE measurements and ABR testing were obtained again and compared with the pretreatment values. There was no statistically significant difference between pre and post-treatment DPOAE responses and ABR thresholds group 2 and 3. However, group 1 demonstrated significant deterioration of the ABR thresholds and DPOAE responses. Our results suggest that DPOAE responses and ABR thresholds were preserved in the cisplatin plus TQ-treated group when compared with the group receiving cisplatin alone. According to these results, cisplatin-induced ototoxicity may be prevented by thymoquinone use in rats.

Time-frequency domain filtering of evoked otoacoustic emissions

Time-domain filtering is a standard analysis technique, which is used to disentangle the two main vector components of the distortion product otoacoustic emission response, exploiting their different phase-frequency relation. In this study, a time-frequency filtering technique based on the continuous wavelet transform is proposed to overcome the intrinsic limitations of the time-domain filtering technique and to extend it also to the analysis of stimulus-frequency and transient-evoked otoacoustic emissions. The advantages of the proposed technique are first discussed on a theoretical basis, then practically demonstrated by applying it to the analysis of synthesized and real otoacoustic data. The results show that the time-frequency approach can be empirically optimized to get effective separation of the components of the otoacoustic response associated with either different generation mechanisms or different generation places. Focusing on a single component of the otoacoustic response with a given time-frequency signature may also improve significantly the signal-to-noise ratio, because the random noise contribution tends to be uniformly distributed on the time-frequency plane.

Clinical evaluation of cochlear hearing status in dogs using evoked otoacoustic emissions

Evoked otoacoustic emission testing is the preferred test in human patients for sensorineural deafness screening in neonates and cochlear outer hair cell function monitoring in adults. This study evaluated evoked otoacoustic emission testing for cochlear function assessment in dogs within a clinical setting. Two populations of anaesthetised dogs were included. In group 1 the evoked otoacoustic emission response was compared to the brainstem auditory evoked response in 10 dogs having hearing assessment. Group 2 comprised 43 presumed normal dogs, in which the suitability of two types of evoked otoacoustic emissions, transient-evoked and distortion product otoacoustic emissions, were evaluated (brainstem auditory evoked response was not performed in this group). Valid transient-evoked otoacoustic emission and distortion-product otoacoustic emission responses were successfully recorded within the clinical setting and correctly identified deaf and hearing ears. Within presumed healthy dogs, normal otoacoustic emission response was demonstrated in more than 80% of dogs using a single, short distortion-product otoacoustic emission run and in 78% of dogs with valid transient-evoked otoacoustic emission responses using a series of three repeated transient-evoked otoacoustic emission short runs. Transient-evoked otoacoustic emission and distortion-product otoacoustic emission testing provided a rapid, non-invasive frequency-specific assessment of cochlear function. Transient-evoked otoacoustic emission and distortion product otoacoustic emission testing is suitable as a screening procedure to detect loss of cochlear function in dogs, although further investigation is needed.

Effects of whole body vibration on outer hair cells’ hearing response to distortion product otoacoustic emissions

Whole body vibration (WBV) is one of the most vexing problems in industries. There is a debate about the effect of WBV exposure on hearing system as vibration-induced hearing loss. The purpose of this study was to investigate outer hair cells' (OHCs') hearing response hearing response to distortion product otoacoustic emissions (DPOAEs) in rabbits exposed to WBV. It was hypothesized that the DPOAE response amplitudes (A(dp)) in rabbits exposed to WBV would be lower than those in control rabbits not exposed to WBV. New Zealand white (NZW) rabbits as vibration group (n = 6, exposed to WBV in the z-axis at 4-8 Hz and 1.0 ms(-2) root mean square for 8 h per day during five consecutive days) and NZW rabbits as control group (n = 6, not exposed to any WBV) were participated. A(dp) and noise floor levels (L(nf)) were examined on three occasions: day 0 (i.e., baseline), day 8 (i.e., immediately 1 h after exposure), and day 11 (i.e., 72 h following exposure) with f(2) frequencies ranging from 500 to 10,000 Hz and primaries L(1) and L(2) levels of 65 and 55 dB sound pressure level, respectively. Main effects were statistically found to be significant for group, time, and frequency (p < 0.05). DPOAE amplitudes were significantly larger for rabbits exposed to WBV, larger on day 8 and larger for mid to high f(2) frequencies (at and above 5,888.50 Hz). Main effects were not statistically found to be significant for ear (p > 0.05). Also, four statistically significant interactions including time by ear, time by frequency, group by frequency, and group by time were detected (p < 0.05). Contrary to the main hypothesis, DPOAE amplitudes were significantly larger for rabbits exposed to WBV. WBV exposure significantly led to enhanced mean A(dp) at mid to high frequencies rather than at low ones.

Clinical characteristics and audiological significance of spontaneous otoacoustic emissions in tinnitus patients with normal hearing

To define the clinical and audiological features of normal-hearing tinnitus patients with spontaneous otoacoustic emissions, and to evaluate the role of spontaneous otoacoustic emissions in tinnitus generation. Thirty-two patients with spontaneous otoacoustic emissions were compared with 29 patients without spontaneous otoacoustic emissions, regarding clinical and audiological aspects. The mean age of the study group subjects was significantly lower, and they experienced the kindling effect less frequently than the control group. The mean tinnitus handicap inventory score of the study group was considerably higher than that of the controls, although the difference was not statistically significant. The study group had significantly quieter tinnitus, and higher transient evoked and distortion product otoacoustic emission responses, compared with the control group. Normal-hearing tinnitus patients with spontaneous otoacoustic emissions have different clinical and audiological characteristics, compared with those without spontaneous otoacoustic emissions. Appropriate evaluation and treatment should be considered at an early stage in these patients.

Severe progressive sensorineural hearing loss improved after removal of large jugular foramen schwannoma

We report a very rare case of hearing improvement after removal of the intracranial part of a jugular foramen schwannoma (JFS) presenting with chronic and severe progressive sensorineural hearing loss (SNHL). The patient presented with progressive hearing impairment in his right ear, lasting 2 years. The patient's pure tone audiogram revealed severe SNHL. His speech discrimination score (SDS) was 0%. Auditory-evoked brain responses (ABRs) comprised only I waves following 30–100 dB stimulation, although distortion-product otoacoustic emissions (DPOAEs) had good responses. These test results indicated that his hearing impairment was retrocochlear SNHL. Magnetic resonance imaging revealed within the right jugular foramen a large intracranial–extracranial tumor that compressed the brainstem. The intracranial part of the tumor was resected through retrosigmoidal craniotomy, and the tumor was pathologically diagnosed as a schwannoma. Several months after the operation, the patient's auditory thresholds improved to a level consistent with mild SNHL, ABR V waves emerged following 60–90 dB stimulation, and SDS improved significantly to 95%. This case demonstrates that hearing improvement can be achieved after surgery for JFS presenting with severe and chronic progressive SNHL, and that good DPOAE responses and the presence of ABR I waves may be predictors of postoperative hearing recovery in JFS.

Short-Term Changes of Hearing and Distortion Product Otoacoustic Emissions in Sudden Sensorineural Hearing Loss

The function of outer hair cells can be measured objectively and noninvasively by distortion product otoacoustic emission (DPOAE). The aims of the study were to investigate the changes of DPOAE in the recovery course and to pursue the relationship between the changes of DPOAE and hearing improvement in patients with sudden sensorineural hearing loss. : Retrospective case series review. Both DPOAE and pure tone audiometry were performed before 7 days after the onset and followed after 2 weeks in 40 patients with sudden sensorineural hearing loss. Patients were grouped on the basis of the initial hearing loss and the results of their recovery. All DPOAE amplitudes were analyzed at 2f1-f2, and DPOAE sum was calculated. The initial DPOAE sum in ears with the initial mild-to-moderate hearing loss (hearing threshold, <or=55 dB) was not different from that in contralateral normal ears, but it was decreased or absent in ears with the initial moderately severe to profound hearing loss (hearing threshold, >55 dB) compared with that in contralateral normal ears. In ears with the initial moderately severe to profound hearing loss, the changes of DPOAE sum values positively correlated with the hearing improvement but not in ears with the initial mild-to-moderate hearing loss. Although the presence of initial DPOAE responses indicated good prognosis, the absence of initial DPOAE responses did not always indicate poor prognosis. Our findings showed that the function of outer hair cells is relatively spared in ears with the initial mild-to-moderate hearing loss, and its recovery is not related to the hearing improvement; however, the function of outer hair cells is impaired in ears with the initial moderately severe to profound hearing loss, and the functional improvement of outer hair cells is important for hearing recovery. Clinical implications of our findings were discussed.

Influence of Calibration Method on Distortion-Product Otoacoustic Emission Measurements: II. Threshold Prediction

Distortion-product otoacoustic emission (DPOAE) stimulus calibrations are typically performed in sound pressure level (SPL) before DPOAE measurements. These calibrations may yield unpredictable DPOAE response levels, presumably because of the presence of standing waves in the ear canal. Forward pressure level (FPL) has been proposed as an alternative method for stimulus calibration because it avoids complications due to standing waves. DPOAE thresholds after four FPL calibrations and one SPL calibration were compared with behavioral thresholds to determine which calibration results in data that yield the highest correlations between the two threshold estimates. Fifty-two subjects with normal hearing and 103 subjects with hearing loss participated in this study, with ages ranging from 11 to 75 yr. These were the same individuals whose data were used to address the influence of calibration method on test performance in an accompanying article. DPOAE input/output (I/O) functions were obtained at f2 frequencies of 2, 3, 4, 6, and 8 kHz with the primary frequency ratio fixed at f2/f1 approximately 1.22. L(1) was set according to the equation L(1) = 0.4 L(2) + 39 with L(2) levels ranging from -20 to 70 dB SPL and FPL in 5-dB steps. I/O functions were obtained at each frequency for each of the five stimulus calibrations: SPL, daily FPL at room temperature, daily FPL at body temperature, reference FPL at room temperature, and reference FPL at body temperature. DPOAE thresholds were estimated using two methods. In the first method, DPOAE threshold was taken as the lowest L(2) for which DPOAE level is 3 dB or greater than the noise floor (signal- to-noise ratio > or =3 dB). In a second method, a linear regression method first described by Boege & Janssen (2002) and later adapted by Gorga et al. (2003), all DPOAE levels in each I/O function are converted to linear pressure and extrapolated to 0 microPa, at which the L(2) is taken as threshold. Correlations of DPOAE thresholds with behavioral thresholds were obtained for each frequency, calibration method, and threshold-prediction method. Correlations were greatest for frequencies of 3 to 6 kHz and lowest for 8 kHz, consistent with previous frequency effects. Calibration method made little difference in correlations between DPOAE and behavioral thresholds at any frequency. A small difference was noted in correlations for the two threshold prediction methods, with the linear regression method yielding slightly higher correlations at all frequencies. Little difference in threshold correlations was observed among the five calibration methods used to calibrate the stimuli before DPOAE measurements. These results were not anticipated, given the known effects of standing waves on ear-canal estimates of SPL at the plane of the probe. In addition, there was no effect of temperature (body versus room) or timing (daily versus reference) for FPL calibrations. It may be important to note that differences between SPL and FPL calibrations should not be seen if a standing wave does not occur at the plane of the probe at or near the frequency being tested. The frequencies (2 to 8 kHz) were chosen because it was expected that effects from standing waves would occur between these frequencies because of the typical lengths of ear canals for the age group tested. Because measurements were taken at only five discrete frequencies in the interval, it is possible that standing waves were present but did not affect the specific test frequencies. In total, these results suggest that SPL calibrations may be adequate when attempting to predict pure-tone thresholds from DPOAEs, despite the fact that they are known to be susceptible to errors associated with standing waves.

Influence of calibration method on distortion-product otoacoustic emission measurements: I. test performance.

Calibration errors in distortion-product otoacoustic emission (DPOAE) measurements because of standing waves cause unpredictable changes in stimulus and DPOAE response level. The purpose of this study was to assess the extent to which these errors affect DPOAE test performance. Standard calibration procedures use sound pressure level (SPL) to determine specified levels. Forward pressure level (FPL) is an alternate calibration method that is less susceptible to standing waves. However, FPL derivation requires prior cavity measurements, which have associated variability. In an attempt to address this variability, four FPL methods were compared with SPL: a reference calibration derived from 25 measurements before all data collection and a daily calibration measurement, both of which were made at body and room temperature. Data were collected from 52 normal-hearing and 103 hearing-impaired subjects. DPOAEs were measured for f2 frequencies ranging from 2 to 8 kHz in half-octave steps, with L2 ranging from -20 to 70 dB SPL (5-dB steps). At each f2, DPOAEs were measured in five calibration conditions: SPL, daily FPL at body temperature (daily body), daily FPL at room temperature (daily room), reference FPL at body temperature (ref body), and reference FPL at room temperature (ref room). Data were used to construct receiver operating characteristic (ROC) curves for each f2, calibration method, and L2. From these curves, areas under the ROC curve (AROC) were estimated. The results of this study are summarized by the following observations: (1) DPOAE test performance was sensitive to stimulus level, regardless of calibration method, with the best test performance observed for moderate stimulus level conditions. (2) An effect of frequency was observed for all calibration methods, with the best test performance at 6 kHz and the worst performance at 8 kHz. (3) At clinically applicable stimulus levels, little difference in test performance among calibration methods was noted across frequencies, except at 8 kHz. At 8 kHz, FPL-based calibration methods provided superior performance compared with the standard SPL calibration. (4) A difference between FPL calibration methods was observed at 8 kHz, with the best test performance occurring for daily calibrations at body temperature. With the exception of 8 kHz, there was little difference in test performance across calibration methods. At 8 kHz, AROCs and specificities for fixed sensitivities indicate that FPL-based calibration methods provide superior performance compared with the standard SPL calibration for clinically relevant levels. Temperature may have an impact on FPL calculations relative to DPOAE test performance. Although the differences in AROC among calibration procedures were not statistically significant, the present results indicate that standing wave errors may impact DPOAE test performance and can be reduced by using FPL, although the largest effects were restricted to 8 kHz.

Temporary reduction of distortion product otoacoustic emissions (DPOAEs) immediately following auditory brainstem response (ABR)

The hearing status of an experimental animal is typically assessed in the laboratory setting by the combined use of auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAEs), carried out in succession, with the former assay preceding the latter. This study reports a cautionary finding that the use of this accepted regimen yields a reduced DPOAE response. When the DPOAEs were performed after ABR testing, transient reduction of the DPOAE amplitudes was observed at all frequencies in both the inbred, C57/B6 and FVB/N, and the outbred, SW mouse strains. DPOAEs were reduced post-ABR in multiple mouse strains which suggests that this finding is not strain-specific but a general consequence of the preceding ABR analysis. The reduction in DPOAE was temporary: when re-tested at one hour, DPOAE amplitudes recovered to pre-ABR levels. In contrast to the ABR’s impact on DPOAE response, ABR thresholds were not altered or reduced when preceded immediately by DPOAE measurements. The molecular alterations underlying the ABR-induced transient reduction of DPOAE remain to be determined. To investigate the potential role of reactive oxygen species in post-ABR DPOAE reduction, transgenic mice over-expressing SOD1, the cytoplasmic enzyme critical for removal of superoxide radicals were subjected to the same auditory testing regimen. Similar to their wild type littermates, the SOD1 transgenic mice also demonstrated post-ABR DPOAE reduction, and thus do not support a role for superoxide radicals in transient reduction of DPOAE. While toxic noise exposure is known to negatively impact OAE, transient decrease in DPOAE levels following standard ABR assay has not been previously described. A practical outcome from this study is a recommendation for reversal of the traditional order for carrying out auditory tests, with the OAE measurements preceding ABR assessment, thus ensuring that the DPOAE response is unaffected.

Transtympanic Ringer's lactate application in the prevention of cisplatinum-induced ototoxicity in a chinchilla animal model

Objective Ototoxicity is currently the most frequent dose-limiting side effect of cisplatinum chemotherapy. To date, there is no protocol to prevent dose-related ototoxicity, despite its prevalence and predictability. Previous animal studies have found lactate to be effective in the prevention of cisplatinum-induced ototoxicity. The objective of this study was to test the protective benefits of transtympanic Ringer's lactate in the prevention of cisplatinum-induced ototoxicity. Study Design A randomized prospective controlled trial was conducted in an animal model. Setting Animal care research facilities of The Montreal Children's Hospital Research Institute. Subjects and Methods A total of 44 chinchillas were exposed to systemic cisplatinum injected intraperitoneally in divided cycles to reach the targeted cumulative dosage of 16 mg/kg. Ototopical application of Ringer's lactate solution 0.2 mL twice per day during the chemotherapy cycles was performed. Each animal had one experimental (Ringer's) and one control ear. Distortion product otoacoustic emissions (DPOAEs) were collected for a wide range of frequencies (between 1 and 16 kHz), and scanning electron microscopy was performed to evaluate the protective effects of Ringer's lactate. Results Ototopical application of Ringer's lactate solution in our established chinchilla animal model did not provide an otoprotective effect as measured by the DPOAE response and electron microscopy. Conclusion In our study, the intratympanic application of Ringer's lactate solution through a tympanostomy ventilation tube did not provide an otoprotective effect. Further studies are needed to better assess the otoprotective or ototoxic effects of Ringer's lactate and other antioxidants on animal and human hearing.

Clinical Test Performance of Distortion-Product Otoacoustic Emissions Using New Stimulus Conditions

To determine whether new stimulus parameters, which have been shown to produce large distortion-product otoacoustic emission (DPOAE) levels in a group of normal-hearing listeners (Neely et al. 2005; Johnson et al. 2006), result in more accurate identification of auditory status and more accurate predictions of behavioral threshold than traditional stimulus conditions. DPOAE input/output (I/O) functions for eight f2 frequencies ranging from 0.7 to 8 kHz were recorded from 96 ears with normal hearing and 226 ears with sensorineural hearing losses ranging from mild to profound. The primary-level differences and primary-frequency ratios were set according to the stimulus relations developed by Johnson et al. (2006). The accuracy of the dichotomous decision task (area under the relative operating characteristic curve [AROC]) for these new stimulus conditions was evaluated as a function of L2 and was compared with previous reports in the literature where traditional stimuli were used (Stover et al. 1996). Here, traditional stimuli are defined as L1 = L2 + 10 and f2/f1 = 1.22 for all L2 and f2 values. In addition to I/O functions, DPgrams with L2 = 55-dB sound pressure level (SPL) and f2 ranging from 0.7 to 8 kHz were recorded for each subject using the traditional stimuli. This provided a direct within-subject comparison of AROC for moderate-level stimuli when the new and traditional stimuli were used. Finally, the accuracy with which DPOAE thresholds predicted behavioral thresholds was evaluated in relation to previous reports in the literature for two definitions of DPOAE threshold, one where the entire I/O function was used to make the prediction and a second where the lowest L2 producing a signal to noise ratio > or =3 dB was used. There was no evidence that the new stimuli improved the accuracy with which auditory status was identified from DPOAE responses. With both the new and traditional stimuli, moderate stimulus levels (L2 = 40- to 55-dB SPL) resulted in the most accurate identification of auditory status. When L2 = 55-dB SPL, the new stimuli produced AROC values that were equivalent to those observed with traditional stimuli. The new stimuli resulted in more accurate prediction of behavioral threshold for several f2 values when using the entire I/O function, although the effect was small. Furthermore, using the entire I/O function to predict behavioral threshold results in more accurate predictions of behavioral threshold than using the signal to noise ratio definition, although this approach can be applied to a smaller percentage of ears. The new stimuli that had been shown previously to produce large DPOAE levels in normal-hearing listeners (Neely et al. 2005; Johnson et al. 2006) do not result in more accurate identification of auditory status and have only a small positive effect on the prediction of behavioral threshold.

A normative study of otoacoustic emissions, ear asymmetry, and gender effect in healthy schoolchildren in Slovakia

Objective The aim of this normative study was to examine cochlear status and possible ear asymmetry and gender effect in transient evoked and distortion product otoacoustic emissions in a group of healthy 12-year-old children in Slovakia. Methods Two hundred and twenty-nine 12-year-old children from Slovakia with normal hearing were included in this study. Adolescents with acute infection, abnormal otoscopic findings and abnormal tympanometry were excluded. Pure tone audiometry was performed in standard conditions in a sound proof room. Recordings of transient evoked (TE) and distortion product otoacoustic emissions (DPOAEs) were performed using an ILO 292 USB Echoport. Parameters of hearing thresholds and OAEs were compared using correlation analysis and Wilcoxon test. Results We found highly statistically significant associations between the hearing thresholds for the left and right ears. When comparing pure tone audiometry with OAEs no significant correlation was found. In TEOAE a significant gender effect and side effect in TEOAE SNR were found. On the other hand there was no side effect in TEOAE response level. In DPOAE neither gender nor side effects were determined. Conclusions This is the first comprehensive information on cochlear status among Slovak adolescents. The TEOAEs were significantly higher in girls than boys, but the ear asymmetry in TEOAE was not significant. For DPOAE responses ear asymmetry and gender did not play a role. The data obtained are a basis for population hearing screening, especially for hearing screening programs in infants and children in Slovakia. Moreover data from particular age group represent a link between data from infants and adults.

Extraction of sources of distortion product otoacoustic emissions by onset-decomposition

The cubic component of the distortion product otoacoustic emission (DPOAE) in response to two tones of frequency f 1 and f 2 is generated by so-called primary- and secondary-source mechanisms in the cochlea. Interference between the resulting two source components can limit the usefulness of DPOAEs in assessing cochlear function. Although techniques are available for separating the source components, depending on the application, they can be either time-consuming or ineffective without a priori knowledge of optimal parameters. Here, we investigated, in humans, the possibility of separating the source components in the time-domain by sampling the onset and offset of the DPOAE-time signal at appropriate instants. Therefore, a DPOAE paradigm was developed in which the f 2 tone was periodically switched on during the continuous presence of the f 1 tone. F 2 was increased in 20-Hz steps from 1.5 to 2.5 kHz and the ratio f 2/ f 1 held constant at 1.2; measurements were made at six primary tone levels, ranging from L 2 = 25 to 65 dB SPL. To investigate the possibility of separating the two sources by appropriate sampling, we developed an algorithm called onset-decomposition. The algorithm is based on the shape properties of DP-grams constructed from DPOAE responses at different time instants in the onset of the DPOAE signal. Thus, at each such time instant, the source components were extracted by time-windowing of the corresponding DP-gram. The time courses of the amplitude onsets of these separated primary- and secondary-source components provided evidence that the primary-source component attained its steady-state before the secondary-source component started to significantly influence the DPOAE by interference with the primary-source component. Consequently, in the final paradigm, the primary-source component is extracted by sampling the DPOAE signal at a single pre-defined time instant after the onset of the f 2 stimulus tone, before the secondary component begins to interfere. Based on the near-absence of interference maxima and minima in the DP-grams, the appropriate sampling instant was 8–10 ms for all frequencies and intensities in the stimulus set. Extracting the primary-source by onset sampling has the advantage that when individual source components for a given f 2 are to be investigated, there is no need to measure a DP-gram. In conclusion, it is shown that the technique can reliably and quickly separate the source components, making it an attractive paradigm for applications in basic research and clinical diagnosis.