Hearing Threshold Estimation Research Articles

Context Dependent Auditory Thresholds Determined by Brainstem Audiometry and Prepulse Inhibition in Mongolian Gerbils

Information on hearing thresholds is not always reliable as differences in these thresholds have been described even for the same species. This may partially be due to different methods used by different labs. A frequently used approach to obtain an estimate of hearing threshold is the electrophysiological recording of auditory brainstem responses (ABR). They are usually recorded under deep anesthesia and represent the auditory evoked far-field potentials at various levels in the central auditory pathway. Alternatively, several behavioral approaches are employed. These commonly use operant or classical conditioning to determine hearing thresholds. A potential disadvantage of these methods is that any sound conditioning may in principle alter auditory perception and therefore auditory thresholds. To exclude this type of methodological bias a prepulse inhibition (PPI) paradigm can be used where an audiogram can be determined without any kind of pre-training. Here we compare the threshold estimates obtained by two different ABR and PPI measurements where stimuli are presented in different contexts, either randomly or non-randomly, to test for a possible effect of auditory sensitization. In addition we test the effect of a frequency specific acoustic trauma on the audiograms obtained with both methods. In general we find behaviorally determined audiograms to be significantly lower in absolute thresh- old compared to ABR measurements. Furthermore non-randomized presentation context of the stimuli generally results in audiograms with 10 to 15 dB lower thresholds than pseudo-randomized presentation. Finally, the amount of threshold loss induced by acoustic trauma is similar for all methods tested.

Using the Auditory Brainstem Response (ABR) to Determine Sensitivity of Hearing in Mutant Mice.

Measurements of auditory evoked potentials can be used to determine reliably an audiometric representation of hearing sensitivity in mice. In a high-throughput phenotyping screen of mice carrying targeted mutations of single genes, the auditory brainstem response (ABR) is used to gain an estimate of hearing threshold for broadband click stimuli and pure tone frequencies ranging from 6 to 30 kHz. Comparison of thresholds obtained in mutant and wild-type mice give a means to determine mild, moderate, and severe hearing impairment. This gives a clear advantage over using a "clickbox" test to assess hearing by observations of the Preyer reflex. The ABR screen has identified several mutant lines with mild and moderate hearing loss, which appear to demonstrate normal Preyer responses. The ABR technique also allows frequency-selective hearing loss to be identified. Curr. Protoc. Mouse Biol. 1:279-287 © 2011 by John Wiley & Sons, Inc.

The Manipulation of Auditory Brain Stem Response Data to Predict the Behavioral Audiogram during Infancy

The auditory brain stem response (ABR) is the current gold standard to estimate hearing thresholds during infancy. The clinical protocols to illicit the ABR are documented, and the correlation between the ABR and auditory sensitivity has been validated extensively. Research also has focused on the maturation of the auditory system and its effects on the ABR threshold. In situ ABR measures were conducted to quantify the maturation of the ABR during infancy for the purposes of controlling for this effect when using ABR thresholds to estimate hearing levels on an audiogram. This article describes a corrective procedure that permits the clinician to obtain the estimated hearing level from ABR thresholds during infancy when immature responses are prevalent.

Clinical Status of the Auditory Steady-State Response in Infants

Pediatric audiology has seen the inclusion of the auditory steady-state response (ASSR) in clinical test batteries as a valuable diagnostic tool. Its unique stimuli, recording and analysis characteristics allow for applications not previously possible with other auditory evoked responses in infants and young children. Although the long-standing research and clinical validation history of the frequency-specific auditory brain stem response (ABR) make it the current gold standard for estimating hearing thresholds, accumulating evidence is establishing the ASSR as a reliable and accurate tool for the diagnosis of hearing loss in infants. Current test-protocol efficiency and accuracy may be improved by including the ASSR to supplement ABR data and to cross-check test results. This article reviews the ASSR and its current clinical applications and limitations for determining hearing thresholds in infants and young children.

Using multi-stimulus auditory steady state response to predict hearing thresholds in high-risk infants

The purpose of this study was to investigate whether multi-stimulus auditory steady-state responses were capable of estimating hearing thresholds in high-risk infants. A retrospective chart review study. Three tertiary referral centers. Infants born between January 2004 and December 2006 who met the criteria for risk factors of congenital hearing loss were enrolled in the study. While under sedation, the multi-stimulus auditory steady-state response was used to determine multi-channel auditory steady-state response thresholds for high-risk infants younger than 13 months. Conditioned play audiometry was then applied to these children at 23-48 months of age to obtain pure tone audiograms. Auditory steady-state response thresholds and pure tone thresholds were then compared. A total of 249 high-risk infants were enrolled in the study. 39 infants were lost during follow-up. The remaining 216 infants completed both examinations. The Pearson correlation coefficients (r) between the ASSR levels and pure tone thresholds were 0.88, 0.94, 0.94 and 0.97 at 500, 1,000, 2,000 and 4,000 Hz, respectively. The strength of the relationship between the auditory steady-state responses and pure tone thresholds increased with more severe degrees of hearing loss and higher frequencies. We conclude that initial multichannel ASSR thresholds measured under sedation are highly correlated with pure tone thresholds obtained 2 or 3 years later. ASSR can be used to predict the frequency-specific hearing thresholds of high-risk infants and can provide information for early hearing intervention.

Hearing threshold estimation using concurrent measurement of distortion product otoacoustic emissions and auditory steady-state responses

Both distortion product otoacoustic emissions (DPOAEs) and auditory steady-state responses (ASSRs) provide frequency-specific assessment of hearing. However, each method suffers from some restrictions. Hearing losses above 50 dB HL are not quantifiable using DPOAEs and their performance at frequencies below 1 kHz is limited, but their recording time is short. In contrast, ASSRs are a time-consuming method but have the ability to determine hearing thresholds in a wider range of frequencies and hearing losses. Thus, recording DPOAEs and ASSRs simultaneously at their adequate frequencies and levels could decrease the overall test time considerably. The goal of the present study was to develop a parameter-setting and test-protocol to measure DPOAEs and ASSRs binaurally and simultaneously at multiple frequencies. Ten normal-hearing and 23 hearing-impaired subjects participated in the study. The interaction of both responses when stimulated simultaneously at frequencies between 0.25 and 6 kHz was examined. Two limiting factors need to be kept. Frequency distance between ASSR carrier frequency f(c) and DPOAE primary tone f(2) needs to be at least 1.5 octaves, and DPOAEs may not be measured if the ASSR stimulus level is 70 dB SPL or above. There was a significant correlation between pure-tone and DPOAE/ASSR-thresholds in sensorineural hearing loss ears.

Maturation of auditory function related to hearing threshold estimations using the auditory brainstem response during infancy

Objective The objective of this study was to quantify the maturation of the Auditory Brainstem Response (ABR) at discrete periods during infancy and to provide a means to appropriately estimate hearing thresholds when the ABR is immature. Methods A longitudinal study was designed to measure the in situ ABR thresholds of infants using air-conduction tone bursts of 500, 2000 and 4000 Hz. Thresholds were measured using an eardrum-level microphone to eliminate the bias related to coupler-referenced scales such as the dB nHL scale used for adult assessments. Results The study found that the in situ thresholds of a sample of normally developing infants decreased significantly during the first 6 months of life. A comparison of these in situ thresholds with those of normal-hearing adults revealed that the ABR response reached maturity in these infants between 4 and 6 months of age for the frequencies 500 and 2000 Hz but remained immature, or elevated, at 6 months of age for 4000 Hz. Conclusions The maturation of the ABR should be considered during the estimation of an infant's audiogram and subsequent diagnosis.

A novel tonality estimation method of spectral components for audio coding applications.

A novel algorithm providing adequate tonality estimates for constant and modulated sinusoidal components was developed. The proposed algorithm was combined with the MPEG psychoacoustic model 2 in order to verify whether replacing the standard tonality estimator with the proposed one leads to a more reliable estimate of hearing threshold. It was verified whether the proposed tonality estimation algorithm may be used as a basis for detecting the signal bands containing only a noise‐like component that can be encoded according to the perceptual noise substitution technique. Subsequently, it was proved that it is possible to estimate the tonality of unmodulated or frequency‐modulated sinusoidal components of audio signals through the comparison of their instantaneous frequency variations determined employing both an estimator processing spectral amplitude samples and an estimator processing spectral phase samples. It was also revealed that distortions introduced during perceptual audio coding may be effectively limited employing the proposed tonality estimation algorithm. In order to fully explore the benefits of the proposed method for coding applications, the listening tests were performed in accordance with the ITU‐T BS.1534 recommendation. [Research partially funded by the Polish Ministry of Science and Higher Education within Grants Nos. PBZ‐MNiSW‐02‐II‐2007 and No. N N517 378736.]

Optimal electrode selection for multi-channel electroencephalogram based detection of auditory steady-state responses

Auditory steady-state responses (ASSRs) are used for hearing threshold estimation at audiometric frequencies. Hearing impaired newborns, in particular, benefit from this technique as it allows for a more precise diagnosis than traditional techniques, and a hearing aid can be better fitted at an early age. However, measurement duration of current single-channel techniques is still too long for clinical widespread use. This paper evaluates the practical performance of a multi-channel electroencephalogram (EEG) processing strategy based on a detection theory approach. A minimum electrode set is determined for ASSRs with frequencies between 80 and 110 Hz using eight-channel EEG measurements of ten normal-hearing adults. This set provides a near-optimal hearing threshold estimate for all subjects and improves response detection significantly for EEG data with numerous artifacts. Multi-channel processing does not significantly improve response detection for EEG data with few artifacts. In this case, best response detection is obtained when noise-weighted averaging is applied on single-channel data. The same test setup (eight channels, ten normal-hearing subjects) is also used to determine a minimum electrode setup for 10-Hz ASSRs. This configuration allows to record near-optimal signal-to-noise ratios for 80% of subjects.

A Procedural Framework for Auditory Steady-State Response Detection

<para xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> Auditory steady-state responses (ASSRs) in EEG measurements are currently used for reliable hearing threshold estimation at audiometric frequencies. Especially, newborns with hearing problems benefit from this technique, as with this information, diagnosis can be better specified and hearing aids can be better fitted at an early age. Unfortunately, measurement duration is still very long for clinical widespread use due to the lack of efficient signal detection techniques with sufficient robustness against artifacts. In this paper, a simplified procedural framework for ASSR detection is worked out that allows the development of a multichannel processing strategy, starting from a detection theory approach. It is shown that a sufficient statistic can be calculated that best captures the amount of ASSR in the recorded data. The evaluation is conducted using data from ten normal-hearing adults. It is concluded that most single- and multichannel approaches are similar in performance when applied to uncontaminated EEG. When artifact-rich EEG is used, the proposed detection-theory-based approach significantly improves the number of ASSR detections compared with a noise-weighted common EEG channel derivation (vertex–occiput). </para>

Accuracy of velocity distortion product otoacoustic emissions for estimating mechanically based hearing loss

Distortion product otoacoustic emissions (DPOAEs) measured as vibration of the human eardrum have been successfully used to estimate hearing threshold. The estimates have proved more accurate than similar methods using sound-pressure DPOAEs. Nevertheless, the estimation accuracy of the new technique might have been influenced by endogenous noise, such as heart beat, breathing and swallowing. Here, we investigate in an animal model to what extent the accuracy of the threshold estimation technique using velocity-DPOAEs might be improved by reducing noise sources. Velocity-DPOAE I/O functions were measured in normal and hearing-impaired anaesthetized guinea pigs. Hearing loss was either conductive or induced by furosemide injection. The estimated distortion product threshold (EDPT) obtained by extrapolation of the I/O function to the abscissa was found to linearly correlate with the compound action potential threshold at the f 2 frequency, provided that furosemide data were excluded. The standard deviation of the linear regression fit was 6 dB as opposed to 8 dB in humans, suggesting that this accuracy should be achievable in humans with appropriate improvement of signal-to-noise ratio. For the furosemide animals, the CAP threshold relative to the regression line provided an estimate of the functional loss of the inner hair cell system. For mechanical losses in the middle ear and/or cochlear amplifier, DPOAEs measured as velocity of the umbo promise an accuracy of hearing threshold estimation comparable to classical audiometry.

Bone Conduction Auditory Steady State Response: Investigations into Reducing Artifact

Auditory steady state responses (ASSRs) can be reliably recorded in sleeping neonates and can be used to estimate hearing thresholds in individuals with normal or impaired hearing. However, artifactual responses can contaminate recordings, particularly when recording bone conduction ASSRs. The aim of this investigation was to study the presence of electromagnetic artifact in bone conduction ASSRs and to investigate methods of reducing the amplitude of the artifact. Using a simulation of a patient, ASSR recordings were obtained to multiple frequency bone-conducted stimuli using the research MASTER system. ASSR stimuli were sinusoidal tones with the carrier frequencies 500, 1000, 2000, and 4000 Hz that were 100% amplitude modulated at 83, 87, 91, and 95 Hz, respectively. After the assessment of different equipment layouts, the effects of (1) altering the analog-to-digital conversion rates and (2) screening the transducer cable and B-71 transducer and connecting the screens to ground were investigated. For ASSR recordings, artifacts were observed at the modulation rates of the 1000-, 2000-, and 4000-Hz carrier frequencies. As expected, the artifact was proportional to stimulus intensity and was observed when using sampling rates of 1000 and 2000 Hz but not 1250 and 1600 Hz. Altering the electrode lead/transducer cable layout and orientation of the B-71 transducer significantly affected the amplitude of the artifact. Screening of the B-71 transducer and cable and connecting the screens to ground reduced the amplitude of the artifact to a level that was not significantly above background noise. A mu-metal screen had a significantly greater effect than aluminum or copper. If stimulus artifact is present in the recorded EEG, for certain choices of carrier frequency and sampling rate it is possible to record artifactual signals at the same modulation rates as those used to elicit ASSRs. This is problematic as the artifact may then be misinterpreted as an ASSR response. The results from this study have demonstrated that careful attention to equipment layout, choice of sampling rate, using grounded screens to screen the B-71 transducer and transducer cable can all be effective in reducing the level of stimulus artifact.

Tone-evoked brainstem responses and auditory steady state responses to 40hz and 80hz amplitude modulated stimuli with different frequencies — a comparative study

Tone burst evoked auditory brainstem responses and auditory steady state responses with 40 or > 80 Hz modulation can be used to determine frequency specific threshold. The present study was taken up to check for the efficacy of estimating hearing thresholds by tone burst ABR and ASSR. The frequency effect (low, mid and high) on estimating the threshold was also focused upon. 20 normal hearing adults (40 ears) in the age range of 16 to 30 years participated in the study. The pure tone audiometry and immittance was initially done. Subsequently, tone-burst ABR, 80Hz ASSR and 40Hz ASSR to estimate the threshold with three frequencies 500Hz (low), 2000Hz (mid) and 4000Hz (high) was done. The data was analyzed statistically using pair sample t-test. ASSR threshold for 80Hz and 40Hz was almost comparable. ASSR was superior to estimate the threshold than tone-burst ABR. For the low frequency the discrepancy between the behavioral threshold and frequency-specific evoked audiometry was more when compared to mid and high frequency. Present study showed that steady-state responses were efficient means of threshold detection than visual detection of ABR wave-V. In awake adult subjects, 40Hz and 80Hz amplitude modulated produced similar results. For the threshold estimation ASSR was better than tone-burst ABR.

The effects of very slow rates of stimulus presentation on event-related potential estimates of hearing threshold

The present study evaluated the use of slow rates of stimulus presentation on the accuracy of the N1-P2 cortical response in estimating hearing threshold. Long interstimulus intervals (ISI) allow the non-specific component of the N1 response to emerge, believed to reflect widespread cortical arousal that facilitates sensory and motor responses. We examined whether the non-specific N1 would be elicited at intensity levels near threshold. Event-related potentials were recorded to 0.5-, 1.0, and 4.0-kHz tone bursts with a long ISI (8–12 s) while the eleven subjects read a book. The stimulus level varied from -5 to 45 dB nHL. The 1.0-kHz tone burst was also presented with a shorter ISI (1.5–2.5 s), akin to that typically used in the audiological setting. The amplitude of N1-P2 was significantly enhanced in the long compared to short ISI condition, but, importantly, only for the stimuli with a level ≥25 dB nHL. Therefore, the N1-P2 recorded with long ISIs was not more precise in estimating threshold than that recorded with short ISIs, remaining visible to within 10 dB of behavioural threshold.

Hearing loss from interrupted, intermittent, and time varying non-Gaussian noise exposure: The applicability of the equal energy hypothesis

Sixteen groups of chinchillas (N=140) were exposed to various equivalent energy noise paradigms at 100 dB(A) or 103 dB(A) SPL. Eleven groups received an interrupted, intermittent, and time varying (IITV) non-Gaussian exposure quantified by the kurtosis statistic. The IITV exposures, which lasted for 8 hday, 5 daysweek for 3 weeks, were designed to model some of the essential features of an industrial workweek. Five equivalent energy reference groups were exposed to either a Gaussian or non-Gaussian 5 days, 24 hday continuous noise. Evoked potentials were used to estimate hearing thresholds and surface preparations of the organ of Corti quantified the sensory cell population. For IITV exposures at an equivalent energy and kurtosis, the temporal variations in level did not alter trauma and in some cases the IITV exposures produced results similar to those found for the 5 day continuous exposures. Any increase in kurtosis at a fixed energy was accompanied by an increase in noise-induced trauma. These results suggest that the equal energy hypothesis is an acceptable approach to evaluating noise exposures for hearing conservation purposes provided that the kurtosis of the amplitude distribution is taken into consideration. Temporal variations in noise levels seem to have little effect on trauma.

Improving Auditory Steady-State Response Detection Using Independent Component Analysis on Multichannel EEG Data

Over the last decade, the detection of auditory steady-state responses (ASSR) has been developed for reliable hearing threshold estimation at audiometric frequencies. Unfortunately, the duration of ASSR measurement can be long, which is unpractical for wide scale clinical application. In this paper, we propose independent component analysis (ICA) as a tool to improve the ASSR detection in recorded single-channel as well as multichannel electroencephalogram (EEG) data. We conclude that ICA is able to reduce measurement duration significantly. For a multichannel implementation, near-optimal performance is obtained with five-channel recordings.

Hearing loss from interrupted, intermittent, and time varying Gaussian noise exposures: The applicability of the equal energy hypothesis

Eight groups of chinchillas (N=74) were exposed to various equivalent energy [100 or 106 dB(A) sound pressure level (SPL)] noise exposure paradigms. Six groups received an interrupted, intermittent, time varying (IITV) Gaussian noise exposure that lasted 8 h/d, 5 d/week for 3 weeks. The exposures modeled an idealized workweek. At each level, three different temporal patterns of Gaussian IITV noise were used. The 100 dB(A) IITV exposure had a dB range of 90-108 dB SPL while the range of the 106 dB(A) IITV exposure was 80-115 dB SPL. Two reference groups were exposed to a uniform 100 or 106 dB(A) SPL noise, 24 h/d for 5 days. Each reference group and the three corresponding IITV groups comprised a set of equivalent energy exposures. Evoked potentials were used to estimate hearing thresholds and surface preparation histology quantified sensory cell populations. All six groups exposed to the IITV noise showed threshold toughening effects of up to 40 dB. All IITV exposures produced hearing and sensory cell loss that was similar to their respective equivalent energy reference group. These results indicate that for Gaussian noise the equal energy hypothesis for noise-induced hearing loss is an acceptable unifying principle.

Effects of Bone Oscillator Coupling Method, Placement Location, and Occlusion on Bone-Conduction Auditory Steady-State Responses in Infants

The aim of these experiments was to investigate procedures used when estimating bone-conduction thresholds in infants. The objectives were: (i) to investigate the variability in force applied using two common bone-oscillator coupling methods and to determine whether coupling method affects threshold estimation, (ii) to examine effects of bone-oscillator placement on bone-conduction ASSR thresholds, and (iii) to determine whether the occlusion effect is present in infants by comparing bone-conduction ASSR thresholds for unoccluded and occluded ears. Experiment 1A: The variability in the amount of force applied to the bone oscillator by trained assistants (n = 4) for elastic-band and hand-held coupling methods was measured. Experiment 1B: Bone-conduction behavioral thresholds in 10 adults were compared for two coupling methods. Experiment 1C: ASSR thresholds and amplitudes to multiple bone-conduction stimuli were compared in 10 infants (mean age: 17 wk) using two coupling methods. Experiment 2: Bone-conduction ASSR thresholds and amplitudes were compared for temporal, mastoid and forehead oscillator placements in 15 preterm infants (mean age: 35 wk postconceptual age (PCA)). Experiment 3: Bone-conduction ASSR thresholds, amplitudes and phase delays were compared in 13 infants (mean age: 15 wk) for an unoccluded and occluded test ear. All infants that participated had passed a hearing screening test. Experiment 1A: Coupling method did not significantly affect the variability in force applied to the oscillator. Experiment 1B: There were no differences in adult bone-conduction behavioural thresholds between coupling methods. Experiment 1C: There was no significant difference between oscillator coupling method or significant frequency x coupling method interaction for ASSR thresholds or amplitudes in the young infants tested. However, there was a nonsignificant 9-dB better threshold at 4000 Hz for the elastic-band method. Experiment 2: Mean bone-conduction ASSR thresholds for the preterm infants were not significantly different for the temporal and mastoid placements. Mean ASSR thresholds for the forehead placement were significantly higher compared to the other two placements (12-18 dB higher on average). Mean ASSR amplitudes were significantly larger for the temporal and mastoid placements compared to the forehead placement. Experiment 3: There was no difference in mean ASSR thresholds, amplitudes or phase delays for the unoccluded versus occluded conditions. Trained assistants can apply an appropriate amount of force to the bone oscillator using either the elastic-band or hand-held method. Coupling method has no significant effect on estimation of bone-conduction thresholds; therefore, either may be used clinically provided assistants are appropriately trained. For preterm infants, there are no differences in ASSRs when the oscillator is positioned at the temporal or mastoid placement. However, thresholds are higher and amplitudes are smaller for the forehead placement, consequently, a forehead placement should be avoided for clinical testing. There does not appear to be a significant occlusion effect in young infants; therefore, it may be possible to do bone-conduction testing with ears unoccluded or occluded without applying a correction factor, although further research is needed to confirm this finding.

Auditory Evoked Potentials in Northern Elephant Seals (&lt;I&gt;Mirounga angustirostris&lt;/I&gt;)

Auditory evoked potentials (AEPs) were investigated in northern elephant seals (Mirounga angustirostris) to characterize the responses elicited by different acoustic stimulus types, examine temporal resolving capabilities, and evaluate the potential for using evoked responses to estimate hearing sensitivity. Clicks and tone pips were presented to individual seals to characterize evoked responses to broadand narrowband stimuli. Tone pip trains and sinusoidally amplitude-modulated (SAM) tones were used to determine modulation rate transfer functions (MRTF) of the auditory system and to determine if the magnitude of the envelope-following response (EFR) relative to the stimulus level can be used to estimate hearing thresholds. Click evoked responses were characterized by three early positive peaks (~2.6, 4.4, and 6.1 ms) and a dominant negative peak at 7.2 ms and had average amplitudes of 264 nV (peak-to-peak [pk-pk]) for a corresponding stimulus level of 126 dB re 20 μPa (pk-pk). The use of dissociative drugs for the immobilization of the seals showed no demonstrable effect on the latencies or amplitudes of the click evoked response. Both the rate following response (RFR) and EFR amplitudes were maximal when the stimulus repetition rate or the amplitude modulation rate, respectively, were < 100 Hz. EFR amplitudes at the rate of amplitude modulation tracked near linearly with stimulus level. Thresholds for a 4-kHz SAM tone were estimated to be 45 dB re 20 μPa. Thus, the recording of AEPs is a viable means of studying auditory processes in the northern elephant seal.

Umbo vibration in response to two‐tone stimuli measured in human subjects

The aim of these experiments was to noninvasively investigate cochlear mechanics near auditory threshold in human subjects by measuring the vibration response of the umbo. The vibration measurement setup consists of a custom‐built laser Doppler vibrometer (LDV), employing a conventional heterodyne interferometer, for which all optical and electronic parts were tailored to the problem of measuring picometer‐sized vibrations in the presence of large, extraneous movements in the order of 0.1 mm (e.g., heart beat, breathing, or swallowing). The cubic distortion product (DP) of the otoacoustic emissions (OAEs) in response to sound stimulation with two tones was measured as vibration on the umbo. For stimulus frequencies, f1 and f2, with f2/f1=1.2 and f2=4–9.5 kHz, and intensities L1 and L2, with L1=0.4L2+39 dB and L2=20–65 dB SPL, the vibration amplitudes were 1–8 pm in subjects (N=20) with hearing loss no more than 25 dB SPL. Application of this vibration technique to a recently proposed method [P. Boege and T. Janssen, J. Acoust. Soc. Am. 111, 1810–1818 (2002)] of objectively estimating hearing threshold by means of extrapolating DPOAE growth functions showed a standard deviation of the estimate of only 8.6 dB.