Normal-hearing Ears Research Articles

An alternate approach to constructing distortion product otoacoustic emission (DPOAE) suppression tuning curves

Distortion product otoacoustic emission (DPOAE) suppression tuning curves (STCs) typically are constructed using suppression criteria of 3 or 6 dB. This paper describes a technique for generating DPOAE STCs using criteria ranging from 3 dB to complete suppression. The criterion effect was examined at various primary levels (f2=4 kHz) in normal-hearing ears. As expected, QERB and tip-to-tail differences decreased as probe level (L2) increased. QERB values were not systematically dependent on criterion. For low L2’s, tip-to-tail differences decreased as criterion increased. Given similarities in methodology, DPOAE STCs constructed from completely suppressed responses might be most appropriate for comparison to psychophysical tuning curves.

Speech-language and educational consequences of unilateral hearing loss in children.

In the past, unilateral hearing loss (UHL) in children was thought to have little consequence because speech and language presumably developed appropriately with one normal-hearing ear. Some studies from the 1980s and 1990s have suggested that a significantly increased proportion of children with UHL may have educational and/or behavioral problems, compared with their normal-hearing peers. Limited data exist about the effect of UHL on acquisition of speech and language skills. To review the current literature about the impact UHL has on the development of speech and language and educational achievement. MEDLINE search between 1966 and June 1, 2003, using the medical subject heading "hearing loss," combined with the textword "unilateral." Studies were limited to those written in English, reporting speech-language and/or educational results in children. Articles were read with attention to study design, population, recruitment of subjects, and outcomes measured. Problems in school included a 22% to 35% rate of repeating at least one grade, and 12% to 41% receiving additional educational assistance. Speech and language delays have been reported in some but not all studies. School-age children with UHL appear to have increased rates of grade failures, need for additional educational assistance, and perceived behavioral issues in the classroom. Speech and language delays may occur in some children with UHL, but it is unclear if children "catch up" as they grow older. Research into this area is necessary to clarify these issues and to determine whether interventions may prevent potential problems.

Crossed and Uncrossed Olivocochlear Pathways Exacerbate Temporary Shifts in Hearing Sensitivity after Narrow Band Sound Trauma in Normal Ears of Animals with Unilateral Hearing Impairment

Olivocochlear (OC) pathways have been shown to reduce the temporary threshold shifts (TTSs) caused by traumatic sounds. More recently they have been shown to exacerbate TTSs under certain conditions. One condition is the normal-hearing ear of animals with a chronic unilateral hearing loss. Testing with pure tone trauma showed that then (a) the normal-hearing ear had a lower-than-normal ‘intrinsic’ susceptibility to intense tones, (b) binaural trauma exacerbated TTSs in the normal-hearing ear through the activity of uncrossed OC (UOC) pathways, and (c) there was no effect on TTSs of the crossed OC (COC) pathway to the normal-hearing ear. The present study is an examination in such animals of effects with noise band trauma. The effects here confirm the previous finding that under such conditions the normal-hearing ear has a lower-than-normal susceptibility to loud sound, and binaural loud sounds exacerbate TTSs in the normal-hearing ear. They extend the previous study by demonstrating that with this traumatic sound, both COC and UOC pathways exacerbate TTSs. These effects contrast against the effects seen in animals with bilaterally normal hearing for the same noise band. Given the commonality of unilateral hearing losses in the normal human population, these data have implications for the functional effects of the OC pathways on loud sound-induced hearing damage.

Ear-canal acoustic admittance and reflectance measurements in human neonates. II. Predictions of middle-ear in dysfunction and sensorineural hearing loss.

This report describes relationships between middle-ear measurements of acoustic admittance and energy reflectance (YR) and measurements of hearing status using visual reinforcement audiometry in a neonatal hearing-screening population. Analyses were performed on 2638 ears in which combined measurements were obtained [Norton et al., Ear Hear. 21, 348-356 (2000)]. The measurements included distortion-product otoacoustic emissions (DPOAE), transient evoked otoacoustic emissions (TEOAE), and auditory brainstem responses (ABR). Models to predict hearing status using DPOAEs, TEOAEs, or ABRs were each improved by the addition of the YR factors as interactions, in which factors were calculated using factor loadings from Keefe et al. [J. Acoust. Soc. Am. 113, 389-406 (2003)]. This result suggests that information on middle-ear status improves the ability to predict hearing status. The YR factors were used to construct a middle-ear dysfunction test on 1027 normal-hearing ears in which DPOAE and TEOAE responses were either both present or both absent, the latter condition being viewed as indicative of middle-ear dysfunction. The middle-ear dysfunction test classified these ears with a nonparametric area (A) under the relative operating characteristic curve of A = 0.86, and classified normal-hearing ears that failed two-stage hearing-screening tests with areas A = 0.84 for DPOAE/ABR, and A = 0.81 for TEOAE/ABR tests. The middle-ear dysfunction test adequately generalized to a new sample population (A = 0.82).

Evoked otoacoustic emissions in patients with Ménière's disease.

This study investigated whether otoacoustic emissions (OAEs) in patients with Ménière's disease show abnormal properties. Patients with Ménière's disease experience vertigo, tinnitus, and hearing loss. OAEs are sounds generated in the inner ear, and their presence is associated with normal hearing. Click-evoked OAEs and distortion product OAEs were measured in 100 patients with Ménière's disease. The incidence of the emissions in affected ears (56%) was lower than in unaffected (i.e., contralateral) ears (85%). The mean emission amplitude in affected ears was also significantly lower (2.6 dB), and the mean amplitude in unaffected ears was lower than in normal-hearing ears (5.3 dB). These differences were likely caused by the hearing loss involved. Further, ears with OAEs clearly showed smaller hearing losses than ears without OAEs (24-dB difference). The average hearing loss showed correlations with the emission amplitudes, although this correlation was not very strong; when plotted against the smallest hearing loss, a certain upper boundary for the emission amplitude was present. Also, the amplitude of click-evoked OAEs showed a considerable correlation with the largest of the three distortion product OAEs. OAEs in patients with Ménière's disease differed from those in normal-hearing ears but did not differ from those in non-Ménière's ears with equivalent hearing loss. This was best observed by comparing emission amplitude with smallest hearing loss instead of mean hearing loss.

Distortion product otoacoustic emission input/output functions in normal-hearing and hearing-impaired human ears.

DPOAE input/output (I/O) functions were measured at 7f2 frequencies (1 to 8 kHz; f2/f1 = 1.22) over a range of levels (-5 to 95 dB SPL) in normal-hearing and hearing-impaired human ears. L1-L2 was level dependent in order to produce the largest 2f1-f2 responses in normal ears. System distortion was determined by collecting DP data in six different acoustic cavities. These data were used to derive a multiple linear regression model to predict system distortion levels. The model was tested on cochlear-implant users and used to estimate system distortion in all other ears. At most but not all f2's, measurements in cochlear implant ears were consistent with model predictions. At all f2 frequencies, the ears with normal auditory thresholds produced I/O functions characterized by compressive nonlinear regions at moderate levels, with more rapid growth at low and high stimulus levels. As auditory threshold increased, DPOAE threshold increased, accompanied by DPOAE amplitude reductions, notably over the range of levels where normal ears showed compression. The slope of the I/O function was steeper in impaired ears. The data from normal-hearing ears resembled direct measurements of basilar membrane displacement in lower animals. Data from ears with hearing loss showed that the compressive region was affected by cochlear damage; however, responses at high levels of stimulation resembled those observed in normal ears.

Optimal stimulus level conditions for measurements of distortion product otoacoustic emissions

Objective: Distortion product otoacoustic emission (DPOAE) is a tool for an objective examination of the cochlea function. While the clinical application of DPOEA test is in progress, the measurements vary depending on the stimulus conditions. We aimed to determine the most appropriate stimulus level in the clinical application of DPOAE test. Methods: Ninety-seven normal hearing ears and 80 hearing-impaired ears (total 177) were subjected to this study. Two levels of stimulations ( L1 and L2) were applied as follows: L1= L2=70 dB; L1= L2=60 dB and L1=60/ L2=50 dB, and DP level was measured at each stimulation, and compared with hearing level. Results: DP level was highest at L1= L2=70 dB. Normal hearing ears and hearing-impaired ears were well differentiated at L1= L2=60 dB. Conclusion: In clinical application of DPOAE test, DP levels should be measured at the stimulus level most appropriate for the purposes.

Unilateral hearing losses alter loud sound-induced temporary threshold shifts and efferent effects in the normal-hearing ear.

In animals with bilaterally normal hearing, olivocochlear pathways can protect the cochlea from the temporary shifts in hearing sensitivity (temporary threshold shifts; TTSs) caused by short-duration intense loud sounds. The crossed olivocochlear pathway provides protection during binaural loud sound, and uncrossed pathways protect when monaural or binaural loud sounds occur in noise backgrounds. Here I demonstrate that when there is a chronic unilateral hearing loss, effects of loud sounds, and efferent effects on loud sound, in the normal-hearing ear differ markedly from normal. Three categories of test animals with unilateral hearing loss were tested for effects at the normal-hearing ear. In all categories a monaural loud tone to the normal-hearing ear produced lower-than-normal TTSs, apparently because of a tonic re-setting of that ear's susceptibility to loud sound. Second, in the two test categories in which the hearing-loss ear was only partly damaged, binaural loud sound exacerbated TTSs in the normal-hearing ear because it caused threshold shifts that were a combination of "pure" TTSs and uncrossed efferent suppression of cochlear sensitivity. (In normal cats, this binaural tone results in crossed olivocochlear protection that reduces TTS.) Binaural loud sound did not produce such uncrossed efferent effects in the test category in which the nontest ear had suffered total hearing loss, suggesting that this uncrossed efferent effect required binaural input to the CNS. It is noteworthy that, in the absence of this uncrossed efferent suppression, the pure loud sound-alone induced TTSs after binaural exposure were low. Thus in the absence of any efferent effect, the normal-hearing cochlea had a reduced susceptibility to loud tone-induced damage. Finally, the results suggest that, with respect to cochlear actions at high sound levels, uncrossed and crossed efferent pathways may exert different effects at the one type of receptor cell.

Clinical relevance of distortion product emissions by means of receiver operating characteristic (ROC) analysis.

The clinical use of distortion product otoacoustic emissions (DPOAE) stems from the observation that the outer hair cells are the most vulnerable part of the cochlea, and damage to these cells is associated with hearing loss and loss of DPOAE. The purpose of this study is to evaluate the applicability of DPOAE in predicting hearing thresholds under clinical conditions. DPOAE measurements (L1 = L2 = 70 dB SPL. f2/f1 = 1.20) of 219 hearing-impaired and normal hearing ears were analyzed. Recordings were acquired for DPOAE at 2 f1-f2 varying from 635 to 4052 Hz. The detectability of DPOAE in hearing-impaired subjects exhibited a strong hearing threshold dependence. Receiver operating characteristic (ROC) analysis yielded the highest sensitivity and specificity for threshold levels of about 30 dB at low frequencies and for threshold levels of about 60 dB at high frequencies. In addition, the separability of groups with different hearing status was more reliable at high frequencies as compared to low frequencies. The DPOAE provide an objective assessment of cochlear function. However, prognosis of hearing thresholds on the basis of DPOAE measurements depends strongly on the test frequency and is associated with large errors. Hence, the clinical use of DPOAE in predicting hearing thresholds is limited.

Distortion product otoacoustic emission test performance when both 2f1-f2 and 2f2-f1 are used to predict auditory status.

The objective of this study was to determine whether distortion product otoacoustic emission (DPOAE) test performance, defined as its ability to distinguish normal-hearing ears from those with hearing loss, can be improved by examining response and noise amplitudes at 2 f1-f2 and 2f2-f1 simultaneously. In addition, there was interest in knowing whether measurements at both DPs and for several primary frequency pairs can be used in a multivariate analysis to further optimize test performance. DPOAE and noise amplitudes were measured at 2f1-f2 and 2 f2-f1 for 12 primary levels (L2 from 10 to 65 dB SPL in 5-dB steps) and 9 pairs of primary frequencies (0.5 to 8 kHz in 1/2-octave steps). All data were collected in a sound-treated room from 70 subjects with normal hearing and 80 subjects with hearing loss. Subjects had normal middle-ear function at the time of the DPOAE test, based on standard tympanometric measurements. Measurement-based stopping rules were used such that the test terminated when the noise floor around the 2 f1-f2 DP was < or = -30 dB SPL or after 32 s of artifact-free averaging, whichever occurred first. Data were analyzed using clinical decision theory in which relative operating characteristics (ROC) curves were constructed and areas under the ROC curves were estimated. In addition, test performance was assessed by selecting the criterion value that resulted in a sensitivity of 90% and determining the specificity at that criterion value. Data were analyzed using traditional univariate comparisons, in which predictions about auditory status were based only on data obtained when f2 = audiometric frequency. In addition, multivariate analysis techniques were used to determine whether test performance can be optimized by using many variables to predict auditory status. As expected, DPOAEs were larger for 2f1-f2 compared to 2 f2-f1 in subjects with normal hearing. However, noise amplitudes were smaller for 2f2-f1, but this effect was restricted to the lowest f2 frequencies. A comparison of signal-to-noise ratios (SNR) within normal-hearing ears showed that the 2f1-f2 DP was more frequently characterized by larger SNRs compared to 2f2-f1. However, there were several subjects in whom 2f2-f1 produced a larger SNR. ROC curve areas and specificities for a fixed sensitivity increased only slightly when data from both DPs were used to predict auditory status. Multivariate analyses, in which the inputs included both DPs for several primary frequency pairs surrounding each audiometric frequency, produced the highest areas and specificities. Thus, DPOAE test performance was improved slightly by examining data at two DP frequencies simultaneously. This improvement was achieved at no additional cost in terms of test time. When measurements at both DPs were combined with data obtained for several primary frequency pairs and then analyzed in a multivariate context, the best test performance was achieved. Excellent test performance (ROC) curve areas >0.95% and specificities >92% at all frequencies, including 500 Hz, were achieved for these conditions. Although the results described should be validated on an independent set of data, they suggest that the accuracy with which DPOAE measurements identify auditory status can be improved with multivariate analyses and measurements at multiple DPs.

Informational Masking in Normal-hearing and Hearing-impaired Listeners

The present study aimed to test whether central, across-channel, informational auditory processing abilities are altered by hearing loss. The informational masking effect exerted on a 1 kHz tone-pip by a simultaneous four-tone masker, whose spectral content changed within as well as across trials, was measured in the left and right ears of normal-hearing subjects and hearing-impaired subjects with either symmetrical or asymmetrical hearing loss between the two ears. In the subjects with normal-hearing or symmetrical hearing loss, the level of the masker was set to 40 dB SL in each ear, in the subjects with asymmetrical hearing loss, the masker was set to 40 dB SL in the best ear and loudness-balanced in the other ear. The results failed to reveal significant differences in informational masking between normal-hearing and hearing-impaired subjects. However, in subjects with asymmetric hearing loss, less informational masking was observed in the ear with the more elevated absolute thresholds than in the opposite ear. Since the latter finding can be explained in terms of across-ear differences in loudness recruitment, it is suggested that central, across-channel, informational processing abilities are not substantially different in hearing-impaired than in normal-hearing ears.

Cochlear implants in children.

In recent years, notable progress has been made in the rehabilitation of children with mild to moderate-severe hearing impairment using new and advanced hearing aids. The major problem which remained was the lack of availability of treatment options for those with severe-to-profound sensorineural hearing loss who received little or no benefit from conventional amplification. The purpose of the cochlear implant is to provide these children with direct electrical stimulation of the auditory nerve. A hearing aid amplifies incoming stimuli while a cochlear implant attempts to replace a function lost by the cochlea. In a normal hearing ear, the hair cells within the cochlea act as a transducer of mechanical energy of sound vibration to energy capable of enervating the eighth nerve. The consequence of a decrease in the number of hair cells is the loss of ability of the cochlea to perform the functions, which result in eighth nerve stimulation. The implant replaces the task of the lost hair cells by converting mechanical energy into the electrical energy necessary to excite the remaining cochlear neurons. In order to truly appreciate the application and unfolding of cochlear implants as applied to the pediatric population, it is important to summarize the development of the devices in general.

Tympanic pressure gradients and otoacoustic emissions.

The purpose of this study was to investigate the immediate effects of tympanic over- and under-pressure, induced by variations in ambient pressure on click-evoked otoacoustic emissions (CEOAEs) in healthy individuals. It was of particular interest to elucidate whether changes in the CEOAE response in both spectral and time domains could be attributed not only to tympanic, but also to cochlear influence. Nine healthy subjects with normal hearing and middle ear pressure were exposed to ambient pressure changes in a pressure chamber. The pressure was progressively changed in 100 daPa steps to accomplish an increase and a decrease in tympanic pressure. Pressure equilibration of the middle ear was avoided. The relative tympanic over- and under-pressure (+/- 320daPa) was monitored by tympanometry and the CEOAEs recorded at every step of tympanic pressure change. There was a statistically significant reduction of the otoacoustic emission (OAE) response levels and reproducibility already at 100 daPa of ambient pressure change. The OAE response was progressively reduced by increased pressure gradients. The CEOAEs recorded during progressive tympanic over- and under-pressure also had increasingly shorter latencies. These changes of the OAE response characteristics were most pronounced in the 750 to 3000 Hz frequency bands. The progressive attenuation of the OAE response and the concomitant shortening of the OAE response latencies were observed during a combination of altered middle and inner ear pressure. Although the middle and inner ear influence cannot be separated we suggest, based on our findings, that the shortening of latencies may partly be caused by inner ear pressure changes and stiffening of the labyrinthine membranes. Further studies are needed to more specifically clarify the relative contribution of the tympanic and labyrinthine influence, respectively, for the various aspects of pressure influence on the OAE response.

Unilateral auditory temporal resolution deficit: A case study

An adult with a unilateral precipitous severe high-frequency hearing loss displayed a selective auditory temporal resolution deficit in the poorer ear, despite excellent word recognition ability in quiet bilaterally. Word recognition performance was inferior in interrupted noise, reverberation, and time-compression conditions when stimuli were presented to the hearing-impaired ear and compared with performance for stimuli presented to the normal-hearing ear or that of normal-hearing listeners. It was suggested that a restricted listening bandwidth was responsible for the performance decrement on the tasks involving temporal resolution. This case illustrates the importance of employing temporal resolution tasks in an audiologic test battery. Such assessment tools may reveal deficits that otherwise may go unnoticed in light of excellent word recognition in quiet.

The Effects of Amplitude Modulation on Acoustic Reflex Decay

The temporal decay of the acoustic reflex provides the basis for an objective audiological test that differentiates cochlear from retrocochlear pathologies. The classic sign of a neural lesion is a rapid decay of the reflex under conditions of pure-tone stimulation for frequencies of 1,000 Hz and below. This restriction to lower frequencies is due to the fact that even normal ears show decay for higher-frequency signals. At present, it is unclear whether the acoustic reflex decay (ARD) seen in normal ears is related to frequency-specific channels or whether the critical variable is the timing information coded within the channels. This study examined ARD in subjects with normal hearing and middle ear function. The degree of ARD was measured for both modulated and unmodulated carrier frequencies of 500, 1,000, 2,000 and 4,000 Hz with amplitude modulation rates of 50–400 Hz. The dependent variable was the half-life of the decaying reflex (ARD 50%) over a 20-second stimulation interval. Significant ARD was present for high-frequency unmodulated carriers but not for low-frequency carriers. For all listeners, ARD was diminished for all modulated stimuli. The results of this study suggest that resistance to ARD is mediated by both the temporal aspects and frequency of a stimulus.

Meniere's Disease and Endolymphatic Hydrops Without Meniere's Symptoms: Temporal Bone Histopathology

We studied temporal bone histopathology in 21 ears with Meniere's disease and 24 ears with endolymphatic hydrops without Meniere's symptoms and compared the findings to those in 10 ears with presbycusis and 11 ears with normal hearing. Normal hearing ears showed less degeneration of cochlear structures than the other ears. In ears with endolymphatic hydrops without Meniere's symptoms, the degeneration of spiral ligament, hair cells, dendrites (peripheral processes) and apical spiral ganglion cells was more severe than in the other three groups. In ears with Meniere's disease and endolymphatic hydrops without Meniere's symptoms, the hair cells and dendrites were more affected than ganglion cells and there was no correlation between hair cell and ganglion cell degeneration. These findings suggest that a permanent threshold shift in late stage endolymphatic hydrops is not related to ganglion cell loss but rather to degeneration of sensory elements.

Age-related changes in transiently evoked otoacoustic emissions and distortion product otoacoustic emissions in normal-hearing ears

Age-related changes in transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were evaluated in normal-hearing ears. The TEOAE was elicited by a non-linear click with a stimulus level of 82±1 dB SPL using ILO 88 in 251 normal-hearing ears. The DPOAE at the frequency of 2fl–f2 was measured with stimulus levels of 70 dB SPL (fl) and 60 dB SPL (f2) and with an f2/fl ratio of 1.2, using ILO 92 in 64 normal-hearing ears. The results obtained showed that TEOAE and DPOAE were decreased with increasing age. Moreover, the same pattern of gradual decrease in TEOAE and in DPOAE suggests the possibility of the same generating mechanism associated with outer hair cells (OHCs).

Distortion product otoacoustic emissions for the assessment of auditory sensitivity

Distortion product otoacoustic emissions (DPOAEs) were evaluated in 494 normal and 506 cochlear-impaired human ears, to determine whether DPOAEs depend on factors such as background noise, the shape of the pure tone audiogram, sex and aging, and whether a DPOAE test can perform well in distinguishing normal-hearing from hearing-impaired ears. The amplitudes of DPOAEs were measured at the frequency of 2f1-f2 (f1 < f2, f2/f1 = 1.22, f2 at 1, 2 and 4 kHz) using as stimuli two pure tones at level of 70 dB from an ILO92 Otoacoustic Emission Analyzer. The correlation coefficients between the DPOAE level and the auditory threshold decreased as the background noise levels at 1 kHz and 2 kHz increased. Therefore, it appeared that ears with large background noise levels would be inadequate for the study of DPOAEs predicting the hearing state. The sensitivity (normal-hearing ears identified as normal hearing) and the specificity (hearing-impaired ears identified as hearing impaired) at the equal-sensitivity-specificity condition were 80.7-86.7% at 1, 2 and 4 kHz, and the areas under the receiver operating characteristic (ROC) curves, which were used to estimate the test performance, were 0.88 for 1 kHz, 0.91 for 2 kHz and 0.92 for 4 kHz. Since these results suggest that a DPOAE can be used as a reliable technique for objective auditory tests, it is thought that actual values (DPOAE level: 4.3 dB at 1 kHz, 5.0 dB at 2 kHz and 2.9 dB at 4 kHz) of false-positive (hearing-impaired ears identified as normal hearing) rates corresponding to 5% can be used in clinical evaluation to separate normal hearing from hearing-impaired ears. There was, however, a significant age effect at 4 kHz on DPOAEs in the ears with the same pure tone hearing thresholds, and the areas of the ROC curves in subjects ranging from 10 to 29 years old were larger than in subjects over 50 years (1 kHz: 0.88 to 0.94 versus 0.83 to 0.84, 2 kHz: 0.95 versus 0.89, 4 kHz: 0.95 to 0.96 versus 0.88 to 0.89). Therefore, it is thought that age-adjusted norms may be necessary for the accurate interpretation of DPOAE results.

Neurotrophins can enhance spiral ganglion cell survival after inner hair cell loss

Following destruction of sensory cells of the organ of Corti, spiral ganglion cells (SGC) in the guinea pig degenerate. Chronic electrical stimulation via cochlear prostheses can enhance their survival, with the effect blocked by stopping the electrically elicited action potentials with tetrodotoxin. Blocking action potentials in the normal hearing ear with tetrodotoxin, however, does not cause degeneration. This suggests that in the pathological ear VIII N activity acts as a survival factor, while in the normal ear there are other survival factors that maintain SGCs. We examined neurotrophins, as survival factors in the deafened ear. Two weeks of treatment with BDNF (brain derived neurotrophic factor) administered chronically via a mini-osmotic pump into scala tympani at 50 ng/ml, provided a statistically significant enhanced SGC survival over untreated deafened ears or deafened ears treated with artificial perilymph. Neurotrophin 3 provided some enhanced survival, but this was not statistically significant over untreated deafened ears. These observations suggest there are survival factors in the inner ear, including those coupled to direct activation of the auditory nerve fibers, that may serve to maintain the auditory nerve. These factors may be applied following deafness to maintain and enhance neural populations and to increase benefits to the profoundly deaf receiving cochlear implants.

Individual differences of transient evoked otoacoustic emissions: Effects of gender and ear canal volume

Transient evoked otoacoustic emissions (TEOAE) are an objective means for measuring cochlear hearing loss in newborn infants. TEOAEs are low-intensity sounds produced by the normal cochlea that are elicited by acoustic stimuli and then recorded in the outer ear canal. Protocols are being developed for clinical use, and pass/fail criteria are usually based on the size of the emission. The common practice is to wait until an emission of 6 dB is achieved before recording a positive result. Within subject, stimulus-related characteristics may influence the results. Quantifying the sources of variability can effect the analysis of the results. This study will investigate the effects of gender and ear canal volume on TEOAE size. Five male and five female young adult volunteers will serve as subjects. None of the volunteers will have a history of otologic disease or use of medication. All subjects will have normal hearing and normal middle ear function. Pure-tone audiometry and single frequency immittance testing (226 Hz probe tone) will be made. TEOAE will be measured using ILO88 hardware controlled by an IBM PC.