Aided Cortical Auditory Evoked Potentials in Infants With Frequency-Specific Synthetic Speech Stimuli: Sensitivity, Repeatability, and Feasibility.

OBJECTIVES: The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants. DESIGN: One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate. RESULTS: The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test. CONCLUSIONS: By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group.

Do cochlear microphonics evoked by narrow-band chirp stimuli affect the objective detection of auditory steady-state responses?

OBJECTIVE: It has recently been discussed whether hearing screening and hearing threshold assessment can accurately be completed using automated ASSR methods for children with auditory neuropathy spectrum disorder (ANSD). Possible causes for the claimed potential failures were investigated here. DESIGN: The study is based on the analysis of stored ASSR raw data. STUDY SAMPLE: This study reviewed raw ASSR data from 274 patients with a total of 5809 individual recordings. RESULTS: Cochlear microphonics (CM) were found in 18 of the 274 patient records. Four of these 18 were obtained from patients with ANSD. One patient with ANSD without click auditory brainstem responses up to 100 dBnHL demonstrated clear ASSR responses from 65 dBnHL upwards. Where click stimulation suggests an auditory nerve defect, narrow-band chirps were shown to evoke ASSR in certain patients. CMs are elicited by narrow-band chirps in the same way as by broadband stimuli. CM residuals as well as a presumed enlarged wave I with absent neural responses, always accompanied by CM, were found as possible causes of misinterpretation at high stimulus levels. A CM detector was created. CONCLUSIONS: The CM detector, indicating the presence of CM, will prevent misinterpretation of clinical ASSR results.

Accuracy of averaged auditory brainstem response amplitude and latency estimates.

OBJECTIVE: The aims were to 1) establish which of the four algorithms for estimating residual noise level and signal-to-noise ratio (SNR) in auditory brainstem responses (ABRs) perform better in terms of post-average wave-V peak latency and amplitude errors and 2) determine whether SNR or noise floor is a better stop criterion where the outcome measure is peak latency or amplitude. DESIGN: The performance of the algorithms was evaluated by numerical simulations using an ABR template combined with electroencephalographic (EEG) recordings obtained without sound stimulus. The suitability of a fixed SNR versus a fixed noise floor stop criterion was assessed when variations in the wave-V waveform shape reflecting inter-subject variation was introduced. STUDY SAMPLE: Over 100 hours of raw EEG noise was recorded from 17 adult subjects, under different conditions (e.g. sleep or movement). RESULTS: ABR feature accuracy was similar for the four algorithms. However, it was shown that a fixed noise floor leads to higher ABR wave-V amplitude accuracy; conversely, a fixed SNR yields higher wave-V latency accuracy. CONCLUSION: Similar performance suggests the use of the less computationally complex algorithms. Different stop criteria are recommended if the ABR peak latency or the amplitude is the outcome measure of interest.

Human cochlear tuning estimates from stimulus-frequency otoacoustic emissions.

Two objective measures of human cochlear tuning, using stimulus-frequency otoacoustic emissions (SFOAE), have been proposed. One measure used SFOAE phase-gradient delay and the other two-tone suppression (2TS) tuning curves. Here, it is hypothesized that the two measures lead to different frequency functions in the same listener. Two experiments were conducted in ten young adult normal-hearing listeners in three frequency bands (1-2 kHz, 3-4 kHz and 5-6 kHz). Experiment 1 recorded SFOAE latency as a function of stimulus frequency, and experiment 2 recorded 2TS iso-input tuning curves. In both cases, the output was converted into a sharpness-of-tuning factor based on the equivalent rectangular bandwidth. In both experiments, sharpness-of-tuning curves were shown to be frequency dependent, yielding sharper relative tuning with increasing frequency. Only a weak frequency dependence of the sharpness-of-tuning curves was observed for experiment 2, consistent with objective and behavioural estimates from the literature. Most importantly, the absolute difference between the two tuning estimates was very large and statistically significant. It is argued that the 2TS estimates of cochlear tuning likely represents the underlying properties of the suppression mechanism, and not necessarily cochlear tuning. Thus the phase-gradient delay estimate is the most likely one to reflect cochlear tuning.

Temporal suppression of the click-evoked otoacoustic emission level-curve.

The click-evoked otoacoustic emission (CEOAE) level-curve grows linearly for clicks below 40-60 dB and saturates for higher inputs. This study investigates dynamic (i.e., time-dependent) features of the CEOAE level-curve by presenting a suppressor-click less than 8 ms before the test-click. An alteration of the CEOAE level-curve, designated here as temporal suppression, was observed within this time period, and was shown to depend on the levels and the temporal separation of the two clicks. Temporal suppression occurred for all four subjects tested, and resulted in a vertical offset from the unsuppressed level-curve for test-click levels greater than 50 dB peak-equivalent level (peSPL). Temporal suppression was greatest for suppressors presented 1-4 ms before the test click, and the magnitude and time scale of the effect were subject dependent. Temporal suppression was furthermore observed for the short- (i.e., 6-18 ms) and long-latency (i.e., 24-36 ms) regions of the CEOAE, indicating that temporal suppression similarly affects synchronized spontaneous otoacoustic emissions (SSOAEs) and purely evoked CEOAE components. Overall, this study demonstrates that temporal suppression of the CEOAE level-curve reflects a dynamic process in human cochlear processing that works on a time scale of 0-10 ms.

Comparison of cochlear delay estimates using otoacoustic emissions and auditory brainstem responses.

Different attempts have been made to directly measure frequency specific basilar membrane (BM) delays in animals, e.g., laser velocimetry of BM vibrations and auditory nerve fiber recordings. The present study uses otoacoustic emissions (OAEs) and auditory brainstem responses (ABRs) to estimate BM delay non-invasively in normal-hearing humans. Tone bursts at nine frequencies from 0.5 to 8 kHz served as stimuli, with care taken to quantify possible bias due to the use of tone bursts with different rise times. BM delays are estimated from the ABR latency estimates by subtracting the neural and synaptic delays. This allows a comparison between individual OAE and BM delays over a large frequency range in the same subjects, and offers support to the theory that OAEs are reflected from a tonotopic place and carried back to the cochlear base via a reverse traveling wave.

A Set of Time-and-Frequency-Localized Short-Duration Speech-Like Stimuli for Assessing Hearing-Aid Performance via Cortical Auditory-Evoked Potentials.

Short-duration speech-like stimuli, for example, excised from running speech, can be used in the clinical setting to assess the integrity of the human auditory pathway at the level of the cortex. Modeling of the cochlear response to these stimuli demonstrated an imprecision in the location of the spectrotemporal energy, giving rise to uncertainty as to what and when of a stimulus caused any evoked electrophysiological response. This article reports the development and assessment of four short-duration, limited-bandwidth stimuli centered at low, mid, mid-high, and high frequencies, suitable for free-field delivery and, in addition, reproduction via hearing aids. The durations were determined by the British Society of Audiology recommended procedure for measuring Cortical Auditory-Evoked Potentials. The levels and bandwidths were chosen via a computational model to produce uniform cochlear excitation over a width exceeding that likely in a worst-case hearing-impaired listener. These parameters produce robustness against errors in insertion gains, and variation in frequency responses, due to transducer imperfections, room modes, and age-related variation in meatal resonances. The parameter choice predicts large spectral separation between adjacent stimuli on the cochlea. Analysis of the signals processed by examples of recent digital hearing aids mostly show similar levels of gain applied to each stimulus, independent of whether the stimulus was presented in isolation, bursts, continuous, or embedded in continuous speech. These stimuli seem to be suitable for measuring hearing-aided Cortical Auditory-Evoked Potentials and have the potential to be of benefit in the clinical setting.

Investigating the Effect of Cochlear Synaptopathy on Envelope Following Responses Using a Model of the Auditory Nerve.

The healthy auditory system enables communication in challenging situations with high levels of background noise. Yet, despite normal sensitivity to pure tones, many listeners complain about having difficulties in such situations. Recent animal studies demonstrated that noise overexposure that produces temporary threshold shifts can cause the loss of auditory nerve (AN) fiber synapses (i.e., cochlear synaptopathy, CS), which appears to predominantly affect medium- and low-spontaneous rate (SR) fibers. In the present study, envelope following response (EFR) magnitude-level functions were recorded in normal hearing (NH) threshold and mildly hearing-impaired (HI) listeners with thresholds elevated above 2 kHz. EFRs were elicited by sinusoidally amplitude modulated (SAM) tones presented in quiet with a carrier frequency of 2 kHz, modulated at 93 Hz, and modulation depths of 0.85 (deep) and 0.25 (shallow). While EFR magnitude-level functions for deeply modulated tones were similar for all listeners, EFR magnitudes for shallowly modulated tones were reduced at medium stimulation levels in some NH threshold listeners and saturated in all HI listeners for the whole level range. A phenomenological model of the AN was used to investigate the extent to which hair-cell dysfunction and/or CS could explain the trends observed in the EFR data. Hair-cell dysfunction alone, including postulated elevated hearing thresholds at extended high frequencies (EHF) beyond 8 kHz, could not account for the recorded EFR data. Postulated CS led to simulations generally consistent with the recorded data, but a loss of all types of AN fibers was required within the model framework. The effects of off-frequency contributions (i.e., away from the characteristic place of the stimulus) and the differential loss of different AN fiber types on EFR magnitude-level functions were analyzed. When using SAM tones in quiet as the stimulus, model simulations suggested that (1) EFRs are dominated by the activity of high-SR fibers at all stimulus intensities, and (2) EFRs at medium-to-high stimulus levels are dominated by off-frequency contributions.

Temporal suppression and augmentation of click-evoked otoacoustic emissions.

This study investigates temporal suppression of click-evoked otoacoustic emissions (CEOAEs), occurring when a suppressor-click is presented close in time to a test-click (e.g. 0-8ms). Various temporal suppression methods for examining temporal changes in cochlear compression were evaluated and measured here for seven subjects, both for short- and long-latency CEOAEs. Long-latency CEOAEs (duration >20ms) typically indicate the presence of synchronised spontaneous otoacoustic emissions (SSOAEs). Temporal suppression can only be linked to changes in CEOAE-compression if the suppressor-click affects the CEOAE magnitude. Phase changes induced by the suppressor-click were shown to bias suppression in two ways: (i) when a specific asymmetric measurement method was used and (ii) when synchronisation between the CEOAE and the click-stimuli was incomplete. When such biases were eliminated, temporal suppression and augmentation (the opposite effect) were observed and shown to be subject-dependent. This indicates that the nonlinearity underlying temporal suppression can work in a more (i.e., suppressed) or less (i.e., augmented) compressive state, depending on the inter-click interval and the subject under test. Temporal suppression was shown to be comparable for CEOAEs and SSOAEs, indicating similar underlying cochlear nonlinear mechanisms. This study contributes to a better understanding of the temporal properties of cochlear dynamics.

On the Cost of Introducing Speech-Like Properties to a Stimulus for Auditory Steady-State Response Measurements.

Validating hearing-aid fittings in prelingual infants is challenging because typical measures (aided audiometry, etc.) are impossible with infants. One objective alternative uses an aided auditory steady-state response (ASSR) measurement. To make an appropriate measurement, the hearing aid's signal-processing features must be activated (or deactivated) as if the ASSR stimulus was real speech. Rather than manipulating the hearing-aid settings to achieve this, an ASSR stimulus with speech-like properties was developed. This promotes clinical simplicity and face validity of the validation. The stimulus consists of narrow-band CE-Chirps®, modified to mimic the International Speech Test Signal (ISTS). This study examines the cost of introducing the speech-like features into the ASSR stimulus. Thus, 90 to 100 Hz ASSRs were recorded to the ISTS-modified stimulus as well as an equivalent stimulus without the ISTS modification, presented through insert phones to 10 young normal-hearing subjects. Noise-corrected ASSR magnitudes and clinically relevant detection times were estimated and analyzed with mixed-model analyses of variance. As a supplement, the observed changes to the ASSR magnitudes were compared with an objective characterization of the stimuli based on modulation power. The main findings were a reduction in ASSR magnitude of 4 dB and an increase in detection time by a factor of 1.5 for the ISTS-modified stimulus compared with the standard. Detection rates were unaffected given sufficient recording time. For clinical use of the hearing-aid validation procedure, the key metric is the detection time. While this varied considerably across subjects, the observed 50% mean increase corresponds to less than 1 min of additional recording time.

A mechanoelectrical mechanism for detection of sound envelopes in the hearing organ.

To understand speech, the slowly varying outline, or envelope, of the acoustic stimulus is used to distinguish words. A small amount of information about the envelope is sufficient for speech recognition, but the mechanism used by the auditory system to extract the envelope is not known. Several different theories have been proposed, including envelope detection by auditory nerve dendrites as well as various mechanisms involving the sensory hair cells. We used recordings from human and animal inner ears to show that the dominant mechanism for envelope detection is distortion introduced by mechanoelectrical transduction channels. This electrical distortion, which is not apparent in the sound-evoked vibrations of the basilar membrane, tracks the envelope, excites the auditory nerve, and transmits information about the shape of the envelope to the brain.

Chest wall motion analysis in healthy volunteers and adults with cystic fibrosis using a novel Kinect-based motion tracking system.

Respiratory disease is the leading cause of death in the UK. Methods for assessing pulmonary function and chest wall movement are essential for accurate diagnosis, as well as monitoring response to treatment, operative procedures and rehabilitation. Despite this, there is a lack of low-cost devices for rapid assessment. Spirometry is used to measure air flow expired, but cannot infer or directly measure full chest wall motion. This paper presents the development of a low-cost chest wall motion assessment system. The prototype was developed using four Microsoft Kinect sensors to create a 3D time-varying representation of a patient's torso. An evaluation of the system in two phases is also presented. Initially, static volume of a resuscitation mannequin with that of a Nikon laser scanner is performed. This showed the system has slight underprediction of 0.441 %. Next, a dynamic analysis through the comparison of results from the prototype and a spirometer in nine cystic fibrosis patients and thirteen healthy subjects was performed. This showed an agreement with correlation coefficients above 0.8656 in all participants. The system shows promise as a method for assessing respiratory disease in a cost-effective and timely manner. Further work must now be performed to develop the prototype and provide further evaluations.

Dynamic nonlinear cochlear model predictions of click-evoked otoacoustic emission suppression.

A comprehensive set of results from 2-click suppression experiments on otoacoustic emissions (OAEs) have been presented by Kapadia and Lutman [Kapadia, S., Lutman, M.E., 2000a. Nonlinear temporal interactions in click-evoked otoacoustic emissions. I. Assumed model and polarity-symmetry. Hear. Res. 146, 89-100]. They found that the degree of suppression of an OAE evoked by a test click varied systematically with the timing and the level of a suppressor click, being greatest for suppressor clicks occurring some time before the test click, particularly at lower levels of suppression. Kapadia and Lutman also showed that although the general shape of the graph of suppression against suppressor click timing could be predicted by a static power law model, this did not predict the asymmetry with respect to the timing of the suppressor click. A generalised automatic gain control (AGC) is presented as a simple example of a dynamic nonlinear system. Its steady state nonlinear behaviour, as quantified by its level curve, and its dynamic behaviour, as quantified by its transient response, can be independently set by the feedback gain law and detector time constant, respectively. The previously reported suppression results, with the asymmetry in the timing, are found to be predicted better by such an AGC having a level curve with a slope of about 0.5 dB/dB, and a detector time constant of about twice the period at the characteristic frequency. Although this gives adequate predictions for high suppression levels, it under predicts the suppression and the asymmetry for lower levels. Further research is required to establish whether simple peripheral feedback models can explain OAE suppression of this type.

Can a Static Nonlinearity Account for the Dynamics of Otoacoustic Emission Suppression?

This study investigates whether time-dependent compression mechanisms in the cochlea are necessary to explain dynamic properties of otoacoustic emissions (OAEs). Dynamic properties of click-evoked OAEs (CEOAEs) have been observed in temporal suppression; the effect where the CEOAE magnitude is reduced when a click is presented less than 10 ms before the test click. A time-domain model of the cochlea that represented the basilar membrane (BM) as a cascade of coupled bandpass filters was used to investigate the cochlear origin of temporal suppression in CEOAEs. The model, implemented with a time-invariant nonlinearity, was able to simulate temporal suppression, but was unable to account for the exact time scale and magnitude of the effect. The results suggest that temporal overlap of BM impulse responses can account for suppression in CEOAEs, but that an additional time-dependent cochlear gain mechanism may be needed to account the high suppression maxima at inter-click intervals larger than zero.

Temporal suppression of long-latency click-evoked otoacoustic emissions.

A comprehensive set of results from double click suppression experiments on otoacoustic emissions (OAEs) have been presented by Hine and Thornton [1] and Kapadia and Lutman [2]. They found that suppression of a click-evoked otoacoustic emission (CEOAE) varied with the timing and level of a suppressor-click presented close in time to the test-click. Maximal suppression was found when the suppressor-click led the test-click by 2-4 ms. The double click suppression experiment set out by Hine and Thornton was repeated here and the analysis extended to the 'long-latency' CEOAE (duration > 20 ms) whereas previous studies only focused on the 'short-latency' CEOAE (duration < 20 ms). The hypothesis was that suppression would continue over the long-latency CEOAE since this region is probably dominated by spontaneous OAEs (SOAEs) synchronising with the click stimulus. The results for two exemplary subjects showed that the nonlinear suppression effect remained on the long-latency CEOAE, indicating that both SOAEs and CEOAEs originate from the same cochlear nonlinearities, as earlier suggested by Kemp and Chum [3]. The apparent similar origin of both types of emissions implies that the same temporal effects influence their responses.

Using the short-time correlation coefficient to compare transient- and derived, noise-evoked otoacoustic emission temporal waveforms.

Transient-evoked otoacoustic emissions (TEOAEs) and derived, noise-evoked otoacoustic emissions (derived-NEOAEs) were measured in seven normally hearing subjects. The evoked OAEs were all recorded at three excitation levels chosen to ensure that the OAE level curve compressive region was reached. The short-time correlation coefficient (STCC) was used to compare the OAE waveforms at different excitation levels, and thus estimate the time over which the response exceeds the noise level. The short-time correlation for TEOAEs is significant for longer than it is for NEOAEs, particularly in some individuals, and the STCC allows this to be quantified. This suggests that derived NEOAEs do not display the highly synchronized dominant frequencies often seen in TEOAEs. This has been confirmed by examining the derived frequency responses for the two types of excitation. Conventional TEOAEs thus appear to measure a combination of two conceptually different processes, while NEOAEs measure just one.

A comparison of various nonlinear models of cochlear compression.

The vibration response of the basilar membrane in the cochlea to sinusoidal excitation displays a compressive nonlinearity, conventionally described using an input-output level curve. This displays a slope of 1 dB/dB at low levels and a slope m < 1 dB/dB at higher levels. Two classes of nonlinear systems have been considered as models of this response, one class with static power-law nonlinearity and one class with level-dependent properties (using either an automatic gain control or a Van der Pol oscillator). By carefully choosing their parameters, it is shown that all models can produce level curves that are similar to those measured on the basilar membrane. The models differ, however, in their distortion properties, transient responses, and instantaneous input-output characteristics. The static nonlinearities have a single-valued instantaneous characteristic that is the same at all input levels. The level-dependent systems are multi-valued with an almost linear characteristic, for a given amplitude of excitation, whose slope varies with the excitation level. This observation suggests that historical attempts to use functional modeling (i.e., Wiener of Volterra series) may be ill founded, as these methods are unable to represent level-dependent nonlinear systems with multi-valued characteristics of this kind.