[Diagnosis of endolymphatic hydrops using low frequency modulated distortion product otoacoustic emissions]. / Diagnostik des endolymphatischen Hydrops mit tieftonmodulierten DPOAE.

BACKGROUND: The low frequency modulation of distortion product otoacoustic emissions (DPOAEs) is an objective audiometric method that appears to be a useful tool for the diagnosis of endolymphatic hydrops (EH), e.g. in patients with Menière's disease, or in those who present only some of the symptoms of the disease. METHOD: Low-frequency modulated DPOAEs were registered in 20 patients with unilateral Menière's disease (13 women and 7 men, aged 40-66 years) and were compared to a control group matched in age and gender. As a diagnostic parameter, the 'modulation index' MI=1/2 MS/DM was used (MS or modulation span, being the difference between the maximal and the minimal DPOAE-amplitude, and DM, being the mean of the suppressed stationary DPOAE-amplitude). RESULTS: In the patients with unilateral Menière's disease, MI was lower than in the control group. This difference was highly significant. In 56% of the patients' contralateral ears MI was lower than the cut off-value and significantly lower than in the control group, but did not differ significantly from the patients' ipsilateral ears. CONCLUSION: The registration of low-frequency modulated DPOAEs is comparable to the generally applied transtympanic electrocochleography in its diagnostic validity. The method is fast and non-invasive and could be applied to monitor the course of the disease.

Phase-dependent suppression of transient evoked and distortion product otoacoustic emissions by a low-frequency tone.

The subjective recording of the masked threshold of short acoustical stimuli with a loud tone of 30 Hz (phase audiogram) has been used for the clinical diagnosis of endolymphatic hydrops (EH). In normally-hearing subjects, a marked modulation of the threshold was found, depending on the phase of the low-frequency tone. A very small dependence was found in patients with Menière's disease, due to the micromechanical changes in the basilar membrane (BM). The same phase relationship becomes apparent in low-frequency suppression of otoacoustic emissions. The amplitudes of TEOAEs are controlled by the phase-dependent displacement of the BM. The suppressed TEOAEs have to be measured separately in each phase relationship. During recording of suppressed DPOAEs, the low-frequency suppressor is permanently superimposed on the pair of primary tones. After time averaging and a moving short-time FFT, the spectral values of the DPOAEs are obtained depending on the phase of the low-frequency tone. Modulation depends also on the masker level, the levels of the primary tones, and on their frequency range. The method of low-frequency suppressed DPOAEs is an objective method to diagnose EH and could be a useful tool in human inner ear research.

Low-frequency modulation of the 2f1-f2 distortion product otoacoustic emissions in the human ear.

Low-frequency masking is a recent clinical procedure for the differential diagnosis of sensory hearing loss. Currently this requires the recording of the phase-dependent masked subjective threshold, which is time consuming and not always accurate. As an objective method, the recording of modulated distortion product otoacoustic emissions (DPOAEs) can be performed continuously, and with better frequency specificity. Results of measurements of the low-frequency modulated two-tone DPOAE 2f1-f2 in the human ear, and its dependence on various acoustic parameters, are presented here for the first time. Similar to the masked hearing threshold, the pattern of the phase-dependent modulated DPOAEs displayed two minima, at the phases of maximal rarefaction and condensation, respectively, with a latency of about 4 ms (suppressor frequency 32.8 Hz). The smaller dip, at maximal condensation, appeared only for a high suppressor level, and for a low level of the primary tone f2. The modulating effect measured for the primary frequencies f1 = 2.5 kHz and f2 = 3 kHz, decreased for 4 and 4.8 kHz, and vanished for 5 and 6 kHz. The results are discussed using a cubic distortion model based on the Boltzmann function for mechano-electrical transduction of the hair cells. The saturation behavior of the increase of the DPOAE level at different phases is compared with the growth rates of the DPOAE level in normal hearing and in sensory hearing loss.

[Frequency specificity of acoustic evoked potentials of early and intermediate latency with high-pass noise masking]. / Untersuchung der Frequenzspezifität akustisch evozierter Potentiale früher und mittlerer Latenz mit Hochpassmaskierung.

In contrast to auditory brainstem potentials (ABR), a more apically defined generation of middle latency evoked potentials (MLR) can be assumed due to the longer integration time present. To date, the effect of stimulus frequency spectra on MLR has not been completely known. By using masking with high-pass filtered white noise in 12 normal-hearing adults, we measured the dependence of amplitude and latency of ABR and MLR on filter frequency. No differences were found between the masking effects for ABR and MLR evoked by tone bursts of 0.5 and 2 kHz. The high-pass masking of click stimuli showed a greater influence on the amplitude and latency of the ABR than on MLR. These different qualities have to be considered clinically when evaluating the methods and results of hearing testing with acoustic evoked potentials. Our findings show that MLR evoked by tone bursts should be used for the frequency selective diagnosis of hearing thresholds, especially in low-frequency ranges.

Low-frequency masking for detection of endolymphatic hydrops in patients with glaucoma.

The coincidence of various eye and ear abnormalities has been described in the literature. Some authors discuss the possible existence of endolymphatic hydrops in patients with glaucoma. Whereas the current diagnostic tests for glaucoma are well-defined and evident, those for endolymphatic hydrops are not so reliable. This has made it difficult to accurately study the coincidence of endolymphatic hydrops and glaucoma. For better detection of endolymphatic hydrops, we performed low-frequency masking tests in 23 patients with primary open-angle glaucoma without signs of Ménìere's disease. The phase dependent sensitivity of the organ of Corti to a short test stimulus can be measured by applying a low-frequency masker tone to determine the modulation depth. Whereas the modulation depth in the normal hearing population is around 20-35 dB, the modulation depth in patients with Ménière's disease may be significantly decreased (5-10 dB), depending on the stage of disease. A decreased modulation depth was found in at least one ear in 19 of our 23 patients with glaucoma. Correlations between homeostatic mechanisms and their histological characteristics, e.g. melanocytes and their hormonal and enzymatic regulation, will be discussed. If the common pathogenesis of eye and ear lesions is better understood, it may be possible to develop new and more effective strategies for prevention and therapy.

Diagnosis of endolymphatic hydrops by low-frequency masking.

Low-frequency masking is a new method for the diagnosis of endolymphatic hydrops. A short acoustic stimulus and a low-frequency masker tone are applied to the same ear in an adjustable phase relationship. We recorded phase-dependent masked thresholds from normal-hearing subjects, and patients with Ménière's disease and sensory hearing loss without vertigo. In normal hearing, there is a mean maximal difference in masking (modulation depth) of 28 dB between the phase delays of 0 degree and 270 degrees. In patients with sensory hearing loss without vertigo, modulation depth is reduced due to recruitment. In Ménière cases, the phase dependence may be totally absent and varies as the disease progresses. Therefore, repeated measurements of masking are required: patients and subjects with normal hearing were tested for a period of 1 year. Also, modulation depth is significantly reduced in the contralateral nonsymptomatic ears of Ménière patients. The results indicate that low-frequency masking is a quick, noninvasive and relevant method for the diagnosis of endolymphatic hydrops.

[Diagnosis of endolymphatic hydrops with low tone masked otoacoustic emissions]. / Diagnostik des endolymphatischen Hydrops mit tieftonmaskierten otoakustischen Emissionen.

BACKGROUND: A new method of diagnosis of endolymphatic hydrops by recording low-tone masked evoked otoacoustic emissions (TEOAE) is presented. METHODS: A short acoustic stimulus and a masker tone of 30 Hz are applied in an adjustable phase relation simultaneously to the same ear. In the normal hearing ear the masker shows little influence on the TEOAE at 0 degrees, whereas the suppression at phase 270 degrees (maximal rarefaction at the eardrum) is nearly complete. However, in cases of endolymphatic hydrops this masking effect is reduced or absent, indicating impaired mobility of the basilar membrane. RESULTS: The masked TEOAE were recorded of patients with normal hearing, Menière's disease, and sudden hearing loss without vertigo. In Menière cases with supposed endolymphatic hydrops, the amplitude modulation of the emissions was found to be much less than in the other groups. CONCLUSIONS: Where TEOAE can be recorded, low-tone masking is a quick, objective, and noninvasive method for the diagnosis of endolymphatic hydrops.

Masking and pitch shift of tone bursts and clicks by low-frequency tones.

From experiments in animals and investigations in humans it is known that the normally phase-dependent masking of a short stimulus by a low-frequency continuous tone does not occur in the case of endolymphatic hydrops. The recording of the masked threshold of short tone stimuli in a loud tone of 30 Hz is to be evaluated for the clinical diagnostics of Ménière's disease. To this purpose, the main parameters of the measurements (type, frequency, duration of the stimulus, and intensity of the masker) and their effect of phase-dependent masking and pitch-shift are investigated. Stimuli above 2 kHz are masked less than those of lower frequencies. Wide-band stimuli are less useful, since only the low-frequency component of their spectrum is masked. The tone stimuli should be short (1 - 2 ms) in order to make the measurement of the phase dependence more accurate. With increasing masker level the masking at phase 0 degree corresponds to the increase in level, at phase 270 degrees the amount is twice as much. The pitch shift which is perceived in low-tone masking depends on the phase of the stimulus, and on the levels of the stimulus and the masking tone. The use of brain stem recordings in the investigation of phase-dependent low tone masking is problematic since well-synchronizing stimuli with high frequency spectral components are masked poorly.

Low-frequency masking of brainstem potentials.

The phase and intensity dependence of masking a click by a loud low-frequency tone was examined with brainstem potentials. Wave V latency is practically unaffected; its amplitude, however, is maximally suppressed at a phase of 270 degrees, i.e. rarefaction in the ear canal and basilar membrane displacement towards the scala tympani. Corresponding to subjective threshold, a minor suppression is also observed for the opposite deflection. In the phase of maximal suppression, wave V can be cancelled by a 30 Hz tone of 115 dB SPL up to click intensities of 40 dB HL. With cochlear damage, total suppression can be achieved at even higher click intensities as long as they are close to the subjective threshold. Low-frequency suppression is discussed as a tool applicable for early diagnosis of endolymphatic hydrops.

[Quantitative results of the brainstem audiometry in middle ear, cochlear, and retrocochlear hearing damage (author's transl)]. / Quantitative Aussagen der Hirnstammaudiometrie bei Mittelohr-, kochleären und retrokochleären Hörschäden.

After a discussion of the technique and validity of the objective audiometry using acoustically evoked brainstem potentials, we demonstrate the shape of potentials at various locations of the scalp. We compare the objective findings for middle and inner ear hearing losses with the subjective audiogram. Disturbances in the middle ear are marked through a letency shift corresponding to the hearing loss with normal bone conducted reaction. When the cochlea is damaged we notice a quick decrease in amplitude from the loudnesscompensation to the threshold with normal latencies. As examples for retro-cochlear damages we give the cases of a child, retarded after encephalitis, of an infant and of a patient with stato-acoustic neurinoma, whereby also the cochlear, subcortical and cortical potentials are evaluated.

[Damages of the auditory pathway at brain stem level investigated by acoustically evoked potentials (author's transl)]. / Untersuchung von Schädigungen der Hörbahn im Bereich des Hirnstammes durch Registrierung früher akustisch evozierter Potentiale

In 57 patients with operated expansive tumors in the postcranial fossa auditory evoked brain stem potentials were investigated. A group of 36 with neurological evidence for the brain stem compression showed significantly prolonged latencies (Fig. 1), whereas the evoked potentials were nearly normal in the preceding state of CSF circulatory disturbances (21 cases). For one patient with a neurinoma of the right trigeminal root the post-operative reduction of the pathological latency shift is demonstrated (Fig. 2). Latency evaluation of evoked brain stem potentials are used in our clinical routine for differential diagnosis of retrocochlear hearing damages.