A Clinically Viable Medial Olivocochlear Reflex Assay Using Transient-Evoked Otoacoustic Emissions.

OBJECTIVES: The contralateral medial olivocochlear reflex (MOCR) strength may indicate various auditory conditions in humans, but a clinically viable assay and equipment are needed for quick, accurate, and reliable measurements. The first experiment compared an earlier version of the assay, which used a nonlinear-mode chirp stimulus, with a new assay using a linear-mode click stimulus, designed to give reliable MOCR measurements in most normal-hearing ears. The second experiment extended the improved assay on a purpose-built binaural hardware platform that used forward-pressure level (FPL) calibration for both the stimulus and the contralateral MOCR elicitor. DESIGN: Transient-evoked otoacoustic emission (TEOAE) tests were measured with and without a 60-dB SPL MOCR-evoking contralateral broadband noise. The normalized MOCR strength (MOCR%) was derived from the TEOAE responses for each trial pair using the complex pressure difference weighted by the TEOAE magnitude. Experiment 1 compared MOCR% within-subject and across-day using two TEOAE stimuli: nonlinear-mode chirps (50 dB SPL, bandpass 1-5 kHz, 14 ms window delayed by 2 ms) and linear-mode clicks (50 dB SPL, bandpass 0.5-2.5 kHz, 13 ms window delayed by 5 ms). TEOAE responses were analyzed in the 0.5 to 2.5 kHz band. Thirty adult participants with normal hearing (30 ears) completed the study. The TEOAE stimulus was calibrated in situ using spectral flattening, and the contralateral noise was calibrated in a coupler. Twelve TEOAE trial pairs were collected for each participant and condition. Experiment 2 used a purpose-built binaural system. The TEOAE stimuli were linear-mode clicks (50 dB SPL, bandpass 1-3 kHz, 13 ms window delayed by 5 ms), analyzed in the 1 to 3 kHz band over ~12 trial pairs. After a probe refit, an additional trial pair was collected for the two early-stopping signal-to-noise ratio criteria (15 and 20 dB). They were evaluated for single-trial reliability and test time. Nineteen adult participants with normal hearing (38 ears) completed the study. The TEOAE clicks and contralateral elicitor noise were calibrated in situ using FPL and delivered with automated timing. RESULTS: MOCR% for linear-mode clicks was distinguishable from measurement variability in 98% to 100% of participants' ears (both experiments), compared with only 73% for the nonlinear-mode chirp (experiment 1). MOCR detectability was assessed using the MOCR% across-subject/within-subject variance ratio. The ratio in experiment 1 for linear-mode clicks was higher (8.0) than for nonlinear-mode chirps (6.4). The ratio for linear-mode clicks (8.9) in experiment 2 was slightly higher than for the comparable linear-mode stimulus (8.0) in experiment 1. TEOAEs showed excellent reliability with high signal-to-noise ratios in both experiments, but reliability was higher for linear-mode clicks than nonlinear-mode chirps. MOCR reliability for the two stimuli was comparable. The FPL pressure response retest reliability derived from the SPL at the microphone was higher than the SPL retest reliability across 0.4 to 8 kHz. Stable results required 2 to 3 trial pairs for the linear-mode click (experiments 1 and 2) and three for the nonlinear-mode chirp (experiment 1), taking around 2 min on average. CONCLUSIONS: The linear-mode click assay produced measurable, reliable, and stable TEOAE and MOCR results on both hardware platforms in around 2 min per ear. The stimulus design and response window ensured that any stimulus artifact in linear mode was unlikely to confound the results. The refined assay is ready to produce high-quality data quickly for clinical and field studies to develop population norms, recognize diagnostic patterns, and determine risk profiles.

Masking release for hearing-impaired listeners: The effect of increased audibility through reduction of amplitude variability.

The masking release (i.e., better speech recognition in fluctuating compared to continuous noise backgrounds) observed for normal-hearing (NH) listeners is generally reduced or absent in hearing-impaired (HI) listeners. One explanation for this lies in the effects of reduced audibility: elevated thresholds may prevent HI listeners from taking advantage of signals available to NH listeners during the dips of temporally fluctuating noise where the interference is relatively weak. This hypothesis was addressed through the development of a signal-processing technique designed to increase the audibility of speech during dips in interrupted noise. This technique acts to (i) compare short-term and long-term estimates of energy, (ii) increase the level of short-term segments whose energy is below the average energy, and (iii) normalize the overall energy of the processed signal to be equivalent to that of the original long-term estimate. Evaluations of this energy-equalizing (EEQ) technique included consonant identification and sentence reception in backgrounds of continuous and regularly interrupted noise. For HI listeners, performance was generally similar for processed and unprocessed signals in continuous noise; however, superior performance for EEQ processing was observed in certain regularly interrupted noise backgrounds.

Auditory and tactile gap discrimination by observers with normal and impaired hearing.

Temporal processing ability for the senses of hearing and touch was examined through the measurement of gap-duration discrimination thresholds (GDDTs) employing the same low-frequency sinusoidal stimuli in both modalities. GDDTs were measured in three groups of observers (normal-hearing, hearing-impaired, and normal-hearing with simulated hearing loss) covering an age range of 21-69 yr. GDDTs for a baseline gap of 6 ms were measured for four different combinations of 100-ms leading and trailing markers (250-250, 250-400, 400-250, and 400-400 Hz). Auditory measurements were obtained for monaural presentation over headphones and tactile measurements were obtained using sinusoidal vibrations presented to the left middle finger. The auditory GDDTs of the hearing-impaired listeners, which were larger than those of the normal-hearing observers, were well-reproduced in the listeners with simulated loss. The magnitude of the GDDT was generally independent of modality and showed effects of age in both modalities. The use of different-frequency compared to same-frequency markers led to a greater deterioration in auditory GDDTs compared to tactile GDDTs and may reflect differences in bandwidth properties between the two sensory systems.

Auditory-filter characteristics for listeners with real and simulated hearing impairment.

Functional simulation of sensorineural hearing impairment is an important research tool that can elucidate the nature of hearing impairments and suggest or eliminate compensatory signal-processing schemes. The objective of the current study was to evaluate the capability of an audibility-based functional simulation of hearing loss to reproduce the auditory-filter characteristics of listeners with sensorineural hearing loss. The hearing-loss simulation used either threshold-elevating noise alone or a combination of threshold-elevating noise and multiband expansion to reproduce the audibility-based characteristics of the loss (including detection thresholds, dynamic range, and loudness recruitment). The hearing losses of 10 listeners with bilateral, mild-to-severe hearing loss were simulated in 10 corresponding groups of 3 age-matched normal-hearing listeners. Frequency selectivity was measured using a notched-noise masking paradigm at five probe frequencies in the range of 250 to 4000 Hz with a fixed probe level of either 70 dB SPL or 8 dB SL (whichever was greater) and probe duration of 200 ms. The hearing-loss simulation reproduced the absolute thresholds of individual hearing-impaired listeners with an average root-mean-squared (RMS) difference of 2.2 dB and the notched-noise masked thresholds with an RMS difference of 5.6 dB. A rounded-exponential model of the notched-noise data was used to estimate equivalent rectangular bandwidths and slopes of the auditory filters. For some subjects and probe frequencies, the simulations were accurate in reproducing the auditory-filter characteristics of the hearing-impaired listeners. In other cases, however, the simulations underestimated the magnitude of the auditory bandwidths for the hearing-impaired listeners, which suggests the possibility of suprathreshold deficits.

Temporal masking functions for listeners with real and simulated hearing loss.

A functional simulation of hearing loss was evaluated in its ability to reproduce the temporal masking functions for eight listeners with mild to severe sensorineural hearing loss. Each audiometric loss was simulated in a group of age-matched normal-hearing listeners through a combination of spectrally-shaped masking noise and multi-band expansion. Temporal-masking functions were obtained in both groups of listeners using a forward-masking paradigm in which the level of a 110-ms masker required to just mask a 10-ms fixed-level probe (5-10 dB SL) was measured as a function of the time delay between the masker offset and probe onset. At each of four probe frequencies (500, 1000, 2000, and 4000 Hz), temporal-masking functions were obtained using maskers that were 0.55, 1.0, and 1.15 times the probe frequency. The slopes and y-intercepts of the masking functions were not significantly different for listeners with real and simulated hearing loss. The y-intercepts were positively correlated with level of hearing loss while the slopes were negatively correlated. The ratio of the slopes obtained with the low-frequency maskers relative to the on-frequency maskers was similar for both groups of listeners and indicated a smaller compressive effect than that observed in normal-hearing listeners.

Temporal modulation transfer functions for listeners with real and simulated hearing loss.

A functional simulation of hearing loss was evaluated in its ability to reproduce the temporal modulation transfer functions (TMTFs) for nine listeners with mild to profound sensorineural hearing loss. Each hearing loss was simulated in a group of three age-matched normal-hearing listeners through spectrally shaped masking noise or a combination of masking noise and multiband expansion. TMTFs were measured for both groups of listeners using a broadband noise carrier as a function of modulation rate in the range 2 to 1024 Hz. The TMTFs were fit with a lowpass filter function that provided estimates of overall modulation-depth sensitivity and modulation cutoff frequency. Although the simulations were capable of accurately reproducing the threshold elevations of the hearing-impaired listeners, they were not successful in reproducing the TMTFs. On average, the simulations resulted in lower sensitivity and higher cutoff frequency than were observed in the TMTFs of the hearing-impaired listeners. Discrepancies in performance between listeners with real and simulated hearing loss are possibly related to inaccuracies in the simulation of recruitment.

Speech reception by listeners with real and simulated hearing impairment: effects of continuous and interrupted noise.

The effects of audibility and age on masking for sentences in continuous and interrupted noise were examined in listeners with real and simulated hearing loss. The absolute thresholds of each of ten listeners with sensorineural hearing loss were simulated in normal-hearing listeners through a combination of spectrally-shaped threshold noise and multi-band expansion for octave bands with center frequencies from 0.25-8 kHz. Each individual hearing loss was simulated in two groups of three normal-hearing listeners (an age-matched and a non-age-matched group). The speech-to-noise ratio (S/N) for 50%-correct identification of hearing in noise test (HINT) sentences was measured in backgrounds of continuous and temporally-modulated (10 Hz square-wave) noise at two overall levels for unprocessed speech and for speech that was amplified with the NAL-RP prescription. The S/N in both continuous and interrupted noise of the hearing-impaired listeners was relatively well-simulated in both groups of normal-hearing listeners. Thus, release from masking (the difference in S/N obtained in continuous versus interrupted noise) appears to be determined primarily by audibility. Minimal age effects were observed in this small sample. Observed values of masking release were compared to predictions derived from intelligibility curves generated using the extended speech intelligibility index (ESII) [Rhebergen et al. (2006). J. Acoust. Soc. Am. 120, 3988-3997].