Analysis of probe fitting stimulus properties on transient evoked otoacoustic emissions.

Objective: The objectives of the current study are first, to evaluate the subjective evaluation of probe fitting stimulus properties, and second, to analyse the effects of different probe fittings on transient evoked otoacoustic emission (TEOAE) response and noise amplitudes in subjects.Design: The Q methodology was used to sort 48 probe fittings differing in stimulus properties in seven categories from totally unacceptable to certainly acceptable. Further, TEOAE response and noise amplitudes were measured in one baseline condition with optimal probe fitting and eight experimental conditions with less than optimal probe fittings.Study sample: The probe fittings were ranked by 18 participants, while the repeated measures design was performed in 34 ear.Results: First, it was found that only 19.61% of all distributions of the probe fittings by the participants had a mutual correlation of at least 70.00%. Almost 60% of the variance of distributions was explained by 83.33% of the participants, although most probe fittings significantly differed from other fittings based on spectral broadness. Second, significant differences in TEOAE response and especially noise amplitudes between conditions were found. Further, TEOAE response and noise amplitudes between the baseline and experimental conditions were significantly different depending on ringing and spectral flatness of the stimulus.Conclusion: A substantial amount of subjectivity during TEOAE measurements is involved with regard to the evaluation of probe fitting stimulus properties. TEOAE response but especially noise amplitudes are influenced by varying stimulus parameters which stresses the importance of inspecting these parameters prior to or during EOAE measurements. Although more research is needed, some guidelines regarding these parameters are given which could improve the accuracy of TEOAEs in practice.

Neonate auditory brainstem response repeatability with controlled force gauge bone-conducted stimulus delivery.

OBJECTIVE: The feasibility and repeatability of neonate auditory brainstem responses (ABRs) with a controlled hand-held applied force gauge for bone-conducted stimulus delivery was examined. DESIGN: A repeated measures test-retest design was employed. STUDY SAMPLE: Participants were 27 healthy neonates. A 4000 Hz bone-conducted CE-Chirp octave band stimulus evoked the ABRs. Intra- and intertester conditions were employed with a prototype hand-held applied force gauge (Etymotic Research) attached to the superior aspect of the bone vibrator. The bone vibrator was placed in a superoposterior auricular position and held manually. The force gauge displayed a desired coupling force via an LED light indicator. RESULTS: Three sets of replicated ABRs were recorded from all neonates: initial test and retest with one tester (i.e. intratester 1 and 2) and final test with a second tester (i.e. intertester). No significant differences in intra- or intertester ABR wave V latencies or amplitudes were found (p > 0.05). Coefficients of reliability (Cronbach's α) were .95 and .43 for wave V latencies and amplitudes, respectively. CONCLUSIONS: A hand-held applied force gauge may be a reliable means of delivering controlled bone-conducted stimuli in ABR assessments in neonates and infants.

Headphone screening to facilitate web-based auditory experiments.

Psychophysical experiments conducted remotely over the internet permit data collection from large numbers of participants but sacrifice control over sound presentation and therefore are not widely employed in hearing research. To help standardize online sound presentation, we introduce a brief psychophysical test for determining whether online experiment participants are wearing headphones. Listeners judge which of three pure tones is quietest, with one of the tones presented 180° out of phase across the stereo channels. This task is intended to be easy over headphones but difficult over loudspeakers due to phase-cancellation. We validated the test in the lab by testing listeners known to be wearing headphones or listening over loudspeakers. The screening test was effective and efficient, discriminating between the two modes of listening with a small number of trials. When run online, a bimodal distribution of scores was obtained, suggesting that some participants performed the task over loudspeakers despite instructions to use headphones. The ability to detect and screen out these participants mitigates concerns over sound quality for online experiments, a first step toward opening auditory perceptual research to the possibilities afforded by crowdsourcing.

Exploring binaural hearing in gerbils (Meriones unguiculatus) using virtual headphones.

The Mongolian gerbil (Meriones unguiculatus) has become a key species in investigations of the neural processing of sound localization cues in mammals. While its sound localization has been tested extensively under free-field stimulation, many neurophysiological studies use headphones to present signals with binaural localization cues. The gerbil's behavioral sensitivity to binaural cues, however, is unknown for the lack of appropriate stimulation paradigms in awake behaving gerbils. We close this gap in knowledge by mimicking a headphone stimulation; we use free-field loudspeakers and apply cross-talk cancellation techniques to present pure tones with binaural cues via "virtual headphones" to gerbils trained in a sound localization task. All gerbils were able to lateralize sounds depending on the interaural time or level difference (ITD and ILD, respectively). For ITD stimuli, reliable responses were seen for frequencies ≤2.9 kHz, the highest frequency tested with ITD stimuli. ITD sensitivity was frequency-dependent with the highest sensitivity observed at 1 kHz. For stimuli with ITD outside the gerbil's physiological range, responses were cyclic indicating the use of phase information when lateralizing narrow-band sounds. For ILD stimuli, reliable responses were obtained for frequencies ≥2 kHz. The comparison of ITD and ILD thresholds with ITD and ILD thresholds derived from gerbils' free-field performance suggests that ongoing ITD information is the main cue for sound localization at frequencies <2 kHz. At 2 kHz, ITD and ILD cues are likely used in a complementary way. Verification of the use of the virtual headphones suggests that they can serve as a suitable substitute for conventional headphones particularly at frequencies ≤2 kHz.

Extended bandwidth real-ear measurement accuracy and repeatability to 10 kHz.

OBJECTIVE: Direct real-ear measurement to the 4-6 kHz range can be measured with suitable accuracy and repeatability. This study evaluates extended bandwidth measurement accuracy and repeatability using narrowband and wideband signal analysis. DESIGN: White noise was measured in female ear canals at four insertion depths using one-third and one-twenty-fourth octave band averaging. STUDY SAMPLE: Fourteen female adults with reported normal hearing and middle-ear function participated in the study. RESULTS: Test-retest differences were within ±2 dB for typical frequency bandwidths at insertion depths administered in clinical practice, and for up to 8 kHz at the experimental 30 mm insertion depth. The 28 mm insertion depth was the best predictor of ear canal levels measured at the 30 mm insertion depth. There was no effect of signal analysis bandwidth on accuracy or repeatability. CONCLUSIONS: Clinically feasible 28 mm probe tube insertions reliably measured up to 8 kHz and predicted intensities up to 10 kHz measured at the 30 mm insertion depth more accurately than did shallower insertion depths. Signal analysis bandwidth may not be an important clinical issue at least for one-third and one-twenty-fourth octave band analyses.

Is it necessary to occlude the ear in bone-conduction testing at 4 kHz, in order to prevent air-borne radiation affecting the results?

OBJECTIVE: To re-evaluate the current BSA recommendation that the test ear should be occluded during the bone-conduction procedure at frequencies above 2 kHz to prevent audible air-borne radiation. DESIGN: Pure-tone audiometry was undertaken during routine hearing tests. The audiograms of fifty-two ears met the criteria for the study and were included. Bone conduction at 4 kHz was tested in three different conditions: test ear open/occluded by earplug and occluded by circumaural earphone. STUDY SAMPLE: Forty-four adults aged 41-77 years with average hearing levels from normal to severe loss. All complied fully with the test procedure. No audiogram had a significant conductive element. RESULTS: There was no significant difference in each of the three test situations. Only two audiograms showed any (5 dB) difference at 4 kHz when bone conduction was retested with the ear occluded. CONCLUSIONS: The errors that result in a false air-bone gap at 4 kHz would not appear to be due to air-borne radiation. Failure to occlude the ear canal at 4 kHz, where air-borne radiation is greatest, makes no significant difference to the audiometric results. It is therefore suggested that it is unnecessary to block the test ear during routine pure-tone bone-conduction testing to prevent audible air-borne radiation, and that this should no longer form part of normal clinical practice.

Bone conduction hearing sensitivity in normal-hearing subjects: transcutaneous stimulation at BAHA vs BCI position.

OBJECTIVE: Bone conduction (BC) stimulation closer to the cochlea has previously been shown to give higher cochlear promontory acceleration measured by laser Doppler vibrometry (LDV). This study is investigating whether stimulation closer to the cochlea also gives improved hearing sensitivity. Furthermore, the study compares shifts in hearing sensitivity (BC thresholds) and ear-canal sound pressure (ECSP). DESIGN: BC hearing thresholds and ECSP have been measured for stimulation at two positions: the existing bone-anchored hearing aid (BAHA) position, and a new bone conduction implant (BCI) position that is located closer to the cochlea. STUDY SAMPLE: The measurements were made on 20 normal-hearing subjects. RESULTS: Depending on frequency, the ipsilateral hearing threshold was 3-14 dB better, and the ipsilateral ECSP was 2-12 dB higher for the BCI than for the BAHA position, with no significant differences between threshold and ECSP shifts at group level for most frequencies, and individually only for some subjects. CONCLUSIONS: It was found that both the objective ECSP and the subjective hearing threshold measurements gave similar improvement as previous LDV measurements for stimulation closer to the cochlea. One exception was that the LDV measurements did not show the improved sensitivity for frequencies below 500 Hz found here.

ABR in newborns: effects of electrode configuration, stimulus rate, and EEG rejection levels on test efficiency.

OBJECTIVE: This study investigated the effect of electrode configuration, stimulus rate, and EEG rejection level on the efficiency of ABR testing in babies. DESIGN: ABR to click stimuli at 40 dB nHL were simultaneously recorded from two electrode configurations, ipsilateral mastoid to high forehead (Mi-Fh) and nape to high forehead (N-Fh), with two EEG rejection levels (± 5 µV and ± 10 µV). Stimulus rates were between 39.1 and 69.1 per second. Efficiency was measured by confidence in the ABR for a given test time. STUDY SAMPLE: Thirty babies who had passed a targeted newborn hearing screen with ABR thresholds ≤ 40 dB nHL. RESULTS: The N-Fh configuration, as expected, gave on average a larger response amplitude compared to the Mi-Fh configuration but was only marginally significantly better in terms of test efficiency. There was no significant effect of stimulus rate on test efficiency between 39.1/s and 59.1/s. The lower ± 5 µV EEG rejection level was more test efficient. CONCLUSIONS: This study provides some evidence that, for ABR threshold testing in babies, alternatives of ipsilateral mastoid or nape electrode and a range of stimulus rates have little or no effect on test efficiency. The results support the use of low EEG rejection limits.

Repeatability of click-evoked otoacoustic emission-based medial olivocochlear efferent assay.

OBJECTIVES: Otoacoustic emissions-based efferent assays are evolving to become a part of auditory diagnostics. The wide range of clinical applications, such as assessment of auditory neuropathy, auditory processing disorders, learning disability, monitoring success in auditory intervention and others illustrate the significance of this measurement. Defining the procedure's test-retest repeatability is of critical importance, to allow for distinction between measurement deviations and true physiological or pathological changes. The purpose of this study was to assess the repeatability of a click-evoked otoacoustic emission-based (CEOAE) test of the medial olivocochlear (MOC) reflex in normal-hearing (NH) adults. DESIGN: Test-retest data were collected from 35 NH young adults in two distinct test sessions separated by 1 to 4 days. CEOAEs were recorded without and with contralateral acoustic stimulation (CAS; 35 dB SL). Three indices of the MOC reflex were computed: CAS-induced (a) absolute changes in CEOAE amplitude, (b) normalized changes in CEOAE amplitude, and (c) changes in CEOAE input-output functions. Repeatability of these indices was assessed by a three-layered approach, which consisted of Bland-Altman plots, coefficient of reliability (Cronbach's α), and analysis of variance. RESULTS: Analyses indicated good repeatability of three CEOAE-based MOC reflex indices. A two-way analysis of variance of the indices demonstrated no significant difference between test and retest. Normalized index showed similar repeatability as other indices. CEOAE signal to noise ratio did not seem to vary between test sessions. Notably, CAS caused a decrease in CEOAE input-output functions slope in a majority of participants (n = 29). CONCLUSIONS: The present study is the first to elucidate the intrasubject variability of absolute and normalized indices of the MOC inhibitory effect. Although the measurements were conducted under realistic conditions resembling the clinical setting, repeatability was generally good in NH adults. For MOC reflex test, the signal to noise ratio of 6 dB for recording CEOAEs seems to be a recommendable criterion when considering practicability and measurement quality in clinical conditions. The present findings exemplify the suitability of CEOAE-based MOC assay as a monitoring tool of medial efferent status over time. The data are intended to assist clinicians and scientists alike in the accurate interpretation of CAS-induced CEOAE changes in the test-retest situation.

Can Uhear me now? Validation of an iPod-based hearing loss screening test.

OBJECTIVE: To evaluate the uHear iPod-based application as a test for hearing loss. METHODS: We recruited 100 adult participants through a single otology practice. Patients with otorrhea and cognitive impairment were excluded. All patients completed the uHear test in the clinic and in the sound booth and underwent a standard audiogram by the same audiologist. We compared the results of the uHear test to the standard audiogram. RESULTS: The uHear was able to correctly diagnose the presence of hearing loss (pure-tone average [PTA] > 40 dB) with a sensitivity of 98% (95% CI = 89-100), a specificity of 82% (95% CI = 75-88), and a positive likelihood ratio of 9 (95% CI = 6.0-16). Compared to the audiogram, the uHear overestimated the PTA among all ears by 14 dB in the clinic and by 8 dB in the sound booth (p < .0001). Compared to the audiogram, the uHear overestimated the PTA among ears with hearing loss by 6 dB in the clinic and by 4 dB in the sound booth. CONCLUSIONS: The uHear application is a reasonable screening test to rule out moderate hearing loss (PTA > 40 dB) and and is valid at quantifying the degree of hearing loss in patients known to have abnormal hearing.

Investigation of a significant increase in referrals during neonatal hearing screening: a comparison of Natus ALGO Portable and ALGO 3i.

OBJECTIVE: Neonatal hearing screening programs in Flanders and the Netherlands use Natus ALGO screening devices. Since 2006 in Flanders and 2009 in the Netherlands, both programs have replaced the older ALGO Portable devices with the newer ALGO 3i devices. However, in both countries, ALGO 3i devices have a significantly higher rate of referrals than ALGO Portable devices. In Flanders, the refer rate has more than doubled with the switch to ALGO 3i devices. In the Netherlands, screening centers which used ALGO 3i devices also showed a significant increase in referrals. In both countries, the percentage of children diagnosed with permanent hearing loss remained approximately the same. DESIGN: A technical comparison of both device types was carried out to identify possible causes for the increase in referrals. The stimulus output of two ALGO Portable and three ALGO 3i devices was recorded and analysed for stimulus level, spectral properties, and stimulus irregularities. RESULTS: ALGO 3i devices stimulate at a peak level 4.6 dB lower than ALGO Portable devices, have a different stimulus spectrum and show unexplained stimulus irregularities during 4% of the stimulation time. CONCLUSIONS: A number of technical differences were found between both device types which could explain the increase in referrals.

Comparison of Mandarin tone and speech perception between advanced combination encoder and continuous interleaved sampling speech-processing strategies in children.

OBJECTIVE: This study was performed to compare cochlear implant (CI) users' performance in Mandarin speech and tone perception between 2 types of speech-processing strategies-advanced combination encoder (ACE) and continuous interleaved sampling (CIS)-under quiet and noisy conditions. METHODS: This study involved 10 congenitally deaf children (age range, 5.7-15.3 years; mean, 9.2 years) who received the Nucleus 24-channel CI system cochlear device (CI24R; Cochlear Ltd, Lane Cove NSW, Australia). The subjects used ACE since switching on their CI devices. Speech and tone perception tests were administered under quiet and noisy (+5 dB signal-to-noise ratio) conditions with ACE and CIS strategies 20 minutes and 2 weeks apart. RESULTS: Regardless of the strategy used, subjects showed significantly higher scores in speech perception than in tone recognition. Under noisy conditions, subjects had significantly higher tone identification scores with the CIS than the ACE strategy (P = .038). There was no significant difference in speech identification score between the strategies. Subjects showed significant higher tone identification and speech perception scores under quiet than noisy (+5 dB signal-to-noise ratio) conditions. Subjectively, 6 subjects preferred the ACE strategy, and the remaining 4 preferred the CIS strategy. The strategy preference of the subjects was related to speech perception performance rather than tone identification. A significant correlation was observed between tone identification and speech recognition, regardless of whether speech was evaluated by consonants (r = 0.669, P < .001), vowels (r = 0.426, P = .001), or sentences (r = 0.294, P = .023). CONCLUSION: There are only 4 patterns of tone in Mandarin, which is far fewer than the number of speech sounds. However, tone identification is poorer than speech perception. The CIS speech-processing strategy may improve tone identification under noisy conditions. Before improved speech strategies to code acoustic characteristics of tone can be developed, it would be worthwhile to try both CIS and ACE for CI users and to select the most suitable speech-processing strategy according to the subjective preference and objective performance.

Development of a device to measure human sound localization.

Measurements of human sound discrimination and localization are important for basic empirical and clinical applications. After a short survey of other methods such as evoked potentials, the development of a new device to measure human sound localization is described and its use illustrated with some examples. Built from a polyacrylic hemisphere or--in a later version--from an orbicular aluminum frame, the apparatus uses multiple speakers to emit auditory stimuli. The patient sits in the middle of the perimeter and has to press a button when a sound is perceived. In addition, the participant has to identify the correct speaker as the source of the sound. With this method it is possible to map the auditory field.

The AB-York crescent of sound: an apparatus for assessing spatial-listening skills in children and adults.

Modern health services need efficient tools for measuring outcomes from interventions, that is, tools of proven efficacy which make minimal demands on the time of clinicians in learning to administer tests and in interpreting results. This paper describes an apparatus designed to meet those requirements. The apparatus administers performance tests of spatial listening for children and adults with unilateral and bilateral cochlear implants. The apparatus was designed with guidance from clinicians. It possesses three key attributes: it is simple to use; the results of tests are scored automatically and are compared with reference data; the apparatus generates comprehensive personalized reports for individual participants that can be included in clinical notes. This paper describes the apparatus and reports results of a test measuring spatial release from masking of speech which illustrates the compatibility between the new apparatus and an older apparatus with which the reference data were gathered.

Binaural measurement of bone conduction click evoked otoacoustic emissions in adults and infants.

Transient evoked otoacoustic emissions (TEOAEs) are usually evoked with air conduction (AC) stimuli. Only a few reports exist about OAEs where stimuli have been delivered using bone conduction (BC) by placing a bone conductor on the forehead or the mastoid. The aims of the present study were to improve the test performance of BC-TEOAEs by using a nonlinear stimulation protocol and to find out, whether this technique can be applied in newborn hearing screening. BC-TEOAEs were measured binaurally in ten normal hearing adults and in ten infants. For measurements in infants, miniaturized probes without loudspeakers were constructed to allow a complete insertion of the probe in the infant's ear canal. It could be shown that robust and valid BC-TEOAEs can be elicited using a nonlinear stimulation protocol. Findings in adults indicated that BC-TEOAEs can be measured with properties similar to AC-TEOAEs. However, mean BC-TEOAE levels were reduced by 0.8-3.7 dB depending on frequency. In view of test time, this is compensated by performing binaural recordings. Measurements in infants indicated that the screening performance of BC-TEOAEs and AC-TEOAEs may be comparable. Further studies have to investigate, whether BC-TEOAEs are more robust than AC-TEOAEs against small conductive hearing loss.

Microphone array based novel infant deafness detector.

This work focuses on an infant deafness detector unit, using the concept of microphone array. This instrument is based on the principle of evoked acoustic emissions (OAEs). The key feature of the microphone array is its ability to increase signal-to-noise ratio (SNR) and reproducibility of the OAE responses. These further significantly contribute to improve the sensitivity and specificity of the overall system. Low level sound pressure values are recorded by the sensitive microphones in microphone array unit and processed using TI's DSP6416. The sound stimulus transmitted to human ear is generated and controlled by the 6416 DSP (Digital signal processor). Hardware circuit details and the algorithm used in signal processing are discussed in this paper. Standard averaging technique is used in the implemented algorithm. The final result speaks about the hearing capacity of a patient. The proof that the usage of microphone arrays leads to better SNR values than using a single microphone in an OAE probe, is successfully carried out in this work.

Effect of varying phase between frequency and amplitude modulation on bone conduction auditory steady state responses.

OBJECTIVES: Auditory steady state response (ASSR) testing provides a means to objectively estimate hearing levels in newborns and adults for whom behavioral tests prove difficult. When testing these patient groups, it is preferable that clear responses to both air and bone conduction stimuli are obtained in a short amount of time. Much of the literature addressing ASSRs, such as investigations of stimulus and recording parameters, have focused on air conduction ASSRs. The aim of this investigation was to study the amplitudes, latencies, and test times of bone conduction ASSRs elicited using amplitude- (AM), frequency- (FM), and mixed-modulated (MM) stimuli and provide suggestions for optimum recording parameters. DESIGN: Bone and air conduction multiple ASSRs were recorded from two groups of 20 normal-hearing adults using the Multiple Auditory Steady State Response research system. AM, FM, and MM sinusoidal tones were used (0.5-, 1-, 2-, and 4-kHz carrier frequencies), which were modulated between 78 and 92 Hz. AM depth was 100% and FM depth was 20%. ASSR amplitudes and latencies (calculated using the "preceding cycles" technique) were analyzed for MM phase settings across the cycle from 0° at 45° intervals and compared with AM responses. Optimum phase settings for bone and air conduction ASSRs were calculated using a sinusoidal model based on the amplitude data. RESULTS: Similar effects of stimulus type and carrier frequency were observed for bone and air conduction ASSRs. AM responses were larger in amplitude compared with FM responses. MM (at all phase settings tested) and AM response latencies increased with decreasing carrier frequency. MM phase setting had a significant (p < 0.01) sinusoidal effect on ASSR amplitudes, compared with AM responses, at 1, 2, and 4 kHz but not 0.5 kHz for air conduction and 1 and 2 kHz but not 0.5 and 4 kHz for bone conduction. Using a sinusoidal function to model this effect, MM phase settings (±95% confidence intervals) of 318° (295 to 350°) and 295° (290 to 310°) are predicted to evoke the largest responses for bone conduction ASSRs at 1 and 2 kHz, respectively. Phase settings of 293° (285 to 310°), 300° (280 to 310°), and 280° (255 to 330°) are predicted for air conduction ASSRs at 1, 2, and 4 kHz, respectively. MM phase setting had little effect on estimated latency. Test times were significantly (p < 0.01) affected by phase setting with both increases and decreases being observed. Test times for ASSRs at 1, 2, and 4 kHz could be significantly reduced if the estimated optimum phase settings are used. CONCLUSIONS: Different stimuli can significantly affect the amplitudes of bone conduction ASSRs. These effects are similar to those observed for air conduction ASSRs. MM stimuli with specific phase settings evoke larger bone conduction ASSRs compared with AM and FM stimuli alone, and calculations show that the time taken to obtain these responses is reduced. Implementation of the suggested optimum settings will promote efficient collection of bone conduction, and indeed air conduction, ASSR data.

Differences in distortion product otoacoustic emission phase recorded from human neonates using two popular probes.

DPOAE (2f(1)-f(2)) phase was measured across a 3-octave frequency range from two groups of newborns using ER10B+ and ER10C probe microphones. A marked phase shift was noted in the mid-to-high frequency range for newborn data recorded with the ER10C only. In contrast, the ER10B+ produced phase that was approximately invariant as a function of frequency for most of the range. Probe-related phase shifts can be effectively eliminated by correcting for variations in the phases of the primary tones. Results highlight the importance of detecting and correcting for system-related phase shifts so they are not misinterpreted as cochlear in origin.

Acoustic measurement: a tutorial for molecular biologists.

Although skilled in in vitro techniques, the molecular biologist may not understand the finer points of acoustical measurement. Measurement is necessary whenever the auditory system function is being measured using the auditory brainstem response (ABR) or distortion product otoacoustic emissions (DPOAE) or is being challenged by a noise exposure. While the theory of measuring an acoustic signal with a calibrated measuring microphone is simple, in practice, it can become complex. The present article presents guidelines for measuring acoustic stimuli which is within the abilities of a well equipped laboratory. It also presents a set of links for further information and some sources for procurement of equipment.