Characterizing a Joint Reflection-Distortion OAE Profile in Humans With Endolymphatic Hydrops.

OBJECTIVES: Endolymphatic hydrops (EH), a hallmark of Meniere disease, is an inner-ear disorder where the membranes bounding the scala media are distended outward due to an abnormally increased volume of endolymph. In this study, we characterize the joint-otoacoustic emission (OAE) profile, a results profile including both distortion- and reflection-class emissions from the same ear, in individuals with EH and speculate on its potential utility in clinical assessment and monitoring. DESIGN: Subjects were 16 adults with diagnosed EH and 18 adults with normal hearing (N) matched for age. Both the cubic distortion product (DP) OAE, a distortion-type emission, and the stimulus-frequency (SF) OAE, a reflection-type emission, were measured and analyzed as a joint OAE profile. OAE level, level growth (input/output functions), and phase-gradient delays were measured at frequencies corresponding to the apical half of the human cochlea and compared between groups. RESULTS: Normal hearers and individuals with EH shared some common OAE patterns, such as the reflection emissions being generally higher in level than distortion emissions and showing more linear growth than the more strongly compressed distortion emissions. However, significant differences were noted between the EH and N groups as well. OAE source strength (a metric based on OAE amplitude re: stimulus level) was significantly reduced, as was OAE level, at low frequencies in the EH group. These reductions were more marked for distortion than reflection emissions. Furthermore, two significant changes in the configuration of OAE input/output functions were observed in ears with EH: a steepened growth slope for reflection emissions and an elevated compression knee for distortion emissions. SFOAE phase-gradient delays at 40 dB forward-pressure level were slightly shorter in the group with EH compared with the normal group. CONCLUSIONS: The underlying pathology associated with EH impacts the generation of both emission types, reflection and distortion, as shown by significant group differences in OAE level, growth, and delay. However, hydrops impacts reflection and distortion emissions differently. Most notably, DPOAEs were more reduced by EH than were SFOAEs, suggesting that pathologies associated with the hydropic state do not act identically on the generation of nonlinear distortion at the hair bundle and intracochlear reflection emissions near the peak of the traveling wave. This differential effect underscores the value of applying a joint OAE approach to access both intracochlear generation processes concurrently.

Characterizing the Relationship Between Reflection and Distortion Otoacoustic Emissions in Normal-Hearing Adults.

Otoacoustic emissions (OAEs) arise from one (or a combination) of two basic generation mechanisms in the cochlea: nonlinear distortion and linear reflection. As a result of having distinct generation processes, these two classes of emissions may provide non-redundant information about hair-cell integrity and show distinct sensitivities to cochlear pathology. Here, we characterize the relationship between reflection and distortion emissions in normal hearers across a broad frequency and stimulus-level space using novel analysis techniques. Furthermore, we illustrate the promise of this approach in a small group of individuals with mild-moderate hearing loss. A "joint-OAE profile" was created by measuring interleaved swept-tone stimulus-frequency OAEs (SFOAEs) and 2f1-f2 distortion-product OAEs (DPOAEs) in the same ears using well-considered parameters. OAE spectra and input/output functions were calculated across five octaves. Using our specific recording protocol and analysis scheme, SFOAEs in normal hearers had higher levels than did DPOAEs, with the most pronounced differences occurring at the highest stimulus levels. Also, SFOAE compression occurred at higher stimulus levels (than did DPOAE compression) and its growth in the compressed region was steeper. The diagnostic implications of these findings and the influence of the measurement protocol on both OAEs (and on their relationship) are discussed.

Swept-Tone Stimulus-Frequency Otoacoustic Emissions in Human Newborns.

Several types of otoacoustic emissions have been characterized in newborns to study the maturational status of the cochlea at birth and to develop effective tests of hearing. The stimulus-frequency otoacoustic emission (SFOAE), a reflection-type emission elicited with a single low-level pure tone, is the least studied of these emissions and has not been comprehensively characterized in human newborns. The SFOAE has been linked to cochlear tuning and is sensitive to disruptions in cochlear gain (i.e., hearing loss) in adult subjects. In this study, we characterize SFOAEs evoked with rapidly sweeping tones in human neonates and consider the implications of our findings for human cochlear maturation. SFOAEs were measured in 29 term newborns within 72 hr of birth using swept tones presented at 2 oct/s across a four-octave frequency range (0.5­8 kHz); 20 normal-hearing young adults served as a control group. The prevalence of SFOAEs in newborns was as high as 90% (depending on how response "presence" was defined). Evidence of probe-tip leakage and abnormal ear-canal energy reflectance was observed in those ears with absent or unmeasurable SFOAEs. Results in the group of newborns with present stimulus-frequency emissions indicate that neonatal swept-tone SFOAEs are adult-like in morphology but have slightly higher amplitude compared with adults and longer SFOAE group delays. The origin of these nonadult-like features is probably mixed, including contributions from both conductive (ear canal and middle ear) and cochlear immaturities.

Variable-rate frequency sweeps and their application to the measurement of otoacoustic emissions.

Swept tones allow the efficient measurement of otoacoustic emissions (OAEs) with fine frequency resolution. Although previous studies have explored the influence of different sweep parameters on the measured OAE, none have directly considered their effects on the measurement noise floor. The present study demonstrates that parameters such as sweep type (e.g., linear or logarithmic), sweep rate, and analysis bandwidth affect the measurement noise and can be manipulated to control the noise floor in individual subjects. Although responses to discrete-tone stimuli can be averaged until the uncertainty of the measurement meets a specified criterion at each frequency, linear or logarithmic sweeps offer no such flexibility. However, measurements of the power spectral density of the ambient noise can be used to construct variable-rate sweeps that yield a prescribed (e.g., constant) noise floor across frequency; in effect, they implement a form of frequency-dependent averaging. The use of noise-compensating frequency sweeps is illustrated by the measurement of distortion-product OAEs at low frequencies, where the ear-canal noise is known to vary significantly.

Effects of Forward- and Emitted-Pressure Calibrations on the Variability of Otoacoustic Emission Measurements Across Repeated Probe Fits.

OBJECTIVE: The stimuli used to evoke otoacoustic emissions (OAEs) are typically calibrated based on the total SPL measured at the probe microphone. However, due to the acoustics of the ear-canal space (i.e., standing-wave interference), this method can underestimate the stimulus pressure reaching the tympanic membrane at certain frequencies. To mitigate this effect, stimulus calibrations based on forward pressure level (FPL) can be applied. Furthermore, the influence of ear-canal acoustics on measured OAE levels can be compensated by expressing them in emitted pressure level (EPL). To date, studies have used artificial shallow versus deep probe fits to assess the effects of calibration method on changes in probe insertion. In an attempt to better simulate a clinical setting, the combined effects of FPL calibration of stimulus level and EPL compensation of OAE level on response variability during routine (noncontrived) probe fittings were examined. DESIGN: The distortion component of the distortion-product OAE (DPOAE) and the stimulus-frequency OAE (SFOAE) were recorded at low and moderate stimulus levels in 20 normal-hearing young-adult subjects across a five-octave range. In each subject, three different calibration approaches were compared: (1) the conventional SPL-based stimulus calibration with OAE levels expressed in SPL; (2) FPL stimulus calibration with OAEs expressed in SPL; and (3) FPL stimulus calibration with OAEs expressed in EPL. Test and retest measurements were obtained during the same session and, in a subset of subjects, several months after the initial test. The effects of these different procedures on the inter- and intra-subject variability of OAE levels were assessed across frequency and level. RESULTS: There were no significant differences in the inter-subject variability of OAE levels across the three calibration approaches. However, there was a significant effect on OAE intra-subject variability. The FPL/EPL approach resulted in the overall lowest test-rest differences in DPOAE level for frequencies above 4 kHz, where standing-wave interference is strongest. The benefit was modest, ranging on average from 0.5 to 2 dB and was strongest at the lower stimulus level. SFOAE level variability did not show significant differences among the three procedures, perhaps due to insufficient signal-to-noise ratio and nonoptimized stimulus levels. Correlations were found between the short-term replicability of DPOAEs and the benefit derived from the FPL/EPL procedure: the more variable the DPOAE, the stronger the benefit conferred by the advanced calibration methods. CONCLUSIONS: Stimulus and response calibration procedures designed to mitigate the effects of standing-wave interference on both the stimulus and the OAE enhance the repeatability of OAE measurements and reduce their dependence on probe position, even when probe shifts are small. Modest but significant improvements in short-term test-retest repeatability were observed in the mid- to high-frequency region when using combined FPL/EPL procedures. The authors posit that the benefit will be greater in a more heterogeneous group of subjects and when different testers participate in the fitting and refitting of subjects, which is a common practice in the audiology clinic. The impact of calibration approach on OAE inter-subject variability was not significant, possibly due to a homogeneous subject population and because factors other than probe position are at play.

Changes in the Compressive Nonlinearity of the Cochlea During Early Aging: Estimates From Distortion OAE Input/Output Functions.

OBJECTIVES: The level-dependent growth of distortion product otoacoustic emissions (DPOAEs) provides an indirect metric of cochlear compressive nonlinearity. Recent evidence suggests that aging reduces nonlinear distortion emissions more than those associated with linear reflection. Therefore, in this study, we generate input/output (I/O) functions from the isolated distortion component of the DPOAE to probe the effects of early aging on the compressive nonlinearity of the cochlea. DESIGN: Thirty adults whose ages ranged from 18 to 64 years participated in this study, forming a continuum of young to middle-age subjects. When necessary for analyses, subjects were divided into a young-adult group with a mean age of 21 years, and a middle-aged group with a mean age of 52 years. All young-adult subjects and 11 of the middle-aged subjects had normal hearing; 4 middle-aged ears had slight audiometric threshold elevation at mid-to-high frequencies. DPOAEs (2f1 - f2) were recorded using primary tones swept upward in frequency from 0.5 to 8 kHz, and varied from 25 to 80 dB sound pressure level. The nonlinear distortion component of the total DPOAE was separated and used to create I/O functions at one-half octave intervals from 1.3 to 7.4 kHz. Four features of OAE compression were extracted from a fit to these functions: compression threshold, range of compression, compression slope, and low-level growth. These values were compared between age groups and correlational analyses were conducted between OAE compression threshold and age with audiometric threshold controlled. RESULTS: Older ears had reduced DPOAE amplitude compared with young-adult ears. The OAE compression threshold was elevated at test frequencies above 2 kHz in the middle-aged subjects by 19 dB (35 versus 54 dB SPL), thereby reducing the compression range. In addition, middle-aged ears showed steeper amplitude growth beyond the compression threshold. Audiometric threshold was initially found to be a confound in establishing the relationship between compression and age; however, statistical analyses allowed us to control its variance. Correlations performed while controlling for age differences in high-frequency audiometric thresholds showed significant relationships between the DPOAE I/O compression threshold and age: Older subjects tended to have elevated compression thresholds compared with younger subjects and an extended range of monotonic growth. CONCLUSIONS: Cochlear manifestations of nonlinearity, such as the DPOAE, weaken during early aging, and DPOAE I/O functions become linearized. Commensurate changes in high-frequency audiometric thresholds are not sufficient to fully explain these changes. The results suggest that age-related changes in compressive nonlinearity could produce a reduced dynamic range of hearing, and contribute to perceptual difficulties in older listeners.

Optimizing swept-tone protocols for recording distortion-product otoacoustic emissions in adults and newborns.

Distortion-product otoacoustic emissions (DPOAEs), which are routinely used in the audiology clinic and research laboratory, are conventionally recorded with discrete tones presented sequentially across frequency. However, a more efficient technique sweeps tones smoothly across frequency and applies a least-squares-fitting (LSF) procedure to compute estimates of otoacoustic emission phase and amplitude. In this study, the optimal parameters (i.e., sweep rate and duration of the LSF analysis window) required to record and analyze swept-tone DPOAEs were tested and defined in 15 adults and 10 newborns. Results indicate that optimal recording of swept-tone DPOAEs requires use of an appropriate analysis bandwidth, defined as the range of frequencies included in each least squares fit model. To achieve this, the rate at which the tones are swept and the length of the LSF analysis window must be carefully considered and changed in concert. Additionally, the optimal analysis bandwidth must be adjusted to accommodate frequency-dependent latency shifts in the reflection-component of the DPOAE. Parametric guidelines established here are equally applicable to adults and newborns. However, elevated noise during newborn swept-tone DPOAE recordings warrants protocol adaptations to improve signal-to-noise ratio and response quality.

Stability of the medial olivocochlear reflex as measured by distortion product otoacoustic emissions.

PURPOSE: The purpose of this study was to assess the repeatability of a fine-resolution, distortion product otoacoustic emission (DPOAE)-based assay of the medial olivocochlear (MOC) reflex in normal-hearing adults. METHOD: Data were collected during 36 test sessions from 4 normal-hearing adults to assess short-term stability and 5 normal-hearing adults to assess long-term stability. DPOAE level and phase measurements were recorded with and without contralateral acoustic stimulation. MOC reflex indices were computed by (a) noting contralateral acoustic stimulation-induced changes in DPOAE level (both absolute and normalized) at fine-structure peaks, (b) recording the effect as a vector difference, and (c) separating DPOAE components and considering a component-specific metric. RESULTS: Analyses indicated good repeatability of all indices of the MOC reflex in most frequency ranges. Short- and long-term repeatability were generally comparable. Indices normalized to a subject's own baseline fared best, showing strong short- and long-term stability across all frequency intervals. CONCLUSIONS: These results suggest that fine-resolution DPOAE-based measures of the MOC reflex measured at strategic frequencies are stable, and natural variance from day-to-day or week-to-week durations is small enough to detect between-group differences and possibly to monitor intervention-related success. However, this is an empirical question that must be directly tested to confirm its utility.

Aging of the medial olivocochlear reflex and associations with speech perception.

The medial olivocochlear reflex (MOCR) modulates cochlear amplifier gain and is thought to facilitate the detection of signals in noise. High-resolution distortion product otoacoustic emissions (DPOAEs) were recorded in teens, young, middle-aged, and elderly adults at moderate levels using primary tones swept from 0.5 to 4 kHz with and without a contralateral acoustic stimulus (CAS) to elicit medial efferent activation. Aging effects on magnitude and phase of the 2f1-f2 DPOAE and on its components were examined, as was the link between speech-in-noise performance and MOCR strength. Results revealed a mild aging effect on the MOCR through middle age for frequencies below 1.5 kHz. Additionally, positive correlations were observed between strength of the MOCR and performance on select measures of speech perception parsed into features. The elderly group showed unexpected results including relatively large effects of CAS on DPOAE, and CAS-induced increases in DPOAE fine structure as well as increases in the amplitude and phase accumulation of DPOAE reflection components. Contamination of MOCR estimates by middle ear muscle contractions cannot be ruled out in the oldest subjects. The findings reiterate that DPOAE components should be unmixed when measuring medial efferent effects to better consider and understand these potential confounds.

Distortion-product otoacoustic emission reflection-component delays and cochlear tuning: estimates from across the human lifespan.

A consistent relationship between reflection-emission delay and cochlear tuning has been demonstrated in a variety of mammalian species, as predicted by filter theory and models of otoacoustic emission (OAE) generation. As a step toward the goal of studying cochlear tuning throughout the human lifespan, this paper exploits the relationship and explores two strategies for estimating delay trends-energy weighting and peak picking-both of which emphasize data at the peaks of the magnitude fine structure. Distortion product otoacoustic emissions (DPOAEs) at 2f1-f2 were recorded, and their reflection components were extracted in 184 subjects ranging in age from prematurely born neonates to elderly adults. DPOAEs were measured from 0.5-4 kHz in all age groups and extended to 8 kHz in young adults. Delay trends were effectively estimated using either energy weighting or peak picking, with the former method yielding slightly shorter delays and the latter somewhat smaller confidence intervals. Delay and tuning estimates from young adults roughly match those obtained from SFOAEs. Although the match is imperfect, reflection-component delays showed the expected bend (apical-basal transition) near 1 kHz, consistent with a break in cochlear scaling. Consistent with other measures of tuning, the term newborn group showed the longest delays and sharpest tuning over much of the frequency range.

Maturation of the human medial efferent reflex revisited.

Past work applying otoacoustic emissions to gauge maturational status of the medial olivocochlear (MOC) reflex in human newborns has produced mixed results. The present study revisits the question while considering the dual nature of the 2f(1) - f(2) distortion product otoacoustic emission (DPOAE) and expanding measures of medial efferent function. Subjects included premature and term-born neonates, 6-month-old infants and young adults. The MOC reflex was elicited with contralateral acoustic stimulation (CAS) while shifts in amplitude and phase of the DPOAE, and its distortion and reflection components, were monitored. Overall, CAS-elicited reductions in DPOAE level did not differ among age groups. For all ages, the MOC reflex was strongest at frequencies below 1.5 kHz, and the reflection component of the DPOAE was most affected, showing maximally reduced amplitude and shallower phase slope when contralateral noise was presented. Results suggest that the MOC reflex likely reaches maturation prior to full-term birth. However, prematurely born neonates show markedly more episodes of CAS-induced DPOAE level enhancement. This may be due to more intrusive component mixing in this age group or disruptions in the formation of the MOC pathway or synapse in the most premature neonates.

The relationship between MOC reflex and masked threshold.

Otoacoustic emission (OAE) amplitude can be reduced by acoustic stimulation. This effect is produced by the medial olivocochlear (MOC) reflex. Past studies have shown that the MOC reflex is related to listening in noise and attention. In the present study, the relationship between strength of the contralateral MOC reflex and masked threshold was investigated in 19 adults. Detection thresholds were determined for 1000-Hz, 300-ms tone presented simultaneously with one repetition of a 300-ms masker in an ongoing train of masker bursts. Three masking conditions were tested: 1) broadband noise 2) a fixed-frequency 4-tone complex masker and 3) a random-frequency 4-tone complex masker. Broadband noise was expected to produce energetic masking and the tonal maskers were expected to produce informational masking in some listeners. DPOAEs were recorded at fine frequency intervals from 500 to 4000 Hz, with and without contralateral acoustic stimulation. MOC reflex strength was estimated as a reduction in baseline level and a shift in frequency of DPOAE fine-structure maxima near 1000-Hz. MOC reflex and psychophysical testing were completed in separate sessions. Individuals with poorer thresholds in broadband noise and in random-frequency maskers were found to have stronger MOC reflexes.

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.

Considering distortion product otoacoustic emission fine structure in measurements of the medial olivocochlear reflex.

In humans, when the medial olivocochlear (MOC) pathway is activated by noise in the opposite ear, changes in distortion product otoacoustic emission (DPOAE) level, i.e., the MOC reflex, can be recorded in the test ear. Recent evidence suggests that DPOAE frequency influences the direction (suppression/enhancement) of the reflex. In this study, DPOAEs were recorded at fine frequency intervals from 500 to 2500 Hz, with and without contralateral acoustic stimulation (CAS) in a group of 15 adults. The MOC reflex was calculated only at DPOAE frequencies corresponding to peaks in the fine structure. Additionally, inverse fast-Fourier transform was conducted to evaluate MOC effects on individual DPOAE components. Results show the following: (1) When considering peaks only, the mean MOC reflex was -2.05 dB and 97% of observations reflected suppression, (2) CAS reduced distortion characteristic frequency component levels more than overlap component levels, and (3) CAS produced an upward shift in fine structure peak frequency. Results indicate that when the MOC reflex is recorded at DPOAE frequencies corresponding to fine structure maxima (i.e., when DPOAE components are constructive and in phase), suppression is reliably observed and level enhancement, which probably reflects component mixing in the ear canal rather than strength of the MOC reflex, is eliminated.

Ipsilateral distortion product otoacoustic emission (2f1-f2) suppression in children with sensorineural hearing loss.

Distortion product otoacoustic emission (DPOAE) ipsilateral suppression has been applied to study cochlear function and maturation in laboratory animals and humans. Although DPOAE suppression appears to be sensitive to regions of specialized cochlear function and to cochlear immaturity, it is not known whether it reflects permanent cochlear damage, i.e., sensorineural hearing loss (SNHL), in a reliable and systematic manner in humans. Eight school-aged children with mild-moderate SNHL and 20 normal-hearing children served as subjects in this study. DPOAE (2f1-f2) suppression data were collected at four f2 frequencies (1500, 3000, 4000, and 6000 Hz) using moderate-level primary tones. Features of the DPOAE iso-suppression tuning curves and suppression growth were analyzed for both subject groups. Results show that DPOAE suppression tuning curves from hearing-impaired subjects can be reliably recorded. DPOAE suppression tuning curves were generally normal in appearance and shape for six out of eight hearing-impaired subjects but showed subtle abnormalities in at least one feature. There was not one single trend or pattern of abnormality that characterized all hearing-impaired subjects. The most prominent patterns of abnormality included: broadened tuning, elevated tip, and downward shift of tip frequency. The unique patterns of atypical DPOAE suppression in subjects with similar audiograms may suggest different patterns of underlying sensory cell damage. This speculation warrants further investigation.