Influence of stimulus parameters on amplitude-modulated stimulus frequency otoacoustic emissions.

The present study evaluated the influence of suppressor frequency (fs) and level (Ls) on stimulus-frequency otoacoustic emissions (SFOAEs) recorded using the amplitude-modulated (AM) suppressor technique described by Neely et al. [J. Acoust. Soc. Am. 118, 2124-2127 (2005a)]. Data were collected in normal-hearing subjects, with data collection occurring in two phases. In phase 1, SFOAEs were recorded with probe frequency (fp) = 1, 2, and 4 kHz and probe levels (Lp) ranging from 0 to 60 dB sound pressure level (SPL). At each fp, Ls ranged from Ls = Lp to Ls = Lp + 30 dB. Additionally, nine relationships between fs and fp were evaluated, ranging from fs/fp = 0.80 to fs/fp = 1.16. Results indicated that for low suppressor levels, suppressors higher in frequency than fp (fs > fp) resulted in higher AM-SFOAE levels than suppressors lower in frequency than fp (fs < fp). At higher suppressor levels, suppressors both higher and lower in frequency than fp produced similar AM-SFOAE levels, and, in many cases, low-frequency suppressors produced the largest response. Recommendations for stimulus parameters that maximize AM-SFOAE level were derived from these data. In phase 2, AM-SFOAEs were recorded using these parameters for fp = 0.7-8 kHz and Lp = 20-60 dB SPL. Robust AM-SFOAE responses were recorded in this group of subjects using the parameters developed in phase 1.

The influence of common stimulus parameters on distortion product otoacoustic emission fine structure.

OBJECTIVES: To determine whether common approaches to setting stimulus parameters influence the depth of fine structure present in the distortion product otoacoustic emission (DPOAE) response. Because the presence of fine structure has been suggested as a possible source of errors, if one of the common parametric approaches results in reduced fine-structure depth, it may be preferred over other approaches. DESIGN: DPOAE responses were recorded in a group of 21 subjects with normal hearing for 1/3-octave intervals surrounding 3 f2s (1, 2, and 4 kHz) at three L2s (30, 45, and 55 dB SPL). For each f2 and L2 combination, L1 and f2/f1 were set according to three commonly used parametric approaches. These included a simple approach, the approach recommended by Kummer et al., and the approach described by Johnson et al. These three approaches primarily differ in the recommended relationship between L1 and L2. For each parametric approach, DPOAE fine structure was evaluated by varying f2 in small steps. Differences in DPOAE level and DPOAE fine-structure depth across f2, L2, and the various stimulus parameters were evaluated using repeated-measures analysis of variance. RESULTS: As expected, significant variations in DPOAE level were observed across the three parametric approaches. For stimulus levels #45 dB SPL, the simple stimuli resulted in lower DPOAE levels than were observed for other approaches. An unexpected finding was that stimulus parameters developed by Johnson et al., which were believed to produce higher DPOAE levels than other approaches, produced the lowest DPOAE levels of the three approaches when f2 = 4 kHz. Significant differences in fine-structure depth were also observed. Greater fine-structure depth was observed with the simple parameters, although this effect was restricted to L2 # 45 dB SPL. When L2 = 55 dB SPL, all three parametric approaches resulted in equivalent fine-structure depth. A significant difference in fine-structure depth across the 3 f2s was also observed. The interval surrounding 2 kHz was associated with greater fine-structure depth than the intervals surrounding 1 and 4 kHz. CONCLUSIONS: The simple stimulus parameters resulted in more fine structure than the other parametric approaches; however, this effect was restricted to L2 # 45 dB SPL. At the moderate stimulus levels used in most clinical applications of DPOAEs (L2 = 55 dB SPL), all three approaches resulted in similar fine-structure depths. These findings suggest that manipulating stimulus parameters, particularly the L1, L2 relationship, is not an effective technique for reducing fine structure, except at the lowest stimulus levels, and that all the common parameters result in equivalent fine structure for moderate stimulus levels. These results also suggest that the stimulus parameters used in future studies of the clinical implications of fine structure may be relatively unimportant, unless stimulus levels #45 dB SPL will be evaluated.

Cochlear sources and otoacoustic emissions.

Current understanding suggests that there are two different mechanisms by which otoacoustic emissions (OAEs) are generated in the cochlea. These mechanisms include a nonlinear-distortion mechanism and a coherent-reflection mechanism. Distortion product OAEs (DPOAEs) are believed to include contributions from both mechanisms, while stimulus frequency OAEs (SFOAES), at least at low and moderate levels, are believed to be generated primarily by the coherent-reflection mechanism. In the case of DPOAEs, the interaction of the two mechanisms produces a series of alternating peaks and valleys in the response level when recorded in small frequency increments. This pattern of peaks and valleys typically is referred to as fine structure. There has been much speculation that the interaction of the two mechanisms and the resulting fine structure limits the clinical test performance of DPOAEs. There are few data to address this speculation. Here, we review the literature that describes the cochlear source mechanisms and their potential relationship to clinical applications. We then present results for preliminary data collected in a group of 10 normal-hearing subjects where we explore the influence of common approaches to setting DPOAE stimulus parameters on the resulting fine structure. These preliminary results suggest that, at the moderate stimulus levels used in clinical applications, each of the different stimulus parameters results in a similar amount of fine structure and, therefore, fine structure cannot be eliminated through manipulation of stimulus parameters. We also review the results of some preliminary efforts to identify stimulus parameters that can be used to record SFOAEs (OAEs generated by the reflection mechanism). The potential clinical applications of SFOAEs have received little attention in the literature. By identifying stimulus parameters producing robust responses in normal-hearing ears, it may be possible to more fully evaluate clinical applications of SFOAEs.

Clinical test performance of distortion-product otoacoustic emissions using new stimulus conditions.

OBJECTIVES: To determine whether new stimulus parameters, which have been shown to produce large distortion-product otoacoustic emission (DPOAE) levels in a group of normal-hearing listeners (Neely et al. 2005; Johnson et al. 2006), result in more accurate identification of auditory status and more accurate predictions of behavioral threshold than traditional stimulus conditions. DESIGN: DPOAE input/output (I/O) functions for eight f2 frequencies ranging from 0.7 to 8 kHz were recorded from 96 ears with normal hearing and 226 ears with sensorineural hearing losses ranging from mild to profound. The primary-level differences and primary-frequency ratios were set according to the stimulus relations developed by Johnson et al. (2006). The accuracy of the dichotomous decision task (area under the relative operating characteristic curve [AROC]) for these new stimulus conditions was evaluated as a function of L2 and was compared with previous reports in the literature where traditional stimuli were used (Stover et al. 1996). Here, traditional stimuli are defined as L1 = L2 + 10 and f2/f1 = 1.22 for all L2 and f2 values. In addition to I/O functions, DPgrams with L2 = 55-dB sound pressure level (SPL) and f2 ranging from 0.7 to 8 kHz were recorded for each subject using the traditional stimuli. This provided a direct within-subject comparison of AROC for moderate-level stimuli when the new and traditional stimuli were used. Finally, the accuracy with which DPOAE thresholds predicted behavioral thresholds was evaluated in relation to previous reports in the literature for two definitions of DPOAE threshold, one where the entire I/O function was used to make the prediction and a second where the lowest L2 producing a signal to noise ratio > or =3 dB was used. RESULTS: There was no evidence that the new stimuli improved the accuracy with which auditory status was identified from DPOAE responses. With both the new and traditional stimuli, moderate stimulus levels (L2 = 40- to 55-dB SPL) resulted in the most accurate identification of auditory status. When L2 = 55-dB SPL, the new stimuli produced AROC values that were equivalent to those observed with traditional stimuli. The new stimuli resulted in more accurate prediction of behavioral threshold for several f2 values when using the entire I/O function, although the effect was small. Furthermore, using the entire I/O function to predict behavioral threshold results in more accurate predictions of behavioral threshold than using the signal to noise ratio definition, although this approach can be applied to a smaller percentage of ears. CONCLUSIONS: The new stimuli that had been shown previously to produce large DPOAE levels in normal-hearing listeners (Neely et al. 2005; Johnson et al. 2006) do not result in more accurate identification of auditory status and have only a small positive effect on the prediction of behavioral threshold.

Distortion product otoacoustic emissions: cochlear-source contributions and clinical test performance.

It has been proposed that the clinical accuracy of distortion product otoacoustic emissions (DPOAEs) is affected by the interaction of distortion and reflection sources contributing to the response. This study evaluated changes in dichotomous-decision test performance and threshold-prediction accuracy when DPOAE source contribution was controlled. Data were obtained from 205 normal and impaired ears with L(2) ranging from 0 to 80 dB SPL and f(2)=2 and 4 kHz. Data were collected for control conditions (no suppressor, f(3)) and with f(3) presented at three levels that previously had been shown to reduce the reflection-source contribution. The results indicated that controlling source contribution with a suppressor did not improve diagnostic accuracy (as reflected by relative operating characteristic curve area) and frequently resulted in poorer test performance compared to control conditions. Likewise, correlations between DPOAE and behavioral thresholds were not strengthened when using the suppressors to control source contribution. While improvements in test accuracy were observed for a subset of subjects (normal ears with the smallest DPOAEs and impaired ears with the largest DPOAEs), the lack of improvement for the larger, unselected subject group suggests that DPOAEs should be recorded in the clinic without attempting to control the source contribution with a suppressor.

Influence of primary-level and primary-frequency ratios on human distortion product otoacoustic emissions.

The combined influence of primary-level differences (L1-L2) and primary-frequency ratio (f2/f1) on distortion product otoacoustic emission (DPOAE) level was investigated in 20 normal-hearing subjects. DPOAEs were recorded with continuously varying stimulus levels [Neely et al. J. Acoust. Soc. Am. 117, 1248-1259 (2005)] for the following stimulus conditions: f2= 1, 2, 4, and 8 kHz and f2/f1=1.05 to 1.4; various L1-L2, including one individually optimized to produce the largest DPOAE. For broadly spaced primary frequencies at low L2 levels, the largest DPOAEs were recorded when L1 was much higher than L2, with L1 remaining relatively constant as L2 increased. As f2/fl decreased, the largest DPOAEs were observed when L1 was closer to L2 and increased as L2 increased. Optimal values for L1-L2 and f2 f1 were derived from these data. In general, average DPOAE levels for the new L1-L2 and f2/f1 were equivalent to or larger than those observed for other stimulus combinations, including the L1-L2 described by Kummer et al. [J. Acoust. Soc. Am. 103, 3431-3444 (1998)] and those defined by Neely et al. in which L1-L2 was evaluated, but f2/f1 was fixed at 1.2.

Using a combination of click- and tone burst-evoked auditory brain stem response measurements to estimate pure-tone thresholds.

DESIGN: A retrospective medical record review of evoked potential and audiometric data were used to determine the accuracy with which click-evoked and tone burst-evoked auditory brain stem response (ABR) thresholds predict pure-tone audiometric thresholds. METHODS: The medical records were reviewed of a consecutive group of patients who were referred for ABR testing for audiometric purposes over the past 4 yrs. ABR thresholds were measured for clicks and for several tone bursts, including a single-cycle, Blackman-windowed, 250-Hz tone burst, which has a broad spectrum with little energy above 600 Hz. Typically, the ABR data were collected because the patients were unable to provide reliable estimates of hearing sensitivity, based on behavioral test techniques, due to developmental level. Data were included only if subsequently obtained behavioral audiometric data were available to which the ABR data could be compared. Almost invariably, the behavioral data were collected after the ABR results were obtained. Because of this, data were included on only those ears for which middle ear tests (tympanometry, otoscopic examination, pure-tone air- and bone-conduction thresholds) indicated that middle ear status was similar at the times of both tests. With these inclusion criteria, data were available on 140 ears of 77 subjects. RESULTS: Correlation was 0.94 between click-evoked ABR thresholds and the average pure-tone threshold at 2 and 4 kHz. Correlations exceeded 0.92 between ABR thresholds for the 250-Hz tone burst and low-frequency behavioral thresholds (250 Hz, 500 Hz, and the average pure-tone thresholds at 250 and 500 Hz). Similar or higher correlations were observed when ABR thresholds at other frequencies were compared with the pure-tone thresholds at corresponding frequencies. Differences between ABR and behavioral threshold depended on behavioral threshold, with ABR thresholds overestimating behavioral threshold in cases of normal hearing and underestimating behavioral threshold in cases of hearing loss. CONCLUSIONS: These results suggest that ABR thresholds can be used to predict pure-tone behavioral thresholds for a wide range of frequencies. Although controversial, the data reviewed in this paper suggest that click-evoked ABR thresholds result in reasonable predictions of the average behavioral thresholds at 2 and 4 kHz. However, there were cases for which click-evoked ABR thresholds underestimated hearing loss at these frequencies. There are several other reasons why click-evoked ABR measurements were made, including that they (1) generally result in well-formed responses, (2) assist in determining whether auditory neuropathy exists, and (3) can be obtained in a relatively brief amount of time. Low-frequency thresholds were predicted well by ABR thresholds to a single-cycle, 250-Hz tone burst. In combination, click-evoked and low-frequency tone burst-evoked ABR threshold measurements might be used to quickly provide important clinical information for both ends of the audiogram. These measurements could be supplemented by ABR threshold measurements at other frequencies, if time permits. However, it may be possible to plan initial intervention strategies based on data for these two stimuli.

Threshold prediction using the auditory steady-state response and the tone burst auditory brain stem response: a within-subject comparison.

OBJECTIVE: The purpose of this study was to evaluate the accuracy with which auditory steady-state response (ASSR) and tone burst auditory brain stem response (ABR) thresholds predict behavioral thresholds, using a within-subjects design. Because the spectra of the stimuli used to evoke the ABR and the ASSR differ, it was hypothesized that the predictive accuracy also would differ, particularly in subjects with steeply sloping hearing losses. DESIGN: ASSR and ABR thresholds were recorded in a group of 14 adults with normal hearing, 10 adults with flat, sensorineural hearing losses, and 10 adults with steeply sloping, high-frequency, sensorineural hearing losses. Evoked-potential thresholds were recorded at 1, 1.5, and 2 kHz and were compared with behavioral, pure-tone thresholds. The predictive accuracy of two ABR protocols was evaluated: Blackman-gated tone bursts and linear-gated tone bursts presented in a background of notched noise. Two ASSR stimulation protocols also were evaluated: 100% amplitude-modulated (AM) sinusoids and 100% AM plus 25% frequency-modulated (FM) sinusoids. RESULTS: The results suggested there was no difference in the accuracy with which either ABR protocol predicted behavioral threshold, nor was there any difference in the predictive accuracy of the two ASSR protocols. On average, ABR thresholds were recorded 3 dB closer to behavioral threshold than ASSR thresholds. However, in the subjects with the most steeply sloping hearing losses, ABR thresholds were recorded as much as 25 dB below behavioral threshold, whereas ASSR thresholds were never recorded more than 5 dB below behavioral threshold, which may reflect more spread of excitation for the ABR than for the ASSR. In contrast, the ASSR overestimated behavioral threshold in two subjects with normal hearing, where the ABR provided a more accurate prediction of behavioral threshold. CONCLUSIONS: Both the ABR and the ASSR provided reasonably accurate predictions of behavioral threshold across the three subject groups. There was no evidence that the predictive accuracy of the ABR evoked using Blackman-gated tone bursts differed from the predictive accuracy observed when linear-gated tone bursts were presented in conjunction with notched noise. Similarly, there was no evidence that the predictive accuracy of the AM ASSR differed from the AM/FM ASSR. In general, ABR thresholds were recorded at levels closer to behavioral threshold than the ASSR. For certain individuals with steeply sloping hearing losses, the ASSR may be a more accurate predictor of behavioral thresholds; however, the ABR may be a more appropriate choice when predicting behavioral thresholds in a population where the incidence of normal hearing is expected to be high.