Contribution of bone conduction click-evoked auditory brainstem responses to diagnosis of hearing loss in infants in France.

INTRODUCTION: Neonatal hearing screening in France involves confirmation by a childhood hearing expert centre in case of suspected hearing loss. Although click-evoked air-conduction auditory brainstem responses (AC-ABR) are the gold standard in France, there are no guidelines for bone-conduction ABRs (BC-ABR). The present study assessed the interest of associating click-evoked BC- and AC-ABRs for diagnostic confirmation in neonatal hearing screening. MATERIALS AND METHODS: A retrospective study included 59 infant ears with conductive hearing loss referred to the centre of Lyon, France. Objective hearing thresholds were compared between click-evoked BC- and AC-ABRs on a method previously validated in a normal-hearing population. RESULTS: There was a significant difference in mean threshold between AC-ABR (53.27±1.189 dBnHL) and BC-ABR (28.1±0.935 dBnHL) (P<0.001). AC thresholds ranged from 40 to 60 dBnHL while BC thresholds exceeded 40 dBnHL in only 9 ears. CONCLUSION: Using BC-ABRs could reduce the false-positive rate in neonatal bilateral permanent hearing loss screening, in complement to AC-ABRs using the same stimulus. Click-evoked BC-ABR could be contributive whenever conductive hearing loss is suspected, in complement to AC-ABR, without unreasonably increasing examination time.

[Exploration of the auditory system in humans: From click to speech auditory brainstem responses]. / Exploration électrophysiologique des voies auditives sous-corticales chez l'humain : du clic au son de parole.

There is a growing and unprecedented interest in the objective evaluation of the subcortical processes that are involved in speech perception, with potential clinical applications in speech and language impairments. Here, we review the studies illustrating the development of electrophysiological methods for assessing speech encoding in the human brainstem: from the pioneer recordings of click-evoked auditory brainstem responses (ABR), via studies of frequency-following responses (FFR) to the most recent measurements of speech ABR (SABR) or ABR in response to speech sounds. Recent research on SABR has provided new insights in the understanding of subcortical auditory processing mechanisms. The SABR test is an objective and non-invasive tool for assessing individual capacity of speech encoding in the brainstem. SABR characteristics are potentially useful both as a diagnosis tool of speech encoding deficits and as an assessment tool of the efficacy of rehabilitation programs in patients with learning and/or auditory processing disorders.

The temporal relationship between speech auditory brainstem responses and the acoustic pattern of the phoneme /ba/ in normal-hearing adults.

OBJECTIVE: To investigate the temporal relationship between speech auditory brainstem responses and acoustic pattern of the phoneme /ba/. METHODS: Speech elicited auditory brainstem responses (Speech ABR) to /ba/ were recorded in 23 normal-hearing subjects. Effect of stimulus intensity was assessed on Speech ABR components latencies in 11 subjects. The effect of different transducers on electromagnetic leakage was also measured. RESULTS: Speech ABR showed a reproducible onset response (OR) 6ms after stimulus onset. The frequency following response (FFR) waveform mimicked the 500Hz low pass filtered temporal waveform of phoneme /ba/ with a latency shift of 14.6ms. In addition, the OR and FFR latencies decreased with increasing stimulus intensity, with a greater rate for FFR (-1.4ms/10dB) than for OR (-0.6ms/10dB). CONCLUSIONS: A close relationship was found between the pattern of the acoustic stimulus and the FFR temporal structure. Furthermore, differences in latency behaviour suggest different generation mechanisms for FFR and OR. SIGNIFICANCE: The results provided further insight into the temporal encoding of basic speech stimulus at the brainstem level in humans.

Effect of stimulus frequency and stimulation site on the N1m response of the human auditory cortex.

The aim of the present study was to investigate the functional organization of the auditory cortex for pure tones of 1, 2, 4, 6, 8 and 12 kHz. Ten subjects were tested with a whole-head magnetometer (151 channels). The location, latency and amplitude of the generators of the N1m (the main component of the response, peaking approximately at 100 ms) were explored simultaneously in the right and left hemispheres under monaural stimulation. Our results revealed that tonotopy is a rather complex functional organization of the auditory cortex. From 1 to 12 kHz, tonotopic maps were found for contralateral as well as for ipsilateral stimulation: N1m generators were found to be tonotopically organized mainly in an anterior-posterior direction in both hemispheres, whatever the stimulated ear, but also in an inferior-superior direction in the right hemisphere. Furthermore, latencies were longer in the left than in the right hemisphere. Two different representations of spectral distribution were found in the right auditory cortex: one for ipsilateral and one for contralateral stimulation.

Medial olivocochlear bundle activation and perceived auditory intensity in humans.

In order to test the hypothesis of a role of cochlear efferent activity in intensity perception in humans, loudness functions, loudness integration, and loudness summation were measured in the absence and in the presence of contralateral noise in normal-hearing subjects. Additionally, relationships with the effect of the noise on evoked otoacoustic emissions (EOAEs) were tested, and comparisons with vestibular neurotomy patients were performed. Overall, the results failed to demonstrate significant effects of contralateral noise stimulation on loudness functions and loudness integration. Furthermore, no significant differences were found in vestibular neurotomy patients. A significant effect of contralateral noise on loudness summation was noted, but was not related to the effect on otoacoustic emissions. The present results fail to support the notion that efferent influences onto the cochlear compression have a significant perceptual effect.

Peripheral auditory lateralization assessment using TEOAEs.

Previous studies indicate a left-right asymmetry in the function of peripheral auditory system. Contralateral acoustic suppression of TEOAEs (transient evoked otoacoustic emissions) enables assessment of medial olivocochlear efferent system functioning, and has demonstrated that this system is more effective in the right than in the left ear. Moreover, TEOAE amplitudes are lower in the left than in the right ear. The aim of the present experiment was to verify firstly the absence of a relationship between medial efferent system asymmetry and TEOAE amplitude asymmetry, and secondly to study TEOAE input/output function slopes. There was no link between the asymmetries in TEOAE amplitude and in the medial efferent system functioning. Further, as previously shown, the medial olivocochlear system increased the TEOAE input/output function slopes. These TEOAE input/output function slopes seem to be consistent factors in peripheral asymmetry since the slope is lower in the right than in the left ear. Moreover, the lower the TEOAE amplitudes, the greater the TEOAE slopes. The slope asymmetry of the two ears could correspond to earlier saturation or a lower augmentation ability of the TEOAE response in the right ear, where the TEOAE amplitude is higher. This asymmetry in growth slopes reinforces the notion of peripheral auditory lateralization.

Effect of contralateral acoustic stimulation on the growth of click-evoked otoacoustic emissions in humans.

Input-output (I/O) functions of click-evoked otoacoustic emissions (CEOAEs) were obtained over a 12 dB range for 64 normally hearing adult listeners with and without contralateral broadband noise (BBN). Contralateral acoustic stimulation (CAS) is a convenient way of suppressing responses to ipsilateral stimuli, probably acting via the medial olivocochlear system (MOCS). The present study shows that this contralateral sound suppression of CEOAEs is largest at low stimulus levels. In fact, the curves obtained under CAS approach the curves obtained without CAS as stimulus level rises. I/O slope analysis for the whole study population (n = 64) showed a slight but significant rise in slope with BBN, which may be interpreted as I/O function decompression. A loss of contralateral suppression effect at high ipsilateral stimulus levels was found in both very low and very high amplitude CEOAE subjects, despite the fact that I/O slopes differed between these two groups, whereas rise in slope under contralateral stimulation failed to be found for these same 2 groups of 16 subjects each. These findings clearly indicate that the MOCS is mostly functional at low sound levels, and suggest that the study of CEOAE I/O slope alteration under CAS may help specify one form of MOCS action on cochlear functioning.

Click-evoked otoacoustic emissions and hearing threshold in sensorineural hearing loss.

The influence of hearing loss on the click-evoked otoacoustic emissions (EOAE) were studied in 931 ears. The EOAEs were never found when hearing loss on the best hearing frequency was above 40 dB HL. The presence of EOAEs reflects the hearing threshold at the best hearing frequency, not only at the middle frequencies.

Interrelations between transiently evoked otoacoustic emissions, spontaneous otoacoustic emissions and acoustic distortion products in normally hearing subjects.

Active cochlear mechanisms and especially outer hair cells seem to be involved in oto-acoustic emissions (OAEs) genesis. This study sought to investigate basic characteristics of spontaneous otoacoustic emissions (SOAEs), click-evoked otoacoustic emissions (TOAEs) and interrelations between SOAEs, TOAEs and 2f1-f2 and 2f2-f1 distortion product OAEs (DPOAEs) in 135 normally hearing subjects. A gender effect was shown on TOAEs and DPOAEs amplitude, and is attributed to the higher incidence of SOAEs in women (58%) than in men (22%). Moreover, SOAEs presence seems to mask the age effect found, especially at high frequency components, on TOAEs amplitude. A general influence of SOAEs on TOAEs and DPOAEs is shown, especially at frequencies ranging from 1 kHz to 3 kHz, collecting more than 66% of the SOAEs peaks recorded. Lastly, correlations between TOAEs frequency band amplitude and 2f1-f2 DPOAEs amplitude, shows frequency specificity, at least at low frequencies (i.e., from 0.5 to 2 kHz) in agreement with previous works suggesting that the 2f1-f2 DPOAEs generation site is at the geometric mean of the primaries. The same correlations calculated with 2f2-f1 DPOAEs amplitude show frequency specificity at low frequencies i.e., at 800 Hz and 1600 Hz. 2f2-f1 DPOAEs in humans are shown to be generated near the 2f2-f1 frequency region on the cochlear partition.

Effects of contralateral white noise on click-evoked emissions in normal and sensorineural ears: towards an exploration of the medial olivocochlear system.

The association between contralateral stimulation and evoked otoacoustic emissions (EOAEs) allows study of sound-evoked olivocochlear feedback and then of the medial olivocochlear system. A method allowing quantification of sound-evoked olivocochlear feedback is proposed. The feedback is present in almost all normal-hearing subjects, but with great interindividual variability. In sensorineural hearing loss, the feedback is present in 20 out of 21 subjects. One paradoxical clinical case is described with a unilateral increase of EOAE intensity during contralateral stimulation.

Evoked otoacoustic emissions: relative importance of age, sex and sensorineural hearing-loss using a mathematical model of the audiogram.

The influence of age, sex and of hearing loss on the EOAEs were studied in 140 subjects. The EOAEs were never found when hearing loss on the best hearing frequency was above 40 dB HL and when the threshold of intelligibility was above 45 dB HL. The presence of EOAEs therefore does not only give specific information on the midfrequencies, but also shows a hearing loss below or equal to 40 dB HL on at least one frequency. In addition, there is a relation between the audiometric curve and the spectrum analysis of EOAEs. These seem to be promising results for clinical applications.

Effect of contralateral acoustic stimulation on active cochlear micromechanical properties in human subjects: dependence on stimulus variables.

1. Outer hair cells (OHCs) have active micromechanical properties that are thought to be the origin of evoked otoacoustic emissions (EOAEs). In the present study, click-evoked otoacoustic emissions were recorded in humans with or without various contralateral acoustic stimulations. A previous study, concentrating on contralateral stimulation with broadband noise, had shown a decrease of the EOAE amplitude in humans. Results support a role for the efferent system in cochlear mechanics; indeed, medial efferent neurons of the olivocochlear bundle terminate on the OHCs. To obtain a better understanding of the medial efferent system functioning in humans, the present study looked at the contralateral suppressive effect as a function of stimulus parameters. 2. The study of the input-output function of the EOAE amplitude with and without a 50-dB SPL contralateral broadband noise showed that the suppressive effect was equivalent to a mean reduction of 3.77 dB. 3. For the EOAEs to tone pips, the contralateral suppressive effect was strongest when the contralateral ear stimuli were narrow bands that were centered around the central EOAE frequency. This frequency specificity disappeared for contralateral narrow band noise levels greater than 50 dB SPL. 4. The contralateral suppressive effect was also observed with transient contralateral sounds (nonfiltered clicks). Significant reductions of the EOAE amplitude were seen with contralateral click levels as low as 17.5 dB SL. Above this level, the EOAE amplitude decreased as the contralateral stimulus level increased. This effect was still present in subjects without any stapedial reflex, but absent in total unilateral hearing-loss subjects. Therefore this suppressive effect is unlikely to be due to alteration of the middle ear function or to transcranially conducted sound. 5. When the contralateral interclick interval exceeded 14.2 ms. the suppressive effect was smaller. With contralateral stimulus level maintained subjectively constant, the effect was found to disappear when the interclick interval was greater than 49.9 ms. A saturation of the contralateral suppressive effect was observed for click rates greater than 70/s (interclick interval less than 14.2 ms). 6. Our study confirms and specifies the contralateral sound suppression effect on cochlear mechanisms in humans, assessing the equivalent reduction, showing a frequency specificity and extending these findings to contralateral transient sounds. Any influence of the acoustic crosstalk was eliminated. A role played by middle ear muscles cannot be absolutely ruled out but is not necessary to produce such a contralateral suppressive effect (the effect being found in subjects after surgical removal of the stapedius muscle) and could not explain the frequency specificity.(ABSTRACT TRUNCATED AT 400 WORDS)

Noise and medial olivocochlear system in humans.

Evoked otoacoustic emissions (EOAE) and sound evoked olivocochlear feedback were performed in 200 subjects (noise induced hearing loss (NIHL), n = 109; sensori-neural hearing loss (SNHL), n = 91). Intensity of EOAE is greater in NIHL than in SNHL. This result does not seem to be related to the medial olivocochlear system since sound olivocochlear feedback was not significantly different between the two groups. No correlations were seen between temporary threshold shifts (TTS) and sound-olivocochlear feedback in the NIHL group.