[A case of Holmes tremor in which 123I-IMP SPECT and MRI findings suggest damage to the cerebellothalamic tract and the dentato-rubro-olivary pathway].

A 75-year-old woman was referred to our department in October 2022 with ataxia and involuntary movements of the right upper and lower limbs. She had experienced a left pontine hemorrhage in March 2021, which was managed conservatively. However, she had residual right-sided hemiplegia. In addition, she had cerebellar ataxia and a 2 |Hz resting tremor of the right upper and lower limbs, which was enhanced while maintaining posture and contemplation. Based on her history, and the findings of MRI and nuclear medicine imaging, we diagnosed the patient with Holmes tremor due to pontine hemorrhage. Holmes tremor is a rare movement disorder secondary to brainstem and thalamic lesions, characterized by a unilateral low-frequency tremor. In this case, 123I-IMP SPECT and MRI shows damage to the cerebellothalamic tract and dentaro-rubro-olivary pathway.

Speech Perception in Noise and Medial Olivocochlear Reflex: Effects of Age, Speech Stimulus, and Response-Related Variables.

PURPOSE: The role of the medial olivocochlear system in speech perception in noise has been debated over the years, with studies showing mixed results. One possible reason for this could be the dependence of this relationship on the parameters used in assessing the speech perception ability (age, stimulus, and response-related variables). METHODS: The current study assessed the influence of the type of speech stimuli (monosyllables, words, and sentences), the signal-to-noise ratio (+5, 0, -5, and -10 dB), the metric used to quantify the speech perception ability (percent-correct, SNR-50, and slope of the psychometric function) and age (young vs old) on the relationship between medial olivocochlear reflex (quantified by contralateral inhibition of transient evoked otoacoustic emissions) and speech perception in noise. RESULTS: A linear mixed-effects model revealed no significant contributions of the medial olivocochlear reflex to speech perception in noise. CONCLUSION: The results suggest that there was no evidence of any modulatory influence of the indirectly measured medial olivocochlear reflex strength on speech perception in noise.

Medial Olivocochlear Reflex Strength in Ears With Low-to-Moderate Annual Noise Exposure.

PURPOSE: Studies in lower mammals demonstrate enhancement of the medial olivocochlear reflex (MOCR) following noise exposure. A similar effect may occur in humans, and there is some evidence of an individual's acoustic history affecting the MOCR. The current work evaluates the relationship between an individual's annual noise exposure history and their MOCR strength. Given the potential role of the MOCR as a biological hearing protector, it is important to identify factors associated with MOCR strength. METHOD: Data were collected from 98 normal-hearing young adults. Annual noise exposure history was estimated using the Noise Exposure Questionnaire. MOCR strength was assayed using click-evoked otoacoustic emissions (CEOAEs) measured with and without noise presented to the contralateral ear. MOCR metrics included the MOCR-induced otoacoustic emission (OAE) magnitude shift and phase shift. A CEOAE signal-to-noise ratio (SNR) of at least 12 dB was required for estimation of the MOCR metrics. Linear regression was applied to evaluate the relationship between MOCR metrics and annual noise exposure. RESULTS: Annual noise exposure was not a statistically significant predictor of the MOCR-induced CEOAE magnitude shift. However, annual noise exposure was a statistically significant predictor of the MOCR-induced CEOAE phase shift-the MOCR-induced phase shift decreased with increasing noise exposure. Additionally, annual noise exposure was a statistically significant predictor of OAE level. CONCLUSIONS: Findings contrast with recent work that suggests MOCR strength increases with annual noise exposure. Compared with previous work, data for this study were collected using more stringent SNR criteria, which is expected to increase the precision of the MOCR metrics. Additionally, data were collected for a larger subject population with a wider range of noise exposures. Whether findings generalize to other exposure durations and levels is unknown and requires future study.

Assessing Medial Olivocochlear Reflex Strengths via Auditory Brainstem Response: Measurement and Variability in Normal-Hearing Individuals.

PURPOSE: Optimal measurement settings to measure the medial olivocochlear reflex (MOCR) in humans have not yet been defined. The purpose of this study was to advance the representation of the MOCR in auditory brainstem response (ABR) as an addition to the current diagnostic portfolio. PARTICIPANTS AND METHOD: Twelve female and 14 male normal-hearing adults participated in the study. Potential effects of a contralateral acoustic stimulus (CAS) on amplitude changes were investigated by recording ABR waveform profiles on the left side at click intensities of 50/60/70 dB nHL with and without CAS (60 dB SPL). Secondly, to detect potential chronological order influences, measurement settings were rearranged on the right side and measurements were repeated. Additionally, ABR thresholds were recorded with and without a CAS in 10 patients. RESULTS: When the effect of contralateral suppression was analyzed on the basis of amplitude changes, there was a change under administration of the CAS signal that was statistically significant. Interestingly, the order of recordings affected the degree of amplitude change. In three out of 10 patients, reproducible suppression effects on ABR thresholds were detectable upon CAS presentation. CONCLUSIONS: To our knowledge, this is the largest study dealing with the recording of the MOCR elicited by a contralateral noise via ABR in normal-hearing individuals. Effects of MOCR are measurable via amplitude changes upon CAS administration. Chronological orders influence the impact of this effect on amplitude changes. Optimal measurement settings have not yet been defined. However, experiments such as this study may help to further improve measurements, and thus advance the representation of the MOC reflex in ABR as an addition to the current diagnostic portfolio.

Lack of correlation between medial olivocochlear reflex strength and sentence recognition in noise.

OBJECTIVE: The medial olivocochlear (MOC) reflex provides unmasking of sounds in noise, but its contribution to speech-in-noise perception remains unclear due to conflicting results. This study determined associations between MOC reflex strength and sentence recognition in noise in individuals with normal hearing. DESIGN: MOC reflex strength was assessed using contralateral inhibition of transient-evoked otoacoustic emissions (TEOAEs). Scores on the AzBio sentence task were quantified at three signal-to-noise ratios (SNRs). Additionally, slope and threshold of the psychometric function were computed. Associations between MOC reflex strength and speech-in-noise outcomes were assessed using Spearman rank correlations. STUDY SAMPLE: Nineteen young adults with normal hearing participated, with data from 17 individuals (mean age = 21.8 years) included in the analysis. RESULTS: Contralateral noise significantly decreased the amplitude of TEOAEs. A range of contralateral inhibition values was exhibited across participants. Scores increased significantly with increasing SNR. Contrary to hypotheses, there were no significant correlations between MOC reflex strength and score, nor were there any significant correlations between MOC reflex strength and measures of the psychometric function. CONCLUSIONS: Results found no significant monotonic relationship between MOC reflex strength and sentence recognition in noise. Future work is needed to determine the functional role of the MOC reflex.

The effect of broadband elicitor laterality on psychoacoustic gain reduction across signal frequency.

There are psychoacoustic methods thought to measure gain reduction, which may be from the medial olivocochlear reflex (MOCR), a bilateral feedback loop that adjusts cochlear gain. Although studies have used ipsilateral and contralateral elicitors and have examined strength at different signal frequencies, these factors have not been examined within a single study. Therefore, basic questions about gain reduction, such as the relative strength of ipsilateral vs contralateral elicitation and the relative strength across signal frequency, are not known. In the current study, gain reduction from ipsilateral, contralateral, and bilateral elicitors was measured at 1-, 2-, and 4-kHz signal frequencies using forward masking paradigms at a range of elicitor levels in a repeated measures design. Ipsilateral and bilateral strengths were similar and significantly larger than contralateral strength across signal frequencies. Growth of gain reduction with precursor level tended to differ with signal frequency, although not significantly. Data from previous studies are considered in light of the results of this study. Behavioral results are also considered relative to anatomical and physiological data on the MOCR. These results indicate that, in humans, cochlear gain reduction is broad across frequencies and is robust for ipsilateral and bilateral elicitation but small for contralateral elicitation.

Efferent-induced shifts in synchronized-spontaneous-otoacoustic-emission magnitude and frequency.

Synchronized-spontaneous otoacoustic emissions (SSOAEs) present as slow-decaying emission energy that persists after the transient-evoked otoacoustic emission (TEOAE). SSOAEs possess high amplitudes and signal-to-noise ratios, making them potentially ideal candidates to assay the medial-olivocochlear reflex (MOCR). The current work quantified MOCR-induced changes to SSOAEs over a 36-dB stimulus level range and compared MOCR effects between TEOAE- and SSOAE-based assays. Otoacoustic emissions were evoked using band limited clicks from 52 to 88 dB peak sound pressure level (pSPL) with and without contralateral-acoustic stimulation (CAS) in 25 normal-hearing, female adults. The CAS was 50-dB sound pressure level (SPL) broadband noise and served to activate the MOCR. The number of SSOAEs increased with the stimulus level through approximately 70 dB pSPL. The presentation of CAS resulted in fewer SSOAEs. SSOAEs exhibited compressive growth and approached saturation for stimulus levels of 70 dB pSPL. The primary effects of CAS were a reduction in the SSOAE magnitude and an upward shift in the SSOAE frequency. These changes were not strongly affected by the stimulus level. Time-domain analysis of the SSOAE revealed an increase in the CAS-induced magnitude shift during the decay portion of the SSOAE. Compared to CAS-induced TEOAE magnitude shifts, SSOAE magnitude shifts were typically 2-3 dB larger. Findings support SSOAEs as a means to assay the MOCR.

Medial olivocochlear reflex effects on synchronized spontaneous otoacoustic emissions.

This study characterized medial olivocochlear (MOC) reflex activity on synchronized spontaneous otoacoustic emissions (SSOAEs) as compared to transient-evoked otoacoustic emissions (TEOAEs) in normal-hearing adults. Using two time windows, changes in TEOAE and SSOAE magnitude and phase due to a MOC reflex elicitor were quantified from 1 to 4 kHz. In lower frequency bands, changes in TEOAE and SSOAE magnitude were significantly correlated and were significantly larger for SSOAEs. Changes in TEOAE and SSOAE phase were not significantly different, nor were they significantly correlated. The larger effects on SSOAE magnitude may improve the sensitivity for detecting the MOC reflex.

Human medial olivocochlear reflex: Contralateral activation effect on low and high frequency cochlear response.

The role of the medial olivocochlear (MOC) reflex has been investigated by assessing changes of cochlear responses (CR) in humans. The CR consists of pre-neural and neural potentials originating from the inner ear, and at high signal levels is dominated by cochlear microphonic (CM). The CM originates from the outer hair cells, where the MOC fibers synapse, and there is little research about using it to investigate the MOC reflex in humans. The current study aimed to investigate the effect of contralateral activation of the MOC reflex on the CR in humans. The CR was recorded in female adults (n = 16) to 500 and 2000 Hz tone burst stimuli presented at 80 dB nHL with and without contralateral broadband noise (CBBN) at 40 dB SPL. Two different methods were utilized to quantify and analyze the CR data: peak amplitude and power spectrum. Results revealed enhancement of the CR amplitude with activation of the MOC reflex. Furthermore, on average, enhancement in the CR amplitude was observed to 500 Hz, but not 2000 Hz stimulus. The CR power spectrum findings revealed similar findings to the peak amplitude. These findings indicate the MOC effect is measurable when using a low frequency stimulus, but not high frequency. Moreover, the CR could be used as a potential tool to study the MOC reflex in humans.

Contralateral suppression of otoacoustic emissions in pre-school children.

BACKGROUND: Contralateral suppression of otoacoustic emissions (OAEs) may serve as an index of the medial olivocochlear (MOC) reflex. To date, this index has been studied in various populations but never in pre-school children. The purpose of this study was to fill this gap and describe how the MOC reflex affects the properties of transiently evoked OAEs (TEOAEs) in this age group. In addition, the influence of the presence of spontaneous OAEs (SOAEs) in the studied ear on the suppression of TEOAEs was also investigated. METHODS: TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured in 126 normally hearing pre-school children aged 3-6 years. The values of response levels, suppression by CAS, and signal-to-noise ratios (SNRs) of TEOAEs were investigated for the whole signal (global) and for half-octave frequency bands from 1 to 4 kHz. Only ears with SNR >6 dB were used in the analyses. SOAEs were acquired using the so-called synchronized SOAEs (SSOAEs) technique. RESULTS: Ears with SSOAEs had higher response levels and SNRs than ears without SSOAEs, and suppression was lower (0.58 dB compared to 0.85 dB). Only 22% of all studied ears had an SNR >20 dB, a level recommended in some studies for measuring suppression. There were no significant effects of age or gender on TEOAE suppression. CONCLUSIONS: Suppression levels for pre-school children did not differ appreciably from those of adults measured under similar conditions in other studies. Taken together with no effect of age in the data studied here, it seems that there is no effect of age on TEOAE suppression. However, we did find that the presence of SSOAEs had an effect on TEOAE suppression, a finding which has not been reported in earlier studies on different populations. We suggest that the presence of SSOAEs might be a crucial factor related to MOC function.

Medial olivocochlear suppression in musicians versus non-musicians.

The medial olivocochlear efferent (MOCE) branch synapses with outer hair cells (OHCs), and the efferent pathway can be activated via a contralateral acoustic stimulus (CAS). The activation of MOCE can change OHC motile responses and convert signals that are capable of controlling the sensitivity of the peripheral hearing system in a frequency-specific manner. The aim of this study was to examine the MOCE system activity in professional musicians using transient evoked otoacoustic emission test and CAS. Musician group showed stronger suppression in all frequency bands in the presence of CAS.

Conversion of Graded Presynaptic Climbing Fiber Activity into Graded Postsynaptic Ca2+ Signals by Purkinje Cell Dendrites.

The brain must make sense of external stimuli to generate relevant behavior. We used a combination of in vivo approaches to investigate how the cerebellum processes sensory-related information. We found that the inferior olive encodes contexts of sensory-associated external cues in a graded manner, apparent in the presynaptic activity of their axonal projections (climbing fibers) in the cerebellar cortex. Individual climbing fibers were broadly responsive to different sensory modalities but relayed sensory-related information to the cortex in a lobule-dependent manner. Purkinje cell dendrites faithfully transformed this climbing fiber activity into dendrite-wide Ca2+ signals without a direct contribution from the mossy fiber pathway. These results demonstrate that the size of climbing-fiber-evoked Ca2+ signals in Purkinje cell dendrites is largely determined by the firing level of climbing fibers. This coding scheme emphasizes the overwhelming role of the inferior olive in generating salient signals useful for instructing plasticity and learning.

The Effect of Otoacoustic Emission Stimulus Level on the Strength and Detectability of the Medial Olivocochlear Reflex.

OBJECTIVES: Previous work demonstrates the importance of a high signal to noise ratio (SNR) when using transient evoked otoacoustic emissions (TEOAEs) to assay the medial olivocochlear reflex (MOCR). Increasing stimulus level provides one means to increase TEOAE SNR. However, this may come at the expense of a smaller MOCR effect. It is not clear whether the gain in SNR associated with the use of higher stimulus levels outweighs the disadvantage of a potentially smaller MOCR effect. The present study investigated the strength and detectability of the MOCR when assayed using TEOAEs at different stimulus levels. The hypothesis was that although the strength of the MOCR decreases with increasing stimulus level, the occurrence of statistically significant MOCR effects increases due to an increase in TEOAE SNR. DESIGN: Twenty-five young adult females with normal hearing participated in the study. TEOAEs were measured in the right ear with and without broadband noise presented in the left ear. The strength of the MOCR was quantified as the percent difference in the TEOAE between the contralateral noise and quiet conditions. Statistical bootstrapping was used to detect significant MOCR effects in individual subjects across different frequency bands and stimulus levels. The relationship between a detectable MOCR (response variable) and frequency, stimulus level, TEOAE SNR, MOCR strength, and subject (predictor variables) was evaluated using generalized linear mixed-effect models. RESULTS: The number of statistically significant MOCR effects increased with stimulus level at all frequencies. Occurrence was highest for the 2-kHz TEOAE frequency band and lowest for the 4-kHz frequency band. The strength of the MOCR decreased with increasing click level. TEOAE SNR, MOCR strength, and stimulus level were significant predictors of a detectable MOCR: The likelihood of a detectable MOCR increased with TEOAE SNR, MOCR strength, and stimulus level. CONCLUSIONS: Despite a reduction in the strength of the MOCR with increasing stimulus level, the detectability of the MOCR increased. This is due, in part, to an increase in TEOAE SNR with stimulus level. For clinical implementation of TEOAE-based MOCR assays, achieving a high SNR is necessary to permit the detection of the MOCR in individual patients.

Auditory event-related potentials and function of the medial olivocochlear efferent system in children with auditory processing disorders.

OBJECTIVE: The objectives were to investigate the function of central auditory pathways and of the medial efferent olivocochlear system (MOCS). DESIGN: Event-related potentials (ERP) were recorded following the delivery of the stimulus /da/ in quiet and in ipsilateral, contralateral, and binaural noise conditions and correlated to the results of the auditory processing disorders (APD) diagnostic test battery. MOCS function was investigated by adding ipsilateral, contralateral, and binaural noise to transient evoked otoacoustic emission recordings. Auditory brainstem responses and pure tone audiogram were also evaluated. STUDY SAMPLE: Nineteen children (7 to 12 years old) with APD were compared with 24 age-matched controls. RESULTS: Otoacoustic emissions and ABR characteristics did not differ between groups, whereas ERP latencies were significantly longer and of higher amplitudes in APD children than in controls, in both quiet and noise conditions. The MOCS suppression was higher in APD children. CONCLUSIONS: Findings indicate that children with APD present with neural deficiencies in both challenging and nonchallenging environments with an increase in the timing of several central auditory processes correlated to their behavioural performances. Meanwhile, their modulation of the auditory periphery under noisy conditions differs from control children with higher suppression.

Adversarial relationship between combined medial olivocochlear (MOC) and middle-ear-muscle (MEM) reflexes and alarm-in-noise detection thresholds under negative signal-to-noise ratios (SNRs).

The role of auditory efferent feedback from the medial olivocochlear system (MOCS) and the middle-ear-muscle (MEM) reflex in tonal detection tasks for humans in the presence of noise is not clearly understood. Past studies have yielded inconsistent results on the relationship between efferent feedback and tonal detection thresholds. This study attempts to address this inconsistency. Fifteen human subjects with normal hearing participated in an experiment where they were asked to identify an alarm signal in the presence of 80 dBA background (pink) noise. Masked detection thresholds were estimated using the method of two-interval forced choice (2IFC). Contralateral suppression of transient-evoked otoacoustic emissions (TEOAEs) was measured to estimate the strength of auditory efferent feedback. Subsequent correlation analysis revealed that the contralateral suppression of TEOAEs was significantly negatively correlated (r = -0.526, n = 15, p = 0.0438) with alarm-in-noise (AIN) detection thresholds under negative signal-to-noise conditions. The result implies that the stronger the auditory efferent feedback, the worse the detection thresholds and thus the poorer the tonal detection performance in the presence of loud noise.

Principal cells of the brainstem's interaural sound level detector are temporal differentiators rather than integrators.

The brainstem's lateral superior olive (LSO) is thought to be crucial for localizing high-frequency sounds by coding interaural sound level differences (ILD). Its neurons weigh contralateral inhibition against ipsilateral excitation, making their firing rate a function of the azimuthal position of a sound source. Since the very first in vivo recordings, LSO principal neurons have been reported to give sustained and temporally integrating 'chopper' responses to sustained sounds. Neurons with transient responses were observed but largely ignored and even considered a sign of pathology. Using the Mongolian gerbil as a model system, we have obtained the first in vivo patch clamp recordings from labeled LSO neurons and find that principal LSO neurons, the most numerous projection neurons of this nucleus, only respond at sound onset and show fast membrane features suggesting an importance for timing. These results provide a new framework to interpret previously puzzling features of this circuit.

Human medial efferent activity elicited by dynamic versus static contralateral noises.

The medial olivocochlear reflex (MOCR) modifies cochlear amplifier function to improve encoding of signals in static noise, but conflicting results have been reported regarding how the MOCR responds to dynamic, temporally-complex noises. The current study utilized three MOCR elicitors with identical spectral content but different temporal properties: broadband noise, amplitude-modulated noise, and speech envelope-modulated noise. MOCR activity was assessed using contralateral inhibition of transient-evoked otoacoustic emissions in 27 normal-hearing young adults. Elicitors were presented contralaterally at two intensities of 50 and 60 dB SPL. Magnitude and growth of contralateral inhibition with increasing elicitor intensity were compared across the three elicitor types. Results revealed that contralateral inhibition was significantly larger at the elicitor intensity of 60 dB SPL than at 50 dB SPL, but there were no significant differences in the magnitude and growth of inhibition across the three elicitors, contrary to hypothesis. These results suggest that the MOCR responds similarly to both static and dynamic noise.

Olivocochlear efferents: Their action, effects, measurement and uses, and the impact of the new conception of cochlear mechanical responses.

The anatomy and physiology of olivocochlear (OC) efferents are reviewed. To help interpret these, recent advances in cochlear mechanics are also reviewed. Lateral OC (LOC) efferents innervate primary auditory-nerve (AN) fiber dendrites. The most important LOC function may be to reduce auditory neuropathy. Medial OC (MOC) efferents innervate the outer hair cells (OHCs) and act to turn down the gain of cochlear amplification. Cochlear amplification had been thought to act only through basilar membrane (BM) motion, but recent reports show that motion near the reticular lamina (RL) is amplified more than BM motion, and that RL-motion amplification extends to several octaves below the local characteristic frequency. Data on efferent effects on AN-fiber responses, otoacoustic emissions (OAEs) and human psychophysics are reviewed and reinterpreted in the light of the new cochlear-mechanical data. The possible origin of OAEs in RL motion is considered. MOC-effect measuring methods and MOC-induced changes in human responses are also reviewed, including that ipsilateral and contralateral sound can produce MOC effects with different patterns across frequency. MOC efferents help to reduce damage due to acoustic trauma. Many, but not all, reports show that subjects with stronger contralaterally-evoked MOC effects have better ability to detect signals (e.g. speech) in noise, and that MOC effects can be modulated by attention.

Efferent modulation of pre-neural and neural distortion products.

Distortion product otoacoustic emissions (DPOAEs) and distortion product frequency following responses (DPFFRs) are respectively pre-neural and neural measurements associated with cochlear nonlinearity. Because cochlear nonlinearity is putatively linked to outer hair cell electromotility, DPOAEs and DPFFRs may provide complementary measurements of the human medial olivocochlear (MOC) reflex, which directly modulates outer hair cell function. In this study, we first quantified MOC reflex-induced DPOAE inhibition at spectral fine structure peaks in 22 young human adults with normal hearing. The f1 and f2 tone pairs producing the largest DPOAE fine structure peak for each subject were then used to evoke DPFFRs with and without MOC reflex activation to provide a related neural measure of efferent inhibition. We observed significant positive relationships between DPOAE fine structure peak inhibition and inhibition of DPFFR components representing neural phase locking to f2 and 2f1-f2, but not f1. These findings may support previous observations that the MOC reflex inhibits DPOAE sources differentially. That these effects are maintained and represented in the auditory brainstem suggests that the MOC reflex may exert a potent influence on subsequent subcortical neural representation of sound.

Increased medial olivocochlear reflex strength in normal-hearing, noise-exposed humans.

Research suggests that college-aged adults are vulnerable to tinnitus and hearing loss due to exposure to traumatic levels of noise on a regular basis. Recent human studies have associated exposure to high noise exposure background (NEB, i.e., routine noise exposure) with the reduced cochlear output and impaired speech processing ability in subjects with clinically normal hearing sensitivity. While the relationship between NEB and the functions of the auditory afferent neurons are studied in the literature, little is known about the effects of NEB on functioning of the auditory efferent system. The objective of the present study was to investigate the relationship between medial olivocochlear reflex (MOCR) strength and NEB in subjects with clinically normal hearing sensitivity. It was hypothesized that subjects with high NEB would exhibit reduced afferent input to the MOCR circuit which would subsequently lead to reduced strength of the MOCR. In normal-hearing listeners, the study examined (1) the association between NEB and baseline click-evoked otoacoustic emissions (CEOAEs) and (2) the association between NEB and MOCR strength. The MOCR was measured using CEOAEs evoked by 60 dB pSPL linear clicks in a contralateral acoustic stimulation (CAS)-off and CAS-on (a broadband noise at 60 dB SPL) condition. Participants with at least 6 dB signal-to-noise ratio (SNR) in the CAS-off and CAS-on conditions were included for analysis. A normalized CEOAE inhibition index was calculated to express MOCR strength in a percentage value. NEB was estimated using a validated questionnaire. The results showed that NEB was not associated with the baseline CEOAE amplitude (r = -0.112, p = 0.586). Contrary to the hypothesis, MOCR strength was positively correlated with NEB (r = 0.557, p = 0.003). NEB remained a significant predictor of MOCR strength (ß = 2.98, t(19) = 3.474, p = 0.003) after the unstandardized coefficient was adjusted to control for effects of smoking, sound level tolerance (SLT) and tinnitus. These data provide evidence that MOCR strength is associated with NEB. The functional significance of increased MOCR strength is discussed.