Amplitude modulation of DPOAEs by acoustic stimulation of the contralateral ear.

CONCLUSION: Otoacoustic emissions generated by outer hair cells (OHCs) are influenced by stimulation of the contralateral ear via a neural pathway involving the olivo-cochlear efferent system. This is often referred to as a contralateral 'suppression reflex', but we suggest that such a term is inappropriate since distortion product otoacoustic emissions (DPOAEs) can be both enhanced and suppressed, and there is continuous modulation with no threshold effects. OBJECTIVE: To characterize the continuous amplitude modulation of DPOAEs by contralateral sound stimulation. MATERIALS AND METHODS: In an animal model (chinchilla), DPOAEs were recorded in real time from one ear during presentation of acoustic stimuli to the opposite ear. RESULTS: DPOAE amplitude is suppressed by an increase in contralateral stimulation, and enhanced by a decrease in same, i.e. the emissions are continuously modulated by activity in the opposite ear. The input-output function shows a linear relationship to this system over a 40-50 dB range of contralateral stimulus levels. After a neural delay time of approximately 25 ms, DPOAE amplitude closely follows contralateral amplitude signals up to modulation frequencies of approximately 20 Hz. Thus, stimuli to one ear continually modulate the OHC system (and therefore the biomechanical amplification) of the contralateral cochlea.

Auditory brainstem activity and development evoked by apical versus basal cochlear implant electrode stimulation in children.

OBJECTIVE: The role of apical versus basal cochlear implant electrode stimulation on central auditory development was examined. We hypothesized that, in children with early onset deafness, auditory development evoked by basal electrode stimulation would differ from that evoked more apically. METHODS: Responses of the auditory nerve and brainstem, evoked by an apical and a basal implant electrode, were measured over the first year of cochlear implant use in 50 children with early onset severe to profound deafness who used hearing aids prior to implantation. RESULTS: Responses at initial stimulation were of larger amplitude and shorter latency when evoked by the apical electrode. No significant effects of residual hearing or age were found on initial response amplitudes or latencies. With implant use, responses evoked by both electrodes showed decreases in wave and interwave latencies reflecting decreased neural conduction time through the brainstem. Apical versus basal differences persisted with implant experience with one exception; eIII-eV interlatency differences decreased with implant use. CONCLUSIONS: Acute stimulation shows prolongation of basally versus apically evoked auditory nerve and brainstem responses in children with severe to profound deafness. Interwave latencies reflecting neural conduction along the caudal and rostral portions of the brainstem decreased over the first year of implant use. Differences in neural conduction times evoked by apical versus basal electrode stimulation persisted in the caudal but not rostral brainstem. SIGNIFICANCE: Activity-dependent changes of the auditory brainstem occur in response to both apical and basal cochlear implant electrode stimulation.

Projections from the medial geniculate body to primary auditory cortex in neonatally deafened cats.

In the present study, anatomical projections from the medial geniculate body (MGB) to primary auditory cortex (AI) were investigated in normal adult cats and in animals that were neonatally deafened with the ototoxic drug amikacin. Cochleotopic/tonotopic maps in AI (based on neural response characteristic frequency) were obtained with microelectrode recording techniques, and single or multiple injections of retrograde tracers (horseradish peroxidase and fluorescent dyes) were introduced into AI. The AI maps of the amikacin-treated cats had an abnormal cochleotopic organization, such that deprived cortical areas exhibited an expanded representation of intact regions of the damaged cochlea. However, retrograde tracer injections into different regions of AI produced a normal pattern of labeling in the ventral division of the medial geniculate body (MGBv). In both experimental and control animals, the main mass of labeled thalamic cells was found in the MGBv. Different isofrequency contours in AI receive input from different portions of the MGBv. Thus, cell arrays labeled by anterior AI injections were situated medially in MGBv, and injections into posterior AI labeled MGBv more laterally. Furthermore, the deafened cats did not develop a more divergent thalamocortical projection compared with normal control animals, indicating that an abnormal spread of the thalamocortical afferents across the frequency domain in AI (anterior-posterior axis) is not responsible for the altered cochleotopic map in these neonatally deafened animals. The relatively normal thalamocortical projection pattern suggests that, after neonatal cochlear lesions, the major reorganization of cochleotopic maps occurs at subthalamic levels.

Psychosocial adjustment to and control of diabetes mellitus: differences by disease type and treatment.

The relationship of diabetic patients' psychosocial adjustment to disease type, treatment mode, and indexes of control was examined in a representative community population. The psychometric properties of the Diabetes Educational Profile (DEP) and its application to psychosocial research in diabetes were also investigated. Findings support the reliability and validity of the DEP. Various measures of psychosocial adjustment were related to diabetes control but the specific relationships depended on the particular aspect of adjustment, the specific measure of diabetes control, and the type of disease and treatment. The findings suggest that analyses that aggregate dissimilar patient groups are subject to misinterpretation due to ecological masking and supressor effects. The results indicate that clinicians and researchers must recognize that patients with different disease types and treatment modes have different norms for psychological adjustment and diabetes control. Further, the particular aspects of psychosocial adjustment associated with diabetes control differ across patient groups.

Single cochlear fibre responses in guinea pigs with long-term endolymphatic hydrops.

Some cochlear fibre response properties have been measured in two GPs approximately one year after induction of endolymphatic hydrops (by surgical obliteration of the endolymphatic sac and duct). These animals are considered as models of the effects of hydrops in Menière's disease, and the purpose of the study was to examine any modifications of fibre response properties which may underly auditory symptoms of the disease in man. Neurones towards more apical cochlear regions (with low characteristic frequencies) showed the greatest deterioration in tuning properties; on average, in the 1-6 kHz range, Q10dB values were reduced by a factor of two compared with normal animals. Discharge rate versus intensity functions of such units were abnormally steep, with dynamic ranges reduced by 10-20 dB. Towards higher frequency regions neurone response properties showed less deterioration (contrasting with many other types of cochlear pathology where, in general, the high frequency basal region exhibits greatest vulnerability). We have also observed in a few units an abnormal bursting in both spontaneous and driven discharge. Interspike intervals during burst are less than 1 ms (within relative refractory period). These findings are related to the auditory symptoms of Menière's disease, in particular, poor frequency selectivity, loudness recruitment and tinnitus.

Reverse correlation study of cochlear filtering in normal and pathological guinea pig ears.

The filtering properties of single cochlear fibres have been determined in normal and kanamycin-treated guinea pigs using the reverse correlation technique. This method allows investigation of filtering over a wide dynamic range. For normal guinea pig fibres, the near threshold filter functions obtained with this method correspond to the tone derived frequency threshold curves ((FTCs). The 10 dB bandwidth of the filter functions increased monotonically with increasing noise levels above threshold. Thus with noise levels at approximately 50 dB above threshold, the 10 dB bandwidth had increased by a factor of 1.3--3. The changes in 3 dB bandwidth with increasing levels were, for some fibres, different from those of the 10 dB bandwidths. For the pathological fibres, the derived filter functions corresponded to their tone determined FTCs, and were therefore comparatively broadly tuned. Their tuning (Q10dB) approximated to those of normal fibres when the latter were measured 60 dB or more above threshold (i.e., at similar levels of stimulus), and did not increase further with increase in level. The findings in the normal guinea pig are consistent with those obtained by others in rodents, but are not consistent with those from the cat, where normal filtering is more robust to high levels of stimulus noise.

Total ablation of cochlear haircells by perilymphatic perfusion with water.

Inner and outer haircells are destroyed within one day following perfusion of the perilymphatic spaces with water, otherwise the structural integrity of the cochlea and the organ of Corti are preserved. This technique is a reliable method to create an acute unilateral deafness model for investigations of auditory function.

Influence of acoustic deprivation on recovery of hair cells after acoustic trauma.

The purpose of this study was to investigate how the recovery of the cochlea, after acoustic trauma, might be influenced by acoustic stimulation or deprivation. In anaesthetized adult chinchillas, both ears were simultaneously exposed to a traumatizing acoustic stimulus (2 kHz tone, at 117 dB SPL for 15 min). Probe microphones positioned in both bullae were used to ensure identical exposure to the two ears; this was important because the experiment relies on within-animal controls. Cochlear action potential thresholds across frequency (CAP audiograms) were used to verify the similarity of threshold shifts to the two ears. Immediately following, a unilateral ossiculectomy was performed which resulted in one cochlea being acoustically deprived during the recovery period, whilst the other was not. In groups of animals with recovery periods of 1, 3, 6, and 12 weeks, both the acoustically deprived and the normally stimulated cochleas were examined with scanning electron microscopy. To quantify hair cell damage, we used a damage scale based on stereociliar integrity; for each cochlea, a standard region 5.5-8.5 mm from the apex was studied in detail. We found that after acoustic trauma, hair cell damage to the cochlea which is deprived of sound during the recovery period, is significantly greater compared with that in the normally stimulated, contra-lateral cochlea. Our results suggest that mechanical activation of the inner ear acts to inhibit long-term degenerative processes, or influence repair of partially damaged hair cells.

A comparison of compound action potential and cochlear microphonic two-tone suppression in the guinea pig.

Cochlear microphonics (CM) and compound action potentials (AP) were recorded simultaneously with differential electrodes in the basal turn of the guinea pig cochlea. When CM two-tone suppression (2TS) curves were compared to AP simultaneous masking curves, good correspondence was observed between CM and AP suppression effects. The relationship between the 10 dB bandwidths of CM and AP 2TS curves remained constant for each animal despite differences between animals resulting from natural variations. Under pathological conditions (acute cochlear hypoxia) both CM and AP two-tone suppression effects were greatly reduced or disappeared. These results can be taken as evidence that CM suppression and AP suppression are the products of a common underlying mechanism.

The effects of crossed olivocochlear bundle section on transient evoked otoacoustic emissions.

The purpose of this study was to investigate the effect of sectioning the crossed olivocochlear bundle (COCB) on transient evoked otoacoustic emissions (TEOAEs) in anesthetized adult chinchillas. Of particular interest is the role of cochlear efferents to the outer haircells (OHCs) and how they control mechanisms responsible for otoacoustic emissions. Specifically the experiment addressed whether a tonic level of inhibitory control is reduced by COCB section. The nonlinear component of TEOAEs was measured before and after COCB section. Analysis was made of the 1, 2, 3, 4, and 5 kHz frequency components and of the total emission, as quantified by fast Fourier transform (FFT) of the raw (time domain) response. After COCB section, the amplitude of the total response and of the 2, 3, 4, and 5 kHz components increased whereas the amplitude of the 1 kHz component decreased. The results indicate that COCB section reduces inhibitory control of the OHC mechanisms responsible for nonlinear TEOAE generation. It is not clear whether the nerve section eliminates a spontaneous level of activity in COCB efferents, or whether it results in the interruption of a stimulus-evoked feedback loop.

Reorganization of auditory cortex after neonatal high frequency cochlear hearing loss.

Cochleotopic representation in cortex (AI) is extensively reorganized in cats having neonatal, bilateral high frequency cochlear hearing loss. Anterior areas of AI, normally devoted to high frequencies, contain neurons which are almost all tuned to one lower frequency. This frequency corresponds, at the level of the cochlea, to the border between normal and damaged haircell regions.

The effects of anesthesia on otoacoustic emissions.

We have measured transient-evoked and distortion-product otoacoustic emissions (OAEs) in the chinchilla and compared them in the awake and anesthetized animal (using either ketamine or barbiturate agents). We report a significant increase in OAE amplitudes during anesthesia, particularly using ketamine. These effects are most evident for transient-evoked otoacoustic emissions (TEOAEs) as measured in the non-linear mode. Our data support the hypothesis that tonic activity levels in cochlear efferents may be reduced by anesthetic effects, either directly or indirectly (e.g., by general reductions in descending pathway activity), and that reduced cochlear efferent activity will result in the observed increase of OAE amplitudes.

Cochlear function after selective inner hair cell degeneration induced by carboplatin.

The ototoxicity of carboplatin, a second generation anti-cancer agent, was examined using the chinchilla as an animal model. In animals treated with a clinical therapeutic dose (400 mg/m2), the dominant degenerative change is to inner hair cells (IHCs). This is in sharp contrast to most other ototoxic agents, which damage primarily the outer hair cells (OHCs). Functional changes to the cochlea have been evaluated in carboplatin treated subjects by recording cochlear action potentials (CAP) and cochlear microphonics (CM); cochlear lesions were evaluated using scanning electron microscopy. In carboplatin treated animals, CAP thresholds to tone-pip stimuli were elevated in proportion to IHC damage in corresponding cochlear regions. In contrast, CM amplitudes and 'thresholds' remained close to normal in most cases, reflecting the preservation of OHCs in the basal turn. These results indicate a high degree of independence between the inner and outer hair cell systems in the cochlear transduction mechanism. We suggest that this species-specific preparation with selective IHC loss will provide a valuable tool for studying, separately, the role of OHCs in both afferent and efferent cochlear function.

Tonotopic mapping in auditory cortex of the chinchilla.

Using single-unit electrophysiological methods we have mapped sound frequency (or cochleotopic) representation in the auditory cortex of the chinchilla. We describe the surgical approach to expose this area. We report on maps from six subjects and note a considerable variation in shape between individuals. In general, the primary area has a cochleotopic/tonotopic organization in which low frequencies are represented rostrally and higher frequencies caudally. Neurons in the primary area have latency and tuning properties comparable to other mammalian species. A region anterior to the primary (AI) auditory are has a reverse tonotopic map and may be analogous to the anterior auditory field (AAF) reported in other species.

Electrophysiological measures of cochlear function in guinea pigs with long-term endolymphatic hydrops.

Experimental endolymphatic hydrops was induced in guinea pigs by obliteration of the endolymphatic sac and duct. From 3 to 24 months after this operation, cochlear action potential (AP) audiograms and AP tuning curves were measured. The purpose of this study was to establish parallels, if any, between this supposed animal model of Menière's disease and the auditory symptoms of the disease in man. In some animals, low and middle frequency AP threshold elevations were observed whilst higher frequency regions maintained normal sensitivity. Other animals developed flat or very gradually sloping AP audiograms. These patterns are qualitatively similar to those found clinically in Menière's disease. AP tuning curves measured in frequency regions of threshold elevation indicated a deterioration of cochlear frequency selectivity; psychophysical and electrocochleographic studies demonstrate related changes in Menière's patients. One animal exhibited modifications in AP thresholds and tuning as a result of glycerol administration. These observations improve our confidence in the validity of this animal model for further studies of the pathophysiology of Menière's disease.

Assessment of vocabulary development in children after cochlear implantation.

OBJECTIVES: To assess vocabulary development in children following cochlear implantation and to evaluate the effect of age at implantation on performance. DESIGN: Retrospective study (mean follow-up, 3(1/2) years). SETTING: Tertiary center. PATIENTS: Children with prelingual deafness provided with a cochlear implant between 1988 and 1999, who serially performed the Peabody Picture Vocabulary Test-Revised (60 patients) and the Expressive One-Word Picture Vocabulary Test-Revised (52 patients). The children were subgrouped into those receiving implants at younger than 5 years and at 5 years or older. OUTCOME MEASURES: Age-equivalent vocabulary test score and gap index (chronological age minus the age-equivalent score, divided by the chronological age at the time of testing) were calculated. For each test, the following were performed: calculation of rate of change for age-equivalent score; comparison of earliest and latest gap indices means (the cohort and intergroup and intragroup comparison); and multiple regression analysis demonstrating the effect of age at implantation, sex, communication mode, etiology of deafness, and residual hearing on the rate of vocabulary development. RESULTS: Expressive and receptive vocabulary development rates were 0.93 and 0.71 (age-equivalent scores per year), respectively. Subgrouped by age at implantation, the children's rates (for both vocabularies) were not statistically different (Peabody Picture Vocabulary Test-Revised, P =.90; Expressive One-Word Picture Vocabulary Test-Revised, P =.23). The global latest gap indices were significantly less than the earliest (Peabody Picture Vocabulary Test-Revised, P =.048; Expressive One-Word Picture Vocabulary Test-Revised, P<.001), indicating an improvement in age-appropriate vocabulary development over time. The age subgroups demonstrated similar results, except for the younger group's receptive gap index. On multiple regression analysis, the significant predictive variables were residual hearing (Expressive One-Word Picture Vocabulary Test-Revised) and male sex and oral communication mode (Peabody Picture Vocabulary Test-Revised). CONCLUSIONS: Children with cochlear implants developed their vocabularies at rates that were sufficient to prevent an increase in their gap indices as related to ideal scores at testing. A late age at implantation does not singularly preclude beneficial development of vocabulary.

Cochlear nerve monitoring during cerebellopontine angle operations.

The authors present their experience with intraoperative monitoring of cochlear nerve action potentials (AP) in 30 adult patients. Operative procedures were acoustic neuroma excision with attempted hearing preservation and selective vestibular neurectomy in patients with incapacitating Meniere's disease and serviceable hearing (SRT less than 50 db, discrimination greater than 60%). Loss of AP is detected rapidly and has been demonstrated after manipulation of the cochlear nerve and after coagulation of small arteries on the tumour capsule. Presence of an AP at the end of the procedure usually correlates with postoperative preservation of hearing. AP monitoring appears to be a reliable means of detecting potentially reversible changes in cochlear nerve function intraoperatively.

The association between community physician's attendance at a medical center's CME courses and their patient referrals to the medical center.

This study attempts to quantify an overall association between CME course attendance and referrals. Attendance at formal CME courses given by the University of Michigan Medical School and referrals to the University Hospitals were examined over a two-year period. Attendance and referrals were linked to physicians in Michigan identified through the Michigan Department of Licensing and Regulation and through the American Medical Association. For physicians who are office-based and likely to be in active practice (age less than 70), those who attended at least one of the University's CME courses referred more patients than those who did not attend one (means of 1.9 referrals per physician and 1.3 referrals per physician, p less than .001). The causal direction of the relationship is not clear, but probably operates in both directions. It is reasonable for medical center marketers to consider CME as an indirect method for marketing clinical services. It is also reasonable for CME directors to identify referring physicians as high-priority groups for marketing CME. Both marketing efforts may be significantly enhanced by linking data bases for referrals and for CME attendance. CME directors must also ensure that marketing efforts do not compromise the objectivity and integrity of the content of the institution's CME program.

Objective measures of cochlear frequency selectivity in animals and in man. A review.

This paper is based on a review lecture presented at the Scientific Workshop on Evoked Potentials at Brugmann University Hospital, Brussels, Belgium on 25 February, 1984. The first part briefly reviews electrophysiological studies in experimental animals which reveal in detail the changes in cochlear function which results from various types of cochlear damage. The experimental animals represent animal models of certain types of sensorineural hearing loss of cochlear origin in man. Particular attention is given to measures of cochlear frequency selectivity and the deterioration which results from cochlear pathology. The second part deals with objective electrophysiological measures of cochlear frequency selectivity (tone on tone suppression curves) in patients with cochlear hearing loss of various etiology. These measures are mainly derived using transtympanic electrocochleography (AP tuning curves); preliminary studies of auditory brainstem response (ABR) P5 tuning curves are also described. Protocols and the rationale for such measures in the clinic are discussed.

Factors contributing to limited open-set speech perception in children who use a cochlear implant.

Cochlear implants have enabled many children with severe to profound sensorineural hearing loss to develop speech perception skills. However, some children experience few gains while others develop high levels of speech perception. We identified potential factors contributing to poor performance with an implant by studying implanted children who do not develop functional speech perception. Five children were identified as developing no open-set word recognition skills after at least 2 years of implant use. This study group was compared to a randomly selected control group (n=10) and an age-matched control group (n=5). Pre-implant factors were examined using a Graded Profile Analysis and post-implant factors were assessed in a retrospective chart review. A greater number of pre-implant concerns were raised in the study group than in randomized controls (P<0.01). Chronological age and duration of deafness were pre-implant concerns in all study group subjects. A greater number of post-implant concerns were found in the study group than in randomly selected controls (P<0.005). We conclude that while appropriate selection of candidates for cochlear implantation is important in predicting speech perception outcomes, post-implant follow-up is also essential and must include regular monitoring of equipment, monitoring of stimulation levels with use of objective measures of stimulation levels if necessary, and consistent habilitation.