Simplified cochlear frequency selectivity measure for sensorineural hearing loss screening: comparison with digit triplet test (DTT) and shortened speech, spatial and qualities of hearing scale (SSQ) questionnaire.

PURPOSE: Pure-tone audiometry (PTA) is the gold standard for screening and diagnosis of hearing loss but is not always accessible. This study evaluated a simplified cochlear frequency selectivity (FS) measure as an alternative option to screen for early frequency-specific sensorineural hearing loss (SNHL). METHODS: FS measures at 1 and 4 kHz center frequencies were obtained using a custom-made software in normal-hearing (NH), slight SNHL and mild-to-moderate SNHL subjects. For comparison, subjects were also assessed with the Malay Digit Triplet Test (DTT) and the shortened Malay Speech, Spatial and Qualities of Hearing Scale (SSQ) questionnaire. RESULTS: Compared to DTT and SSQ, the FS measure at 4 kHz was able to distinguish NH from slight and mild-to-moderate SNHL subjects, and was strongly correlated with their thresholds in quiet determined separately in 1-dB step sizes at the similar test frequency. Further analysis with receiver operating characteristic (ROC) curves indicated area under the curve (AUC) of 0.77 and 0.83 for the FS measure at 4 kHz when PTA thresholds of NH subjects were taken as ≤ 15 dB HL and ≤ 20 dB HL, respectively. At the optimal FS cut-off point for 4 kHz, the FS measure had 77.8% sensitivity and 86.7% specificity to detect 20 dB HL hearing loss. CONCLUSION: FS measure was superior to DTT and SSQ questionnaire in detecting early frequency-specific threshold shifts in SNHL subjects, particularly at 4 kHz. This method could be used for screening subjects at risk of noise-induced hearing loss.

Simplified cochlear frequency selectivity assessment in normal-hearing and hearing-impaired listeners.

OBJECTIVE: The ear's spectral resolution or frequency selectivity (FS) is a fundamental aspect of hearing but is not routinely measured in clinical practice. This study evaluated a simplified FS testing procedure for clinical use by replacing the time-consuming two-interval forced choice (2IFC) method with method of limits (MOL) carried out using a custom-made software and consumer-grade equipment. DESIGN AND STUDY SAMPLE: Study 1 compared the FS measure obtained with MOL and 2IFC procedure at two centre frequencies (CFs) (1 and 4 kHz) in 21 normal-hearing listeners. Study 2 determined the FS measure using MOL at five CFs (0.5-8 kHz) in 32 normal-hearing and nine sensorineural hearing loss listeners and compared them with their thresholds in quiet. RESULTS: FS measurements with MOL and 2IFC methods were highly correlated and had statistically comparable intra-subject test-retest reliability. FS measures determined with MOL were reduced in the hearing-impaired compared to normal-hearing listeners at the CF corresponding to their hearing loss. Linear regression analysis showed significant relationship between FS deterioration and quiet threshold loss (p < 0.0001, R2 = 0.56). CONCLUSIONS: The simplified and affordable FS testing method can be used alongside audiometry to provide additional information about the cochlear function.

The equivalent threshold sound pressure levels and test-retest threshold variability of a consumer-grade insert earphone fitted with stock, foam, and otoacoustic emission probe ear tips.

OBJECTIVE: Consumer-grade insert earphones (IEs) can be utilised for audiometry, but their calibration values and threshold reliability may differ from the audiometric IE. This study measured the equivalent threshold sound pressure levels (ETSPLs), and the test-retest threshold variation when a consumer IE (Sennheiser CX100) was fitted with: (1) silicone stock ear tips that came along with the earphone, (2) replacement foam ear tips (KZ acoustics) and (3) silicone otoacoustic emission (OAE) probe ear tips. DESIGN AND STUDY SAMPLE: Study 1 determined ETSPL values in 25 normal-hearing subjects aged 18-25 years at seven test frequencies (500-8000 Hz). Study 2 assessed the intra- and inter-session test-retest threshold reliability in a separate group of 50 adult subjects. RESULTS: The ETSPL values for the consumer IE deviated from the reference values for audiometric IEs, with the largest differences (7-9 dB) observed at 500 Hz across ear tips. This is likely related to shallow tip insertions. However, test-retest threshold variations were comparable to those reported for audiometric transducers. CONCLUSIONS: Ear tip-specific corrections to the reference thresholds in the standards are required for calibration of consumer IEs used in low-cost audiometry when their ear tips only allow superficial insertion into the ear canal.

Calibration and initial validation of a low-cost computer-based screening audiometer coupled to consumer insert phone-earmuff combination for boothless audiometry.

OBJECTIVE: To undertake calibration and preliminary validation of a custom-designed computer-based screening audiometer connected to consumer insert phone-earmuff combination for adult pure tone audiometry. DESIGN: Part 1 involved electroacoustic measurement and biological calibration of a laptop-earphone pair used for the computer-based audiometry (CBA). Part 2 compared CBA thresholds obtained without a sound booth with those measured using the gold-standard clinical audiometry. STUDY SAMPLE: 17 young normal-hearing volunteers (Part 1) and 43 normal and hearing loss subjects (Part 2) recruited from an audiology clinic via convenience sampling. RESULTS: The transducer-device combination produced outputs suitable for measuring thresholds down to 0 dB HL. Threshold pairs obtained from the CBA and clinical audiometry were highly correlated (Spearman's correlation coefficient, ρ = 0.92, p < 0.0001) and had a good degree of agreement (mean difference of -1.06 ± 7.63 dB). Also, the CBA showed about 90% sensitivity and 80% specificity for detecting hearing loss based on low (0.5, 1, 2 kHz) and high frequency (4, 8 kHz) pure tone averages of >25 dB HL. CONCLUSIONS: The use of a computer-based audiometer application with consumer insert phone-earmuff combination can offer a cost-effective solution for boothless screening audiometry.

Contralateral proximal interference.

A contralateral "cue" tone presented in continuous broadband noise both lowers the threshold of a signal tone by guiding attention to it and raises its threshold by interference. Here, signal tones were fixed in duration (40 ms, 52 ms with ramps), frequency (1500 Hz), timing, and level, so attention did not need guidance. Interference by contralateral cues was studied in relation to cue-signal proximity, cue-signal temporal overlap, and cue-signal order (cue after: backward interference, BI; or cue first: forward interference, FI). Cues, also ramped, were 12 dB above the signal level. Long cues (300 or 600 ms) raised thresholds by 5.3 dB when the signal and cue overlapped and by 5.1 dB in FI and 3.2 dB in BI when cues and signals were separated by 40 ms. Short cues (40 ms) raised thresholds by 4.5 dB in FI and 4.0 dB in BI for separations of 7 to 40 ms, but by ∼13 dB when simultaneous and in phase. FI and BI are comparable in magnitude and hardly increase when the signal is close in time to abrupt cue transients. These results do not support the notion that masking of the signal is due to the contralateral cue onset/offset transient response. Instead, sluggish attention or temporal integration may explain contralateral proximal interference.

Efferent pathways modulate hyperactivity in inferior colliculus.

Animal models have demonstrated that mild hearing loss caused by acoustic trauma results in spontaneous hyperactivity in the central auditory pathways. This hyperactivity has been hypothesized to be involved in the generation of tinnitus, a phantom auditory sensation. We have recently shown that such hyperactivity, recorded in the inferior colliculus, is still dependent on cochlear neural output for some time after recovery (up to 6 weeks). We have now studied the capacity of an intrinsic efferent system, i.e., the olivocochlear system, to alter hyperactivity. This system is known to modulate cochlear neural output. Anesthetized guinea pigs were exposed to a loud sound and after 2 or 3 weeks of recovery, single-neuron recordings in inferior colliculus were made to confirm hyperactivity. Olivocochlear axons were electrically stimulated and effects on cochlear neural output and on highly spontaneous neurons in inferior colliculus were assessed. Olivocochlear stimulation suppressed spontaneous hyperactivity in the inferior colliculus. This result is in agreement with our earlier finding that hyperactivity can be modulated by altering cochlear neural output. Interestingly, the central suppression was generally much larger and longer lasting than reported previously for primary afferents. Blockade of the intracochlear effects of olivocochlear system activation eliminated some but not all of the effects observed on spontaneous activity, suggesting also a central component to the effects of stimulation. More research is needed to investigate whether these central effects of olivocochlear efferent stimulation are due to central intrinsic circuitry or to coactivation of central efferent collaterals to the cochlear nucleus.

Integrating an open-source course management system (Moodle) into the teaching of a first-year medical physiology course: a case study.

Educators in medical schools around the world are presently experimenting with innovative ways of using web-based learning to supplement the existing teaching and learning process. We have recently used a popular open-source course management system (CMS) called the modular object-oriented dynamic learning environment (Moodle) to construct an online site (DPhysiol) to facilitate our face-to-face teaching of physiology to a group of first-year students in the Bachelor of Medicine and Bachelor of Surgery program. The integration of the Moodle site into our teaching was assessed using online log activity, student examination marks, and feedback from students. The freely available Moodle platform was simple to use, helped to effectively deliver course materials, and has features that allowed cooperative learning. Students who used the CMS throughout their academic year and commented favorably regarding its use as a complement to the face-to-face classroom sessions. The group of students used the CMS obtained significantly higher scores in the final examination compared with the previous class that did not use the CMS. In addition, there was a significant correlation between student participation and performance in online quizzes and their final examination marks. However, students' overall online usage of the CMS did not correlate with their examination marks. We recommend Moodle as a useful tool for physiology educators who are interested in integrating web-based learning into their existing teaching curriculum.

Auditory attentional filter in the absence of masking noise.

Signals containing attended frequencies are facilitated while those with unexpected frequencies are suppressed by an auditory filtering process. The neurocognitive mechanism underlying the auditory attentional filter is, however, poorly understood. The olivocochlear bundle (OCB), a brainstem neural circuit that is part of the efferent system, has been suggested to be partly responsible for the filtering via its noise-dependent antimasking effect. The current study examined the role of the OCB in attentional filtering, particularly the validity of the antimasking hypothesis, by comparing attentional filters measured in quiet and in the presence of background noise in a group of normal-hearing listeners. Filters obtained in both conditions were comparable, suggesting that the presence of background noise is not crucial for attentional filter generation. In addition, comparison of frequency-specific changes of the cue-evoked enhancement component of filters in quiet and noise also did not reveal any major contribution of background noise to the cue effect. These findings argue against the involvement of an antimasking effect in the attentional process. Instead of the antimasking effect mediated via medial olivocochlear fibers, results from current and earlier studies can be explained by frequency-specific modulation of afferent spontaneous activity by lateral olivocochlear fibers. It is proposed that the activity of these lateral fibers could be driven by top-down cortical control via a noise-independent mechanism. SIGNIFICANCE: The neural basis for auditory attentional filter remains a fundamental but poorly understood area in auditory neuroscience. The efferent olivocochlear pathway that projects from the brainstem back to the cochlea has been suggested to mediate the attentional effect via its noise-dependent antimasking effect. The current study demonstrates that the filter generation is mostly independent of the background noise, and therefore is unlikely to be mediated by the olivocochlear brainstem reflex. It is proposed that the entire cortico-olivocochlear system might instead be used to alter the hearing sensitivity during focus attention via frequency-specific modulation of afferent spontaneous activity.

Effects of medial olivocochlear efferent stimulation on the activity of neurons in the auditory midbrain.

Medial olivocochlear (MOC) efferents are known to suppress spontaneous activity and sound-evoked responses of primary afferents by their actions on outer hair cells in the cochlea. This study investigated the effects of MOC activation on the responses of single neurons in the central nucleus of the inferior colliculus (CNIC) of anaesthetized guinea pigs. Extracellular responses of CNIC neurons to contralateral tones were recorded with and without MOC stimulation in normal animals and in animals acutely treated with gentamicin to eliminate peripheral effects of MOC activation. In normal animals, input-output functions of CNIC neurons showed a variety of changes. Some effects resembled qualitatively those reported for primary afferents. However, other effects were also observed, including an increase of firing rates at medium- to high-tone levels and in a small number of neurons (10%), an increase in spontaneous activity. In addition, larger threshold shifts and larger reductions of spontaneous firing rates were observed as compared to effects seen in the periphery. In gentamicin-treated animals, activation of MOC efferents did not produce any changes in the input-output functions or spontaneous activity of CNIC neurons. This observation is consistent with the majority of MOC-induced changes in monaural responses in the CNIC being mediated by the actions of MOC terminals in the cochlea and resulting from the interplay between altered afferent input and central circuitry.

Unmasking effects of olivocochlear efferent activation on responses of inferior colliculus neurons.

Behavioural studies suggest a role for the medial olivocochlear (MOC) system in improving detection and discrimination of signals in noise. Physiological studies in the cochlea support this notion, showing unmasking, an improvement of the dynamic range of primary auditory afferents in response to tones in noise after MOC system activation. However, little is known about unmasking effects in higher centres. We investigated the effects of MOC stimulation on the responses of neurons in the guinea pig inferior colliculus to masked tones. In 50% of neurons background noise increased the basal rate and decreased maximum rate, an effect similar to that reported in primary afferents. In 35% of neurons maximum rate was increased by the background noise. Activation of the MOC system caused an increased slope and output dynamic range in the majority of input-output functions. Statistical analysis showed that this increased the discriminability of the tones within the noise. Hence, antimasking effects of olivocochlear activation that have been described in the cochlea can still be observed in the midbrain. However, 27% of neurons showed a variety of effects that have not been described in primary afferents, suggesting involvement of central circuitry in modulating effects of MOC stimulation on higher centres.

Hearing Risk among Young Personal Listening Device Users: Effects at High-Frequency and Extended High-Frequency Audiogram Thresholds.

OBJECTIVE: The usage of personal listening devices (PLDs) is associated with risks of hearing loss. The aim of this study is to evaluate the effects of music exposure from these devices on high-frequency hearing thresholds of PLD users. MATERIALS AND METHODS: A total of 282 young adults were questioned regarding their listening habits and symptoms associated with PLD listening. Their audiogram thresholds were determined at high (3-8 kHz) frequencies and extended high frequencies (EHFs, 9-16 kHz). The preferred listening volumes of PLD users were used to compute their overall 8-h equivalent music exposure levels (LAeq8h). RESULTS: Approximately 80% of the subjects were regular PLD users. Of these, 20.1% had LAeq8h of ≥75 dBA, while 4.4% of them had LAeq8h of ≥85 dBA, which carries a high risk of hearing damage. Compared with those exposed to LAeq8h of <75 dBA, subjects who had LAeq8h of ≥75 dBA reported a significantly higher incidence of tinnitus and difficulty in hearing others immediately after using PLDs. PLD users who were exposed to LAeq8h of ≥75 dBA and had been using their devices for ≥4 years also showed significantly higher mean audiogram thresholds compared with non-users at most EHFs tested. In addition, the thresholds of PLD users at EHFs showed a weak but significant positive correlation with their LAeq8h. CONCLUSION: The present findings suggest that excessive exposure to music among PLD users may lead to initial effects on their hearing at very high frequencies.