Evidence for apical-basal transition in the delay of the reflection components of otoacoustic emissions.

Stimulus-frequency, transient-evoked, and distortion product otoacoustic emissions (OAEs) have been measured in eight normal-hearing human ears over a wide stimulus level range, with high spectral resolution. The single-reflection component of the response was isolated using time-frequency filtering, and its average delay was measured as a function of frequency and stimulus level. The apical-basal transition was studied by fitting the average delay of the filtered single-reflection OAEs, expressed in number of cycles, to a three-slope power-law function with two knot frequencies. The results show that the scale-invariant prediction of constant dimensionless delay approximately holds only over a narrow intermediate frequency range (1-2.5 kHz). Below 1 kHz, and, to some extent, above 2.5 kHz, the dimensionless delay increases with frequency, at all stimulus levels. Comparison with the numerical simulations of a delayed-stiffness active cochlear model show that the increase of tuning with frequency reported by behavioral experiments only partly explains this result. The low-frequency scaling symmetry breaking associated with the deviation of the Greenwood tonotopic map from a pure exponential function is also insufficient to explain the steep low-frequency increase of the OAE delay. Other sources of symmetry breaking, not included in the model, could therefore play a role.

Oxidative stress biomarkers and otoacoustic emissions in humans exposed to styrene and noise.

OBJECTIVE: Evaluating the correlation between otoacoustic emission levels, styrene exposure, and oxidative stress biomarkers concentration in styrene-exposed subjects, to investigate the role of oxidative stress in outer hair cell damage. DESIGN: Distortion product otoacoustic emissions were measured in the exposed workers and in a control group. Separation between the distortion and reflection otoacoustic components was performed by time-frequency-domain filtering. The urinary concentration of the DNA and RNA oxidation products, namely 8-oxo-7,8-dihydroguanine (oxoGua), 8-oxo-7,8-dihydro-2'-deoxyguanosine (oxodGuo), and 8-oxo-7,8-dihydroguanosine (oxoGuo), were evaluated. STUDY SAMPLE: Nine subjects exposed to styrene in a fiberglass factory, eight control subjects. The two groups were statistically equivalent in mean age. RESULTS: Statistically significant differences were found in the distortion component levels between the exposed and the control group. High levels of the oxidative damage biomarkers were found in the workers exposed to high levels of styrene. Significant negative correlation was found between the otoacoustic emission distortion component levels and the concentration of the oxoGuo biomarker. CONCLUSIONS: Exposure-induced damage of the cochlear amplifier is shown in the mid-frequency range, confirming animal experiments, in which hair cells in the cochlear middle turn were damaged. Hearing damage is consistent with the outer hair cell apoptosis pathway associated with oxidative stress.

Susceptibility of linear and nonlinear otoacoustic emission components to low-dose styrene exposure.

OBJECTIVE: To investigate potential susceptibility of active cochlear mechanisms to low-level styrene exposure by comparing TEOAEs in workers and controls. DESIGN: Two advanced analysis techniques were applied to detect sub-clinical changes in linear and nonlinear cochlear mechanisms of OAE generation: the wavelet transform to decompose TEOAEs into time-frequency components and extract signal-to-noise ratio and latency of each component, and the bispectrum to detect and extract nonlinear TEOAE contributions as quadratic frequency couplings (QFCs). STUDY SAMPLE: Two cohorts of workers were examined: subjects exposed exclusively to styrene (N = 9), and subjects exposed to styrene and noise (N = 6). The control group was perfectly matched by age and sex to the exposed group. RESULTS: Exposed subjects showed significantly lowered SNR in TEOAE components at mid-to-high frequencies (above 1.6 kHz) and a shift of QFC distribution towards lower frequencies than controls. No systematic differences were observed in latency. CONCLUSION: Low-level styrene exposure may have induced a modification of cochlear functionality as concerns linear and nonlinear OAE generation mechanisms. The lack of change in latency seems to suggest that the OAE components, where generation region and latency are tightly coupled, may not have been affected by styrene and noise exposure levels considered here.

Experimental evidence for the basal generation place of the short-latency transient-evoked otoacoustic emissions.

Time-frequency analysis of the transient-evoked otoacoustic emission response was performed on a population of subjects affected by sensory-neural hearing loss characterized by a sharp audiometric profile, caused by firearm noise exposure (42 ears), and on a control population of normal-hearing subjects (84 ears). Time-frequency filtering permitted a careful evaluation of the relation between the audiometric profile and the spectral shape of the long- and short-latency otoacoustic components. Both filtered spectra closely follow the shape of the audiometric profile, with a frequency shift between them. The typical frequency shift was evaluated by averaging the otoacoustic spectra and the audiograms among groups of ears with the same cutoff frequency. Assuming that the otoacoustic emission source function depends on the local effectiveness of the cochlear amplifier, this experimental evidence suggests that the short-latency response is generated at a cochlear place displaced towards the base by about 0.5-1 mm with respect to the generation place of the long-latency component. The analysis of the control group demonstrates that, below 4 kHz, the observed effect is not dependent on the data acquisition and analysis procedure. These results confirm previous theoretical estimates and independent experimental evidence based on the measured latency difference between the two components.

Otoacoustic emission sensitivity to exposure to styrene and noise.

The ototoxic effect of the exposure to styrene is evaluated, also in the presence of simultaneous exposure to noise, using otoacoustic emissions as biomarkers of mild cochlear damage. Transient-evoked and distortion product otoacoustic emissions were recorded and analyzed in a sample of workers (15 subjects) exposed to styrene and noise in a fiberglass manufacturing facility and in a control group of 13 non-exposed subjects. Individual exposure monitoring of the airborne styrene concentrations was performed, as well as biological monitoring, based on the urinary concentration of two styrene metabolites, the Mandelic and Phenylglyoxylic acids. Noise exposure was evaluated using wearable phonometers, and hearing loss with pure tone audiometry. Due to their different job tasks, one group of workers was exposed to high noise and low styrene levels, another group to higher styrene levels, close to the limit of 20 ppm, and to low noise levels. A significant negative correlation was found between the otoacoustic emission levels and the concentration of the styrene urinary metabolites. Otoacoustic emissions, and particularly distortion products, were able to discriminate the exposed workers from the controls, providing also a rough estimate of the slope of the dose-response relation between otoacoustic levels and styrene exposure.

[Synergistic exposure to noise and styrene and cochlear functionality in a sample of exposed workers: preliminary results]. / Esposizione sinergica a rumore e stirene e funzionalità cocleare in un campione di lavoratori esposti: risultati preliminari.

This study is aimed at testing the cochlear functionality using otoacoustic emissions, analyzing the synergistic effects of simultaneous exposure to noise and organic solvents EBTx on workers of a glass-reinforced plastic products factory. Exposure to organic solvents was assessed using ambiental measurements and evaluation of the salivary concentration. Biological monitoring was performed evaluating the urinary concentration of the styrene metabolites. Statistical analysis shows that otoacoustic tests can discriminate between different exposure groups. Significant differences were found between controls and subjects exposed to high styrene and low noise levels, showing the ototoxic effect (at sub-clinical level) of the styrene exposure.

[Pilot study of professional exposure and hearing functionality of orchestra musicians of a national lyric theatre]. / Studio pilota dell'esposizione professionale a rumore e della funzionalità uditiva dei musicisti di una orchestra lirica nazionale.

The sound exposure of classic orchestra musicians is not well assessed in Italy even though the protectionistic law includes all the working environments, as stated in the European Directive 2003/10/EC relative to the protection of workers against noise-induced damage. Scientific data in the literature show that the musicians are exposed to high daily personal exposure levels. These levels can systematically exceed the 85 dB(A) in the case of percussionists. In this study, preliminary results are shown relative to an experimental campaign performed in a lyric National Theatre. The aim of the study was the assessment of the risk due to high sound level in the theatre musicians and their cochlear functionality. The noise levels were measured by using wearable phonometers and multichannel sound analyzers. The signals were recorded during the whole working time in the rehearsal hall and in the fossa. The cochlear functionality was monitored before and immediately after rehearsal in a sample of volunteers by means of otoacoustic emission tests. Both TEOAE and DPOAE were measured using the ILO292 portable system. The data show that OAE-based tests can effectively discriminate between different classes of exposure. A good correlation was found between the daily exposure level and the DPOAE level.

Variability among polysulphone calibration curves.

Within an epidemiological study regarding the correlation between skin pathologies and personal ultraviolet (UV) exposure due to solar radiation, 14 field campaigns using polysulphone (PS) dosemeters were carried out at three different Italian sites (urban, semi-rural and rural) in every season of the year. A polysulphone calibration curve for each field experiment was obtained by measuring the ambient UV dose under almost clear sky conditions and the corresponding change in the PS film absorbance, prior and post exposure. Ambient UV doses were measured by well-calibrated broad-band radiometers and by electronic dosemeters. The dose-response relation was represented by the typical best fit to a third-degree polynomial and it was parameterized by a coefficient multiplying a cubic polynomial function. It was observed that the fit curves differed from each other in the coefficient only. It was assessed that the multiplying coefficient was affected by the solar UV spectrum at the Earth's surface whilst the polynomial factor depended on the photoinduced reaction of the polysulphone film. The mismatch between the polysulphone spectral curve and the CIE erythemal action spectrum was responsible for the variability among polysulphone calibration curves. The variability of the coefficient was related to the total ozone amount and the solar zenith angle. A mathematical explanation of such a parameterization was also discussed.

Neonatal pain analyzer: development and validation.

We developed a pain analyzer (ABC analyzer) to perform automatic acoustic analysis of neonatal crying and to provide an objective estimate of neonatal pain. The ABC analyzer uses a validated pain scale (ABC scale) based on three acoustic parameters: pitch frequency, normalized RMS amplitude, and presence of a characteristic frequency- and amplitude-modulated crying feature, defined as "siren cry". Here we assessed the reliability of the analyzer. We enrolled 57 healthy neonates. Each baby was recorded with a video camera during heel prick. Pain intensity was evaluated using a validated scale [Douleur Aigue du Nouveau-Né (DAN) scale] and the analyzer and the two scores were compared. We found a statistically significant concordance between the DAN score and ABC analyzer score (p < 0.0001). The ABC analyser is a novel approach to cry analysis that should now have its properties carefully evaluated in a series of studies, just as is necessary in the development of any other pain measurement tool.

Localization of the Reflection Sources of Stimulus-Frequency Otoacoustic Emissions.

The generation of stimulus-frequency otoacoustic emission (SFOAE) residuals in humans is analyzed both theoretically and experimentally to investigate the relation between the frequency difference between the probe and the suppressor tone and the localization of the residual source. Experimental measurements of the SFOAE residual were performed using suppressors of increasing frequency to separate the otoacoustic response from the probe stimulus. From the response to the probe alone, the SFOAE response was also estimated, using spectral smoothing, and compared with the residuals obtained for different frequency suppressors. A nonlinear delayed-stiffness active cochlear model was used to compute the spatial distribution of the residual sources according to a recent model of the local reflectivity from roughness, as a function of the suppressor frequency. The simulations clarified the role of high-frequency suppressors, showing that in humans, with increasing suppressor frequency, the generation region of the residual is only slightly basally shifted with respect to the case of a near-frequency suppressor, near the basal edge of the peak of the resonant basilar membrane response. As a consequence, the hierarchy among different-delay components correspondingly changes, gradually favoring short-delay components, with increasing suppressor frequency. Good agreement between the experimental and theoretical dependence of the level of otoacoustic components of different delay on the frequency shift between probe and suppressor confirms the validity of this interpretation.

Linear and nonlinear transient evoked otoacoustic emissions in humans exposed to noise.

Transient evoked otoacoustic emissions (TEOAEs) have been analyzed in a population of 134 ears, divided into three classes: (1) nonexposed ears in bilaterally normal hearing subjects, (2) audiometrically normal ears of subjects exposed to noise and affected by unilateral high-frequency (f>3 kHz) hearing loss in the contralateral ear, and (3) the contralateral impaired ears of the exposed subjects. The statistical distributions of global and spectral signal-to-noise ratio (SNR) were analyzed. TEOAEs were recorded both in the linear and nonlinear acquisition mode to evaluate the effectiveness of two standard averaging techniques with respect to their sensitivity to the early effects of noise exposure. Good discrimination between nonexposed and exposed ears was obtained using either the linear or the nonlinear mode. Despite its intrinsically higher SNR, the linear mode is not more sensitive than the nonlinear mode for this purpose because it is not possible to find a window for effectively cancelling the linear artifact while keeping a suitable sensitivity to the short-latency high-frequency aspect of the response. Moreover, with respect to another measurable parameter, the TEOAE latency, good discrimination is obtained only by using the nonlinear mode because, again, the linear artifact masks the high-frequency TEOAE response.

The calibration of personal dosemeters used for evaluating exposure to solar UV in the workplace.

In the framework of an epidemiological study regarding the correlation between solar UV radiation exposure and skin pathologies in a population of outdoor workers, the possibility of using polysulphone film personal dosemeters to quantify the Subjects UVB exposure has been evaluated. An original experimental set-up is presented. in a preliminary version, which ill be used both for solar irradiance spectroradiometric measurements and for the reading of personal dosemeters. The polysulphone absorption is similar to the CIE erythemal response curve. Due to UVB radiation exposure, the polysulphone film dosemeters photodegrade with a measrable absorbance change. The absorbance variation after the dosemeter exposure to UV radiation has been correlated to the UVB effective dose. The calibration curve obtained by this method may be particularly useful for the evaluation of small closes. The method will be used to quantify the personal exposure of workers whose exposure conditions are characterised by high variability.

[Clinical contribution to the knowledge of retroperitoneal tumors of the pelvic excavation]. / Contributo clinico alla conoscenza dei tumori retroperitoneali dello scavo pelvico.

Two cases of primitive retroperitoneal tumors of the pelvic excavation have been reported: a neurinosarcoma and a liposarcoma. Particular, this work emphasizes the rarity of the neurinosarcoma in that seat, the atypical clinical presentation, the complex diagnostic researches performed and the problems of the differential diagnosis. In the diagnosis of these neoplasms, the Authors emphasize, the main role performed by the "classic" radiology and its most recently acquired means as (ECO, TAC, EMR). These can give precise informations about the seat and the size of the neoplasms and especially, about it's relationship with the adjacent tissues. By using these new means, other examinations some what dangerous, can be avoided. The Authors conclude that from the therapeutical point of view, surgery is still the main weapon against these neoplasms, even if sometimes it is demolishing and does not sensibly improve the prognosis. Surgery can be associated with radiotherapy and/or chemotherapy.

[Functional urination disorders in patients recovering in an intensive care unit for more than 30 days]. / I disturbi funzionali della minzione in pazienti ricoverati in unità di terapia intensiva (ICU) per più di 30 giorni.

Patients in rest-homes, intensive care units, long hospitalization and dialysis and whoever stays in a hospital continuously or occasionally for long periods of time may run into the well-known and typical complications of prolonged hospitalization. We have studied the urologic aspect in all the cases of the Medical- Surgical Emergency Institute in the Hospital of Ancona (seated in Torrette), over the period 1990-96, in patients hospitalized for at least 30 days. All the patients were followed and studied with the same method, though taking into account their different pathological conditions. They were treated by the same medical and paramedical staff. The same antibiotic therapy and the same checkup were adopted for all of them. We have noticed that out of 122 patients the most frequent pathologies have been urinary infections (19%); while sepsis with different pathogenesis was recorded in 4% of the patients. The method of study applied during and after the hospitalization was used also in rehabilitation centres and included: urologic examination, rectal touch (in men), direct X-ray of the abdomen, ultrasound of the urinary tract, X-ray urography, if required; moreover urodynamic examination, MRI of encephalon and spinal marrow in patients with neurological lesions. The catheter was removed in all the patients and none of the following conditions were observed: vesical lithiasis, abscesses, fistulae in penoscrotal angle, urethrostenosis, injuries to renal emunctory. In conclusion we believe that the functional symptoms of minction--be they of obstructive or irritable nature--are not existent and that the urologic prognosis in long term patients in excellent, provided that prophylaxis is carried on against hospital urinary infections as their occurrence is very frequent and therapy is expensive. It can also be stated the patient hospitalized in ICU will not present damages to the urinary tract, even if he/she has been hospitalized because of injuries to the urinary tract, provided that the urologic tutoring, together with the action of the physician handling the Emergency, follow the rules for asepsis, the best biocompatible materials are use, infections are monitored, the extensions of cerebrospinal injuries are examined and therapeutic axioms, such as barren and clean intermittent catheterism, are finally adopted.

[Neoplasms with unknown primary location]. / Neoplasie a sede primitiva ignota.

Neoplasms with unknown primary location (U.P.L.N.) represent an important chapter of oncological pathology which has not yet been completely defined regarding diagnostics, therapy and prognosis. U.P.L.N. recur in clinical practice in 0.5%-10% of cases and show equal sharing in both sexes: still mortality is high. This is in agreement with the biological behavior of U.P.L.N. which is that of a neoplastic illness, systemic from the onset and therefore immediately aggressive. Treatments commonly used only slightly alter the course of the disease. If the general state of the patients allows it, treatment must include every available therapeutical remedy (CHR, RDT, CHM) conveniently evaluated in every single case and preferably under the guidance of the apparent histotype and of the onset seat. The histotype of an U.P.L.N. sensibly affects the prognosis of the patient: there is an improvement in well differentiated and lodged forms and conversely, there is a sharp impairment with fast evolution in the less differentiated and variably metastasized forms. In our case-report, the U.P.L.N. rate has been 5.37% on 1786 cancer diagnoses from February 1980 until January 1988. In 65% of these cases, the histotype sustaining the pathology was represented by adenocarcinoma, in 21% by epidermoid carcinoma and in the remaining 14% by undifferentiated carcinoma. The clinical onset most frequently observed has involved the lymph nodes, followed by involvement of the serosa, bones, lungs and liver. Complex therapeutic treatments have not provided clear results, but the use of anthracyclines and cyclophosphamide seems promising. Finally, we suggest the use of immunomodulators (such as interferons, thymus hormone, lymphokines) in association with the classic chemotherapeutics.

Quantitative evaluation of personal exposure to UV radiation of workers and general public.

Due to meteorological conditions variability and to the variability of exposure patterns, which can be largely different during a working day, personal dosemeters use can be necessary to obtain a correct quantitative evaluation of the radiation dose absorbed by an exposed worker. Different classes of personal dosemeters exist and, among them, electronic dosemeters and polysulphone film dosemeters. An experimental campaign is presented conduced in a cultivated area of Tuscany and some aspects are discussed about an experimental campaign performed on a population of volunteers on a central Italy beach near Rome. The aim of the present work is to show some relevant issues in a dosimetric approach to the exposure evaluation of outdoor workers and, in general, of the public during recreational activities.

Modeling otoacoustic emissions by active nonlinear oscillators.

The phenomenology of spontaneous otoacoustic emissions (OAEs) is compared to theoretical predictions given by models in which they are produced by active nonlinear oscillators. Along with the well-known Van der Pol oscillator, a new active oscillator model is proposed and analyzed here. Numerical simulations and multi-scale analytical computation results are compared to experimental data of neonatal spontaneous and evoked OAEs. A simple analysis technique is proposed, in which the time evolution after a click stimulus of the amplitude of each spectral line corresponding to a spontaneous OAE is studied. Apart from a few stationary lines, an approximately exponential decay law, with characteristic damping coefficients in the 20-200 Hz range, was found to fit the data. These results are not compatible with a Van der Pol oscillator model, and show that some important aspects of the OAE phenomenology can be better explained by the proposed oscillator. Other interesting features of the spontaneous end evoked OAE phenomenology, such as spontaneous OAE suppression by external tones and the following recovery, as well as stimulus/response curves in the linear and nonlinear mode of acquisition, are also well reproduced by the proposed model.

On the frequency dependence of the otoacoustic emission latency in hypoacoustic and normal ears.

Experimental measurements of the otoacoustic emission (OAE) latency of adult subjects have been obtained, as a function of frequency, by means of wavelet time-frequency analysis based on the iterative application of filter banks. The results are in agreement with previous OAE latency measurements by Tognola et al. [Hear. Res. 106, 112-122 (1997)], as regards both the latency values and the frequency dependence, and seem to be incompatible with the steep 1/f law that is predicted by scale-invariant full cochlear models. The latency-frequency relationship has been best fitted to a linear function of the cochlear physical distance, using the Greenwood map, and to an exponential function of the cochlear distance, for comparison with derived band ABR latency measurements. Two sets of ears [94 audiometrically normal and 42 impaired with high-frequency (f > 3 kHz) hearing loss] have been separately analyzed. Significantly larger average latencies were found in the impaired ears in the mid-frequency range. Theoretical implications of these findings on the transmission of the traveling wave are discussed.

Spontaneous otoacoustic emissions and relaxation dynamics of long decay time OAEs in audiometrically normal and impaired subjects.

The relationship between hearing loss, detected by measuring the audiometric threshold shift, and the presence of long-lasting otoacoustic emissions, has been studied in a population of 66 adult males, by analyzing the cochlear response in the 80 ms following the subministration of a click stimulus. Most long-lasting OAEs are also recognizable as Synchronized Spontaneous OAEs (SSOAEs). The OAE characteristic decay times were evaluated according to the model by Sisto and Moleti [J. Acoust. Soc. Am. 106, 1893 (1999)]. The starting hypothesis, confirmed by the results, is that long decay time and large equilibrium amplitude are both manifestations of the effectiveness of the active feedback mechanism. The prevalence and frequency distribution of long-lasting OAEs, and of their SSOAE subset, have been separately analyzed for normal and impaired ears. No long-lasting OAE was found within the hearing loss frequency range, but several were found in impaired ears outside the hearing loss range, both at lower and higher frequencies. This result suggests that the correlation between the presence of long-lasting OAEs and good cochlear functionality be local in the frequency domain. The monitor of the OAE decay time is proposed as a new possible method for early detecting hearing loss in populations exposed to noise.