Analysis of evoked otoacoustic emissions in patients with high frequency cochlear hearing loss

Evoked otoacoustic emissions (EOAE) and auditory brainstem evoked response (ABR) were tested in patients with high frequency cochlear hearing loss and subjects with normal hearing. Results showed that: 1. In the normal group, the main component of EOAE varied between 0.5-5kHz. 2. There was a close correlation between the pure-tone audiogram figure and EOAE spectrum. 3. The I/O function curves of EOAE displayed non-linear characteristics and a trend of saturation with higher stimulus levels in the normal group. In the patient group the growth rates of EOAE and ABR were remarkably higher than those in the normal group with high stimulus levels. It suggests that the abnormal EOAE are probably relevant to the recruitment phenomenon in cochlear hearing loss.     

Clinical applicability of transient evoked otoacoustic emissions: identification and classification of hearing loss

The study aimed at the development of a clinically applicable methodology that could: (1) discriminate transient evoked otoacoustic emission (TEOAE) recordings from normal hearing or hearing impaired individuals; (2) classify the nature of the hearing loss as conductive or as cochlear, and (3) define clear-cut TEOAE clinical criteria. A classification algorithm based on a multivariate discriminant analysis of fast Fourier transform data from recordings evoked by click stimuli of 50 +/- 2, 62 +/- 2, 68 +/- 2 and 80 +/- 2 dB SPL was used to discriminate 302 normal subjects from 383 subjects suffering from mild to moderate hearing losses. The best discriminant model (QDF80) produced a sensitivity of 93.8% and a specificity of 79.4%. When extra correlation criteria were serially applied to the classification outcome, the specificity was increased to 85.3%, but the sensitivity was marginally decreased to 91.7%. The classification of the correctly identified hearing-impaired cases yielded 93.8% identification of conductive and 75.1% identification of cochlear cases. A sensitivity analysis of the misclassified hearing-impaired cases suggested that the TEOAE spectra are well correlated with the 2-kHz but poorly correlated with the 4-kHz octave frequency.     

Multi-variant analysis of otoacoustic emissions and estimation of hearing thresholds: transient evoked otoacoustic emissions

Evaluation of cochlear hearing loss by means of transiently evoked otoacoustic emissions is already established in clinical practice. However, accurate prediction of pure-tone thresholds is still questioned and is still regarded as troublesome. Both click- and tone-burst-evoked otoacoustic emissions at several intensity levels were measured and analysed in 157 ears from normally hearing and 432 ears from patients with different degrees of pure sensory hearing loss using the ILO88/92 equipment. Results of otoacoustic emissions (OAE), elicited by clicks and tone-bursts at centre frequencies from 1 to 5 kHz, were analysed using two different statistical methods. Both multivariate discriminant analysis and forward multiple regression analysis were used to determine which OAE variables were most discriminating and best at predicting hearing thresholds. We found that a limited set of variables obtained from both tone-burst and click measurements can accurately predict and categorize hearing loss levels up to a limit of 60 dB HL. We found correct classification scores of pure-tone thresholds between 500 and 4000 Hz up to 100 per cent when using combined click and tone-burst otoacoustic measurements. Prediction of pure-tone thresholds was correct with a maximum estimation error of 10 dB for audiometric octave frequencies between 500 and 4000 Hz. Measurements of multiple tone-bursts OAEs have a significant clinical advantage over the use of clicks alone for clinical applications, and a good classification and prediction of pure-tone thresholds with otoacoustic emissions is possible.     

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

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

Spontaneous and evoked otoacoustic emissions

The integration of Poland with the European Community makes the harmonization of Polish legislation necessary. Among numerous Directives, which provisions should be introduced into domestic legislation before Poland enters the European Union, the Directives related to materials and articles intended to contact with food consist a large group. The review and analysis of 17 Directives that appeared up to the end of year 1997 have been done. The list of these Directives is shown in the Table I. The framework Directive 89/109/EEC on the approximation of the laws of the Member States relating to materials and articles intended to come into contact with foodstuffs have been comprehensively discussed together with the specific Directives concerning the following matters: symbol which should accompany the materials and articles intendet to contact with food: Directive 80/590/EEC; plastics materials: Directive 90/128/EEC with later ammendments provided by the Directives: 90/128/EEC, 93/9/EEC, 95/3/EC and 96/11/EC; vinyl chloride monomer (acceptable limit and analytical method): Directives: 78/142/EEC, 80/766/EEC and 81/432/EEC, regenerated cellulose film-Directives: 93/10/ECC i 93/111/EEC; ceramic articles: Directive 84/500/EEC; testing migration of constituents of plastic materials-Directives: 85/572/EEC and 82/711/EEC with later ammendments: Directives: 93/8/EEC, 97/48/EC, The relevant Polish regulatory provisions concerning the matters related to materials and articles intendet to contact with foodstuffs have also been discussed. The need for harmonization of Polish regulations with the relevant legislation adopted by the Member States of the European Community was emphasized.     

Recording otoacoustic emissions in expert evaluation of chronic noise-induced hearing loss

In order to assess occupational hearing loss, damage to outer hair cell function must be demonstrated. Measurements of transiently evoked otoacoustic emissions (TEOAE) and distortion products (DPOAE) allow clinicians to investigate objectively the cochlear amplification process. In this prospective study, 50 persons with suspected occupational hearing losses were tested with pure-tone and speech audiometry. Additionally, TEOAE and DPAOE were determined. Significant linear correlations were observed when comparing hearing thresholds and speech discriminations with evoked emissions. Three groups were formed based on the OAE results: group A, TEOAE- and DPOAE-positive; group B, TEOAE-negative, DPOAE positive; group C, TEOAE- and DPOAE-negative. The groups were compared with regard to the weighted and simple discrimination scores and percentage of hearing loss computed according to the Boenninghaus-R?ser tables. Analysis of variance showed significant differences in hearing losses among the three groups, allowing an objective statement to be made about the degree of work compromise: group A, < 10%; group B, 10-15% group C, > or = 20%.     

Are normal hearing thresholds a sufficient condition for click-evoked otoacoustic emissions?

Transiently evolked otoacoustic emissions (TEOAE) have been reported in several studies as absent in a small minority of normal ears. Other studies have reported TEOAEs in all normal ears. Differences between studies may arise directly from criteria for TEOAE identification, criteria for selection of normals, or statistically due to limited sample sizes. In order to understand and model cochlear processes involved in TEOAE generation, it needs to be known whether the presence of normal hearing leads automatically to generation of TEOAEs. The present study set out to establish in a large sample if any ears could be found that lacked TEOAEs despite normal hearing threshold levels (HTL). A total of 397 ears from highly cooperative adult subjects were examined under laboratory conditions. Using cross correlation between replicate nonlinear waveforms as the criterion, TEOAEs were present in 99.2% of the sample (lower CI 98.1%). However, careful visual assessment of the recorded waveforms for the remaining ears did not unequivocally show absence of TEOAE characteristics in any ear with normal HTLs. While TEOAE strength varies widely among ears, no clear evidence was found to show that TEOAEs can be absent when HTLs are normal.     

Transient evoked otoacoustic emissions in infants: effects of gender, ear asymmetry and activity status

This study examined the effects of gender, ear asymmetry and activity status of infants on various measures of transient evoked otoacoustic emission (TEOAE), including signal-to-noise ratio (SNR) and reproducibility of emissions, using TEOAE as a mass screening procedure in a community health setting. Five hundred and sixty-eight infants were screened for hearing at two months of age, before immunization. The ILO88 Otodynamic Analyzer Quickscreen program was used for all testing with pass/fail criteria similar to those used in the Rhode Island hearing assessment project. The results indicated a significant difference in SNR across sex, with females showing a higher mean SNR. The right ear was found to have higher values in 'reproducibility' and 'response level' than the left ear. A significant difference in SNR across activity states was also evident. Implications from these findings, as applied to community-based screening programs, are discussed.     

Nonlinear characteristics of electrically evoked otoacoustic emissions

By coupling 3-(2-mercaptoethyl)quinazoline-2,4(1H,3H)dione (MECH) to divinyl sulfone activated agarose, a novel thiophilic matrix was obtained which allows the binding of immunoglobulins from different sources. In contrast to other thiophilic gels, antibodies are bound at low ionic strength and can easily be desorbed in intact form by elution with dilute alkali. The potential of using the MECH-gel was demonstrated by the purification of antibodies from human and animal (goat, rabbit, mouse) sera. The functional integrity of the purified antibodies was established with cytoplasmic islet cell antibodies from the sera of patients with type I diabetes and autoantibodies against thyroid peroxidase from patients with Graves' and Hashimoto's disease.     

The application of otoacoustic emissions in paediatric hearing screening

We conducted auditory test of 132 high risk infants by using both otoacoustic emissions (OAE) and auditory brainstem response (ABR) screening. The result showed that the passing rate was 88.3% (233/264 ears) for OAE and 92% (243/264 ears) for ABR. The sensitivity and specificity of OAE in comparison to ABR were 90.5% (19/21 ears) and 95% (230/243 ears) respectively. The mean test time was 3 min for OAE and 30 min for ABR. We therefore conclude that OAE is a highly sensitive, reliable and convenient method to be used for paediatric hearing screening.     

Random noise in the spectra of evoked otoacoustic emissions

Adult male rats were given an oral dose of 10 mg/kg aspartame 14C-labelled in the methanol carbon. At timed intervals of up to 6 hours, the radioactivity in plasma and several organs was investigated. Most of the radioactivity found (>98% in plasma, >75% in liver) was bound to protein. Label present in liver, plasma and kidney was in the range of 1-2% of total radioactivity administered per g or mL, changing little with time. Other organs (brown and white adipose tissues, muscle, brain, cornea and retina) contained levels of label in the range of 1/12 to 1/10th of that of liver. In all, the rat retained, 6 hours after administration about 5% of the label, half of it in the liver. The specific radioactivity of tissue protein, RNA and DNA was quite uniform. The protein label was concentrated in amino acids, different from methionine, and largely coincident with the result of protein exposure to labelled formaldehyde. DNA radioactivity was essentially in a single different adduct base, different from the normal bases present in DNA. The nature of the tissue label accumulated was, thus, a direct consequence of formaldehyde binding to tissue structures. The administration of labelled aspartame to a group of cirrhotic rats resulted in comparable label retention by tissue components, which suggests that liver function (or its defect) has little effect on formaldehyde formation from aspartame and binding to biological components. The chronic treatment of a series of rats with 200 mg/kg of non-labelled aspartame during 10 days resulted in the accumulation of even more label when given the radioactive bolus, suggesting that the amount of formaldehyde adducts coming from aspartame in tissue proteins and nucleic acids may be cumulative. It is concluded that aspartame consumption may constitute a hazard because of its contribution to the formation of formaldehyde adducts.     

Transitory evoked and distortion products of otoacoustic emissions in absent auditory evoked potentials

Transient click-evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) are produced by an active biomechanical process in the cochlea, presumably related to outer hair-cell activity. Although it is generally accepted that in most cases of hearing loss with absent auditory evoked potentials neither TEOAE nor DPOAE can be found, some cases with such a constellation have been described. Here we report another four cases of children with severe to profound hearing loss where we discovered reproducible TEOAE and DPAOE, whereas auditory evoked potentials were missing. TEOAE and DPOAE recordings in these cases indicate substantially preserved outer hair-cell function independent of profound pre-sensineural hearing loss. Since the incidence of children with preserved otoacoustic emissions together with impairment of synaptic or postsynaptic function of the first neuron is not known, the unconditioned use of TEOAE nor DPOAE as a screening instrument must be seriously questioned. Secondly, in conjunction with subjective audiometry and brain-stem-evoked potentials, emission recordings is an indispensable measurement prior to cochlear implantation and use of high-power hearing aids.     

Contralateral suppression of transiently evoked otoacoustic emissions and neuro-otology

Transiently evoked otoacoustic emissions can be suppressed with simultaneous contralateral sound stimulation. This is considered to be effected via the efferent pathway from the superior olivary complex (SOC) to the contralateral cochlea. This study examined this effect in patients with extrinsic and intrinsic lesions of the brainstem which may affect the efferent pathway either within the vestibular nerve which carries the efferent bundle to the cochlea or within the brainstem at the level of the SOC. Suppression is reduced or absent in these patients and the site and size of the lesion determines whether the suppression is affected unilaterally or bilaterally. Lesions affecting the auditory afferent pathway without significant alteration in hearing appear to affect the efferent pathway too.     

Relationship between evoked otoacoustic emissions and middle-ear dynamic characteristics

Evoked otoacoustic emissions (EOAEs) are considered to originate from outer hair cell movement and to be transmitted to the external auditory meatus through the ossicular chain and eardrum in a retrograde fashion. Therefore, the effect of the middle ear on EOAEs seems to be large. A sweep frequency middle-ear analyzer (MEA) has been developed that gives much more information on middle-ear dynamic characteristics than a conventional impedance meter. In this paper, applying our own EOAE measuring system and the MEA, EOAEs and middle-ear dynamic characteristics of normal subjects were measured, and an attempt was made to clarify the relationship between EOAEs and middle-ear dynamic characteristics. It is concluded that EOAEs are detected most distinctly at the middle-ear resonance frequency and that EOAEs are most detectable in normal subjects whose middle-ear mobility is moderate.     

The effect of furosemide on evoked otoacoustic emissions in guinea pigs

After recording transiently evoked otoacoustic emissions (TEOAEs) to a click stimulus in guinea pigs by using the IL088 which was developed by Bray and Kemp (1987) for easy recording and analysis of TEOAE, the changes after intravenous administration of furosemide (30 mg/kg or 50 mg/kg) were examined. The wave of the TEOAE could be detected from 20 of 24 ears (83%). After the i.v. injection of furosemide (30 mg/kg), TEOAE powers (total echo power and highest peak power in FFT pictures) decreased quickly and showed minimum values after 5-10 min. Then they increased rapidly and recovered normally within 60 min after injection. However, no ears showed TEOAEs during the 5- to 10-min period following the injection of the 50-mg/kg dose of furosemide. They then recovered slowly as compared with the group treated with the lower dose of furosemide (30 mg/kg). These changes are similar to those of the endocochlear potential (EP) after furosemide injection. These data support the notion that the EP can contribute to the mechanism of TEOAE generation.     

Statistical evaluation of hearing screening by distortion product otoacoustic emissions

The aim of this study was to provide a statistical evaluation of the screening properties of distortion product otoacoustic emissions (DPOEs) in individuals with clinically normal hearing and in patients with pure sensorineural deafness of various degrees. The main informational parameters used were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the analysis of receiver operating characteristic (ROC) curves. For each frequency tested, ears were classified as a function of their audiometric threshold. Two groups were defined relative to an arbitrary reference, the "audiometric criterion." The PPV decreased and NPV increased with increases in the audiometric criterion. Each point of the ROC curve represents the relationship between the false alarm rate and the hit rate for each audiometric criterion ranging between 10 and 75 dB hearing level: the lower the audiometric criterion, the lower the hit rate value, and the lower the false alarm value. The audiometric criterion giving the highest hit rate and the lowest false alarm rate was 55 to 60 dB hearing level for primaries at 60 and 70 dB sound pressure level, or 25 to 30 dB hearing level for primaries at 30, 40, and 50 dB sound pressure level. These two different behaviors of ROC curves are consistent with the hypothesis that DPOEs do not represent activity at a single location along the basilar membrane.     

Changes in otoacoustic emissions in patients with idiopathic sudden deafness

Transiently click-evoked (TEOAE), distortion product (DPOAE) and spontaneous otoacoustic emissions (SOAE) were recorded and changes in these tests were studied during the recovery process in 15 cases of idiopathic sudden deafness (ISD). In all these cases the amplitudes of TEOAEs and DPOAEs increased concurrently with the recovery of the hearing threshold. Ears with ISD were not different in their OAE characteristics from ears with other forms of sensorineural hearing loss (SNHL). In 4 of the 15 cases, SOAEs could be detected when hearing had recovered. These results suggest that the function of outer hair cells (OHCs) had deteriorated when the hearing threshold was elevated and that OHC activity recovered as hearing improved to nearly normal levels in ISD cases with good outcome.     

Transient-evoked otoacoustic emissions and contralateral suppression in patients with unilateral tinnitus

OBJECTIVE: Finding an optimal soldering system for a titanium prosthesis has become increasingly important with the successful introduction of titanium and titanium alloys to dentistry. This study examined the effect of corrosion on the strength of the soldered joints of pure titanium and Ti-6Al-4V alloys joined using various solders. METHODS: Commercially pure titanium and Ti-6Al-4V alloy rods (2 mm in diameter; 25 mm long) were soldered in an argon atmosphere using four solders: two kinds of titanium-based solder, a gold-based solder, and a silver-based solder. Tensile strengths were examined before or after immersion treatments. Specimens were immersed in either a 0.9% NaCl or 1.0% lactic acid solution held at 35 degrees C for 3 and 8 wk. The amounts of various metal elements released were determined by atomic absorption photospectroscopy. The natural potentials and potentiodynamic polarization behavior of the soldered specimens in 0.9% NaCl or 1.0% lactic acid were determined by a computer-assisted corrosion measurement system. The results were analyzed by ANOVA and Student's t-test. RESULTS: The cp-titanium and Ti-6Al-4V samples soldered with titanium-based solders exhibited tensile strengths of 300-400 MPa and were not significantly affected by immersion in either solution (no significant difference at p < 0.05). The strengths of both the cp-titanium and titanium alloy specimens soldered with gold-based solder were significantly lower than for any of the other specimens and were affected by immersion in the 0.9% NaCl solution (p < 0.01). The cp-titanium and Ti-6Al-4V specimens that were soldered with titanium-based solders did not show any transpassive regions or breakdown in the natural electrode potential range. On the contrary, the specimens soldered with gold-based and silver-based solders showed transpassive regions or breakdown potentials at less than 0 mV in 0.9% NaCl solution. SIGNIFICANCE: It is recommended that titanium-based solder be employed for titanium and titanium alloys.     

Temporal patterns of transient-evoked otoacoustic emissions in normal and impaired cochleae

The spatial distribution of outer hair cells that participate in generating transient-EOE frequency-components has been investigated in man. According to several models (e.g. Wilson (1990) Hear. Res. 2, 527-532; Zwicker (1986) J. Acoust. Soc. Am. 80, 154-162; Wilson and Kemp (Eds.), Cochlear Mechanisms, Structures, Functions and Models, Plenum Press, NY), EOEs result from interferences between broadly distributed contributions, responsible for their long frequency-dependent delay. This work presents an analysis of the temporal patterns of click- and tone-burst-EOEs in human ears when contributions to EOEs are reduced by noise-induced lesions with audiometric notches centred around 4 kHz (N = 46). Although the auditory thresholds at the frequencies of the studied EOE-components were always normal, these components exhibited drastic and predictable changes compared to normal control ears (N = 40). (1) Their temporal pattern at the highest EOE frequency fmax just below the audiometric notch appeared to be determined by the cochlear state at high frequencies (6 to 8 kHz). Either it was normal and the EOE exhibited a complicated beat-structure, or it was impaired and the time envelope of the EOE was simple. In contrast, any type of time pattern could be observed in normal ears. (2) The temporal patterns of EOEs one octave below fmax always presented many beats and short delays. The proposed interpretation is that contributions to a transient-EOE component at frequency f can come from distant basal cochlear areas, i.e. more than 1 and sometimes 1.5 octaves from the place tuned to f. Therefore, the possible relationships between transient-EOEs and tuning mechanisms which presumably involve only a small number of OHC need further investigations.