Cost of illness: an inextricable maze or an aid in decision making? The case of schizophrenia

Distortion-product otoacoustic emissions (DPOAEs) are still undergoing evaluation for clinical use. Although the effects of ageing on otoacoustic emissions have been studied quite extensively in the past, DPOAE response-growth or input-output (I-O) measures, which are well suited as an objective method for monitoring cochlear function at specific frequencies, have been less thoroughly examined. The aim of the present study was to assess the 2f1-f2 DPOAEs in a clinical setting in order to examine the response of 20 normally hearing middle-aged adults and to compare the results with those of 20 people of the same age with ears of sensorineural high-frequency hearing loss (HL). The experiment consisted of two stages. First, the DPOAE-gram was recorded in 1-4-octave steps at a stimulus level of 70 dB SPL over a frequency range of the f2 primary tone which extended from 1.001 to 6.299 kHz. Secondly, in order to elicit DPOAE I-O functions, the two primary stimuli were presented at equilevel intensities ranging from 20 to 71 dB SPL. The stimulus-level step size was 3 dB. The I-O functions were recorded at five separate DPOAE frequencies, with the f2 frequency most closely related to the clinical audiogram (f2 = 1.0, 1.5, 2.0, 4.0 and 6.0 kHz). Two clearly separated portions in the form of the I-O function for normally hearing ears were found. The first portion, in response to primary levels of 60 dB SPL and below, showed a plateau (saturating) behaviour. If primary levels exceeded 60 dB SPL, I-O functions became more linear. The attenuation of the saturation portion of the I-O function in ears with high-frequency HL across the frequency-test range is difficult to explain because elevated behavioural thresholds were observed only for frequencies > 1.5 kHz. Thus, the more linear I-Os associated with the hearing-loss frequencies may indicate deficiencies in the active properties of outer hair cells (OHCs), whereas those for I-Os < 1.5 kHz, where hearing was normal, may indicate a beginning of damage to active OHC micromechanical processes prior to their clinical manifestation. DPOAE recordings from people with high-frequency HL, possibly age-related, supplement recordings of TEOAEs and give complementary information on degenerative changes in the outer hair-cells. DPOAE I-O functions may reveal discrete pathological alterations both in the active cochlear signal processing and in the passive mechanisms of the cochlea prior to their detection by clinical audiometric tests.     

Distortion product otoacoustic emissions for the assessment of auditory sensitivity

Distortion product otoacoustic emissions (DPOAEs) were evaluated in 494 normal and 506 cochlear-impaired human ears, to determine whether DPOAEs depend on factors such as background noise, the shape of the pure tone audiogram, sex and aging, and whether a DPOAE test can perform well in distinguishing normal-hearing from hearing-impaired ears. The amplitudes of DPOAEs were measured at the frequency of 2f1-f2 (f1 < f2, f2/f1 = 1.22, f2 at 1, 2 and 4 kHz) using as stimuli two pure tones at level of 70 dB from an ILO92 Otoacoustic Emission Analyzer. The correlation coefficients between the DPOAE level and the auditory threshold decreased as the background noise levels at 1 kHz and 2 kHz increased. Therefore, it appeared that ears with large background noise levels would be inadequate for the study of DPOAEs predicting the hearing state. The sensitivity (normal-hearing ears identified as normal hearing) and the specificity (hearing-impaired ears identified as hearing impaired) at the equal-sensitivity-specificity condition were 80.7-86.7% at 1, 2 and 4 kHz, and the areas under the receiver operating characteristic (ROC) curves, which were used to estimate the test performance, were 0.88 for 1 kHz, 0.91 for 2 kHz and 0.92 for 4 kHz. Since these results suggest that a DPOAE can be used as a reliable technique for objective auditory tests, it is thought that actual values (DPOAE level: 4.3 dB at 1 kHz, 5.0 dB at 2 kHz and 2.9 dB at 4 kHz) of false-positive (hearing-impaired ears identified as normal hearing) rates corresponding to 5% can be used in clinical evaluation to separate normal hearing from hearing-impaired ears. There was, however, a significant age effect at 4 kHz on DPOAEs in the ears with the same pure tone hearing thresholds, and the areas of the ROC curves in subjects ranging from 10 to 29 years old were larger than in subjects over 50 years (1 kHz: 0.88 to 0.94 versus 0.83 to 0.84, 2 kHz: 0.95 versus 0.89, 4 kHz: 0.95 to 0.96 versus 0.88 to 0.89). Therefore, it is thought that age-adjusted norms may be necessary for the accurate interpretation of DPOAE results.     

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.     

General characteristics and suppression tuning properties of the distortion-product otoacoustic emission 2f1-f2 in the barn owl

The distortion-product otoacoustic emission (DPOAE) 2f1-f2 was measured in the ear canal of the barn owl. DPOAE were elicited by primary tones in 11 frequency regions from 1 to 9 kHz. The highest DPOAE output levels and best thresholds were found for f1 frequencies of 4 to 7 kHz and additionally at the lowest f1 frequency investigated. In some cases, the DPOAE sound pressures were only 37 dB below the primary-tone levels (PTL). The optimal primary-tone frequency ratios ranged from 1.05 to 1.45 and varied strongly among the different frequency regions investigated. The largest optimal ratios were measured in the middle frequency range for f1. At lower and higher f1, the optimal ratios decreased. DPOAE levels could be suppressed in a frequency-selective way by adding a third tone. As in other non-mammals, the best suppressive frequencies were near f1, suggesting DPOAE generation near the frequency place of this primary tone. This is in contrast to what is known for mammalian species, where the DPOAE is thought to be generated near f2. To obtain 6 dB of suppression of the DPOAE level, suppressor-tone levels ranging from 13 dB below to 4 dB above the primary-tone level were necessary. The Q10dB-values of suppression tuning curves increased as a function of frequency up to a value of 15.8. This tendency resembled the increase in frequency selectivity of auditory nerve fibers in this species.     

Effect of perilymphatic fistulas on evoked otoacoustic emissions in the guinea pig

Round window perilymphatic fistulas were surgically created in 20 guinea pigs. Distortion product otoacoustic emissions (DPOAEs) at 2fl - f2 were recorded prior to and immediately following laceration of the round window. The stimuli were equal level sinusoids (f1 < f2) with f2 ranging from 2 to 10 kHz, a fixed f2:f1 ratio of 1.25, and stimulus levels (L2 = L1) ranging from 20 to 80 dB SPL. After an 18-day survival period, emission measurements were repeated, and fluorescein was infused into the cerebrospinal fluid to verify patency or closure of the fistula. Nine animals demonstrated patent fistulas, whereas 11 had closed fistulas. There was a statistically significant reduction in DPOAE amplitude after an acute fistula across all stimulus levels (p < .001). At 18 days the DPOAE amplitudes in animals with healed fistulas could not be differentiated from controls, whereas DPOAE amplitudes in animals with patent fistulas were statistically different from controls (p < .05). The results suggest that evoked otoacoustic emissions may be useful in detecting perilymphatic fistulas.     

CD1 hearing-impaired mice. I: Distortion product otoacoustic emission levels, cochlear function and morphology

The levels of distortion product otoacoustic emissions (DPOAEs) were measured in a strain of hearing-impaired mutant mice (CD1) at various stages of outer hair cell impairment and compared to those of a control inbred strain (CBA/J). Parallel measurements of cochlear potentials and auditory brainstem evoked responses (ABRs) were performed and surface preparations of organs of Corti were observed using phalloidin staining of filamentous actin. Comparison of DPOAEs (elicited by stimulus levels of 60 and 70 dB SPL) with standard functional tests allowed the categorization of CD1 ears into two groups on the basis of the presence or absence of DPOAE, which corresponded to mean ABR thresholds greater or less than 40 dB nHL respectively. When adopting ABR threshold as the gold standard, this procedure yielded rates of false-positives and -negatives ranging from 5 to 16%. However, individual predictions of electrophysiological function from DPOAE levels were not accurate, owing to their large variance, and attempts to optimize stimulus levels did not reduce this variance. In contrast, the profiles of DPOAE level vs. f2 exhibited large correlations with ABR threshold profiles as a function of f2. It was also noteworthy that the mean levels of DPOAEs in CD1 mice recorded in frequency intervals with normal ABR thresholds were significantly smaller than those of CBA/J mice. Although hearing loss was revealed early both by DPOAEs and by other functional tests, surface preparations often remained normal until about 3-4 months of age.     

Changes in distortion product otoacoustic emissions during prolonged noise exposure

The aim of this study was to evaluate the reduction in 2f1-f2 distortion product otoacoustic emission (DPOAE) amplitude resulting from prolonged noise exposures. A group of five chinchillas was exposed continuously to an octave-band noise centered at 4.0 kHz for a total of 42 days, 6 days at each of seven exposure levels. Exposure level increased in 8-dB steps from 48 to 96 dB SPL. DPOAE input-output (I/O) functions were measured at octave intervals over a range of primary tone f2 frequencies between 1.2 and 9.6 kHz. Measurements were obtained (1) pre-exposure, (2) during days 3-6 of each 6-day exposure, and (3) 4 weeks after the final exposure. Continuous noise exposure caused a reduction in DPOAE amplitude that was greatest at f2 frequencies within and above (3.4-6.8 kHz) the octave-band noise exposure. For these f2 frequencies, DPOAE amplitudes decreased as exposure level increased up to approximately 72-80 dB SPL; higher exposure levels failed to cause any further reduction in DPOAE amplitude. The noise level at which DPOAE amplitude began to decrease was approximately 50 dB SPL. Above this critical level, DPOAE amplitude decreased 1.3 dB for every dB increase in noise level up to approximately 75 dB SPL.     

Variation in hsp gene expression and Hsp polymorphism: do they contribute to differential disease susceptibility and stress tolerance?

Auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) have been applied to the evaluation of peripheral auditory function. To date, no comparison of their relative sensitivities to aminoglycoside toxicity has been reported. The purpose of this study was to compare click evoked ABR testing and 2f1-f2 DPOAEs as detectors of cochlear damage induced by gentamicin treatment in guinea-pigs. ABR thresholds to click stimuli were recorded. DPOAE amplitude input/output functions were recorded using three different primary tone level conditions. In one condition, L1 was changed relative to a fixed L2. In the next condition, L2 was changed relative to a fixed L1. In the third condition, L1 and L2 were both changed while maintaining a consistent L1-L2 difference. Baseline L1-L2 differences were determined by adjusting L2 to produce the maximum DPOAE amplitude in each ear of each subject. Guinea-pigs were treated for a four week period with intramuscular injections of gentamicin. ABRs and DPOAEs were monitored and compared to baseline recordings or untreated control groups. DPOAE testing detected cochlear damage earlier than ABR testing. Changes in DPOAE input/output functions were noted after two weeks of treatment while changes in ABR threshold were not identified until after three weeks of treatment. The sensitivity of the DPOAE testing was related to the stimulus conditions utilized. L1-L2 differences were determined in the control group and for the initial test session by fixing L1 at 75 dB SPL and lowering L2 until the maximum DPOAE amplitude was obtained for each ear. All subsequent testing was begun using the optimal L1-L2 difference for each ear. The stimulus condition in which only L1 was changed and L2 was fixed resulted in the least sensitive DPOAE indicator of cochlear damage. The condition in which both L1 and L2 were changed, but the L1-L2 difference remained constant, resulted in the most sensitive indicator of damage. The onset and degree of cochlear damage secondary to gentamicin treatment was subject dependent. This study demonstrates that 2f1-f2 DPOAE testing is preferable to click evoked ABR testing for early detection of gentamicin toxicity of the cochlea. It also indicates that DPOAE stimulus parameters must be considered when developing test protocols. Specifically, recording the DPOAE amplitude input/output function while maintaining an effective L1-L2 difference is preferable to changing either L1 or L2 individually.     

R-phenylisopropyladenosine attenuates noise-induced hearing loss in the chinchilla

Reactive oxygen species, which are cytotoxic to living tissues, are thought to be partly responsible for noise-induced hearing loss. In this study R-phenylisopropyladenosine (R-PIA), a stable non-hydrolyzable adenosine analogue which has been found effective in upregulating antioxidant enzyme activity levels, was topologically applied to the round window of the right ears of chinchillas. Physiological saline was applied to the round window of the left ears (control). The animals were then exposed to a 4 kHz octave band noise at 105 dB SPL for 4 h. Inferior colliculus evoked potential thresholds and distortion product otoacoustic emissions (DPOAE) were measured and hair cell damage was documented. The mean threshold shifts immediately after the noise exposure were 70-90 dB at frequencies between 2 and 16 kHz. There were no significant differences in threshold shifts at this point between the R-PIA-treated and control ears. By 4 days after noise exposure, however, the R-PIA-treated ears showed 20-30 dB more recovery than saline-treated ears at frequencies between 4 and 16 kHz. More importantly, threshold measurements made 20 days after noise exposure showed 10-15 dB less permanent threshold shifts in R-PIA-treated ears. The amplitudes of DPOAE also recovered to a greater extent and outer hair cell losses were less severe in the R-PIA-treated ears. The results suggest that administration of R-PIA facilitates the recovery process of the outer hair cell after noise exposure.     

Effect of contralateral noise exposure on otoacoustic distortion product emissions in man

The influence of contralateral white noise with levels of 50 and 60 dBnHL on the amplitude of distortion-product otoacoustic emissions (DPOAE) was measured. Thirty ears of normally hearing adults (17 women, 13 men, mean age 26.5 +/- 5.3 years) were examined. Two representative DPOAE frequencies 2f1-f2 = 1342 Hz and 6341 Hz were compared. The lower DPOAE frequency was placed in the frequency region where middle-ear pressure has a strong influence on DPOAE amplitudes, the higher DPOAE frequency respectively in the region where lesser influence is exerted by middle-ear pressure. During the application of contralateral white noise a statistically significant total of 85% of DPOAE amplitudes was reduced, although there was some variation in the individual behaviour of DPOAE amplitudes. In general the higher DPOAE frequency (6341 Hz) was reduced distinctly less than the lower DPOAE frequency (1342 Hz). The reaction of DPOAE amplitude depended closely on the time course of the contralateral stimulus and amplitude reductions were present over 10 minutes without adaptation or fatigue. It is not possible to differentiate between middle-ear or inner-ear mediate effects but the middle ear is at least involved. Based on the presence of those DPOAE amplitude reductions over ten minutes without adaptation or fatigue and the fact that lower frequencies are influenced much more than higher frequencies a synergistic effect--middle-ear and efferent mediated--is suggested.     

Estimating cochlear filter response properties from distortion product otoacoustic emission (DPOAE) phase delay measurements in normal hearing human adults

This study examined cochlear filter response properties derived from f1- and f2-sweep phase delay difference measures in 60 normal hearing human adults. Seven different f2 frequencies ranging from 1.1 to 9.2 kHz were presented (f2/f1 ratios of 1.1-1.3). F2 intensity level was varied in 5 dB steps from 30 to 50 dB SPL (the level of f1 was 15 dB above the level of f2). DPOAE delay estimates in a f2-sweep paradigm are longer than in a f1-sweep paradigm at the same frequency and intensity. This indicates that the f2-sweep DPOAE phase delay is composed of a greater proportion of the filter response time at the site of DPOAE generation than the f1-sweep delay. This proportion was isolated by subtracting f1-sweep DPOAE delays from f2-sweep delays at similar f2 frequencies and intensities. Under the assumption of linearity and minimum phase the impulse response of the filter at each f2 stimulus level was calculated from the mean phase delay difference. Frequency response properties were calculated by Fourier transformation of the impulse response at each f2 frequency and intensity. High frequency low intensity impulse responses had longer response times and narrower frequency bandwidths than low frequency high intensity responses. The Q10dB values of DPOAE derived tuning curves ranged from 2.4 (1.5 kHz) to 7.3 (8.5 kHz).     

2f1-f2 distortion product otoacoustic emissions in White Leghorn chickens (Gallus domesticus): effects of frequency ratio and relative level

The effects of primary tone frequency ratio (f2/f1 ratio) and relative level (L2/L1) on the amplitude of the cubic difference tone (CDT: 2f1-f2) distortion product otoacoustic emissions (DPOAEs) were investigated in adult White Leghorn chickens (Gallus domesticus). In experiment 1, 9 f2/f1 ratios ranging from 1.05 to 1.8 were investigated. Measurements were obtained from both ears of 4 chickens at 7 f1 frequencies ranging from 0.8 to 4.0 kHz. The primary tones were equal in level, and varied from 20 to 80 dB SPL. The mean CDT amplitude increased with increasing primary tone level once the measurement noise floor was exceeded. The input/ output functions assumed one of two shapes: one in which there was a systematic increase in DPOAE amplitude with increasing primary tone level, and the other in which there was a plateau in the input/output function near 65-70 dB SPL. At the highest primary tone level (80 dB SPL), there was a decrease in the CDT amplitude with increasing f2/f1 ratio. At high primary tone levels, the f2/f1 ratio which produced the largest CDT was 1.05 or 1.1, while at lower primary tone levels the largest CDT occurred at f2/f1 ratios of 1.2-1.3. In experiment 2, L2 was held constant at 70 dB SPL, and L1 varied from 50 to 80 dB SPL. For f1 frequencies of 0.8 and 3.2 kHz, there was an increase in the CDT amplitude with increasing L1, followed by an asymptote at higher levels. In contrast, for 1.6 and 2.0 kHz f1 frequencies, the amplitude increased, plateaued and then increased again at higher levels. Informal measurements suggest that spontaneous otoacoustic emissions (SOAEs) are rarely seen in chickens. However, a reliable SOAE was observed in 1 chicken, which could be suppressed by external sounds and anoxia.     

Cytochemical and biochemical studies on adenylate cyclase activity in preneoplastic and neoplastic liver tissue and cultured liver cells

OBJECTIVE: To assess the accuracy of: 1) distortion product otoacoustic emission (DPOAE) measures for the identification of frequencies at which auditory sensitivity is normal or near normal; and 2) click and nonmasked tone burst-evoked auditory brain stem response (ABR) thresholds for behavioral threshold estimation for children with sensorineural hearing loss characterized by islands of normal sensitivity. DESIGN: DPOAEs and ABRs were recorded from five hearing-impaired and eight normal-hearing pediatric ears. The accuracy with which DPOAEs permitted identification of frequencies at which elevated hearing thresholds were present was examined. ABR and pure-tone threshold differences for the impaired ears were calculated. RESULTS: For three of the five hearing-impaired ears, significant impairments would have been missed based on click-evoked ABR thresholds. One of those hearing-impaired ears provided an essentially normal 500 Hz tone burst-evoked ABR threshold as well. Four of the hearing-impaired ears provided a 500 Hz tone burst-evoked ABR threshold within 10 dB of the respective pure-tone threshold. However, click-evoked ABR and 500 Hz tone burst-evoked ABR threshold data did not adequately delineate the hearing loss configuration for hearing aid frequency response selection. DPOAEs were present at three out of four frequencies from 1000 to 4000 Hz at which sensitivity was normal or near normal (< or =25 dB HL) and absent at 10 out of 11 frequencies at which sensitivity was impaired. The use of DPOAEs to identify frequencies at which sensitivity was normal and the use of tone burst ABR thresholds at frequencies where DPOAEs were absent provided a better estimate of these pure-tone audiograms than was provided by click-evoked and 500 Hz tone burst-evoked ABR thresholds.     

Time course of the medial olivocochlear efferent effect on otoacoustic emissions in humans

The time course of the medial olivocochlear efferent system has been studied in humans, using the suppressive effect of a contralateral broad-band noise (CBBN) on 2f1-f2 distortion product otoacoustic emissions (DPOAE) amplitude. DPOAE were recorded with F2 at 1.5 kHz, with a temporal resolution of 2.6 s, in the presence and absence of a 40 dB SL continuous CBBN, whose duration ranged between 30 s and 20 min. The CBBN suppressive effect on DPOAE amplitude was greatest from the first 2.6 s, and was sustained for 20 min. At the CBBN offset, when the CBBN duration was > or = 2 min, DPOAE amplitude continued to increase for > 1 min, showing an efferent effect outlasting CBBN stimulation.     

Vulnerability and adaptation of distortion product otoacoustic emissions to endocochlear potential variation

The endocochlear potential (EP) was reversibly decreased in adult gerbils by the intraperitoneal injection of furosemide, while cochlear functioning was monitored by measurement of distortion production otoacoustic emissions (DPE) at a range of stimulus intensities. Stimulus frequencies for DPEs were f1 = 6.8 and f2 = 8 kHz (f2/f1 = 1.18). Emissions monitored in the ear canal and scala media were 2f1-f2, 3f1-2f2, 2f2-f1, and f2-f1. Typically, the EP decreased smoothly, reached a minimum one-half hour after injection, then recovered slowly over several hours. Emissions at 2f1-f2 and 3f1-2f2 at low stimulus levels were particularly vulnerable to the change in EP. These vulnerable emissions showed characteristic trajectories in which the amplitudes changed little with the initial EP decrease, then dropped sharply as the EP continued to decrease. However, the amplitudes then began to recover even before the EP reached minimum, and recovered completely while the EP remained subnormal. The trajectories of the other odd order emissions were similar, but lacked the abrupt decrease. The variation of the even order (f2-f1) component was completely different, but appeared related to the odd order trajectories in a complex fashion. During the initial decrease for the vulnerable components, the decrease in emission amplitude (in dB) was found to be proportional to the square of the change in EP (in mV). The recovery with a subnormal EP was interpreted as an adaptive effect with a time constant of about 15 min.     

Basal cochlear lesions result in increased amplitude of otoacoustic emissions

We have measured the changes in transient otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) during and after ototoxic amikacin treatment in an animal (chinchilla) model. TEOAE and DPOAE were recorded from 6 adult chinchillas over a 6-week time course starting just before a 5-day or 7-day treatment period with amikacin sulphate (400 mg/kg/day, i.m.). After final recordings, cochlear morphology was assessed by scanning electron microscopy. Generally, both DPOAE and TEOAE amplitudes change during and after treatment in a systematic fashion. High-frequency components change first, followed by lower-frequency components. We note that there is often a long latency to the onset of changes in otoacoustic emissions (OAE), and that these changes can continue for weeks after treatment. Most importantly we report that when the basal region of the cochlea is damaged in the frequency region above the OAE recording bandwidth (0.6-6 kHz for TEOAE; 1-6.7 kHz for DPOAE), we often find an increase in OAE amplitudes. More specifically, we note that as a cochlear lesion progresses apically, there is often a transient increase in a frequency-specific OAE before it reduces or is lost. Our results suggest that the increase in OAE amplitudes precedes the expression of detectable cochlear pathology.     

Distortion-product otoacoustic emissions in kanamycin-treated guinea pig cochlea

Measurement of distortion-product otoacoustic emissions (DPOAE) is widely accepted as one of the most valuable tools for evaluating the frequency of specific cochlear pathology. Previous studies have revealed that distortion-product levels in the ear canal are definitely correlated with degree of damage in the cochlea. However, there seem to be no clear data of help in predicting the distribution and grade of damage in the cochlea quantitatively on the basis of the results of this non-invasive test. The present study is designed to assess correlations between degree of outer hair cell (OHC) damage by a potent ototoxic antibiotic, kanamycin, and DPOAE levels at the characteristic frequency at the site. Guinea pigs were used after daily intramuscular administration of kanamycin for 7 or 10 days. DPOAE levels were measured using a system (CUBDIS: Etymotic Research) with 78 frequency combinations of iso-intensity primaries from 0.5kHz to 16kHz of f2. The frequency ratio (f2/f1) was set at 1.2. Distortion-product level plots versus f2 (DP-grams) were constructed. The integrity of the OHC system was evaluated histologically by the succinic dehydrogenase (SDH) method under a light microscope. Cochleograms were constructed by calculating percentages of intact OHCs along the basilar membrane in 1-mm blocks. The DP-grams and the histopathological cochleograms showed essentially identical patterns in the kanamycin-damaged guinea pig cochlea. The results suggest that: 1) The generation of DPOAE requires functioning OHCs. 2) DPOAE measurement provides information allowing prediction of OHC damage distribution in the cochlea without histological investigations. 3) Careful setting of primary levels and other parameters is necessary to reliably predict the pathology. 4) Attempts to detect of minimal OHC damage could fail. 5) DPOAE seem very useful for monitoring cochlear function in clinically.     

Distortion product otoacoustic emissions in healthy newborns: normative data

Distortion product otoacoustic emissions (DPOAE) offer an alternative to transiently evoked otoacoustic emissions (TEOAE) as an audiological test. The former can be used as a screening technique, and may also provide frequency-specific information about the functional state of the cochlea. We recorded DPOAE in a group of healthy newborns to establish the characteristics of a DPOAE "audiogram" (DP-gram) in this population. The DP-gram can be obtained with characteristics quite similar to those observed in adults, with two sharp peaks of maximum amplitude at F2 frequencies of 2 kHz and 5-6 kHz, and a decline in DPOAE amplitude in midfrequencies. The results confirm the limitations of DPOAE recording for testing parts of the basilar membrane where lower frequencies are coded.     

Transient-evoked and 2F1-F2 distortion product oto-acoustic emissions in dogs: preliminary findings

Transient (click)-evoked oto-acoustic emissions (TEOAEs) and distortion product oto-acoustic emissions (DPOAEs) were recorded in a feasibility study in 7 healthy mixed-breed dogs using the ILO 92 OAE analyser (Otodynamics, Hartfield, UK). Five dogs were found to have normal hearing in both ears and 2 dogs in the left ear only following otoscopy, tympanometry and auditory brainstem response audiometry. Twelve sets of TEOAEs (click-evoked) to 80 dB peSPL click stimulus and 9 sets of DPOAEs (2F1-F2) to 8 different stimulus levels of the primary tones (L1/L2) were collected at 11 test frequencies (F2) in these normal-hearing dogs. TEOAEs were successfully recorded in 11 of the 12 ears using the default user setting and in all 12 ears using the quickscreen program. DPOAEs were successfully recorded in all 9 ears tested. While the TEOAEs parameters matched those for humans, the average signal-to-noise ratio of DPOAEs was considerably higher in the dogs. Stimulus levels at 55/55, 55/45 and 55/35 dB SPL were demonstrated to produce DPOAEs that seem to reflect the active dynamic status of the outer hair cell system. Postmortem DPOAEs at these stimulus levels and TEOAEs at 80 Db peSPL could not be elicited 5 min following euthanasia of dogs. However, DPOAEs could still be recorded albeit with reduced amplitude at stimulus levels where L1 > 55 dB SPL. The results suggest that TEOAEs and DPOAEs in dogs have the potential to provide valuable insights into their mechanisms of generation, and the specific role and behaviour of outer hair cells of the cochlea in certain pathological conditions, particularly in drug-induced ototoxicity, in humans.     

Postoperative pain management in children has been improved, but can be further optimized

BACKGROUND: The aim of the study was to investigate the potential and difference of pure tone audiogram, TEOAE and DPOAE in the detection of temporary threshold shift. METHODS: 46 disco visitors who were exposed to disco music at an average intensity of 105 dB (A) for 1, 1 1/2 and 2 hours respectively underwent audiological examination before and after noise exposure. Audiological measurements performed were an audiogram and measurements of the TEOAE and DPOAE using the system ILO 92 (Otodynamics). RESULTS: The frequency range where the threshold shift occurred was around 4000 Hz in the 1 hour group and spread over all frequencies when the exposure time increased. The average threshold shift over all frequencies and probands was 6.2 dB for the 1 hour group, 7.1 dB for the 1 1/2 hour group and 10.1 dB after 2 hours of noise exposure. TEOAE amplitudes showed significant reduction only at 2000 and 3000 Hz. Even at threshold shifts exceeding 15 dB, however not in all cases, a reduction of TEOAE amplitudes occurred. Similar results were obtained regarding the DPOAE measurements. CONCLUSIONS: We conclude that TEOAE and DPOAE are not ideal instruments in the detection of temporary threshold shift after noise exposure.