A developmental study of distortion product otoacoustic emission (2f1-f2) suppression in humans

Weakened Cochlear Nonlinearity During Human Aging and Perceptual Correlates

OBJECTIVE

As humans age, compressive nonlinearity-a hallmark of healthy cochlear function-changes. The nonlinear distortion-component of the distortion product otoacoustic emission (DPOAE) provides a noninvasive gauge of cochlear nonlinearity. Earlier published work has suggested that weakened nonlinearity begins in middle age; the current work extends this investigation into the eight decade of life using advanced DPOAE data collection and analysis methods as well as multiple metrics of nonlinearity, including a test of loudness scaling.

DESIGN

The 2f1-f2 DPOAE was recorded in 20 young adults, 25 middle-aged adults and 32 older adults from f2 = 0.78 to 9.4 kHz with primary tones (f2/f1 = 1.22) swept upward at a rate of 0.5 octave/sec. Only frequencies with audiometric thresholds ≤20 dB HL were included in the analysis and to the extent possible, ears were audiometrically matched to eliminate hearing threshold as a contributing factor to the observed age effects. Input/output functions were generated for the separated distortion-component of the DPOAE to probe compressive nonlinearity of the cochlea, and ipsilateral suppression of the DPOAE was conducted to probe two-tone suppression. To investigate the perceptual effects of weakening nonlinearity on loudness perception, the same subjects performed categorical loudness scaling. Age effects on both DPOAE and loudness scaling variables were assessed, and correlations were conducted between key OAE and perceptual metrics.

RESULTS

Age × Frequency ANOVAs revealed that the compression knee of the DPOAE I/O function occurred at higher stimulus levels in both groups of older adults compared to young adults, suggesting an expanded linear range with aging; also, the compressive slope (growth beyond the knee point) was steeper in older-adults compared to young adults. These results were most notable at high frequencies. ANOVAs including age and auditory threshold as factors confirmed that the age effect observed was independent of threshold. Additionally, in smaller subsets of subjects with audiometrically matched data, these same trends persisted, further ruling out hearing threshold as an influential factor. The growth of DPOAE ipsilateral suppression was shallower near 4 kHz in middle-aged and older adults compared to young adults and elevated suppression thresholds were observed. Results of categorical loudness scaling showed steeper growth of loudness for older adults and, at fixed sensation levels (dB SL), the older-adult group rated tones as louder than did their young-adult counterparts, suggesting abnormal loudness growth and perception. Several correlations between the compression knee of the DPOAE I/O function and key metrics of loudness scaling were significant and accounted for up to one-third of the variance.

CONCLUSIONS

Results indicate that the aging cochlea begins to show weakened nonlinearity in middle age and it progressively weakens further into senescence. The perceptual impact of weakened nonlinearity during aging is manifested as abnormal loudness judgments; that is, in older-adult ears, a tone considered comfortable or medium in young-adult ears can be considered loud. The biophysical origin of this weakened nonlinearity is not known. It is hypothesized to reflect aging-related damage to, or loss of, outer hair cells and their stereocilia. More work is warranted to better define the perceptual impact of a linearized cochlear response in older adults and to consider how this deficit might impact the fitting of hearing aids and other intervention strategies.

Comparison of distortion-product otoacoustic emission and stimulus-frequency otoacoustic emission two-tone suppression in humans

Distortion-product otoacoustic emission (DPOAE) and stimulus-frequency otoacoustic emission (SFOAE) are two types of acoustic signals emitted by the inner ear in response to tonal stimuli. The levels of both emission types may be reduced by the inclusion of additional (suppressor) tones with the stimulus. Comparison of two-tone suppression properties across emission type addresses a clinically relevant question of whether these two types of emission provide similar information about cochlear status. The purpose of this study was to compare DPOAE suppression to SFOAE suppression from the same ear in a group of participants with normal hearing. Probe frequency was approximately 1000 Hz, and the suppressor frequency varied from -1.5 to 0.5 octaves relative to the probe frequency. DPOAE and SFOAE suppression were compared in terms of (1) suppression growth rate (SGR), (2) superimposed suppression tuning curves (STCs), and (3) STC-derived metrics, such as high-frequency slope, cochlear amplifier gain, and Q_ERB (ERB, equivalent rectangular bandwidth). Below the probe frequency, the SGR was slightly greater than one for SFOAEs and slightly less than two for DPOAEs. There were no differences in STC metrics across emission types. These observations may provide useful constraints on physiology-based models of otoacoustic emission suppression.

Swept-Tone Stimulus-Frequency Otoacoustic Emissions in Human Newborns

Several types of otoacoustic emissions have been characterized in newborns to study the maturational status of the cochlea at birth and to develop effective tests of hearing. The stimulus-frequency otoacoustic emission (SFOAE), a reflection-type emission elicited with a single low-level pure tone, is the least studied of these emissions and has not been comprehensively characterized in human newborns. The SFOAE has been linked to cochlear tuning and is sensitive to disruptions in cochlear gain (i.e., hearing loss) in adult subjects. In this study, we characterize SFOAEs evoked with rapidly sweeping tones in human neonates and consider the implications of our findings for human cochlear maturation. SFOAEs were measured in 29 term newborns within 72 hr of birth using swept tones presented at 2 oct/s across a four-octave frequency range (0.5–8 kHz); 20 normal-hearing young adults served as a control group. The prevalence of SFOAEs in newborns was as high as 90% (depending on how response “presence” was defined). Evidence of probe-tip leakage and abnormal ear-canal energy reflectance was observed in those ears with absent or unmeasurable SFOAEs. Results in the group of newborns with present stimulus-frequency emissions indicate that neonatal swept-tone SFOAEs are adult-like in morphology but have slightly higher amplitude compared with adults and longer SFOAE group delays. The origin of these nonadult-like features is probably mixed, including contributions from both conductive (ear canal and middle ear) and cochlear immaturities.

Stimulus-frequency otoacoustic emissions in human newborns

This study presents the first reported measurements of stimulus frequency emissions (SFOAEs) in 15 human newborns and compares their magnitudes and phase-gradient delays to those reported in adults. SFOAEs in newborns were measured at stimulus levels as low as 15 dB sound pressure level (SPL). Responses were compared between adults and newborns at stimulus levels where SFOAEs in both age groups demonstrated approximately linear growth (<40 dB SPL for newborns, <25 dB SPL for adults). Neonates had adult-like SFOAE delays when compared in this fashion, which compensates for newborn middle ear inefficiencies.

Distortion-product otoacoustic emission reflection-component delays and cochlear tuning: estimates from across the human lifespan

A consistent relationship between reflection-emission delay and cochlear tuning has been demonstrated in a variety of mammalian species, as predicted by filter theory and models of otoacoustic emission (OAE) generation. As a step toward the goal of studying cochlear tuning throughout the human lifespan, this paper exploits the relationship and explores two strategies for estimating delay trends-energy weighting and peak picking-both of which emphasize data at the peaks of the magnitude fine structure. Distortion product otoacoustic emissions (DPOAEs) at 2f1-f2 were recorded, and their reflection components were extracted in 184 subjects ranging in age from prematurely born neonates to elderly adults. DPOAEs were measured from 0.5-4 kHz in all age groups and extended to 8 kHz in young adults. Delay trends were effectively estimated using either energy weighting or peak picking, with the former method yielding slightly shorter delays and the latter somewhat smaller confidence intervals. Delay and tuning estimates from young adults roughly match those obtained from SFOAEs. Although the match is imperfect, reflection-component delays showed the expected bend (apical-basal transition) near 1 kHz, consistent with a break in cochlear scaling. Consistent with other measures of tuning, the term newborn group showed the longest delays and sharpest tuning over much of the frequency range.

Signal-processing strategy for restoration of cross-channel suppression in hearing-impaired listeners

Because frequency components interact nonlinearly with each other inside the cochlea, the loudness growth of tones is relatively simple in comparison to the loudness growth of complex sounds. The term suppression refers to a reduction in the response growth of one tone in the presence of a second tone. Suppression is a salient feature of normal cochlear processing and contributes to psychophysical masking. Suppression is evident in many measurements of cochlear function in subjects with normal hearing, including distortion-product otoacoustic emissions (DPOAEs). Suppression is also evident, to a lesser extent, in subjects with mild-to-moderate hearing loss. This paper describes a hearing-aid signal-processing strategy that aims to restore both loudness growth and two-tone suppression in hearing-impaired listeners. The prescription of gain for this strategy is based on measurements of loudness by a method known as categorical loudness scaling. The proposed signal-processing strategy reproduces measured DPOAE suppression tuning curves and generalizes to any number of frequency components. The restoration of both normal suppression and normal loudness has the potential to improve hearing-aid performance and user satisfaction.

Maturation and aging of the human cochlea: a view through the DPOAE looking glass

Cochlear function changes throughout the human lifespan. Distortion product otoacoustic emissions (DPOAEs) were recorded in 156 ears to examine these changes and speculate as to their mechanistic underpinnings. DPOAEs were analyzed within the context of current OAE generation theory, which recognizes distinct emission mechanisms. Seven age groups including premature newborns through senescent adults were tested with a swept-tone DPOAE protocol to examine magnitude and phase features of both the mixed DPOAE and individual distortion and reflection components. Results indicate (1) 6-8-month-old infants have the most robust DPOAE and component levels for frequencies >1.5 kHz; (2) older adults show a substantial reduction in DPOAE and distortion-component levels combined with a smaller drop in reflection-component levels; (3) all age groups manifest a violation of distortion phase invariance at frequencies below 1.5 kHz consistent with a secular break in cochlear scaling; the apical phase delay is markedly longer in newborns; and (4) phase slope of reflection emissions is most shallow in the older adults. Combined findings suggest that basilar membrane motion in the apical half of the cochlea is immature at birth and that the cochlea of senescent adults shows reduced nonlinearity and relatively shallow reflection-component phase slope, which can be interpreted to suggest degraded tuning.

Effect of age on click-evoked otoacoustic emission: A systematic review

OBJECTIVE:

The aims of this study were to investigate the changes of the total intensity of transient evoked otoacoustic emission (TEOAE) and signal-to-noise ratio in various frequency bands as a function of aging, and to explore the role of age-related decline of cochlear outer hair cells.

DATA SOURCES:

The literature was searched using the PubMed database using ‘transient-evoked otoacoustic emissions’ as a keyword. Articles were limited as follows: Species was ‘Humans’; languages were ‘English and Chinese’; publication date between 1990-01-01 and 2010-12-31. The references of the found were also searched to obtain additional articles.

DATA SELECTION:

Inclusion criteria: (1) Articles should involve the total TEOAE level or signal-to-noise ratio. (2) The measurement and analysis system used was Otodynamics ILO analysis system (ILO88, ILO92, ILO96 or ILO292). (3) Studies involved groups of greater than 10 subjects and TEOAE results were from normally hearing ears. (4) If more papers from the same author or laboratory analyzed the same subjects, only one was used.

MAIN OUTCOME MEASURES:

The correlations of the age scale with the total level and signal-to-noise ratio of TEOAE was determined, respectively.

RESULTS:

(1) TEOAE total level gradually increased until 2 months of age, and then decreased with increasing age. Significant negative correlations between total TEOAE level and age were found (r = –0.885, P = 0.000). (2) The most rapid decrease of TEOAE amplitude occurred at 1 year old. The total TEOAE level decreased about 4.25 dB SPL between 2 months to 1 year old, then about 0.26–0.52 dB SPL from 1 year to 10 years old, about 0.23 dB SPL from 11 years to 25 years old, and about 0.14 dB SPL from 26 years to 60 years old. (3) The signal-to-noise ratio in the frequency bands centered at 1.5, 2, 3 and 4 kHz decreased with increasing age after 2 months of age. Significant negative correlations between the signal-to-noise ratio and age were found for frequency bands ranging from 1.5 kHz to 4 kHz, with the highest correlations at 4 kHz (r = –0.890, P < 0.01), then at 3 kHz (r = –0.889, P < 0.01), at 2 kHz (r = –0.850, P < 0.01) and at 1.5 kHz (r = –0.705, P < 0.05). Conversely, a positive correlation between the signal-to-noise ratio centered at 1 kHz and age was found, but was not statistically significant (r = 0.298, P = 0.374).

CONCLUSION:

The total TEOAE response level decreased with increasing age after the first 2 months of age. The signal-to-noise ratio also decreased with increasing age in frequency bands above 1.5 kHz. The signal-to-noise ratio in higher frequencies decreased faster than in lower frequencies, leading to the maximum signal-to-noise ratio shift form 3.2–4.0 kHz in neonates to 1.5 kHz in adults, and further decreasing the total TEOAE response level. The age-related TEOAE spectrum peak shift is most likely because the outer hair cells functioning in higher frequencies are more prone to damage than those for lower frequencies.

Contralateral suppression of otoacoustic emissions: input-output functions in neonates

Background

The literature suggests that contralateral acoustic stimulation (CAS) alters the amplitude of the distortion product otoacoustic emissions (DPOAEs), but it is still unknown whether the DPOAE Input/Output (I/O) functions are also affected. To elucidate this aspect of the DPOAEs, the present study assessed the effects of CAS on DPOAE I/O functions at the frequencies of 2 kHz and 4 kHz, in a sample of term neonatal subjects.

Material/Methods

Sixty randomly selected neonates were included in the study. The DPOAE I/O functions were obtained at 2 kHz and 4 kHz, in the presence of a 60 dB SPL broad band-contralateral white noise, using the TDH39 headphones contralaterally. DPOAEs were recorded up to a stimulus level of L₂=35 dB peSPL.

Results

Significant DPOAE amplitude suppression effects were observed at various L₂ stimulus levels for both tested frequencies at 2 and 4 kHz. In contrast, the corresponding DPOAE slopes showed various alterations that were not statistically significant.

Conclusions

The data from the present study show that contralateral acoustic stimulation significantly affects only the amplitude of the DPOAE I/O functions; the slope is affected, but not significantly. This observation can shed light on the nature of CAS, suggesting that the latter is primarily a linear phenomenon without the cochlear compression and non-linear components seen in the healthy cochlea. From the available data it is not possible to infer whether the sample size has influenced the obtained results and the study should be repeated with a larger sample size and assessing more frequencies.

Frequency shifts with age in click-evoked otoacoustic emissions of preterm infants

A previous study [Brienesse et al. (1997). Pediatr. Res. 42, 478-483] demonstrated a positive shift with increasing postmenstrual age (PMA) in the frequencies of synchronized spontaneous otoacoustic emissions (SSOAEs) in preterm infants. We used a mixed model approach to describe a shift with PMA in the spectra of click-evoked otoacoustic emissions (CEOAEs) measured in a group of 22 preterm infants. The rate in shift in CEOAE spectral components was found to be frequency dependent, with a mean estimate of 10 Hz/week for frequencies around 2 kHz and 30 Hz/week for frequencies around 4.25 kHz. This rate decreased with increasing PMA. Because SSOAEs are often part of the CEOAE response, a comparison was made between the shifts in SSOAEs and CEOAEs in a sub-group of 16 preterm infants. The results indicate that the shifts found for both types of OAE are similar, which supports a common mechanism for this change in OAE-characteristic. At present it is not clear to what extent developmental processes in the cochlea and the middle ear can account for these frequency shifts in the spectra of CEOAEs and SSOAEs during the preterm period.

Temporal aspects of suppression in distortion-product otoacoustic emissions

This study examined the time course of cochlear suppression using a tone-burst suppressor to measure decrement of distortion-product otoacoustic emissions (DPOAEs). Seven normal-hearing subjects with ages ranging from 19 to 28 yr participated in the study. Each subject had audiometric thresholds ≤ 15 dB HL [re ANSI (2004) Specifications for Audiometers] for standard octave and inter-octave frequencies from 0.25 to 8 kHz. DPOAEs were elicited by primary tones with f(2) = 4.0 kHz and f(1) = 3.333 kHz (f(2)/f(1) = 1.2). For the f(2), L(2) combination, suppression was measured for three suppressor frequencies: One suppressor below f(2) (3.834 kHz) and two above f(2) (4.166 and 4.282 kHz) at three levels (55, 60, and 65 dB SPL). DPOAE decrement as a function of L(3) for the tone-burst suppressor was similar to decrements obtained with longer duration suppressors. Onset- and setoff- latencies were ≤ 4 ms, in agreement with previous physiological findings in auditory-nerve fiber studies that suggest suppression results from a nearly instantaneous compression of the waveform. Persistence of suppression was absent for the below-frequency suppressor (f(3) = 3.834 kHz) and was ≤ 3 ms for the two above-frequency suppressors (f(3) = 4.166 and 4.282 kHz).

Distortion-product otoacoustic emission suppression tuning curves in humans

Distortion-product otoacoustic emission (DPOAE) suppression data as a function of suppressor level (L(3)) for f(2) frequencies from 0.5 to 8 kHz and L(2) levels from 10 to 60 dB sensation level were used to construct suppression tuning curves (STCs). DPOAE levels in the presence of suppressors were converted into decrement versus L(3) functions, and the L(3) levels resulting in 3 dB decrements were derived by transformed linear regression. These L(3) levels were plotted as a function of f(3) to construct STCs. When f(3) is represented on an octave scale, STCs were similar in shape across f(2) frequency. These STCs were analyzed to provide estimates of gain (tip-to-tail difference) and tuning (Q(ERB)). Both gain and tuning decreased as L(2) increased, regardless of f(2), but the trend with f(2) was not monotonic. A roughly linear relation was observed between gain and tuning at each frequency, such that gain increased by 4-16 dB (mean ≈ 5 dB) for every unit increase in Q(ERB), although the pattern varied with frequency. These findings suggest consistent nonlinear processing across a wide frequency range in humans, although the nonlinear operation range is frequency dependent.

Growth of suppression in humans based on distortion-product otoacoustic emission measurements

Distortion-product otoacoustic emissions (DPOAEs) were used to describe suppression growth in normal-hearing humans. Data were collected at eight f(2) frequencies ranging from 0.5 to 8 kHz for L(2) levels ranging from 10 to 60 dB sensation level. For each f(2) and L(2) combination, suppression was measured for nine or eleven suppressor frequencies (f(3)) whose levels varied from -20 to 85 dB sound pressure level (SPL). Suppression grew nearly linearly when f(3) ≈ f(2), grew more rapidly for f(3) < f(2), and grew more slowly for f(3) > f(2). These results are consistent with physiological and mechanical data from lower animals, as well as previous DPOAE data from humans, although no previous DPOAE study has described suppression growth for as wide a range of frequencies and levels. These trends were evident for all f(2) and L(2) combinations; however, some exceptions were noted. Specifically, suppression growth rate was less steep as a function of f(3) for f(2) frequencies ≤ 1 kHz. Thus, despite the qualitative similarities across frequency, there were quantitative differences related to f(2), suggesting that there may be subtle differences in suppression for frequencies above 1 kHz compared to frequencies below 1 kHz.

The role of suppression in psychophysical tone-on-tone masking

This study tested the hypothesis that suppression contributes to the difference between simultaneous masking (SM) and forward masking (FM). To obtain an alternative estimate of suppression, distortion-product otoacoustic emissions (DPOAEs) were measured in the presence of a suppressor tone. Psychophysical-masking and DPOAE-suppression measurements were made in 22 normal-hearing subjects for a 4000-Hz signal/f(2) and two masker/suppressor frequencies: 2141 and 4281 Hz. Differences between SM and FM at the same masker level were used to provide a psychophysical estimate of suppression. The increase in L(2) to maintain a constant output (L(d)) provided a DPOAE estimate of suppression for a range of suppressor levels. The similarity of the psychophysical and DPOAE estimates for the two masker/suppressor frequencies suggests that the difference in amount of masking between SM and FM is at least partially due to suppression.

Changes in the DP-gram during the preterm and early postnatal period

OBJECTIVES

To describe and define changes in the infant DP-gram during an age continuum from the preterm period through the first 6 mo of postnatal life. This information provides normative guidelines for audiologists or hearing screeners using DPOAEs to monitor infant hearing status.

DESIGN

In this retrospective study, 2f1 - f2 DP-grams (DPOAE level x f2) were recorded with primary tones at 65/55 dB SPL, f2/f1 = 1.2, and f2 frequencies ranging from 1500 to 9000 Hz. Results from one ear of 290 healthy infants ranging in age from 31 wks postconceptional age to 6-mo-old were examined. Data were collected using both longitudinal design (repeated tests on the same infant over time) and cross-sectional methodology (a different group of subjects representing each age category). Subjects were divided into three groups according to age and experimental design. The effects of age and frequency on DPOAE level were analyzed in the three groups separately.

RESULTS

The combined results from the three databases indicate that (1) DPOAE level increased for mid-frequencies throughout the preterm period, from 31 to 33 wks until the time period associated with term birth. This change was significant for 4500 and 6000 Hz; (2) DPOAE level decreased as f2 frequency increased. In many infants, a shallow trough was observed with peak amplitude at 1500 Hz, a reduction in response amplitude through 4500 Hz, and a second peak around 6000 Hz; (3) during the postnatal period from birth through 6 mo, DPOAE level did not change significantly as a function of age and the DP-gram was relatively flat across f2 frequency; and (4) infants showed mean DPOAE levels that were 4 to 12 dB higher than adult levels.

CONCLUSIONS

The results indicate a frequency-dependent increase in DPOAE level during the preterm period in human infants. After birth, there is little change in amplitude through 6 mo. The infant DPOAE remains larger than adult amplitude at all ages tested, as shown in other reports, well into childhood, suggesting continued changes in DPOAE level during the first decade of life. Recent research suggests that immaturities of the conductive pathway may account for infant-adult differences in DPOAE level; however, it is not yet clear whether other sources contribute.

Low-frequency and high-frequency distortion product otoacoustic emission suppression in humans

Distortion product otoacoustic emission suppression (quantified as decrements) was measured for f(2)=500 and 4000 Hz, for a range of primary levels (L(2)), suppressor frequencies (f(3)), and suppressor levels (L(3)) in 19 normal-hearing subjects. Slopes of decrement-versus-L(3) functions were similar at both f(2) frequencies, and decreased as f(3) increased. Suppression tuning curves, constructed from decrement functions, were used to estimate (1) suppression for on- and low-frequency suppressors, (2) tip-to-tail differences, (3) Q(ERB), and (4) best frequency. Compression, estimated from the slope of functions relating suppression "threshold" to L(2) for off-frequency suppressors, was similar for 500 and 4000 Hz. Tip-to-tail differences, Q(ERB), and best frequency decreased as L(2) increased for both frequencies. However, tip-to-tail difference (an estimate of cochlear-amplifier gain) was 20 dB greater at 4000 Hz, compared to 500 Hz. Q(ERB) decreased to a greater extent with L(2) when f(2)=4000 Hz, but, on an octave scale, best frequency shifted more with level when f(2)=500 Hz. These data indicate that, at both frequencies, cochlear processing is nonlinear. Response growth and compression are similar at the two frequencies, but gain is greater at 4000 Hz and spread of excitation is greater at 500 Hz.

A comparative study of distortion-product-otoacoustic-emission fine structure in human newborns and adults with normal hearing

Distortion product otoacoustic emissions (DPOAE) measured in human newborns are not adult-like. More than a decade of work from various investigators has created a well-developed body of evidence describing these differences but the putative anatomy or physiology has only been partially explained. Recently, Abdala and Keefe [J. Acoust. Soc. Am. 120, 3832-3842 (2006)] have identified outer and middle ear immaturities that at least partially describe the differences observed between newborn and adult input-output functions and suppression tuning curves. DPOAE fine structure characteristics and their maturation have not been examined to any extent in the literature. Fine structure characteristics in two groups of ten newborns and young adults with normal hearing sensitivity are compared here. Consistent with previous reports, the newborns show higher DPOAE levels; greater fine structure depth and wider fine structure spacing is also observed in the newborns. Differences in fine structure morphology are also observed between the two age groups. While some of these findings are attributable to an immature outer and middle ear system in the newborns, it is argued that some observed differences in fine structure characteristics might be due to remnant immaturities in passive motion of the basilar membrane in the newborn cochlea.

Distortion product otoacoustic emission suppression tuning and acoustic admittance in human infants: birth through 6 months

Previous work has reported non-adultlike distortion product otoacoustic emission (DPOAE) suppression in human newborns at f2=6000 Hz, indicating an immaturity in peripheral auditory function. In this study, DPOAE suppression tuning curves (STCs) were recorded as a measure of cochlear function and acoustic admittance/reflectance (YR) in the ear canal recorded as a measure of middle-ear function, in the same 20 infants at birth and through 6 months of age. DPOAE STCs changed little from birth through 6 months, showing excessively narrow and sharp tuning throughout the test period. In contrast, several middle-ear indices at corresponding frequencies shifted systematically with increasing age, although they also remained non-adultlike at 6 months. Linear correlations were conducted between YR and DPOAE suppression features. Only two correlations out of 76 were significant, and all but three YR variables accounted for <10% of the variance in DPOAE suppression tuning. The strongest correlation was noted between admittance phase at 5700 Hz and STC tip-to-tail (R=0.49). The association between middle-ear variables and DPOAE suppression may be stronger during other developmental time periods. Study of older infants and children is needed to fully define postnatal immaturity of human peripheral auditory function.

Effects of middle-ear immaturity on distortion product otoacoustic emission suppression tuning in infant ears

Distortion product otoacoustic emission (DPOAE) measures of cochlear function, including DPOAE suppression tuning curves and input/output (I/O) functions, are not adultlike in human infants. These findings suggest the cochlear amplifier might be functionally immature in newborns. However, many noncochlear factors influence DPOAEs and must be considered. This study examines whether age differences in DPOAE I/O functions recorded from infant and adult ears reflect maturation of ear-canal/middle-ear function or cochlear mechanics. A model based on linear middle-ear transmission and nonlinear cochlear generation was developed to fit the adult DPOAE I/O data. By varying only those model parameters related to middle-ear transmission (and holding cochlear parameters at adult values), the model successfully fitted I/O data from infants at birth through age 6 months. This suggests that cochlear mechanics are mature at birth. The model predicted an attenuation of stimulus energy through the immature ear canal and middle ear, and evaluated whether immaturities in forward transmission could explain the differences consistently observed between infant and adult DPOAE suppression. Results show that once the immaturity was compensated for by providing infants with a relative increase in primary tone level, DPOAE suppression tuning at f2= 6000 Hz was similar in adults and infants.

Distortion-product otoacoustic emission suppression growth in normal and noise-exposed rabbits

This study investigated noise-induced changes in suppression growth (SG) of distortion product otoacoustic emissions (DPOAEs). Detailed measurements of SG were obtained in rabbits as a function of f2 frequencies at four primary-tone levels. SG measures were produced by using suppressor tones (STs) presented at two fixed distances from f2. The magnitude of suppression was calculated for each ST level and depicted as contour plots showing the amount of suppression as a function of the f2 frequency. At each f2, SG indices included slope, suppression threshold, and an estimate of the tip-to-tail value. All suppression measures were obtained before and after producing a cochlear dysfunction using a monaural exposure to a 2-h, 110-dB SPL octave-band noise centered at 2 kHz. The noise exposure produced varying amounts of cochlear damage as revealed by changes in DP-grams and auditory brainstem responses. However, average measures of SG slopes, suppression thresholds, and tip-to-tail values failed to mirror the mean DP-gram loss patterns. When suppression-based parameters were correlated with the amount of DPOAE loss, small but significant correlations were observed for some measures. Overall, the findings suggest that measures derived from DPOAE SG are limited in their ability to detect noise-induced cochlear damage.

Effects of aspirin on distortion product otoacoustic emission suppression in human adults: a comparison with neonatal data

One of the distortion product otoacoustic emission (DPOAE) paradigms used to study cochlear function is DPOAE (2f1-f2) ipsilateral suppression. Newborns do not have adultlike DPOAE suppression. At 6000 Hz, infants show excessively narrow DPOAE suppression tuning and shallow growth of suppression for low-frequency suppressor tones. The source of this immaturity is not known but the outer hair cell (OHC) is one possible locus. In the present study, DPOAE suppression was measured at f2 = 1500 and 6000 Hz from two groups with impaired OHC function in an attempt to model the observed immaturity in neonates: adults with aspirin-induced OHC dysfunction and subjects with sensorineural hearing loss (SNHL). Their DPOAE suppression results were compared to those obtained from a group of term newborns to address whether infant DPOAE suppression resembles suppression from individuals with known OHC dysfunction. Results indicate that aspirin systematically alters DPOAE suppression in adults at f2 = 6000 Hz, but not 1500 Hz. However, neither aspirin-induced OHC dysfunction nor naturally occurring SNHL produces "neonatal-like" DPOAE suppression at either test frequency. This finding does not support the hypothesis that non-adultlike DPOAE suppression characterizing newborns can be explained by minor impairments or alterations of OHC function.

Distortion product otoacoustic emissions for hearing threshold estimation and differentiation between middle-ear and cochlear disorders in neonates

Our aim in the present study was to apply extrapolated DPOAE I/O-functions [J. Acoust. Soc. Am. 111, 1810-1818 (2002); 113, 3275-3284 (2003)] in neonates in order to investigate their ability to estimate hearing thresholds and to differentiate between middle-ear and cochlear disorders. DPOAEs were measured in neonates after birth (mean age = 3.2 days) and 4 weeks later (follow-up) at 11 test frequencies between f2 = 1.5 and 8 kHz and compared to that found in normal hearing subjects and cochlear hearing loss patients. On average, in a single ear hearing threshold estimation was possible at about 2/3 of the test frequencies. A sufficient test performance of the approach is therefore suggested. Thresholds were higher at the first measurement compared to that found at the follow-up measurement. Since thresholds varied with frequency, transitory middle ear dysfunction due to amniotic fluid instead of cochlear immaturity is suggested to be the cause for the change in thresholds. DPOAE behavior in the neonate ears differed from that found in the cochlear hearing loss ears. From a simple model it was concluded that the difference between the estimated DPOAE threshold and the DPOAE detection threshold is able to differentiate between sound conductive and cochlear hearing loss.

Distortion product otoacoustic emission (2f1-f2) suppression in 3-month-old infants: evidence for postnatal maturation of human cochlear function?

The complete timeline for maturation of human cochlear function has not been defined. Distortion product otoacoustic emission (DPOAE)-based measures of cochlear function show non-adult-like responses from premature and term-born neonates at high f2 frequencies; however, older infants were not included in these studies. In the present experiment, previously collected DPOAE ipsilateral suppression data from premature neonates were combined with new data collected from adults, term-born neonates, and 3-month-old infants to further examine the time course for maturation of cochlear function. DPOAE suppression tuning curves (STC) and suppression growth patterns were measured in the three age groups at f2 = 6000 Hz, L1 = 65, L2 = 55 dB SPL, with an f2/f1 of 1.2. Results indicate that term-born neonates and 3-month-old infants have non-adult-like STC width, slope on the low-frequency flank, and tip features. However, the two infant groups are not significantly different from one another. Suppression growth patterns for low-frequency suppressor tones show a clear developmental progression. In general, the younger the infant, the more shallow and compressive the suppression growth for the lowest suppressor frequencies. These findings suggest a high-frequency postnatal immaturity in cochlear function as measured by DPOAE suppression. Results may have been influenced by noncochlear factors, such as middle-ear immaturity. These factors are reviewed and considered.

Frequency specificity of distortion-product otoacoustic emissions produced by high-level tones despite inefficient cochlear electromechanical feedback

Distortion product otoacoustic emissions (DPOAEs) are thought to stem from the outer hair cells (OHCs) around the normally narrow place tuned to the primary tone stimuli. They are thus said to be frequency-specific: their local absence should accurately pinpoint local OHC damage. Yet the influence of impaired tuning on DPOAE frequency specificity is poorly documented. Mice with local damage to OHCs were examined. Their DPOAEs were frequency-specific in that audiometric notches were accurately tracked. The same cochleae were further impaired by ischemia or furosemide injection inducing strial dysfunction with flat loss of sensitivity and tuning, while the preexisting pattern of damaged OHCs remained unaltered. Despite the loss of cochlear activity, DPOAEs produced by high-level (> or =70 dB SPL) primaries remained large in about the same interval where they had been initially normal, i.e., that with nondamaged OHCs, albeit with a slight frequency shift, of -1.1 kHz on average. Thus, the ability of DPOAEs to map structurally intact OHCs cannot be a mere consequence of cochlear tuning as it largely persists in its absence. The key element for this correct mapping is likely part of intact OHC structures (e.g., stereocilia bundles) and must have some tuning of its own.

Development of f2/f1 ratio functions in humans

Otoacoustic emissions (OAEs) presumably represent active processes within the cochlea fundamental to frequency-selectivity in peripheral auditory function. Maturation of the cochlear amplifier, vis-a-vis frequency encoding or selectivity, has yet to be fully characterized in humans. The purpose of this study was to further investigate the maturation of features of the f2/f1 frequency ratio (Distortion Product OAE amplitude X f2/f1 ratio) presumed to reflect cochlear frequency selectivity. A cross-sectional, multivariate study was completed comparing three age groups: pre-term infants, term infants and young adult subjects. Frequency ratio functions were analyzed at three f2 frequencies--2000, 4000 and 6000 Hz. An analysis included an estimation of the optimal ratio (OR) and a bandwidth-like measure (Q3). Analysis revealed significant interactions of age x frequency x gender for optimal ratio and a significant interaction of age x frequency for Q3. Consistent and statistically significant differences for both OR and Q3 were found in female subjects and when f2 = 2 or 6 kHz. This supports research by others [Abdala, J. Acoust. Soc. Am. 114, 3239-3250 (2003)] suggesting that the development of cochlear active mechanisms may still be somewhat in flux at least through term birth. Furthermore, OAEs appear to demonstrate gender differences in the course of such maturational changes.

A longitudinal study of distortion product otoacoustic emission ipsilateral suppression and input/output characteristics in human neonates

Past work has shown that distortion product otoacoustic emission (DPOAE) (2f1-f2) ipsilateral suppression and input/output (I/O) characteristics are not adult-like in prematurely born neonates [Abdala, J. Acoust. Soc. Am. 110, 1465-1476 (2001)]. These age differences are most pronounced at f2 = 6000 Hz and have been interpreted to indicate a subtle immaturity in human cochlear function prior to term birth. It is still not clear, however, whether term-born neonates are completely adult-like in cochlear function. To study this question, DPOAE suppression and I/O functions for f2 = 6000 Hz were measured in a group of prematurely born neonates at weekly intervals over a period of 7-8-weeks, a group of normal-hearing adults, and during a one-time test session in a group of term-born neonates. Results show that there was no significant change in suppression tuning, suppression growth, and various I/O characteristics across test session for premature neonates, but there was an age-group effect; even once prematurely born neonates reached the equivalence of term-like status (38-40-weeks postconceptional weeks), they continued to show narrower suppression tuning than adults, shallower suppression growth for low-frequency side suppressor tones, and an elevated amplitude saturation plateau on the I/O function. Term-born neonates showed DPOAE results that were comparable to those measured from premature neonates and unlike adult findings. These results suggest that a subtle immaturity in cochlear function persists into the postnatal period.

Audiologic assessment in infants

PURPOSE

The purpose of this review is to provide the reader with current information regarding the standards for audiologic assessment of infants and very young children. The nature of the appropriate test battery and the need for adjusting test procedures to meet the specific needs of infants and toddlers are emphasized.

RECENT FINDINGS

The basic measures in the audiologic test battery include frequency-specific threshold tests by air and bone conduction, predicted by electrophysiologic measures when necessary; immittance measures including tympanometry and acoustic reflex using a high-frequency probe tone for infants under 4 months of age; and otoacoustic emissions. The ABR can be used with frequency-specific stimuli to predict the audiogram in newborns with a great deal of accuracy. Newer techniques, such as Auditory Steady State Response, are promising but need further study before they can be used reliably to predict hearing levels in infants. Finally, infants with hearing loss can be fit with amplification using prescriptive formulae, such as the Desired Sensation Level, which give appropriate hearing aid characteristics for infants based on their hearing thresholds. These fittings must be verified using objective electro-acoustic measures tailored to infants.

SUMMARY

Infants failing newborn hearing screenings can be evaluated by audiologists to predict all necessary audiologic data and those found to have hearing loss can be fitted with appropriate amplification in the newborn period. Procedures must be carefully tailored to this age group.

Maturation of cochlear nonlinearity as measured by distortion product otoacoustic emission suppression growth in humans

The growth of distortion product otoacoustic emission (DPOAE) suppression follows a systematic, frequency-dependent pattern. The pattern is consistent with direct measures of basilar-membrane response growth, psychoacoustic measures of masking growth, and measures of neural rate growth. This pattern has its basis in the recognized nonlinear properties of basilar-membrane motion and, as such, the DPOAE suppression growth paradigm can be applied to human neonates to study the maturation of cochlear nonlinearity. The objective of this experiment was to investigate the maturation of human cochlear nonlinearity and define the time course for this maturational process. Normal-hearing adults, children, term-born neonates, and premature neonates, plus a small number of children with sensorineural hearing loss, were included in this experiment. DPOAE suppression growth was measured at two f2 frequencies (1500 and 6000 Hz) and three primary tone levels (55-45, 65-55, and 75-65 dB SPL). Slope of DPOAE suppression growth, as well as an asymmetry ratio (to compare slope for suppressor tones below and above f2 frequency), were generated. Suppression threshold was also measured in all subjects. Findings indicate that both term-born neonates and premature neonates who have attained term-like age, show non-adult-like DPOAE suppression growth for low-frequency suppressor tones. These age effects are most evident at f2 = 6000 Hz. In neonates, suppression growth is shallower and suppression thresholds are elevated for suppressor tones lower in frequency than f2. Additionally, the asymmetry ratio is smaller in neonates, indicating that the typical frequency-dependent pattern of suppression growth is not present. These findings suggest that an immaturity of cochlear nonlinearity persists into the first months of postnatal life. DPOAE suppression growth examined for a small group of hearing-impaired children also showed abnormalities.

Ipsilateral distortion product otoacoustic emission (2f1-f2) suppression in children with sensorineural hearing loss

Distortion product otoacoustic emission (DPOAE) ipsilateral suppression has been applied to study cochlear function and maturation in laboratory animals and humans. Although DPOAE suppression appears to be sensitive to regions of specialized cochlear function and to cochlear immaturity, it is not known whether it reflects permanent cochlear damage, i.e., sensorineural hearing loss (SNHL), in a reliable and systematic manner in humans. Eight school-aged children with mild-moderate SNHL and 20 normal-hearing children served as subjects in this study. DPOAE (2f1-f2) suppression data were collected at four f2 frequencies (1500, 3000, 4000, and 6000 Hz) using moderate-level primary tones. Features of the DPOAE iso-suppression tuning curves and suppression growth were analyzed for both subject groups. Results show that DPOAE suppression tuning curves from hearing-impaired subjects can be reliably recorded. DPOAE suppression tuning curves were generally normal in appearance and shape for six out of eight hearing-impaired subjects but showed subtle abnormalities in at least one feature. There was not one single trend or pattern of abnormality that characterized all hearing-impaired subjects. The most prominent patterns of abnormality included: broadened tuning, elevated tip, and downward shift of tip frequency. The unique patterns of atypical DPOAE suppression in subjects with similar audiograms may suggest different patterns of underlying sensory cell damage. This speculation warrants further investigation.

Suppression tuning in noise-exposed rabbits

Psychophysical, basilar-membrane (BM), and single nerve-fiber tuning curves, as well as suppression of distortion-product otoacoustic emissions (DPOAEs), all give rise to frequency tuning patterns with stereotypical features. Similarities and differences between the behaviors of these tuning functions, both in normal conditions and following various cochlear insults, have been documented. While neural tuning curves (NTCs) and BM tuning curves behave similarly both before and after cochlear insults known to disrupt frequency selectivity, DPOAE suppression tuning curves (STCs) do not necessarily mirror these responses following either administration of ototoxins [Martin et al., J. Acoust. Soc. Am. 104, 972-983 (1998)] or exposure to temporarily damaging noise [Howard et al., J. Acoust. Soc. Am. 111, 285-296 (2002)]. However, changes in STC parameters may be predictive of other changes in cochlear function such as cochlear immaturity in neonatal humans [Abdala, Hear. Res. 121, 125-138 (1998)]. To determine the effects of noise-induced permanent auditory dysfunction on STC parameters, rabbits were exposed to high-level noise that led to permanent reductions in DPOAE level, and comparisons between pre- and postexposure DPOAE levels and STCs were made. Statistical comparisons of pre- and postexposure STC values at CF revealed consistent basal shifts in the frequency region of greatest cochlear damage, whereas thresholds, Q10dB, and tip-to-tail gain values were not reliably altered. Additionally, a large percentage of high-frequency lobes associated with third tone interference phenomena, that were exhibited in some data sets, were dramatically reduced following noise exposure. Thus, previously described areas of DPOAE interference above f2 may also be studied using this type of experimental manipulation [Martin et al., Hear. Res. 136, 105-123 (1999); Mills, J. Acoust. Soc. Am. 107, 2586-2602 (2002)].

Distortion product otoacoustic emission suppression tuning curves in normal-hearing and hearing-impaired human ears

Distortion product otoacoustic emission (DPOAE) suppression measurements were made in 20 subjects with normal hearing and 21 subjects with mild-to-moderate hearing loss. The probe consisted of two primary tones (f2, f1), with f2 held constant at 4 kHz and f2/f1 = 1.22. Primary levels (L1, L2) were set according to the equation L1 = 0.4 L2 + 39 dB [Kummer et al., J. Acoust. Soc. Am. 103, 3431-3444 (1998)], with L2 ranging from 20 to 70 dB SPL (normal-hearing subjects) and 50-70 dB SPL (subjects with hearing loss). Responses elicited by the probe were suppressed by a third tone (f3), varying in frequency from 1 octave below to 1/2 octave above f2. Suppressor level (L3) varied from 5 to 85 dB SPL. Responses in the presence of the suppressor were subtracted from the unsuppressed condition in order to convert the data into decrements (amount of suppression). The slopes of the decrement versus L3 functions were less steep for lower frequency suppressors and more steep for higher frequency suppressors in impaired ears. Suppression tuning curves, constructed by selecting the L3 that resulted in 3 dB of suppression as a function of f3, resulted in tuning curves that were similar in appearance for normal and impaired ears. Although variable, Q10 and Q(ERB) were slightly larger in impaired ears regardless of whether the comparisons were made at equivalent SPL or equivalent sensation levels (SL). Larger tip-to-tail differences were observed in ears with normal hearing when compared at either the same SPL or the same SL, with a much larger effect at similar SL. These results are consistent with the view that subjects with normal hearing and mild-to-moderate hearing loss have similar tuning around a frequency for which the hearing loss exists, but reduced cochlear-amplifier gain.

Transient emission suppression tuning curve attributes in relation to psychoacoustic threshold

Ipsilateral suppression characteristics of transiently evoked otoacoustic emissions (TEOAEs) are described in relation to psychoacoustic threshold at 4000 Hz and the presence or absence of spontaneous otoacoustic emissions in 41 adults with normal hearing. TEOAE amplitudes were measured in response to 4000-Hz tonebursts presented in linear blocks at 40 and 50 dB SPL while puretone suppressors were introduced at a variety of frequencies and levels ipsilateral to and simultaneously with the tonebursts. Suppressors close to the toneburst frequency were most effective in decreasing the amplitude of the TEOAEs, while those more remote in frequency required significantly greater intensity for a similar amount of suppression. Consequently, characteristic tuning curve shapes were obtained. Tuning-curve tip levels were closely associated with the level of the toneburst and tip frequencies occurred at or above the toneburst frequency. Tuning-curve widths (Q10), however, varied significantly across subjects with similar psychoacoustic thresholds in quiet determined by a two-alternative forced-choice method. The results suggest that a portion of that variability may be explained by the presence or absence of spontaneous otoacoustic emissions in an individual ear.

Suppression and enhancement of distortion-product otoacoustic emissions by interference tones above f(2). II. Findings in humans

Distortion-product otoacoustic emission (DPOAE) suppression tuning curves (STCs) can be obtained in a variety of laboratory animals and humans by sweeping the frequencies and levels of a third tone (f(3)) around a set of f(1) and f(2) primaries. In small laboratory animals, it was previously observed that, when the suppressor tone (f(3)) is above f(2), substantial suppression and or enhancement (suppression/enhancement) could be obtained. In the present study, it was of interest to determine if similar suppression/enhancement phenomena could be observed in humans and to what extent this might influence the interpretation of STC results reported in the literature. To this end, STCs were measured for DPOAEs at 2f(1)-f(2) and 2f(2)-f(1) in human subjects at geometric-mean frequencies (GM) of 1, 2, 3, and 4 kHz, and primary-tone equilevels of 80/80 and 75/75 dB SPL and unequal levels of 65/55 dB SPL. Overall, STC parameters were found to be comparable to those reported in the literature. For the 2f(1)-f(2) DPOAE, STC tip frequencies tuned to the region of the primaries, and tip frequencies were slightly influenced by primary-tone level. STC tip thresholds were typically within 10 dB of the level of L(2), and Q(10dB) values ranged from 1.0 to 2.5, which was consistent with the higher-level primaries employed. The 2f(1)-f(2) DPOAE showed consistent regions of suppression that were approximately an octave above the GM for the 1-kHz, 65/55-dB SPL condition. The 2f(2)-f(1) DPOAE tuned to its characteristic place above f(2) and showed reliable enhancement above the STC tip region for the 1-kHz, 75/75-dB SPL primaries. Overall, the results clearly revealed that human ears also display suppression/enhancement phenomena when f(3) reaches frequencies considerably above f(2). If suppression/enhancement phenomena reflect secondary DPOAE sources, then these sources are present in the ear-canal signal from humans as well as small laboratory animals.

Objective estimates of cochlear tuning by otoacoustic emission analysis

A new method is presented for estimating cochlear tuning starting from measurements of either the transient evoked otoacoustic emission latency or the spontaneous otoacoustic emission minimal spacing. This method could be useful in obtaining indirect information about the tuning curve, particularly for subjects that, like neonates, cannot be studied with psycho-acoustical techniques. Theoretical models of the acoustic transmission along the cochlea based on the transmission line formalism predict a relation between the otoacoustic emission latency and the frequency. This relation depends on the tuning curve, i.e., the frequency dependence of the quality factor of the cochlear resonances. On the other hand, models for the generation of spontaneous emissions based on the concept of coherent scattering from cochlear random inhomogeneities imply an independent relation between the tuning curve and the minimal frequency spacing between spontaneous emissions. In this study, experimental measurements of the otoacoustic emission latency and of the minimal spacing between spontaneous emissions are presented. Theoretical relations are derived, which connect these two measured quantities and the tuning curve. The typically longer latency of neonates implies a higher degree of tuning at high levels of stimulation.

Evidence of upward spread of suppression in DPOAE measurements

Measurements of DPOAE level in the presence of a suppressor were used to describe a pattern that is qualitatively similar to population studies in the auditory nerve and to behavioral studies of upward spread of masking. DPOAEs were measured in the presence of a suppressor (f3) fixed at either 2.1 or 4.2 kHz, and set to each of seven levels (L3) from 20 to 80 dB SPL. In the presence of a fixed f3 and L3 combination, f2 was varied from about 1 oct below to at least 1/2 oct above f3, while L2 was set to each of 6 values (20-70 dB SPL). L1 was set according to the equation L1 = 0.4L2 + 39 [Janssen et al., J. Acoust. Soc. Am. 103, 3418-3430 (1998)]. At each L2, L1 combination, DPOAE level was measured in a control condition in which no suppressor was presented. Data were converted into decrements (the amount of suppression, in dB) by subtracting the DPOAE level in the presence of each suppressor from the DPOAE level in the corresponding control condition. Plots of DPOAE decrements as a function of f2 showed maximum suppression when f2 approximately = f3. As L3 increased, the suppressive effect spread more towards higher f2 frequencies, with less spread towards lower frequencies relative to f3. DPOAE decrement versus L3 functions had steeper slopes when f2 > f3, compared to the slopes when f2 < f3. These data are consistent with other findings that have shown that response growth for a characteristic place (CP) or frequency (CF) depends on the relation between CP or CF and driver frequency, with steeper slopes when driver frequency is less than CF and shallower slopes when driver frequency is greater than CF. For a fixed amount of suppression (3 dB), L3 and L2 varied nearly linearly for conditions in which f3 approximately = f2, but grew more rapidly for conditions in which f3 < f2, reflecting the basal spread of excitation to the suppressor. The present data are similar in form to the results observed in population studies from the auditory nerve of lower animals and in behavioral masking studies in humans.

Contralateral sound stimulation suppresses the compound action potential from the auditory nerve in humans

BACKGROUND

In the past decade, contralateral sound suppression of otoacoustic emissions has been extensively used to study the role of the medial olivocochlear efferent in humans. In most studies, the suppressive effect of contralateral sound stimulation was not greater than 2 to 4 dB. However, the relation between the degree of otoacoustic emission reduction and the neural auditory threshold is unknown.

METHODS

The current study investigates the effect of contralateral sound stimulation by measuring compound action potential response from the auditory nerve during retrosigmoid surgery in humans.

RESULTS

Although only a small number of subjects responded to contralateral sound stimulation, we report that efferent activation by contralateral sound stimulation results in 10 dB effective neural attenuation.

CONCLUSIONS

Together with previous otoacoustic emission measurements in humans, this result demonstrates that the suppressive effect of contralateral noise suppression is greater when measured with compound action potential than otoacoustic emissions, and that contralateral sound suppressive effect is at least as strong in humans as in animals.

The use of distortion product otoacoustic emission suppression as an estimate of response growth

Distortion product otoacoustic emission (DPOAE) levels in response to primary pairs (f2 = 2 or 4 kHz, L2 ranging from 20 to 60 dB SPL, L1 = 0.4L2 + 39 dB) were measured with and without suppressor tones (f3), which varied from 1 octave below to 1/2 octave above f2, in normal-hearing subjects. Suppressor level (L3) varied from -5 to 85 dB SPL. DPOAE levels were converted into decrements by subtracting the level in the presence of the suppressor from the level in the absence of a suppressor. DPOAE decrement vs L3 functions showed steeper slopes when f3 < f2 and shallower slopes when f3 > f2. This pattern is similar to other measurements of response growth, such as direct measures of basilar-membrane motion, single-unit rate-level functions, suppression of basilar-membrane motion, and discharge-rate suppression from lower animals. As L2 increased, the L3 necessary to maintain 3 dB of suppression increased at a rate of about 1 dB/dB when f3 was approximately equal to f2, but increased more slowly when f3 < f2. Functions relating L3 to L2 in order to maintain a constant 3-dB reduction in DPOAE level were compared for f3 < f2 and for f3 approximately = f2 in order to derive an estimate related to "cochlear-amplifier gain." These results were consistent with the view that "cochlear gain" is greater at lower input levels, decreasing as level increases.

Effects of reversible noise exposure on the suppression tuning of rabbit distortion-product otoacoustic emissions

Distortion-product otoacoustic emissions (DPOAEs) at 2f1-f2 can be suppressed by the introduction of a third "suppressor" tone. Plotting the suppression of the DPOAE level against the changing frequency and level of the suppressor produces frequency-tuning functions referred to as suppression tuning curves (STCs). The dominant features of STCs, including their shape, are similar to the features of neural tuning curves (NTCs) recorded from single auditory nerve fibers. However, recent findings using reversible diuretics suggest that STCs do not provide the same measure of cochlear frequency selectivity as provided by NTCs. To determine if STCs are also insensitive to the adverse effects of excessive sounds, the present study exposed rabbits to a moderate-level noise that produced temporary threshold shift-like (TTS) effects on DPOAEs, and examined the influence of such exposures on STCs. DPOAEs were produced using primary tones with geometric-mean frequencies centered at 2.8 or 4 kHz, and with L1 and L2 values of 45/45, 50/35, 50/50, and 55/45 dB SPL. STCs were obtained before and during recovery for a period of approximately 2 h immediately following, and at 1, 2, 3, and 7 d post-exposure to a 2 kHz octave band noise, at levels and durations sufficient to cause significant but reversible reductions in DPOAE levels. STC data included tip center frequency, tip threshold, and Q10dB measures of tuning for suppression criteria of 3, 6, 9, and 12 dB. Recovery was variable between animals, but all rabbits recovered fully by 7 d post-exposure. STC center frequencies measured during the TTS typically tuned to a slightly higher frequency, while tip thresholds tended to decrease and Q10dB increase. Together, the results indicate that, despite similarities in the general properties of STCs and NTCs, these two types of tuning curves are affected differently following reversible cochlear insult.

DPOAE suppression tuning: cochlear immaturity in premature neonates or auditory aging in normal-hearing adults?

Previous work has shown that distortion product otoacoustic emission (DPOAE) suppression tuning curves (STCs) recorded from premature neonates are narrower than adult STCs at both low and high frequencies. This has been interpreted to indicate an immaturity in cochlear function prior to term birth. However, an alternative explanation for this finding is that adult DPOAE STCs are broadened and reflect cochlear hair cell loss in normal-hearing adults due to aging, and natural exposure to noise and ototoxins. This alternative hypothesis can be tested by studying suppression tuning in normal-hearing school-aged children. If normal-hearing children, who have not aged significantly or been exposed to noise/ototoxins, have DPOAE suppression tuning similar to adults, the auditory aging hypothesis can be ruled out. However, if children have tuning similar to premature neonates and dissimilar from adults, it implicates aging or other factors intrinsic to the adult cochlea. DPOAE STCs were recorded at 1500, 3000, and 6000 Hz using optimal parameters in normal-hearing children and adults. DPOAE STCs collected previously from premature neonates were used for age comparisons. In general, results indicate that tuning curves from children are comparable to adult STCs and significantly different from neonatal STCS at 1500 and 6000 Hz. Only the growth of suppression was not adultlike in children and only at 6000 Hz. These findings do not strongly support the auditory aging hypothesis as a primary explanation for previously observed neonatal-adult differences in DPOAE suppression tuning. It suggests that these age differences are most likely due to immaturities in the neonatal cochlea. However, nonadultlike suppression growth observed in children at 6000 Hz warrants further attention and may be indicative of subtle alternations in the adult cochlea at high frequencies.

Maturation of the human cochlear amplifier: distortion product otoacoustic emission suppression tuning curves recorded at low and high primary tone levels

The cochlear amplifier shows level-dependent function and works optimally at low levels. For this reason, manipulation of stimulus level is a route through which the human cochlear amplifier can be investigated in a noninvasive manner. Distortion product otoacoustic emissions (DPOAEs) evoked as a function of stimulus level provide a tool for exploration of human cochlear amplifier function and, when applied to neonates, for investigation of cochlear maturation. The current experiment generated 2f1-f2 DPOAE ipsilateral suppression tuning curves (STCs) at three primary tone levels and five f2 frequencies in a large group of premature and term neonates and adults. The differences between tuning generated with low- and high-level primary tones was measured to provide a gross estimate of the "tuning enhancement effect" attributed to the cochlear amplifier. Other features of the DPOAE suppression tuning curves were measured as well. Consistent with previous reports, at 1500 and 6000 Hz, STCs were narrower, with a steeper slope on the low-frequency flank of the tuning curve in premature neonates versus adults. Additionally, only DPOAE STCs from adults and term neonates became markedly broader and more shallow when recorded with high-level primary tones. It has been hypothesized that the excessive narrowness of suppression tuning and the absence of a level effect on DPOAE STCs recorded in premature neonates reflects a subtle immaturity in cochlear amplifier function just prior to term birth.

Distortion product otoacoustic emissions in human hypercholesterolemia

Epidemiological and experimental studies suggest that hypercholesterolemia promotes the development of sensorineural hearing loss; however, the underlying cellular pathomechanism remains obscure. In the present study, 20 healthy subjects and 20 patients with familial hypercholesterolemia were compared with respect to their hearing function. None of the 40 persons reported any history of hearing disorder. In accordance with this subjective impression, mean hearing thresholds were within the normal, age-dependent ranges in both groups. In contrast, the single-generator distortion product otoacoustic emissions (sgDPOAE) were reduced at and above 4 kHz. Input-output functions of DPOAE could be subdivided into three groups: (i) normal, with unity slope at low intensities and slope less than unity (0.24+/-0.07 dB/dB at higher intensities; (ii) pathologic, described by a single straight line; (iii) ill-defined, with data usually indistinguishable from the background noise level. The ill-defined DPOAE behavior was only found in patients with hypercholesterolemia; namely, for 25% of patients at f(2)=1.5 kHz and for 50% at f(2)=4 kHz. Patients belonging to the pathologic and ill-defined DPOAE groups had significantly (P<0.05) higher total serum cholesterol and LDL-cholesterol levels compared with subjects from the normal DPOAE group. While hearing thresholds of patients with ill-defined growth functions were not statistically different from those of normal subjects, speech scores were significantly reduced in these cases. The data imply that nonlinear mechanical processes in the cochlea are compromised in hypercholesterolemic patients.

Distortion product otoacoustic emission suppression in subjects with auditory neuropathy

OBJECTIVE

The objective of this experiment was to address: 1) whether normal efferent system function is required for normal cochlear tuning as measured by distortion product otoacoustic emission (DPOAE) suppression in humans and 2) whether cochlear function, assessed by DPOAE suppression tuning, is normal in a small group of patients with auditory neuropathy.

DESIGN

DPOAE suppression tuning curves (STCs) are similar to other physiologic measures of tuning. They are generated by evoking a DPOAE with two simultaneously presented pure tones and then suppressing the distortion product with a third tone of varying frequency and level. In this study, DPOAE STCs were generated with f2 frequencies of 1500, 3000, and 6000 Hz in 15 normal-hearing adults and four subjects with documented auditory neuropathy. Tuning curve width, slope and tip characteristics, as well as rate of suppression growth were measured in each group. Contralateral suppression of otoacoustic emissions (OAEs) was also recorded as an index of medial efferent function.

RESULTS

Results show that the four subjects with auditory neuropathy lacked efferent suppression of OAEs. However, these four subjects showed normal estimates of cochlear tuning as measured by DPOAE suppression results.

CONCLUSIONS

This finding suggests that normal efferent system function is not required at the time of test for normal DPOAE suppression tuning. It also suggests that cochlear function as evaluated by detailed measures of DPOAE suppression, is normal in these "typical" patients with auditory neuropathy.

Frequency responses of two- and three-tone distortion product otoacoustic emissions in Mongolian gerbils

The frequency responses of distortion product otoacoustic emission (DPOAEs) were investigated in adult Mongolian gerbils. The main goal was to investigate in this species the extent to which DPOAE measurements might be useful in estimating cochlear frequency-tuning characteristics. Specifically, this study investigated the parameter space for generation of DPOAEs to determine those regions, if any, where the emission responses gave "simple" frequency responses, i.e., responses similar in form to typical neural responses. At the same time, it was desired to determine in this species the existence, extent, and nature of the more complex three-tone emission frequency responses as observed in some other species [e.g., Martin et al., Hearing Res. 136, 105-123 (1999)]. In the present work, two-tone frequency response curves (f2/f1 ratio functions) were obtained by varying the lower frequency, f1, while holding the f2 frequency and both amplitudes (L1, L2) constant. Only for frequencies, f2, near 8 kHz did the response at the emission frequency, 2 f1-f2, form a simple, relatively broad peak. At all lower frequencies, the two-tone frequency response curve was typically complex and composed of multiple peaks. In comparison, three-tone frequency responses were constructed by fixing the primary stimulus pair (f1, f2) and varying a third tone widely in frequency (f3) and intensity (L3). Points in f3 and L3 which caused a criterion reduction in primary emission amplitude (at 2 f1-f2) were used to construct emission suppression tuning curves (STCs). Only for primary frequencies, f2, at 8 kHz and above were the emission STCs found to be simple, with shapes similar to neural frequency-tuning curves. At lower primary frequencies, particularly for relatively low primary frequency ratios (low f2/f1), three-tone responses were very complex. This complex response usually included a region of anomalous suppression in which very low suppression levels (L3) could result in significant decreases in the primary emission amplitude, often exceeding 12 dB. Regions of such anomalous suppression were typically observed under the following conditions: (1) for all f2 frequencies from 0.5 to 4 kHz; (2) for f3 frequencies between 1.4 and 8 kHz; (3) i.e., for f3 frequencies 1-3 octaves above the primary frequency, f2; (4) at L3 levels often 10 dB lower or more than the usual "best frequency" threshold, i.e., even lower than the relative minimum threshold found near the primary stimulus frequencies; (5) exhibiting sharp amplitude decreases often accompanied by emission phase shifts of about 180 deg; (6) present in both cubic emissions (2 f1-f2 and 2 f2-f1); (7) to be less extreme at larger primary stimulus frequency ratios (larger f2/f1); and (8) less extreme at larger intensity ratios (larger L1/L2). Because of the anomalous behavior at f2 frequencies below 8 kHz, "simple" emission STCs were typically only obtainable, if at all, near the extreme boundaries of the parameter space giving measurable emission amplitudes.

Distortion product otoacoustic emission (2f1-f2) amplitude growth in human adults and neonates

Distortion product otoacoustic emissions (DPOAEs) are thought to be by-products of an active amplification process in the cochlea and thus serve as a metric for evaluating the integrity of this process. Because the cochlear amplifier functions in a level-dependent fashion, DPOAEs recorded as a function of stimulus level (i.e., a DPOAE growth function) may provide important information about the range and operational characteristics of the cochlear amplifier. The DPOAE growth functions recorded in human adults and neonates may provide information about the maturation of these active cochlear processes. Two experiments were conducted. Experiment I included normal-hearing adults and term-born neonates. The 2f1-f2 DPOAE growth functions were recorded for both age groups at three f2 frequencies. Experiment II was an extension of the first experiment but added a subject group of premature neonates. The results of these studies indicate that DPOAE growth functions most often show amplitude saturation and nonmonotonic growth for all age groups. However, premature neonates show monotonic growth and the absence of amplitude saturation more often than adults. Those premature neonates who do show saturation also show an elevated threshold for amplitude saturation relative to adults. In contrast, term neonates are adultlike for most measures except that they show a larger percentage of nonsaturating growth functions than adults. These results may indicate immaturity in cochlear amplifier function prior to term birth in humans. Outer hair cell function and/or efferent regulation of outer hair cell function are hypothesized sources of this immaturity, although some contribution from the immature middle ear cannot be ruled out.

Suppression and enhancement of distortion-product otoacoustic emissions by interference tones above f(2). I. Basic findings in rabbits

The present study measured interference-response areas (IRAs) for distortion-product otoacoustic emissions (DPOAEs) at 2f(1)-f(2), 3f(1)-2f(2), and 2f(2)-f(1). The IRAs were obtained in either awake or anesthetized rabbits, or in anesthetized guinea pigs and mice, by sweeping the frequencies and levels of an interference tone (IT) around a set of f(1) and f(2) primary tones, at several fixed frequencies and levels, while plotting the effects of the IT on DPOAE level. An unexpected outcome was the occurrence of regions of suppression and/or enhancement of DPOAE level when the IT was at a frequency slightly less than to more than an octave above f(2). The IRA of the 2f(1)-f(2) DPOAE typically displayed a high-frequency (HF) lobe of suppression, while the 2f(2)-f(1) emission often exhibited considerable amounts of enhancement. Moreover, for the 2f(2)-f(1) DPOAE, when enhancement was absent, its IRA usually tuned to a region above f(2). Whether or not suppression/enhancement was observed depended upon primary-tone level and frequency separation, as well as on the relative levels of the two primaries. Various physiological manipulations involving anesthesia, eighth-nerve section, diuretic administration, or pure-tone overstimulation showed that these phenomena were of cochlear origin, and were not dependent upon the acoustic reflex or cochlear-efferent activity. The aftereffects of applying diuretics or over-exposures revealed that suppression/enhancement required the presence of sensitive, low-level DPOAE-generator sources. Additionally, suppression/enhancement were general effects in that, in addition to rabbits, they were also observed in mice and guinea pigs. Further, corresponding plots of DPOAE phase often revealed areas of differing phase change in the vicinity of the primary tones as compared to regions above f(2). These findings, along with the effects of tonal exposures designed to fatigue regions above f(2), and instances in which DPOAE level was dependent upon the amount of suppression/enhancement, suggested that the interactions of two DPOAE-generator sources contributed, in some manner, to these phenomena.