Contralateral suppression of DPOAE measured in real time

Gender differences in contralateral suppression of spontaneous otoacoustic emissions in individuals with auditory neuropathy spectrum disorders

PURPOSE

The current study aims to evaluate gender variations in the efferent auditory system functioning in the ANSD population and compare them to normal hearing persons using contralateral suppression of spontaneous OAE (SOAEs).

METHODS

For the current study, a total of 54 ears were considered prospectively. 27 ears with normal hearing (NH) sensitivity were in group I, while 27 ears with ANSD were in group II. All of the subjects had a regular audiological examination followed by synchronised SOAE recordings with and without broadband noise (in the contralateral ear) at 50 dB SPL and statistical analysis was carried out.

RESULTS

Wilcoxon signed rank test revealed a significant decrease in SOAE amplitude with contralateral noise stimulation in NH, while no such trend was observed in ANSD. However, contralateral SOAE stimulation resulted in significant high-frequency shifts for both the ANSD and NH groups in the noise condition. In the comparison of gender effects on SOAE amplitude and frequency shifts using Mann-Whitney, no significant gender differences were seen. The lack of gender differences in SOAE suppression is explained based on global standing wave theory and local oscillator theory.

CONCLUSIONS

Contralateral effect of noise on SOAE shows frequency shifts, but not amplitude shifts both of which are not affected by gender effects.

Understanding degraded speech leads to perceptual gating of a brainstem reflex in human listeners

The ability to navigate "cocktail party" situations by focusing on sounds of interest over irrelevant, background sounds is often considered in terms of cortical mechanisms. However, subcortical circuits such as the pathway underlying the medial olivocochlear (MOC) reflex modulate the activity of the inner ear itself, supporting the extraction of salient features from auditory scene prior to any cortical processing. To understand the contribution of auditory subcortical nuclei and the cochlea in complex listening tasks, we made physiological recordings along the auditory pathway while listeners engaged in detecting non(sense) words in lists of words. Both naturally spoken and intrinsically noisy, vocoded speech-filtering that mimics processing by a cochlear implant (CI)-significantly activated the MOC reflex, but this was not the case for speech in background noise, which more engaged midbrain and cortical resources. A model of the initial stages of auditory processing reproduced specific effects of each form of speech degradation, providing a rationale for goal-directed gating of the MOC reflex based on enhancing the representation of the energy envelope of the acoustic waveform. Our data reveal the coexistence of 2 strategies in the auditory system that may facilitate speech understanding in situations where the signal is either intrinsically degraded or masked by extrinsic acoustic energy. Whereas intrinsically degraded streams recruit the MOC reflex to improve representation of speech cues peripherally, extrinsically masked streams rely more on higher auditory centres to denoise signals.

The medial olivocochlear reflex strength is modulated during a visual working memory task

Top-down modulation of sensory responses to distracting stimuli by selective attention has been proposed as an important mechanism by which our brain can maintain relevant information during working memory tasks. Previous works in visual working memory (VWM) have reported modulation of neural responses to distracting sounds at different levels of the central auditory pathways. Whether these modulations occur also at the level of the auditory receptor is unknown. Here, we hypothesize that cochlear responses to irrelevant auditory stimuli can be modulated by the medial olivocochlear system during VWM. Twenty-one subjects (13 males, mean age 25.3 yr) with normal hearing performed a visual change detection task with different VWM load conditions (high load = 4 visual objects; low load = 2 visual objects). Auditory stimuli were presented as distractors and allowed the measurement of distortion product otoacoustic emissions (DPOAEs) and scalp auditory evoked potentials. In addition, the medial olivocochlear reflex strength was evaluated by adding contralateral acoustic stimulation. We found larger contralateral acoustic suppression of DPOAEs during the visual working memory period (n = 21) compared with control experiments (n = 10), in which individuals were passively exposed to the same experimental conditions. These results show that during the visual working memory period there is a modulation of the medial olivocochlear reflex strength, suggesting a possible common mechanism for top-down filtering of auditory responses during cognitive processes.NEW & NOTEWORTHY The auditory efferent system has been proposed to function as a biological filter of cochlear responses during selective attention. Here, we recorded electroencephalographic activity and otoacoustic emissions in response to auditory distractors during a visual working memory task in humans. We found that the olivocochlear efferent activity is modulated during the visual working memory period suggesting a common mechanism for suppressing cochlear responses during selective attention and working memory.

The limitation of risk factors as a means of prognostication in auditory neuropathy spectrum disorder of perinatal onset

OBJECTIVE

The management of hearing loss due to auditory neuropathy spectrum disorder (ANSD) in neonates and infants is challenging because speech and language development prognosis cannot be directly inferred from early audiometric hearing thresholds. Consequently, appropriate intervention with hearing aids or cochlear implantation (CI) can be delayed. Our objective was to determine whether any features of patient history could be used to identify CI candidates with ANSD at an earlier age.

METHOD

A database was maintained over 11 years to monitor cases of perinatal onset ANSD. Risk factors associated with the perinatal time period considered pertinent to hearing outcomes were assessed, including prematurity, birth weight, APGAR score, ototoxic drugs, and hyperbilirubinemia. Children with cochlear nerve aplasia and genetic mutations were excluded. Hearing outcome was determined according to mode of auditory rehabilitation beyond 30 months of age: A) no hearing device; B) hearing aid; C) CI.

RESULTS

Of twenty-eight children with ANSD, nine (32%) had behavioural thresholds and language development sufficient to require no assistive device, 9 (32%) were fitted with hearing aids and 10 (36%) had CIs. The average age at CI (3.45 ± 2.07 years) was significantly older than the age at CI of other children in our program with prelingual hearing loss (2.05 ± 1.14 years; p = 0.01 Mann-Witney U Test). None of the putative risk factors for hearing loss reliably predicted the need for subsequent CI.

CONCLUSION

The small sample size in this study is sufficient to confirm that clinical history alone does not reliably predict which young children with perinatal-onset ANSD will require CI. Consequently, timing for CI remains delayed in these children, potentially affecting speech and language outcome. The pathogenesis of perinatal-onset ANSD remains undetermined and novel means of assessment are required for prognostication in affected infants.

Olivocochlear Efferents in Animals and Humans: From Anatomy to Clinical Relevance

Olivocochlear efferents allow the central auditory system to adjust the functioning of the inner ear during active and passive listening. While many aspects of efferent anatomy, physiology and function are well established, others remain controversial. This article reviews the current knowledge on olivocochlear efferents, with emphasis on human medial efferents. The review covers (1) the anatomy and physiology of olivocochlear efferents in animals; (2) the methods used for investigating this auditory feedback system in humans, their limitations and best practices; (3) the characteristics of medial-olivocochlear efferents in humans, with a critical analysis of some discrepancies across human studies and between animal and human studies; (4) the possible roles of olivocochlear efferents in hearing, discussing the evidence in favor and against their role in facilitating the detection of signals in noise and in protecting the auditory system from excessive acoustic stimulation; and (5) the emerging association between abnormal olivocochlear efferent function and several health conditions. Finally, we summarize some open issues and introduce promising approaches for investigating the roles of efferents in human hearing using cochlear implants.

Frequency Tuning of the Efferent Effect on Cochlear Gain in Humans

Cochlear gain reduction via efferent feedback from the medial olivocochlear bundle is frequency specific (Guinan, Curr Opin Otolaryngol Head Neck Surg 18:447-453, 2010). The present study with humans used the Fixed Duration Masking Curve psychoacoustical method (Yasin et al., J Acoust Soc Am 133:4145-4155, 2013a; Yasin et al., Basic aspects of hearing: physiology and perception, pp 39-46, 2013b; Yasin et al., J Neurosci 34:15319-15326, 2014) to estimate the frequency specificity of the efferent effect at the cochlear level. The combined duration of the masker-plus-signal stimulus was 25 ms, within the efferent onset delay of about 31-43 ms (James et al., Clin Otolaryngol 27:106-112, 2002). Masker level (4.0 or 1.8 kHz) at threshold was obtained for a 4-kHz signal in the absence or presence of an ipsilateral 60 dB SPL, 160-ms precursor (200-Hz bandwidth) centred at frequencies between 2.5 and 5.5 kHz. Efferent-mediated cochlear gain reduction was greatest for precursors with frequencies the same as, or close to that of, the signal (gain was reduced by about 20 dB), and least for precursors with frequencies well removed from that of the signal (gain remained at around 40 dB). The tuning of the efferent effect filter (tuning extending 0.5-0.7 octaves above and below the signal frequency) is within the range obtained in humans using otoacoustic emissions (Lilaonitkul and Guinan, J Assoc Res Otolaryngol 10:459-470, 2009; Zhao and Dhar, J Neurophysiol 108:25-30, 2012). The 10 dB bandwidth of the efferent-effect filter at 4000 Hz was about 1300 Hz (Q(10) of 3.1). The FDMC method can be used to provide an unbiased measure of the bandwidth of the efferent effect filter using ipsilateral efferent stimulation.

Effect of human auditory efferent feedback on cochlear gain and compression

The mammalian auditory system includes a brainstem-mediated efferent pathway from the superior olivary complex by way of the medial olivocochlear system, which reduces the cochlear response to sound (Warr and Guinan, 1979; Liberman et al., 1996). The human medial olivocochlear response has an onset delay of between 25 and 40 ms and rise and decay constants in the region of 280 and 160 ms, respectively (Backus and Guinan, 2006). Physiological studies with nonhuman mammals indicate that onset and decay characteristics of efferent activation are dependent on the temporal and level characteristics of the auditory stimulus (Bacon and Smith, 1991; Guinan and Stankovic, 1996). This study uses a novel psychoacoustical masking technique using a precursor sound to obtain a measure of the efferent effect in humans. This technique avoids confounds currently associated with other psychoacoustical measures. Both temporal and level dependency of the efferent effect was measured, providing a comprehensive measure of the effect of human auditory efferents on cochlear gain and compression. Results indicate that a precursor (>20 dB SPL) induced efferent activation, resulting in a decrease in both maximum gain and maximum compression, with linearization of the compressive function for input sound levels between 50 and 70 dB SPL. Estimated gain decreased as precursor level increased, and increased as the silent interval between the precursor and combined masker-signal stimulus increased, consistent with a decay of the efferent effect. Human auditory efferent activation linearizes the cochlear response for mid-level sounds while reducing maximum gain.

Age related changes to the dynamics of contralateral DPOAE suppression in human subjects

Background

The two ears are linked with a neural pathway such that stimulation of one ear has a modulating effect on the contralateral cochlea. This is mediated by cochlear afferent neurons connecting with olivo-cochlear efferents. The monitoring of this pathway is easily achieved by measuring contralateral suppression of otoacoustic emissions, and there is some clinical value in the ability to assess the integrity of this pathway. An important step in an evaluation of clinical utility is to assess any age-related changes. Accordingly, in the present study we measure the dynamics of contralateral DPOAE suppression in a population of normal hearing subjects of different ages.

Methods

Using a real-time DPOAE recording method we assessed contralateral DPOAE suppression in 95 ears from 51 subjects (age range 2–52 years). DPOAE (2f₁-f₂; f₂ = 4.4 kHz; f₂/f₁ = 1.22) input–output functions were measured. In response to contralateral broadband noise, dynamic aspects of DPOAE suppression were measured, specifically suppression onset latency and time constants.

Results

An age-related reduction in DPOAE amplitudes was observed. Both the detectability and the degree of contralateral DPOAE suppression were decreased in older age groups. We find an age-related increase in the latency of onset of DPOAE suppression to contralateral stimulation, but no significant change in suppression time-constants.

Conclusion

Olivo-cochlear function as revealed by contralateral suppression of DPOAEs shows some important age-related changes. In addition to reduced emissions (outer haircell suppression) we find an increased latency that may reflect deterioration in auditory brainstem function. Regarding clinical utility, it is possible that the changes observed may reflect an aspect of age-related hearing loss that has not been previously considered.

Contralateral ear occlusion for improving the reliability of otoacoustic emission screening tests

Newborn hearing screening is an established healthcare standard in many countries and testing is feasible using otoacoustic emission (OAE) recording. It is well documented that OAEs can be suppressed by acoustic stimulation of the ear contralateral to the test ear. In clinical otoacoustic emission testing carried out in a sound attenuating booth, ambient noise levels are low such that the efferent system is not activated. However in newborn hearing screening, OAEs are often recorded in hospital or clinic environments, where ambient noise levels can be 60–70 dB SPL. Thus, results in the test ear can be influenced by ambient noise stimulating the opposite ear. Surprisingly, in hearing screening protocols there are no recommendations for avoiding contralateral suppression, that is, protecting the opposite ear from noise by blocking the ear canal. In the present study we have compared transient evoked and distortion product OAEs measured with and without contralateral ear plugging, in environmental settings with ambient noise levels <25 dB SPL, 45 dB SPL, and 55 dB SPL. We found out that without contralateral ear occlusion, ambient noise levels above 55 dB SPL can significantly attenuate OAE signals. We strongly suggest contralateral ear occlusion in OAE based hearing screening in noisy environments.

Separating the contributions of olivocochlear and middle ear muscle reflexes in modulation of distortion product otoacoustic emission levels

OBJECTIVES

Mediated by the medial olivocochlear system (MOCS), distortion product otoacoustic emission (DPOAE) levels are reduced by presentation of contralateral acoustic stimuli. Such acoustic signals can also evoke a middle ear muscle reflex (MEMR) that also attenuates recorded DPOAE levels. Our aim is to clearly differentiate these two inhibitory mechanisms and to analyze each separately, perhaps allowing the development of novel tests of hearing function.

METHODS

DPOAE were recorded in real time from chinchillas with normal auditory brainstem response thresholds and middle ear function. Amplitude reduction and its onset latency caused by contralateral presentation of intermittent narrow-band noise (NBN) were measured. Stapedius and tensor tympani muscle tendons were divided without disturbing the ossicular chain, and DPOAE testing was repeated.

RESULTS

Peak reduction of (2f1 - f2) DPOAE levels occurred when the center frequency of contralateral NBN approximated the primary tone f2, indicating an f2-frequency-specific response. For a 4.5-kHz centered NBN, DPOAE (f2 = 4.4 kHz) inhibition was 0.1 dB (p < 0.001). This response remained present after tendon division, consistent with an MOCS origin. Low-frequency NBN (center frequency: 0.5 kHz) reduced otoacoustic emission levels (0.1 dB, p < 0.001) across a wide range of DPOAE frequencies. This low-frequency response was abolished by division of the middle ear muscle tendons, clearly indicating MEMR involvement.

CONCLUSIONS

Following middle ear muscle tendon division, DPOAE inhibition by contralateral stimuli approximating the primary tone f2 persists, whereas responses evoked by lower contralateral frequencies are abolished. This distinguishes the different roles of the MOCS (f2 frequency specific) and MEMR (low frequency only) in contralateral modulation of DPOAE. This analysis helps clarify the pathways involved in an objective test that might have clinical benefit in the testing of neonates.

Estimating peripheral gain and compression using fixed-duration masking curves

Estimates of human basilar membrane gain and compression obtained using temporal masking curve (TMC) and additivity of forward masking (AFM) methods with long-duration maskers or long masker-signal silent intervals may be affected by olivocochlear efferent activation, which reduces basilar membrane gain. The present study introduces a fixed-duration masking curve (FDMC) method, which involves a comparison of off- and on-frequency forward masker levels at threshold as a function of masker and signal duration, with the total masker-signal duration fixed at 25 ms to minimize efferent effects. Gain and compression estimates from the FDMC technique were compared with those from TMC (104-ms maskers) and AFM (10- and 200-ms maskers) methods. Compression estimates over an input-masker range of 40-60 dB sound pressure level were similar for the four methods. Maximum compression occurred at a lower input level for the FDMC compared to the TMC method. Estimates of gain were similar for TMC and FDMC methods. The FDMC method may provide a more reliable estimate of BM gain and compression in the absence of efferent activation and could be a useful method for estimating effects of efferent activity when used with a precursor sound (to trigger efferent activation), presented prior to the combined masker-signal stimulus.

Measurement of medial olivocochlear efferent activity in humans: comparison of different distortion product otoacoustic emission-based paradigms

OBJECTIVE

To assess the suitability of contralateral suppression (CS) of distortion product otoacoustic emissions (DPOAEs) for measurement of activity of the medial olivocochlear (MOC) efferents.

BACKGROUND

The MOC efferent system has been shown to be involved in sound discrimination, selective attention to tones, sound localization, and protection of the cochlea against noise. A great variety of paradigms for measurement of MOC activity by CS of OAE (MOC reflex [MOCR]), has been described. An issue of this approach is the dependence of the CS values on stimulus parameters, especially when DPOAE are used.

METHODS

Four different measurement paradigms, which used different combinations of stimulus frequencies and primary tone levels, were applied in 16 human subjects.

RESULTS

Mean absolute values of CS were in the range of 1.2 to 2.6 dB. The use of different stimulus parameters produced not only MOCR values of different size-which was expected-but, in many cases, also different relative classifications of the subjects according to their MOCR strength.

CONCLUSION

The suppression effects on DPOAE demonstrated in this study reflect MOC activity. However, the new conclusion from our data is that CS of DPOAE measurements, as they were used in this study, may not allow for a consistent quantitative classification of human subjects according to their MOCR strength. This finding concerns interpretation of previous studies using CS of DPOAE and analogous future studies. One future approach may lie in the separation of the DPOAE components to distinguish interference phenomena, which complicate interpretation of CS values.

Efeito de supressão nas vias auditivas: um estudo com os potenciais de média e longa latência

OBJETIVO: avaliar o efeito de supressão no Potencial Evocado Auditivo de Média e Longa Latência em indivíduos sem alterações auditivas, com presença de emissões otoacústicas (EOA) transientes em ambas as orelhas. MÉTODOS: foram avaliados 25 indivíduos (50 orelhas) de 18 a 30 anos de idade, de ambos os sexos, utilizando-se os Potenciais Evocados Auditivos de Média e Longa latência sem e com ruído branco contralateral. Os sujeitos não apresentavam queixa relacionada ao Processamento Auditivo. Foram verificados e comparados os valores numéricos das latências e amplitudes das ondas na avaliação convencional sem ruído e com ruído contralateral. RESULTADOS: a média aritmética da amplitude de resposta na situação com ruído (mascaramento) reduziu em todas as posições (C3/A1, C4/A1, C3/A2 e C4/A2), porém estes achados foram estatisticamente significantes nas posições C4/A1, C3/A2 e C4/A2. CONCLUSÃO: a diminuição da amplitude pode ter relação com o número de sinapses realizadas. O efeito de supressão na amplitude pode estar relacionado à ação do sistema eferente que suprime o número de sinapses neuronais.

Distortion product otoacoustic emission contralateral suppression functions obtained with ramped stimuli

The purpose of this research was to investigate the changes that occur in human distortion product otoacoustic emission (DPOAE) level functions over continuous frequency bands in response to activation of the medial olivocochlear (MOC) efferent system by contralateral broadband noise. DPOAEs were obtained using continuous upward ramps of the lower frequency tone (f(1)) while the higher frequency tone (f(2)) was fixed. These ramps were designed to change the stimulus frequency ratio f(2)/f(1) over a fixed range for each fixed f(2) value of 2, 3, and 4 kHz. Contralateral noise was presented on alternating ramps and the DPOAEs with and without contralateral noise were averaged separately. Stimulus frequency ratios of 1.10 and 1.22, and noise levels of 60 and 50 dB sound pressure level (SPL) were employed. Changes in DPOAE level were generally suppression (a reduction in DPOAE magnitude), but enhancement was also observed. For most participants, changes were evident for much of the frequency ranges tested. Average absolute changes for 60 dB SPL noise were 0.95, 0.81, and 0.42 dB for the wider stimulus frequency ratios and f(2) of 2, 3, and 4 kHz, respectively. For the narrower ratio and 60 dB SPL noise, the changes were larger with average absolute changes of 1.33, 1.09, and 0.87 dB. For the narrower ratio and 50 dB SPL noise, the changes were 1.08, 0.78, and 0.55 dB with f(2) of 2, 3, and 4 kHz, respectively. DPOAE nulls were observed and a common response pattern was a shift of emission morphology to higher frequencies with contralateral acoustic stimulation. The method appears promising for relatively rapid evaluation of the MOC efferent system in humans and offers information complementary to measurement strategies that explore the effects of stimulus level.

Amplitude modulation of DPOAEs by acoustic stimulation of the contralateral ear

CONCLUSION

Otoacoustic emissions generated by outer hair cells (OHCs) are influenced by stimulation of the contralateral ear via a neural pathway involving the olivo-cochlear efferent system. This is often referred to as a contralateral 'suppression reflex', but we suggest that such a term is inappropriate since distortion product otoacoustic emissions (DPOAEs) can be both enhanced and suppressed, and there is continuous modulation with no threshold effects.

OBJECTIVE

To characterize the continuous amplitude modulation of DPOAEs by contralateral sound stimulation.

MATERIALS AND METHODS

In an animal model (chinchilla), DPOAEs were recorded in real time from one ear during presentation of acoustic stimuli to the opposite ear.

RESULTS

DPOAE amplitude is suppressed by an increase in contralateral stimulation, and enhanced by a decrease in same, i.e. the emissions are continuously modulated by activity in the opposite ear. The input-output function shows a linear relationship to this system over a 40-50 dB range of contralateral stimulus levels. After a neural delay time of approximately 25 ms, DPOAE amplitude closely follows contralateral amplitude signals up to modulation frequencies of approximately 20 Hz. Thus, stimuli to one ear continually modulate the OHC system (and therefore the biomechanical amplification) of the contralateral cochlea.

Olivocochlear reflex effect on human distortion product otoacoustic emissions is largest at frequencies with distinct fine structure dips

Activity of the medial olivocochlear efferents can be inferred by measuring the change of the level of distortion product otoacoustic emissions (DPOAE) during ipsilateral or contralateral acoustic stimulation, the so-called medial olivocochlear reflex (MOCR). A limitation of this measurement strategy, however, is the distinct variability of MOCR values depending on DPOAE primary tone levels and frequency, which makes selection of the stimulus parameters difficult. The objective of this study was to evaluate the dependence of MOCR values on DPOAE fine structure in humans. MOCR during contralateral acoustic stimulation was measured at frequencies with distinct non-monotonicity ("dip") in the DPOAE fine structure, and in frequencies with flat fine structure. One hundred and twenty one different primary tone level combinations were used (L(1)=50-60dB SPL, L(2)=35-45dB SPL, 1dB steps). The measurement was repeated on another day. The major findings were: (1) Largest MOCR effects can be found in frequencies which exhibit a distinct dip in DPOAE fine structure. (2) Primary tone levels have a critical influence on the magnitude of the MOCR effect. MOCR changes of up to 23dB following a L(1) change of only 1dB were observed. Averages of the maximum MOCR change per 1dB step were in the 3-5dB-range. Both findings can be interpreted in the light of the DPOAE two-generator model [Heitmann, J., Waldmann, B., Schnitzler, H.U., Plinkert, P.K., Zenner, H.P. 1998. Suppression of distortion product otoacoustic emissions (DPOAE) near 2f1-f2 removes DP-gram fine structure - evidence for a secondary generator. Journal of the Acoustical Society of America 103, 1527-1531]. According to the present results we propose, that assessing MOCR specifically at frequencies with a distinct dip in the DPOAE fine structure, in combination with fine variation of the stimulus tone levels, allows for a more targeted search for maximum MOCR effects. Future studies must show if this approach can contribute to the further clarification of the physiological roles of the olivocochlear efferents.

Auditory efferent activation in CBA mice exceeds that of C57s for varying levels of noise

The medial olivocochlear efferent (MOC) system enhances signals in noise and helps mediate auditory attention. Contralateral suppression (CS) of distortion product otoacoustic emissions (DPOAEs) has revealed age-related MOC declines. Here, differences in CS as a function of contralateral noise intensity (43-67 dB sound pressure level) were measured; 2f1-f2 DPOAE grams were recorded for young adult CBA and C57 mice. In CBAs, CS was a monotonic function of contralateral noise level. The C57s showed normal hearing, measured with DPOAE amplitudes and auditory brainstem response thresholds, but showed little CS, suggesting a loss of efferent dynamics preceding any deficiencies of the afferent auditory system.

Contralateral suppression of otoacoustic emission in patients with tinnitus

Introduction: The medial olivocochlear bundle effect is studied through the suppression of otoacoustic emissions and seems to be influenced by the laterality of the central nervous system, presenting no symmetry between right and left ear. A dysfunction of this bundle may be involved in the generation of tinnitus, although this fact was not confirmed. Objectives: Study the suppression of distortion product otoacoustic emissions in tinnitus patients. Material and Method: A case-controlled study involving 44 tinnitus patients from the Tinnitus Group of the ENT Department of the University of São Paulo Medical School and 44 controls who underwent distortion product otoacoustic emissions testing with and without contralateral noise. Only the results from the right ears from both groups were compared. Results: There was a relationship between the presence of tinnitus and the absence of suppression at all frequencies studied (OR>2.1). Conclusion: There was a correlation between diminished effectiveness of the medial olivocochlear bundle and the presence of tinnitus.

Otoacoustic emissions

PURPOSE OF REVIEW

Otoacoustic emissions offer the practitioner a number of beneficial features as a noninvasive and objective measure of the ear's ability to process acoustic stimuli.

RECENT FINDINGS

Since their discovery, a number of clinical applications of otoacoustic emissions have been established, including their utility in the differential diagnosis of sensorineural hearing loss, in the screening of cochlear function in infants and other difficult-to-test patients, and in the monitoring of outer hair cell healthiness in patients who are exposed to potentially damaging agents or who have progressive hearing ailments.

SUMMARY

Clinical applications of OAEs have developed very rapidly and OAEs have become the standard of care, at least, for pediatric patients.