Pressure transfer function and absorption cross section from the diffuse field to the human infant ear canal

Fundamental Concepts for Assessment and Interpretation of Wideband Acoustic Immittance Measurements

Assessment of middle ear impedance using noninvasive electroacoustic measurements has undergone successive developments since its first clinical application in the 1940s, and gained widespread adoption since the 1970s in the form of 226-Hz tympanometry, and applications in multifrequency tympanometry. More recently, wideband acoustic immittance (WAI) is allowing unprecedented assessments of the middle ear acoustic mechanics thanks to the ability to record responses over a wide range of frequencies. The purpose of this article is to present fundamental concepts for the assessment and interpretation of wideband measures, including a review of acoustic impedance and its relation to the mass, stiffness, and resistance components of the middle ear. Additionally, an understanding of the middle ear transfer function reveals the relationship between impedance and middle-ear gain as a function of frequency. Wideband power absorbance, a WAI measure, quantifies the efficiency of sound conduction through the middle ear over a wide range of frequencies, and can serve as an analogous clinical measure to the transfer function. The interpretation of absorbance measures in ears with or without a conductive condition using absorbance measured at ambient pressure and pressurized conditions (wideband tympanometry) is described using clinical case examples. This article serves as an introduction to the fundamental principles of WAI measurements.

Effects of Self-Generated Noise on Quiet Threshold by Transducer Type in School-Age Children and Adults

Purpose Low-frequency detection thresholds in quiet vary across transducers. This experiment tested the hypothesis that transducer effects are larger in young children than adults, due to higher levels of self-generated noise in children. Method Listeners were normal-hearing 4.6- to 11.7-year-olds and adults. Warble-tone detection was measured at 125, 250, 500, and 1000 Hz with a sound-field speaker, insert earphones, and supra-aural headphones. Probe microphone recordings measured self-generated noise levels. Results Thresholds were similar across ages for speaker measurements. Transducer effects were larger for children than adults, with mean child-adult threshold differences at 125 Hz of 3.4 dB (insert earphones) and 6.6 dB (supra-aural headphones). Age effects on threshold were broadly consistent with noise levels measured in the ear canal. Conclusions Self-generated noise appears to elevate children's low-frequency thresholds measured with occluding transducers. These effects could be particularly relevant to the diagnosis of minimal and mild hearing loss in children.

Theoretical investigation of the low frequency fundamental mechanism of the objective occlusion effect induced by bone-conducted stimulation

The objective occlusion effect induced by bone-conducted stimulation refers to the low frequency acoustic pressure increase that results from occluding the ear canal opening. This phenomenon is commonly interpreted as follows: the bone-conducted sound "leaks" through the earcanal opening and is "trapped" by the occlusion device. This instinctive interpretation misrepresents the fundamental mechanism of the occlusion effect related to the earcanal impedance increase and already highlighted by existing electro-acoustic models. However, these models simplify the earcanal wall vibration (i.e., the origin of the phenomenon) to a volume velocity source which, in the authors' opinion, (i) hinders an exhaustive comprehension of the vibro-acoustic behavior of the system, (ii) hides the influence of the earcanal wall vibration distribution, and (iii) could blur the interpretation of the occlusion effect. This paper analyzes, illustrates, and interprets the vibro-acoustic behavior of the open and occluded earcanal using an improved finite element model of an outer ear in conjunction with an associated electro-acoustic model developed in this work. The two models are very complementary to dissect physical phenomena and to highlight the influence of the earcanal wall vibration distribution, characterized here by its curvilinear centroid position, on the occlusion effect.

Limitations of present models of blast-induced sound power conduction through the external and middle ear

The use of models to predict the effect of blast-like impulses on hearing function is an ongoing topic of investigation relevant to hearing protection and hearing-loss prevention in the modern military. The first steps in the hearing process are the collection of sound power from the environment and its conduction through the external and middle ear into the inner ear. Present efforts to quantify the conduction of high-intensity sound power through the auditory periphery depend heavily on modeling. This paper reviews and elaborates on several existing models of the conduction of high-level sound from the environment into the inner ear and discusses the shortcomings of these models. A case is made that any attempt to more accurately define the workings of the middle ear during high-level sound stimulation needs to be based on additional data, some of which has been recently gathered.

Longitudinal Development of Wideband Absorbance and Admittance Through Infancy

Purpose The aim of this article was to study the normal longitudinal development of wideband absorbance and admittance measures through infancy. Method Two hundred one infants who passed the newborn hearing screen (automated auditory brainstem response) were tested at birth and then followed up at approximately 6, 12, and 18 months of age. Most infants were of either White (86%) or Asian (11%) descent. At each test session, infants passed tympanometry and distortion product otoacoustic emission tests. High-frequency (1000-Hz) tympanometry was used at birth and 6 months of age, and low-frequency (226-Hz) tympanometry was used at 12 and 18 months of age. Wideband pressure reflectance was also measured at each session and analyzed in terms of absorbance, admittance at the probe tip, and admittance normalized for differences in ear canal area. Multilevel hierarchical models were fitted to the absorbance and admittance data to investigate for effects of age, ear side, gender, ethnicity, and frequency. Results There were considerable age effects on wideband absorbance and admittance measurements over the first 18 months of life. The most dramatic changes occurred between birth and 6 months of age, and there were significant differences between all age groups in the 3000- to 4000-Hz region. There were significant ethnicity effects that were substantial for certain combinations of ethnicity, age, and frequency (e.g., absorbance at 6000 Hz at 12 months of age). Conclusion There are large developmental effects on wideband absorbance and admittance measures through infancy. For absorbance, we recommend separate reference data be used at birth, 6 months of age, and 12-18 months of age. For admittance (both normalized and at the probe tip), we advise using separate normative regions for each age group (neonates and 6, 12, and 18 months).

Ultrasound Imaging Reveals Accelerated In-utero Development of a Sensory Apparatus in Echolocating Bats

Organ development, both in-utero and after birth, follows a different path for every organ depending upon how early the newborn will use it. Perception of the environment using echolocation occurs very early in the life of neonatal bats. In nostril-emitting echolocating bats of the families Hipposideridae and Rhinolophidae, the shape and area of the nasal-horseshoe is crucial for echolocation emission. We therefore hypothesized that most of this organ’s ontogeny will be completed in-utero while skull and wings will develop slower and continue their growth after birth. We used intrauterine ultrasonography of pregnant females, and measured newborn Asellia tridens (Hipposideridae) to test our hypothesis at different stages of ontogeny. We found that horseshoe development is completed in-utero and neonates begin emitting precursor echolocation calls already two days after birth. In contrast, skull and forearm only develop to 70% and 40% of adult size (respectively), and continue development after birth.

Sound pressure distribution within human ear canals: II. Reverse mechanical stimulation

This work is part of a study of the interactions of ear canal (EC) sound with tympanic membrane (TM) surface displacements. In human temporal bones, the ossicles were stimulated mechanically "in reverse" to mimic otoacoustic emissions (OAEs), and the sound field within the ear canal was sampled with 0.5-2 mm spacing near the TM surface and at more distal locations within the EC, including along the longitudinal EC axis. Sound fields were measured with the EC open or occluded. The reverse-driven sound field near the TM had larger and more irregular spatial variations below 10 kHz than with forward sound stimulation, consistent with a significant contribution of nonuniform sound modes. These variations generally did not propagate more than ∼4 mm laterally from the TM. Longitudinal sound field variations with the EC open or blocked were consistent with standing-wave patterns in tubes with open or closed ends. Relative contributions of the nonuniform components to the total sound pressure near the TM were largest at EC natural frequencies where the longitudinal component was small. Transverse variations in EC sound pressure can be reduced by reducing longitudinal EC sound pressure variations, e.g., via reducing reflections from occluding earplugs.

A Set of Time-and-Frequency-Localized Short-Duration Speech-Like Stimuli for Assessing Hearing-Aid Performance via Cortical Auditory-Evoked Potentials

Short-duration speech-like stimuli, for example, excised from running speech, can be used in the clinical setting to assess the integrity of the human auditory pathway at the level of the cortex. Modeling of the cochlear response to these stimuli demonstrated an imprecision in the location of the spectrotemporal energy, giving rise to uncertainty as to what and when of a stimulus caused any evoked electrophysiological response. This article reports the development and assessment of four short-duration, limited-bandwidth stimuli centered at low, mid, mid-high, and high frequencies, suitable for free-field delivery and, in addition, reproduction via hearing aids. The durations were determined by the British Society of Audiology recommended procedure for measuring Cortical Auditory-Evoked Potentials. The levels and bandwidths were chosen via a computational model to produce uniform cochlear excitation over a width exceeding that likely in a worst-case hearing-impaired listener. These parameters produce robustness against errors in insertion gains, and variation in frequency responses, due to transducer imperfections, room modes, and age-related variation in meatal resonances. The parameter choice predicts large spectral separation between adjacent stimuli on the cochlea. Analysis of the signals processed by examples of recent digital hearing aids mostly show similar levels of gain applied to each stimulus, independent of whether the stimulus was presented in isolation, bursts, continuous, or embedded in continuous speech. These stimuli seem to be suitable for measuring hearing-aided Cortical Auditory-Evoked Potentials and have the potential to be of benefit in the clinical setting.

When the Sound Becomes the Goal. 4E Cognition and Teleomusicality in Early Infancy

In this paper we explore early musical behaviors through the lenses of the recently emerged "4E" approach to mind, which sees cognitive processes as Embodied, Embedded, Enacted, and Extended. In doing so, we draw from a range of interdisciplinary research, engaging in critical and constructive discussions with both new findings and existing positions. In particular, we refer to observational research by French pedagogue and psychologist François Delalande, who examined infants' first "sound discoveries" and individuated three different musical "conducts" inspired by the "phases of the game" originally postulated by Piaget. Elaborating on such ideas we introduce the notion of "teleomusicality," which describes the goal-directed behaviors infants adopt to explore and play with sounds. This is distinguished from the developmentally earlier "protomusicality," which is based on music-like utterances, movements, and emotionally relevant interactions (e.g., with primary caregivers) that do not entail a primary focus on sound itself. The development from protomusicality to teleomusicality is discussed in terms of an "attentive shift" that occurs between 6 and 10 months of age. This forms the basis of a conceptual framework for early musical development that emphasizes the emergence of exploratory, goal-directed (i.e., sound-oriented), and self-organized musical actions in infancy. In line with this, we provide a preliminary taxonomy of teleomusical processes discussing "Original Teleomusical Acts" (OTAs) and "Constituted Teleomusical Acts" (CTAs). We argue that while OTAs can be easily witnessed in infants' exploratory behaviors, CTAs involve the mastery of more specific and complex goal-directed chains of actions central to musical activity.

Acoustic Immittance, Absorbance, and Reflectance in the Human Ear Canal

Ear canal measurements of acoustic immittance (a term that groups impedance and its inverse, admittance) and the related quantities of acoustic reflectance and power absorbance have been used to assess auditory function and aid in the differential diagnosis of conductive hearing loss for over 50 years. The change in such quantities after stimulation of the acoustic reflex also has been used in diagnosis. In this article, we define these quantities, describe how they are commonly measured, and discuss appropriate calibration procedures and standards necessary for accurate immittance/reflectance measurements.

Loudness and acoustic parameters of popular children's toys

OBJECTIVE

This project was conducted to evaluate the loudness and acoustic parameters of toys designed for children. In addition, we investigated whether occluding the toys' speaker with tape would result in a significant loudness reduction; thereby potentially reducing the risk of noise induced hearing loss.

METHODS

Twenty-six toys were selected after an initial screening at two national retailers. Noise amplitudes at 0.25, 0.5, 1, 2, 4, and 8kHz were measured using a digital sound level meter at a distance of 0 and 30cm. The toys' speakers were then occluded using adhesive tape and the same acoustic parameters were re-measured.

RESULTS

Mean maximum noise amplitude of the toys at 0cm and 30cm was 104dBA (range, 97-125dBA) and 76dBA (range, 67-86dBA), respectively. Mean maximum noise amplitude after occlusion at 0cm and 30cm distances was 88dBA (range, 73-110dBA) and 66dBA (range, 55-82dBA), respectively, with a p-value <0.001.

CONCLUSIONS

Proper use of the loudest toys at a distant of 30cm between the speaker and the child's ear will likely not pose a risk of noise-induced hearing loss. However, since most toys are used at closer distances, use of adhesive tape is recommended as an effective modification to decrease the risk of hearing loss.

Noise producing toys and the efficacy of product standard criteria to protect health and education outcomes

An evaluation of 28 commercially available toys imported into New Zealand revealed that 21% of these toys do not meet the acoustic criteria in the ISO standard, ISO 8124-1:2009 Safety of Toys, adopted by Australia and New Zealand as AS/NZS ISO 8124.1:2010. While overall the 2010 standard provided a greater level of protection than the earlier 2002 standard, there was one high risk toy category where the 2002 standard provided greater protection. A secondary set of toys from the personal collections of children known to display atypical methods of play with toys, such as those with autism spectrum disorders (ASD), was part of the evaluation. Only one of these toys cleanly passed the 2010 standard, with the remainder failing or showing a marginal-pass. As there is no tolerance level stated in the standards to account for interpretation of data and experimental error, a value of +2 dB was used. The findings of the study indicate that the current standard is inadequate in providing protection against excessive noise exposure. Amendments to the criteria have been recommended that apply to the recently adopted 2013 standard. These include the integration of the new approaches published in the recently amended European standard (EN 71) on safety of toys.

Middle-ear velocity transfer function, cochlear input immittance, and middle-ear efficiency in chinchilla

The transfer function H(V) between stapes velocity V(S) and sound pressure near the tympanic membrane P(TM) is a descriptor of sound transmission through the middle ear (ME). The ME power transmission efficiency (MEE), the ratio of sound power entering the cochlea to power entering the middle ear, was computed from H(V) measured in seven chinchilla ears and previously reported measurements of ME input admittance Y(TM) and ME pressure gain G(MEP) [Ravicz and Rosowski, J. Acoust. Soc. Am. 132, 2437-2454 (2012); J. Acoust. Soc. Am. 133, 2208-2223 (2013)] in the same ears. The ME was open, and a pressure sensor was inserted into the cochlear vestibule for most measurements. The cochlear input admittance Y(C) computed from H(V) and G(MEP) is controlled by a combination of mass and resistance and is consistent with a minimum-phase system up to 27 kHz. The real part Re{Y(C)}, which relates cochlear sound power to inner-ear sound pressure, decreased gradually with frequency up to 25 kHz and more rapidly above that. MEE was about 0.5 between 0.1 and 8 kHz, higher than previous estimates in this species, and decreased sharply at higher frequencies.

Ear-canal reflectance, umbo velocity, and tympanometry in normal-hearing adults

OBJECTIVE

This study compares measurements of ear-canal reflectance (ECR) to other objective measurements of middle ear function including audiometry, umbo velocity (VU), and tympanometry in a population of strictly defined normal-hearing ears.

DESIGN

Data were prospectively gathered from 58 ears of 29 normal-hearing subjects, 16 females and 13 males, aged 22 to 64 yr. Subjects met all of the following criteria to be considered as having normal hearing: (1) no history of significant middle ear disease; (2) no history of otologic surgery; (3) normal tympanic membrane on otoscopy; (4) pure-tone audiometric thresholds of 20 dB HL or better for 0.25 to 8 kHz; (5) air-bone gaps no greater than 15 dB at 0.25 kHz and 10 dB for 0.5 to 4 kHz; (6) normal, type-A peaked tympanograms; and (7) all subjects had two "normal" ears (as defined by these criteria). Measurements included pure-tone audiometry for 0.25 to 8 kHz, standard 226 Hz tympanometry, ECR for 0.2 to 6 kHz at 60 dB SPL using the Mimosa Acoustics HearID system, and umbo velocity (VU) for 0.3 to 6 kHz at 70 to 90 dB SPL using the HLV-1000 laser Doppler vibrometer (Polytec Inc).

RESULTS

Mean power reflectance (|ECR|) was near 1.0 at 0.2 to 0.3 kHz, decreased to a broad minimum of 0.3 to 0.4 between 1 and 4 kHz, and then sharply increased to almost 0.8 by 6 kHz. The mean pressure reflectance phase angle (∠ECR) plotted on a linear frequency scale showed a group delay of approximately 0.1 msec for 0.2 to 6 kHz. Small significant differences were observed in |ECR| at the lowest frequencies between right and left ears and between males and females at 4 kHz. |ECR| decreased with age but reached significance only at 1 kHz. Our ECR measurements were generally similar to previous published reports. Highly significant negative correlations were found between |ECR| and VU for frequencies below 1 kHz. Significant correlations were also found between the tympanometrically determined peak total compliance and |ECR| and VU at frequencies below 1 kHz. The results suggest that middle ear compliance contributes significantly to the measured power reflectance and umbo velocity at frequencies below 1 kHz but not at higher frequencies.

CONCLUSIONS

This study has established a database of objective measurements of middle ear function (ECR, umbo velocity, tympanometry) in a population of strictly defined normal-hearing ears. These data will promote our understanding of normal middle ear function and will serve as a control for comparison to similar measurements made in pathological ears.

Direct measurement of ear canal volume in a pediatric population: can we explain its individual variation in terms of age and body weight?

OBJECTIVE

The aim of this work was to measure the external auditory canal (EAC) volume in children directly and to analyze its variation according to age and body weight.

METHODS

This was a prospective study at a university-based, secondary referral hospital. Volumes of the bony and cartilaginous EACs were measured using a 1 ml tuberculin syringe filled with 95% ethyl alcohol before inserting ventilation tube(s). Three hundred thirty-eight ears from 194 children (107 boys and 87 girls) were enrolled in this study (mean age=58.8 ± 25.2 months). They were between the 10th and 90th percentiles for age and gender based on the 2007 growth chart for Korean children.

RESULTS

EAC volume tended to increase with age. The volumes of cartilaginous and total EACs were significantly larger in boys than in girls. The volume of the bony EAC was significantly larger in right than in left ears. Under the assumption that EAC volume is a linear function of age as well as body weight, these factors explained less than one-third of overall variation. Preferably, the growth of EAC seemed to be not linear with aging in pediatric population.

CONCLUSIONS

Our cubic model seemed to be more fit to the growth of EAC than simple linear model did and age and body weight alone were not clinically useful predictors of ear canal volume needed for the fitting of hearing aids in pediatric population. Because this variation can result in a large variation of real ear to coupler difference (RECD), this study supports that individual measurement of the RECD is crucial for fitting appropriate hearing aids in children.

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.

Pure-tone auditory threshold in school children

To determine pure-tone auditory thresholds, 197 screened children at a typical primary school in a German town (~70,000 inhabitants) were examined. All children underwent a tympanometry and an audiometry at 17 frequencies from 125 to 16 kHz. Regarding age effects, two groups (6-8 and 9-12 years) were analyzed. The cross-sectional research was supplemented by a follow-up study with 35 children of the first graders 3 years later. School children have the poorest hearing sensitivity at low frequencies (below 1 kHz) and the best sensitivity at the extended high frequencies above 8 kHz. Hearing thresholds are rising significantly with age. Through all frequencies, averaged improvements were 3.8 dB (right ear) and 3.7 dB (left ear) at the cross-sectional study and 3.7 dB (right ear) and 5.1 dB (left ear) at the longitudinal study. The overall deviation (left and right) from the standard thresholds for adults were 7.4 and 3.6 dB for the younger and older age groups, respectively. The ear canal volume (ECV) measured by tympanometric tests was at mean with 1.06 cm(3) for the 6- to 8-year age group significantly lower (p < 0.001) in comparison with 1.18 cm(3) for the 9- to 12-year age group. Also, girls had significant (p < 0.001) smaller ECV (mean 1.07 cm(3)) than boys (1.17 cm(3)). Auditory performance improves with rising age in school children.

Specification of absorbed-sound power in the ear canal: application to suppression of stimulus frequency otoacoustic emissions

An insert ear-canal probe including sound source and microphone can deliver a calibrated sound power level to the ear. The aural power absorbed is proportional to the product of mean-squared forward pressure, ear-canal area, and absorbance, in which the sound field is represented using forward (reverse) waves traveling toward (away from) the eardrum. Forward pressure is composed of incident pressure and its multiple internal reflections between eardrum and probe. Based on a database of measurements in normal-hearing adults from 0.22 to 8 kHz, the transfer-function level of forward relative to incident pressure is boosted below 0.7 kHz and within 4 dB above. The level of forward relative to total pressure is maximal close to 4 kHz with wide variability across ears. A spectrally flat incident-pressure level across frequency produces a nearly flat absorbed power level, in contrast to 19 dB changes in pressure level. Calibrating an ear-canal sound source based on absorbed power may be useful in audiological and research applications. Specifying the tip-to-tail level difference of the suppression tuning curve of stimulus frequency otoacoustic emissions in terms of absorbed power reveals increased cochlear gain at 8 kHz relative to the level difference measured using total pressure.

Effects of maturation on tympanometric wideband acoustic transfer functions in human infants

Wideband acoustic transfer function (ATF) measurements of energy reflectance (ER) and admittance magnitude (|Y|) were obtained at varying static ear-canal pressures in 4-, 12-, and 27-week-old infants and young adults. Developmental changes in wideband ATF measurements varied as a function of frequency. For frequencies from 0.25 to 0.75 kHz there was as much as a 30% change in mean ER and mid |Y| with changes in static ear-canal pressure between 4 and 24 weeks of age. From 0.75 to 2 kHz, the effects of pressure produced a small number of significant differences in ER and mid |Y| with age, suggestive of a developmentally stable frequency range. Between 2 and 6 kHz, there were differential effects of pressure for the youngest infants; negative pressures caused increased ER and mid |Y| and positive pressures caused decreased ER and mid |Y|; the magnitude of this effect decreased with age. Findings from this study demonstrate developmental differences in wideband tympanometric ATF measurements in 4-, 12- and 24-week-old infants and provide additional insight on the effects of static ear-canal pressure in the young infant's ear. The maturational effects shown in the experimental data are discussed in light of known age-related anatomical changes in the developing outer and middle ear.

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.

Developmental effects of multiple looks in speech sound discrimination

PURPOSE

The change/no-change procedure (J. E. Sussman & A. E. Carney, 1989), which assesses speech discrimination, has been used under the assumption that the number of stimulus presentations does not influence performance. Motivated by the tenets of the multiple looks hypothesis (N. F. Viemeister & G. H. Wakefield, 1991), work by R. F. Holt and A. E. Carney (2005) called this assumption into question (at least for adults): Nonsense syllable discrimination improved with more stimulus presentations. This study investigates the nature of developmental differences and the effects of multiple stimulus presentations in the change/no-change procedure.

METHOD

Thirty normal-hearing children, ages 4.0-5.9 years, were tested on 3 consonant-vowel contrasts at various signal-to-noise ratios using combinations of 2 and 4 standard and comparison stimulus repetitions.

RESULTS

Although performance fell below that which is predicted by the multiple looks hypothesis in most conditions, discrimination was enhanced with more stimulus repetitions for 1 speech contrast. The relative influence of standard and comparison stimulus repetitions varied across the speech contrasts in a manner different from that of adults.

CONCLUSION

Despite providing no additional sensory information, multiple stimulus repetitions enhanced children's discrimination of 1 set of nonsense syllables. The results have implications for models of developmental speech perception and assessing speech discrimination in children.

Effects of Bone Oscillator Coupling Method, Placement Location, and Occlusion on Bone-Conduction Auditory Steady-State Responses in Infants

OBJECTIVE

The aim of these experiments was to investigate procedures used when estimating bone-conduction thresholds in infants. The objectives were: (i) to investigate the variability in force applied using two common bone-oscillator coupling methods and to determine whether coupling method affects threshold estimation, (ii) to examine effects of bone-oscillator placement on bone-conduction ASSR thresholds, and (iii) to determine whether the occlusion effect is present in infants by comparing bone-conduction ASSR thresholds for unoccluded and occluded ears.

DESIGN

Experiment 1A: The variability in the amount of force applied to the bone oscillator by trained assistants (n = 4) for elastic-band and hand-held coupling methods was measured. Experiment 1B: Bone-conduction behavioral thresholds in 10 adults were compared for two coupling methods. Experiment 1C: ASSR thresholds and amplitudes to multiple bone-conduction stimuli were compared in 10 infants (mean age: 17 wk) using two coupling methods. Experiment 2: Bone-conduction ASSR thresholds and amplitudes were compared for temporal, mastoid and forehead oscillator placements in 15 preterm infants (mean age: 35 wk postconceptual age (PCA)). Experiment 3: Bone-conduction ASSR thresholds, amplitudes and phase delays were compared in 13 infants (mean age: 15 wk) for an unoccluded and occluded test ear. All infants that participated had passed a hearing screening test.

RESULTS

Experiment 1A: Coupling method did not significantly affect the variability in force applied to the oscillator. Experiment 1B: There were no differences in adult bone-conduction behavioural thresholds between coupling methods. Experiment 1C: There was no significant difference between oscillator coupling method or significant frequency x coupling method interaction for ASSR thresholds or amplitudes in the young infants tested. However, there was a nonsignificant 9-dB better threshold at 4000 Hz for the elastic-band method. Experiment 2: Mean bone-conduction ASSR thresholds for the preterm infants were not significantly different for the temporal and mastoid placements. Mean ASSR thresholds for the forehead placement were significantly higher compared to the other two placements (12-18 dB higher on average). Mean ASSR amplitudes were significantly larger for the temporal and mastoid placements compared to the forehead placement. Experiment 3: There was no difference in mean ASSR thresholds, amplitudes or phase delays for the unoccluded versus occluded conditions.

CONCLUSIONS

Trained assistants can apply an appropriate amount of force to the bone oscillator using either the elastic-band or hand-held method. Coupling method has no significant effect on estimation of bone-conduction thresholds; therefore, either may be used clinically provided assistants are appropriately trained. For preterm infants, there are no differences in ASSRs when the oscillator is positioned at the temporal or mastoid placement. However, thresholds are higher and amplitudes are smaller for the forehead placement, consequently, a forehead placement should be avoided for clinical testing. There does not appear to be a significant occlusion effect in young infants; therefore, it may be possible to do bone-conduction testing with ears unoccluded or occluded without applying a correction factor, although further research is needed to confirm this finding.

How does the sound pressure generated by circumaural, supra-aural, and insert earphones differ for adult and infant ears?

OBJECTIVE

To determine how the ear canal sound pressure levels generated by circumaural, supra-aural, and insert earphones differ when coupled to the normal adult and infant ear.

DESIGN

The ratio between the sound pressure generated in an adult ear and an infant ear was calculated for three types of earphones: a circumaural earphone (Natus Medical, ALGO with Flexicoupler), a supra-aural earphone (Telephonics, TDH-49 with MXAR cushion), and an insert earphone placed in the ear canal (Etymoup and down arrow tic Research, ER-3A). The calculations are based on (1) previously published measurements of ear canal impedances in adult and infant (ages 1, 3, 6, 12, and 24 months) ears (Keefe et al., 1993, Acoustic Society of America, 94:2617-2638), (2) measurements of the Thévenin equivalent for each earphone configuration, and (3) acoustic models of the ear canal and external ear.

RESULTS

Sound-pressure levels depend on the ear canal location at which they are measured. For pressures at the earphone: (1) Circumaural and supra-aural earphones produce changes between infant and adult ears that are less than 3 dB at all frequencies, and (2) insert earphones produce infant pressures that are up to 15 dB greater than adult pressures. For pressures at the tympanic membrane: (1) Circumaural and supra-aural earphones produce infant pressures that are within 2 dB of adult ears at frequencies below 2000 Hz and that are 5 to 7 dB smaller in infant ears than adult ears above 2000 Hz, and (2) insert earphones produce pressures that are 5 to 8 dB larger in infant ears than adult ears across all audiometric frequencies.

CONCLUSIONS

Sound pressures generated by all earphone types (circumaural, supra-aural, and insert) depend on the dimensions of the ear canal and on the impedance of the ear at the tympanic membrane (e.g., infant versus adult). Specific conclusions depend on the location along the ear canal at which the changes between adult and infant ears are referenced (i.e., the earphone output location or the tympanic membrane). With circumaural and supra-aural earphones, the relatively large volume of air within the cuff of the earphone dominates the acoustic load that these earphones must drive, and differences in sound pressure generated in infant and adult ears are generally smaller than those with the insert earphone in which the changes in ear canal dimensions and impedance at the tympanic membrane have a bigger effect on the load the earphone must drive.

A retrospective study of the spectral probability of spontaneous otoacoustic emissions: rise of octave shifted second mode after infancy

The recording of otoacoustic emissions (OAEs) is today a widely used tool in medical diagnosis. The mechanisms of OAE generation in the cochlea and their transmission to the external ear canal, however, are not well understood and a matter of long-standing debates. Here, the frequency distribution of 1660 spontaneous otoacoustic emissions (SOAEs) from three surveys, covering 296 human subjects, is analyzed. Neonates show a monomodal distribution with a peak at 4 kHz, but both children (5-11 y) and adults show an identical bimodal distribution, with two peaks in an octave distance (1.5 and 3 kHz). For the combined children and adult data, distribution density at the two peak tops is 2.8 and 2.7 times as high as at the low between them. Mean SOAE amplitudes are unrelated to the two peaks, but show a significant narrow-band dip precisely at the low in between at 2140 Hz (P<0.008). External ear canal resonance can explain the single 4 kHz mode at birth and the 3 kHz mode in children and adults. The octave shifted 1.5 kHz mode remains without mechanical explanation. It may reflect descending neural influence from central octave band processing. The results are relevant for the interpretation of OAE levels in medical diagnosis.

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.

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.

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.

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.

Gender effects in auditory brainstem responses to air- and bone-conducted clicks in neonates

Examinations of gender differences in auditory brainstem response (ABR) wave V latencies and thresholds to air- and bone-conducted clicks were undertaken with neonates. Two hundred and two full-term neonates participated (i.e., 103 males and 99 females). Wave V latency measures for air- and bone-conducted click stimuli of 30, 45, and 60 dB nHL and 15 and 30 dB nHL, respectively, and thresholds to air- and bone-conducted clicks were determined. Female newborns displayed statistically significant shorter wave V latencies than male newborns for air-conducted click stimuli (i.e., approximately 0.2-0.3 ms; P=.0016). There were no significant gender differences in wave V latencies to bone-conducted click stimuli (P=.11). With respect to ABR thresholds, no statistically significant differences were observed for either air-conducted clicks (P=.054) or bone-conducted clicks (P=.18).

EDUCATIONAL OBJECTIVES

As a result of this activity, the participant will be able to (1) describe gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates and (2) summarize possible explanations for observed gender differences in ABR wave V latencies and thresholds to air- and bone-conducted clicks with neonates.

Infants' sensitivity to broadband noise

Infants have higher pure-tone thresholds than adults. One explanation is that infants do not adopt the frequency-selective listening strategy that adults use when detecting tones. In contrast to other models of infants' immature sensitivity, the listening strategy account predicts that infants will be more sensitive to broadband sounds, relative to adults. Infants 7-9 months old were tested in two experiments to examine their sensitivity to broadband noise. Unmasked and masked thresholds for a 1000-Hz tone and for broadband noise were estimated adaptively for infants and adults using an observer-based behavioral procedure. The difference between infants and adults in unmasked threshold were 14 and 7 dB for tones and noise, respectively. The difference between infants and adults in masked threshold were 10 and 5 dB for tones and noise, respectively. Psychometric functions for detection of broadband noise were also obtained from some infants and adults. Infants' psychometric functions were similar to those obtained in tone detection with shallower slopes and lower upper asymptotes than adults'. This suggests that the relative improvement in infants' threshold for broadband noise is not due to greater attentiveness to the noise. A model of infants' sound detection invoking inattentiveness, listening strategy, and an unspecified source of internal noise may account for the characteristics of the infant psychometric function.

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.

Maturation of medial efferent system function in humans

Otoacoustic emissions are typically reduced in amplitude when broadband noise is presented to the contralateral ear. This contralateral suppression is attributed to activation of the medial olivocochlear system, which has an inhibitory effect on outer hair-cell activity. By studying the effects of contralateral noise on cochlear output at different stages of auditory maturation in human neonates, it is possible to describe the timecourse for development of medial efferent system function in humans. The present study recorded 2 f1-f2 distortion product otoacoustic emissions (DPOAE) in human adults, term and premature neonates at three f2 frequencies: 1500, 3000, and 6000 Hz, using fixed primary tone frequency ratio (f2/f1 = 1.2) and level separation (10 dB, L1 > L2). Average DPOAE growth functions were recorded with and without contralateral broadband noise. Results indicate that contralateral suppression of DPOAEs is absent at 6000 Hz, but present at 1500 and 3000 Hz for all ages. However, DPOAE amplitude from premature neonates was not altered by noise in an adult-like manner; in this age group, DPOAE amplitude was equally likely to by suppressed or enhanced by noise presented contralaterally. Contralateral enhancement may reflect a temporary stage of immaturity in outer hair cell-medial efferent fiber synapses just prior to term birth.

Long-term and short-term variations in amplitude and frequency of spontaneous otoacoustic emissions in pre-term infants

In pre-term infants, spontaneous otoacoustic emission (SOAE) frequencies show an upward shift with time. The present study aimed to monitor the SOAE amplitude variation during this frequency shift. A long-term observation of 87 SOAE frequencies from 18 pre-term infants yielded a positive frequency shift of 0.72 per cent per week, which was not accompanied by a simultaneous amplitude shift, as the mean variations in SOAE amplitude were practically zero. Furthermore, there was no relationship between the short-term SOAE amplitude variation and the infant's post-conceptional age. Only the absolute amount of SOAE amplitude variation seemed to grow with time. Comparison with induced variations in SOAE frequency argues against a middle ear influence on the SOAE frequency shift. In our view, the absence of any amplitude shift during the upward SOAE frequency shift further suggests cochlear development during the last period of gestation.

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

Suppression of the 2f1-f2 distortion product otoacoustic emission (DPOAE) provides an effective paradigm for the study of functional cochlear maturation in humans. DPOAE iso-suppression tuning curves (STCs) represent some aspect of peripheral filtering, probably related to the boundaries of distortion generation. Studies conducted thus far suggest that the cochlear tuning assessed by this technique is adult-like in humans by term birth (Abdala et al., Hear. Res. 98 (1996) 38-53; Abdala and Sininger, Ear Hear. 17 (1996) 374-385). However, there have been no studies of cochlear tuning in premature human neonates. DPOAE STCs and suppression growth functions were measured from 14 normal-hearing adults, 33 term and 85 premature neonates to investigate the developmental time course of cochlear frequency resolution and non-linearity. Premature neonates showed non-adult-like DPOAE suppression at f2 of 1500 and 6000 Hz: (1) STCs were narrower in width (Q10) and steeper in slope on the low-frequency flank of the tuning curve; (2) suppressor tones lower in frequency than f2 produced atypically shallow growth of DPOAE suppression. The influence of immature conductive pathways cannot be entirely ruled out as a factor contributing to these results. However, findings may indicate that an immaturity exists in cochlear frequency resolution and non-linearity just prior to term birth. The bases of this immaturity are hypothesized to be outer hair cell in origin.

Distortion product otoacoustic emissions in human newborns and adults. I. Frequency effects

This study varied stimulus frequency and recorded distortion product otoacoustic emissions (DPOAEs) in human newborns and adults. Because of outer and middle ear acoustics, the same auditory input resulted in higher newborn stimulus sound pressure levels across a broad frequency range in the occluded outer ear canal. Noise levels in the canal were 5-15 dB lower for adults at frequencies less than about 3 kHz. The 2 f1-f2 DPOAE was the most reliably recorded DPOAE except at the lowest frequencies assessed. At the lowest frequencies the 2 f2-f1 DPOAE was more frequently recorded than any other DPOAE. There were no striking developmental differences in the kinds of DPOAEs that were recorded. The amplitudes of consecutively recorded 2 f1-f2 DPOAEs were generally within 1.5 dB of each other for all age groups (slightly better reproducibility for adults than newborns). The phases of consecutively recorded 2 f1-f2 DPOAEs were generally within 15 degrees of each other (often less than 10 and 5 degrees for newborns and adults respectively). At the highest frequencies assessed (f2 = 4.2-9.9 kHz) all subjects had similar amplitude 2 f1-f2 DPOAEs. At lower frequencies adult 2 f1-f2 amplitudes were significantly less than those of newborns. At the lowest frequencies reliably assessed (f2 = 1.5-2.1 kHz) term newborns had significantly larger 2 f1-f2 DPOAEs than preterm newborns. Newborn and adult 2 f1-f2 DPOAE amplitude X f2/f1, functions were quite similar although there were reliable differences. Age related differences in the outer and middle ears may explain some of the differences in DPOAEs that were observed.

Sound-power collection by the auditory periphery of the Mongolian gerbil Meriones unguiculatus: III. Effect of variations in middle-ear volume

The effects of variations in middle-ear cavity size on hearing sensitivity in the Mongolian gerbil are predicted by computing the effect on acoustic power input to the middle ear. Acoustic power collection from a diffuse sound field was computed from measurements of the middle-ear input impedance and external-ear radiation impedance and mathematical models of the middle and external ear presented in the first two papers of this series [J. Acoust. Soc. Am. 92, 157-177 (1992); J. Acoust. Soc. Am. 99, 3044-3063 (1996)]. A reduction in middle-ear cavity volume to 1/4 its normal value is predicted to cause a frequency-selective elevation in auditory threshold of as much as 12 dB, with the largest elevation occurring in the 1-2 kHz range. Greater reductions produce larger threshold elevations. Increases in cavity volume cause decreases in the predicted threshold of at most 12 dB. Threshold predictions for volumes equal to those of the smaller hamster and the larger kangaroo-rat middle-ear cavity volumes resemble threshold functions measured in those animals. Results are consistent with the idea that large middle-ear cavities evolved in gerbil to improve hearing sensitivity below 3 kHz and thereby improve the animal's chances for survival.

Development of cochlear active mechanisms in humans differs between gender

Despite onset of function early during the third term of gestation, the human auditory system demonstrates continued maturation, thought previously to occur primarily at the neural level. The electromotile properties of outer hair cells appear to contribute substantially to hearing sensitivity and frequency selectivity and lead to the generation of otoacoustic emissions (OAEs). This report demonstrates continued development of cochlear active mechanisms (i.e. end-organ level) after onset of cochlear function, as reflected by OAEs. Significant gender differences also are reported, corresponding to recently observed intersex differences in cochlear length and precursory to gender differences observed in the adult.

Preliminary observations on the development of auditory sensitivity in infants with Down syndrome

OBJECTIVE

Hearing loss commonly is associated with Down syndrome, but little is known about the development of auditory sensitivity in individuals with Down syndrome. This study had two objectives: 1) to determine whether an observer-based procedure can be used to assess the behavioral sensitivity of infants with Down syndrome, and 2) to provide preliminary information about the early course of hearing development among infants with Down syndrome.

DESIGN

Behavioral measures of sensitivity were made in 16 infants with Down syndrome using an observer-based procedure. Ten of the infants were followed longitudinally between 2 and 12 mo of age. All infants passed a screening auditory brain stem response at 20 dB nHL during the study and completed screening tympanometry at each test session. The infants detected a 4000 Hz tone at levels ranging from 25 to 50 dB SPL; psychometric functions and thresholds for the tone were obtained.

RESULTS

Infants with Down syndrome completed 80% of the test sessions they began, a rate similar to that seen in normally developing infants in the same type of study. Performance improved with increasing stimulus level, as one would expect, and thresholds were obtained from 15 of 16 infants for at least one age. The performance of infants with Down syndrome generally improved with age. The sensitivity of 2- to 3-mo-olds was poorer than that of older infants, but little if any improvement in sensitivity occurred between 4 and 12 mo. This pattern is similar to that seen in normally developing infants. Thresholds of infants with Down syndrome were 10 to 25 dB higher than those reported for normally developing infants. The psychometric functions of infants with Down syndrome were shallower than the psychometric functions of normally developing infants, and the slope of the psychometric functions did not change with age. Infants with Down syndrome achieved only 75 to 80% correct at any of the levels tested, 5 to 10% poorer than reported for other infants. These characteristics of the psychometric functions of the infants with Down syndrome suggest that they are inattentive during testing more often than are normally developing infants.

CONCLUSIONS

An observer-based procedure can be used to obtain reasonable thresholds from infants with Down syndrome who are as young as 2 mo of age. Both sensory and nonsensory factors could contribute to the threshold elevation seen in infants with Down syndrome. At least on preliminary examination, the course of auditory sensitivity development of infants with Down syndrome is qualitatively similar to that seen in normally developing infants.

Otoacoustic emissions in preterm infants: indications for cochlear development?

A longitudinal study of click-evoked otoacoustic emissions (CEOAEs) in 19 ears of 11 preterm infants--post-conceptional age (PCA): 30 to 39 weeks--resulted in a total of 90 CEOAE recordings. All but one of the 19 ears showed an increase of CEOAE amplitude at increasing PCA. The mean increase rate was 1.36 dB per week (dB/wk) for the left ears (n = 11, SD = 1.04 dB/wk), and 1.17 dB/wk for the right ears (n = 8, SD = 0,87 dB/wk). In six ears of three infants we were able to follow a total of 15 frequencies of spontaneous otoacoustic emissions (SOAEs). All of the monitored SOAE frequencies showed a positive shift in frequency with time, ranging from about 10 Hz/wk around 2000 Hz to about 50 Hz/wk around 5000 Hz. This increase of CEOAE amplitude and SOAE frequency indicates that OAE properties are not fully developed in preterm infants. Although the influence of middle ear properties cannot be excluded or proved, the observed SOAE frequency shift suggests development of the fine structures in the cochlea itself.

Maturation of the middle and external ears: acoustic power-based responses and reflectance tympanometry

OBJECTIVE

The maturation of the external and middle ear in the human infant has significant effects on the interpretation of measured ear-canal responses to acoustic stimuli. A tutorial section is presented of power-based response functions, accompanied by a hierarchy of stimulus specifications contrasting pressure-based and power-based responses. An experimental section follows on reflectance tympanometry, the aims of which are to introduce and assess the feasibility of the technique and to discuss implications for tests of hearing development.

DESIGN

A tympanometric measurement of admittance is used with an estimate of ear-canal area to calculate a so-called reflectance tympanogram as a function of frequency and static pressure in the ear canal. Selected results on 226 Hz reflectance tympanograms are reported for normal-hearing adults and for infants of age 3 to 6 mo with both normal and flat 226 Hz admittance tympanograms. A multifrequency reflectance tympanogram is reported for an adult.

RESULTS

Measured at ambient ear-canal pressure, the acoustic external- and middle-ear responses of infants of age 1 to 6 mo are compared with those of adults. The admittance level is influenced by the ear-canal area, the interplay of compliant- and inertance-controlled effects in the middle ear, and the presence of losses. Ear-canal area is a major factor in distinguishing infant from adult responses. Energy reflectance provides a measure of middle-ear power transmission that is approximately independent of probe placement in the ear canal and that varies with maturation. These power-based responses, measured at ambient pressure, are contrasted with tympanometric measurements. Reflectance tympanometry is defined and easily measured in infants and adults. Some infants with flat 226 Hz tympanograms have energy reflectance in the normal range at higher frequencies (2 to 4 kHz).

CONCLUSION

Acoustic measurements of power-based responses in the ear canal-reflectance, admittance, and impedance-provide insight into the maturation of the external and middle ear. Reflectance tympanometry tests the relative accuracy underlying the tympanometric measurement of compensated eardrum admittance and may have clinical utility.

The development of cochlear frequency resolution in the human auditory system

OBJECTIVE

The objectives of this study were: 1) to evaluate the maturity of cochlear frequency resolution in human neonates, and 2) to further elucidate the differential time course for development of frequency resolution at the cochlear and auditory-neural levels of the auditory system.

DESIGN

This paper describes a relatively new technique using distortion product otoacoustic emision (DPOAE) suppression to study cochlear tuning. DPOAE suppression tuning curves (STCs) were generated in 15 normal-hearing adults and 26 healthy, term-born neonates at 1500, 3000, and 6000 Hz. The 2f1-f2 DPOAE was measured in all subjects with primary tones of 65 and 50 dB SPL (L1 > L2) and a 1.22 f2/f1 frequency ratio. Initially, an unsuppressed DPOAE was recorded. After this, a suppressor tone was introduced, and its level varied until DPOAE amplitude was reduced by 6 dB. By plotting the suppressor level required to achieve criterion amplitude reduction by suppressor frequency (for many tones), a DPOAE STC was generated. DPOAE STC shape, width, slope, and tip characteristics were analyzed for both adults and neonates.

RESULTS

General shape and appearance of DPOAE STCs were comparable for adults and neonates, as was STC tip frequency and level. Statistical analyses of tuning-curve width (Q) and slope (dB/octave) failed to show age effects, further confirming the similarity between adults and neonates. DPOAE STCs were stable, show minimal intra- and intersubject variability, and closely resemble and behave like physiologic measures of tuning from the VIIIth nerve.

CONCLUSIONS

Results suggest that: 1) cochlear tuning and related active processes are basically mature by term birth in the human auditory system, 2) tuning immaturities reported in infants as old as 6 mo of age probably involve auditory-neural immaturities, and 3) suppression of the 2f1-f2 DPOAE seems, to provide an indirect measure of cochlear frequency resolution in humans.

Hearing threshold as measured by auditory brain stem response in human neonates

OBJECTIVES

This article evaluates the concept of auditory threshold and discusses the limitations of assessing threshold in human neonates. The advantages and limitations of assessing neonatal threshold by means of auditory brain stem response (ABR) are discussed, and data from several studies of newborn ABR threshold are compared. The authors report data from their own study designed to compare adult and neonatal ABR threshold using tonal stimuli.

EXPERIMENTAL DESIGN

Several studies are compared. Data from the authors are ABR thresholds for tone bursts of 0.5, 1.5, 4, and 8 kHz, determined from 2-channel recordings in full-term neonates and adults. Stimuli were calibrated in SPL by means of a probe microphone inserted into the ear canal along with the insert transducer of each subject.

RESULTS

All studies find a degree of threshold elevation in neonates relative to adult threshold. Neonatal ABR thresholds from our laboratory for stimuli from 500 through 8000 Hz are elevated relative to adult thresholds by 5 to 25 dB. Threshold elevation in our data and in other studies has found that neonatal ABR thresholds to high-frequency stimuli show the largest elevation relative to adults and low-frequency stimuli the most mature.

CONCLUSIONS

Thresholds of neonates, as measured by the ABR, are immature especially for high-frequency stimuli. Proper stimulus calibrations, which removes the influence of ear canal resonance, are important for comparisons of data across age groups. Developmental differences in the conductive mechanism and neural immaturity are the most harmonious explanations for elevation of neonatal ABR thresholds.