Pure-tone threshold estimation from extrapolated distortion product otoacoustic emission I/O-functions in normal and cochlear hearing loss ears

A new method for direct pure-tone threshold estimation from input/output functions of distortion product otoacoustic emissions (DPOAEs) in humans is presented. Previous methods use statistical models relating DPOAE level to hearing threshold including additional parameters e.g., age or slope of DPOAE I/O-function. Here we derive a DPOAE threshold from extrapolated DPOAE I/O-functions directly. Cubic 2 f1-f2 distortion products and pure-tone threshold at f2 were measured at 51 frequencies between f2=500 Hz and 8 kHz at up to ten primary tone levels between L2=65 and 20 dB SPL in 30 normally hearing and 119 sensorineural hearing loss ears. Using an optimized primary tone level setting (L1 = 0.4L2 + 39 dB) that accounts for the nonlinear interaction of the two primaries at the DPOAE generation site at f2, the pressure of the 2 f1-f2 distortion product pDP is a linear function of the primary tone level L2. Linear regression yields correlation coefficients higher than 0.8 in the majority of the DPOAE I/O-functions. The linear behavior is sufficiently fulfilled for all frequencies in normal and impaired hearing. This suggests that the observed linear functional dependency is quite general. Extrapolating towards pDP=0 yields the DPOAE threshold for L2. There is a significant correlation between DPOAE threshold and pure-tone threshold (r=0.65, p<0.001). Thus, the DPOAEs that reflect the functioning of an essential element of peripheral sound processing enable a reliable estimation of cochlear hearing threshold up to hearing losses of 50 dBHL without any statistical data.     

Suppression of distortion product otoacoustic emissions and hearing threshold

A distortion product otoacoustic emission (DPOAE) suppression tuning curve (STC) shows the minimum level of suppressor tone that is required to reduce DPOAE level by a fixed amount, as a function of suppressor frequency. Several years ago, Mills [J. Acoust. Soc. Am. 103, 507-523 (1998)] derived, theoretically, an approximately linear relationship between the tip-to-tail suppressor level difference on a DPOAE STC, and the gain of the cochlear amplifier, defined as the maximum increase in the active over the passive basilar membrane (BM) response. In this paper, preliminary data from adult human subjects are presented that establish a correlation between this tip-to-tail DPOAE STC difference and the threshold of hearing, the latter measured at the frequency of the f2 primary tone. Assuming that both suppression and the DPOAE are by-products of active, nonlinear BM dynamics, the above result suggests that threshold elevation in mild levels of hearing loss may be attributed, in part, to a reduction of cochlear amplifier gain, which is detectable with the suppression paradigm.     

Further efforts to predict pure-tone thresholds from distortion product otoacoustic emission input/output functions

Recently, Boege and Janssen [J. Acoust. Soc. Am. 111, 1810-1818 (2002)] fit linear equations to distortion product otoacoustic emission (DPOAE) input/output (UO) functions after the DPOAE level (in dB SPL) was converted into pressure (in microPa). Significant correlations were observed between these DPOAE thresholds and audiometric thresholds. The present study extends their work by (1) evaluating the effect of frequency, (2) determining the behavioral thresholds in those conditions that did not meet inclusion criteria, and (3) including a wider range of stimulus levels. DPOAE I/O functions were measured in as many as 278 ears of subjects with normal and impaired hearing. Nine f2 frequencies (500 to 8000 Hz in 1/2-octave steps) were used, L2 ranged from 10 to 85 dB SPL (5-dB steps), and L1 was set according to the equation L1 = 0.4L2 + 39 dB [Kummer et al., J. Acoust. Soc. Am. 103, 3431-3444 (1998)] for L2 levels up to 65 dB SPL, beyond which L1 = L2. For the same conditions as those used by Boege and Janssen, we observed a frequency effect such that correlations were higher for mid-frequency threshold comparisons. In addition, a larger proportion of conditions not meeting inclusion criteria at mid and high frequencies had hearing losses exceeding 30 dB HL, compared to lower frequencies. These results suggest that DPOAE I/O functions can be used to predict audiometric thresholds with greater accuracy at mid and high frequencies, but only when certain inclusion criteria are met. When the SNR inclusion criterion is not met, the expected amount of hearing loss increases. Increasing the range of input levels from 20-65 dB SPL to 10-85 dB SPL increased the number of functions meeting inclusion criteria and increased the overall correlation between DPOAE and behavioral thresholds.     

Spontaneous otoacoustic emissions and relaxation dynamics of long decay time OAEs in audiometrically normal and impaired subjects

The relationship between hearing loss, detected by measuring the audiometric threshold shift, and the presence of long-lasting otoacoustic emissions, has been studied in a population of 66 adult males, by analyzing the cochlear response in the 80 ms following the subministration of a click stimulus. Most long-lasting OAEs are also recognizable as Synchronized Spontaneous OAEs (SSOAEs). The OAE characteristic decay times were evaluated according to the model by Sisto and Moleti [J. Acoust. Soc. Am. 106, 1893 (1999)]. The starting hypothesis, confirmed by the results, is that long decay time and large equilibrium amplitude are both manifestations of the effectiveness of the active feedback mechanism. The prevalence and frequency distribution of long-lasting OAEs, and of their SSOAE subset, have been separately analyzed for normal and impaired ears. No long-lasting OAE was found within the hearing loss frequency range, but several were found in impaired ears outside the hearing loss range, both at lower and higher frequencies. This result suggests that the correlation between the presence of long-lasting OAEs and good cochlear functionality be local in the frequency domain. The monitor of the OAE decay time is proposed as a new possible method for early detecting hearing loss in populations exposed to noise.     

Impact of three hours of discotheque music on pure-tone thresholds and distortion product otoacoustic emissions

The aim of this study was to investigate whether distortion product otoacoustic emissions (DPOAEs) are a suitable means for detecting changes in outer hair cell (OHC) functionality due to exposure to three hours of discotheque music and whether efferent reflex strength of the medial olivocochlear bundle is able to predict the ear's susceptibility to high-level noise. High-resolution DPOAEs (Δf(2)=47 Hz) were recorded between 3.5 and 4.5 kHz at close-to-threshold primary tone levels. For comparison, high-resolution pure-tone audiometry was conducted in the same frequency range. Efferent reflex strength was measured by means of DPOAEs at a specific frequency with and without contralateral acoustic stimulation. A significant deterioration of more than 10 dB was found for pure-tone thresholds and DPOAE levels indicating that three hours of high-level noise exert a considerable influence on hearing capability and OHC functionality. A significant correlation between shifts in pure-tone threshold and shifts in DPOAE level occurred when removing data with differing calibration across measurements. There was no clear correlation between efferent reflex strength and shifts in pure-tone threshold or shifts in DPOAE level suggesting that the applied measures of efferent reflex strength may not be suitable for quantifying individual vulnerability to noise.     

Distortion product otoacoustic emission of symphony orchestra musicians before and after rehearsal

The 2f1-f2 distortion product otoacoustic emission (DPOAE) and hearing levels are obtained for 12 normal-hearing symphony orchestra musicians both before and after their rehearsal. The DPOAE fine structures are determined and analyzed according to the character and prevalence of ripples. Hearing levels, DPOAE levels, and DPOAE fine structures before and after rehearsal are similar, indicating that no or marginal temporary change of the state of hearing were caused by the exposure. The data were further compared to similar data for occupationally nonexposed subjects, one group which was age and gender matched, and other two groups of younger individuals (one group with better hearing levels than the other). The data for the age and gender matched group compared well with the musicians data (and the data for the group of better-hearing younger individuals). In general, the analyses of hearing thresholds and DPOAE data thus lead to the same conclusions concerning the state of hearing.     

Distortion product otoacoustic emission (DPOAE) in tinnitus patients

The aim of this study was to determine the effect of tinnitus (experiment I) and the combined effect of tinnitus and sensorineural hearing loss (experiment II) on the distortion product otoacoustic emission (DPOAE) for two age groups of tinnitus patients. Tinnitus patients with normal earing, along with normal-hearing control subjects, participated in experiment I. They were divided into two age groups, below 50 and above 50 years. Experiment I showed that the DPOAE levels in the tinnitus patients were lower than those in the normal-hearing (nontinnitus) subjects. The differences depended on the frequency and the age of the patients, suggesting the confounding influence of presbyacusis. The second group of tinnitus patients with increasing and notch-like hearing loss participated in experiment II. They were also divided into two age groups, below 50 and above 50 years. The data from experiment II showed that DPOAE activity well reflects the increasing and notch-like hearing loss functions up to about 40 dB HL. The effect of age on the DPOAE level was clearly noted only for the tinnitus patients with clinically normal-hearing thresholds and was ambiguous for the tinnitus patients with hearing loss.     

In search of basal distortion product generators

The 2f1-f2 distortion product otoacoustic emission (DPOAE) is thought to arise primarily from the complex interaction of components that come from two different cochlear locations. Such distortion has its origin in the nonlinear interaction on the basilar membrane of the excitation patterns resulting from the two stimulus tones, f1 and f2. Here we examine the spatial extent of initial generation of the 2f1-f2 OAE by acoustically traumatizing the base of the cochlea and so eliminating the contribution of the basal region of the cochlea to the generation of 2f1-f2. Explicitly, amplitude-modulated, or continuously varying in level, stimulus tones with f2/f1= 1.2 and f2 =8000-8940 Hz were used to generate the 2f1-f2 DPOAE in guinea pig before and after acoustically traumatizing the basal region of the cochlea (the origin of any basal-to-f2 distortion product generators). It was found, based on correlation analysis, that there does not appear to be a basal-to-f2 distortion product generation mechanism contributing significantly to the guinea pig 2f1-f2 OAE up to L1 = 80 dB sound pressure level (SPL).     

Simultaneous recording of stimulus-frequency and distortion-product otoacoustic emission input-output functions in human ears

Stimulus frequency otoacoustic emission (SFOAE) input-output (I/O) functions were elicited in normal-hearing adults using unequal-frequency primaries in equal-level and fixed-suppressor level (Ls) conditions. Responses were repeatable and similar across a range of primary frequency ratios in the fixed-Ls condition. In comparison to equal-frequency primary conditions [Schairer, Fitzpatrick, and Keefe, J. Acoust. Soc. Am. 114, 944-966 (2003)], the unequal-frequency, fixed-Ls condition appears to be more useful for characterizing SFOAE response growth and relating it to basilar-membrane response growth, and for testing the ability to predict audiometric thresholds. Simultaneously recorded distortion-product OAE (DPOAE) I/O functions had higher thresholds than SFOAE I/O functions, and they identified the onset of the nonlinear-distortion mechanism in SFOAEs. DPOAE threshold often corresponded to nonmonotonicities in SFOAE I/O functions. This suggests that the level-dependent nonmonotonicities and associated phase shifts in SFOAE I/O functions were due to varying degrees of cancellation of two sources of SFOAE, such as coherent reflection and distortion mechanisms. Level-dependent noise was observed on-band (at the frequencies of the stimuli) but not off-band, or in the DPOAEs. The variability was observed in ears with normal hearing and ears with cochlear implants. In general, these results indicate the source of the variability is biological, possibly from within the middle ear.     

Influence of primary frequencies ratio on distortion product otoacoustic emissions amplitude. II. Interrelations between multicomponent DPOAEs, tone-burst-evoked OAEs, and spontaneous OAEs

Distortion product otoacoustic emissions (DPOAEs) are used widely in humans to assess cochlear function. It is well known that 2f1-f2 DPOAE amplitude increases as the f2/f1 ratio increases from 1.0 to about 1.20, and then decreases as the f2/f1 ratio increases above 1.20, showing an amplitude ratio function, which is thought to be related to cochlear filtering properties. Different lower sideband DPOAEs are believed to show the same amplitude ratio functions as the 2f1-f2 DPOAE, with a magnitude peak situated at a constant DPOAE frequency relative to f2. More recently, several studies have suggested the involvement of a DPOAE component coming from its own distortion product place as well as the DPOAE component coming from the f2 place. To investigate DPOAE generation sites and the importance of the DPOAE frequency place, amplitude ratio functions of 2f1-f2, 3f1-2f2, 4f1-3f2 and 2f2-f1, 3f2-2f1, 4f2-3f1 DPOAE components have been systematically studied in 18 normally hearing subjects, using an f2 fixed, f1 sweep method, and an f1 fixed, f2 sweep method, at ten different f2 frequencies. Results show a dependency of the distortion magnitude peak on f2 frequency for each lower sideband DPOAE, and a small frequency shift of the distortion peak for the high order lower sideband DPOAE components. Strong correlation between the different lower sideband DPOAE amplitude were obtained, whether they were recorded with the same f1 (and a different f2) or with the same f2 (and a different f1), suggesting that lower side-band DPOAE amplitude does not depend on small variations in the f2 frequency. Moreover, correlations between DPOAE amplitude and tone-burst evoked otoacoustic emissions (TBOAEs) are highly significant for TBOAEs centered at the f2 frequency and at 1/2 octave below the f2 frequency, suggesting some degree of importance of the cochlear status at frequencies below f2 in DPOAE amplitude. Subjects presenting spontaneous otoacoustic emissions showed a greater lower sideband DPOAE amplitude recorded for low f2/f1 ratios, and a distortion magnitude peak shifted towards higher frequencies. The best correlation between upper sideband DPOAE amplitude and lower sideband DPOAE amplitude occurred for lower sideband DPOAEs generated by an f2 frequency 1/2 octave to 1 octave below the primaries used to generate upper sideband DPOAEs, suggesting a site of generation basal to f2 for the upper sideband DPOAEs. Correlations between TBOAE amplitude and upper sideband DPOAE amplitude agreed with a site of upper sideband DPOAE generation basal to f2, and which would move with the DPOAE frequency itself.     

Cochlear generation of intermodulation distortion revealed by DPOAE frequency functions in normal and impaired ears

Distortion product otoacoustic emission (DPOAE) frequency functions were measured in normal-hearing and hearing-impaired ears. A fixed-f2/swept-f1 paradigm was used with f2 fixed at half-octave intervals from 1 to 8 kHz. L1 was always 10 dB greater than L2, and L2 was varied from 65 to 10 dB SPL in 5-dB steps. The responses were quantified by the frequency and amplitude of the peak response. Peak responses were closer to f2 in higher frequency regions and for lower intensity stimulation. Results from hearing-impaired subjects suggest that audiometric thresholds at the distortion product frequency, fdp, in addition to hearing status at f2, can affect DPOAE results. Results are discussed in terms of several manifestations of a second resonance model, as well as a dual source model for the generation of DPOAEs as measured in the ear canal of humans. It appears that a dual source model accounts for the data better than second filter models.     

Hearing threshold estimation using concurrent measurement of distortion product otoacoustic emissions and auditory steady-state responses

Both distortion product otoacoustic emissions (DPOAEs) and auditory steady-state responses (ASSRs) provide frequency-specific assessment of hearing. However, each method suffers from some restrictions. Hearing losses above 50 dB HL are not quantifiable using DPOAEs and their performance at frequencies below 1 kHz is limited, but their recording time is short. In contrast, ASSRs are a time-consuming method but have the ability to determine hearing thresholds in a wider range of frequencies and hearing losses. Thus, recording DPOAEs and ASSRs simultaneously at their adequate frequencies and levels could decrease the overall test time considerably. The goal of the present study was to develop a parameter-setting and test-protocol to measure DPOAEs and ASSRs binaurally and simultaneously at multiple frequencies. Ten normal-hearing and 23 hearing-impaired subjects participated in the study. The interaction of both responses when stimulated simultaneously at frequencies between 0.25 and 6 kHz was examined. Two limiting factors need to be kept. Frequency distance between ASSR carrier frequency f(c) and DPOAE primary tone f(2) needs to be at least 1.5 octaves, and DPOAEs may not be measured if the ASSR stimulus level is 70 dB SPL or above. There was a significant correlation between pure-tone and DPOAE/ASSR-thresholds in sensorineural hearing loss ears.     

Comparison of distortion-product otoacoustic emission growth rates and slopes of forward-masked psychometric functions

Slopes of forward-masked psychometric functions (FM PFs) were compared with distortion-product otoacoustic emission (DPOAE) input/output (I/O) parameters at 1 and 6 kHz to test the hypothesis that these measures provide similar estimates of cochlear compression. Implicit in this hypothesis is the assumption that both DPOAE I/O and FM PF slopes are functionally related to basilar-membrane (BM) response growth. FM PF-slope decreased with signal level, but this effect was reduced or reversed with increasing hearing loss; there was a trend of decreasing psychometric function (PF) slope with increasing frequency, consistent with greater compression at higher frequencies. DPOAE I/O functions at 6 kHz exhibited an increase in the breakpoint of a two-segment slope as a function of hearing loss with a concomitant decrease in the level of the distortion product (L(d)). Results of the comparison between FM PF and DPOAE I/O parameters revealed only a weak correlation, suggesting that one or both of these measures may provide unreliable information about BM compression.     

Effects of aspirin on distortion product fine structure: interpreted by the two-source model for distortion product otoacoustic emissions generation

Distortion product otoacoustic emission (DPOAE) fine structure is due to the interaction of two major components coming from different places in the cochlea. One component is generated from the region of maximal overlap of the traveling waves generated by the two primaries and is attributed to nonlinear distortion (nonlinear component). The other component arises predominantly from the tonotopic region of the distortion product and is attributed to linear coherent reflection (reflection component). Aspirin (salicylate) ototoxicity can cause reversible hearing loss and reduces otoacoustic emission generation in the cochlea. The two components are expected to be affected differentially by cochlear health. Changes in DPOAE fine structure were recorded longitudinally in three subjects before, during, and after aspirin consumption. Full data sets were analyzed for two subjects, but only partial data could be analyzed from the third subject. Resulting changes in the two components of DPOAE fine structure revealed variability among subjects and differential effects on the two components. For low-intensity primaries, both components were reduced with the reflection component being more vulnerable. For high-intensity primaries, the nonlinear component showed little or no change, but the reflection component was always reduced.     

Similarity in loudness and distortion product otoacoustic emission input/output functions: implications for an objective hearing aid adjustment

The aim of the present study was to compare distortion product otoacoustic emissions (DPOAEs) to loudness with regard to the potentiality of DPOAEs to determine characteristic quantities of the cochlear-impaired ear and to derive objective hearing aid parameters. Recently, Neely et al. [J. Acoust. Soc. Am. 114, 1499-1507 (2003)] compared DPOAE input/output functions to the Fletcher and Munson [J. Acoust. Soc. Am. 5, 82-108 (1933)] loudness function finding a close resemblance in the slope characteristics of both measures. The present study extended their work by performing both loudness and DPOAE measurements in the same subject sample, and by developing a method for the estimation of gain needed to compensate for loss of cochlear sensitivity and compression. DPOAEs and loudness exhibited similar behavior when plotted on a logarithmic scale and slope increased with increasing hearing loss, confirming the findings of Neely et al. To compensate for undesired nonpathological impacts on the magnitude of DPOAE level, normalization of DPOAE data was implemented. A close resemblance between gain functions based on loudness and normalized DPOAE data was achieved. These findings suggest that DPOAEs are able to quantify the loss of cochlear sensitivity and compression and thus might provide parameters for a noncooperative hearing aid adjustment.     

Reliability of distortion-product otoacoustic emissions and their relation to loudness

The reliability of distortion-product otoacoustic emission (DPOAE) measurements and their relation to loudness measurements was examined in 16 normal-hearing subjects and 58 subjects with hearing loss. The level of the distortion product (L(d)) was compared across two sessions and resulted in correlations that exceeded 0.90. The reliability of DPOAEs was less when parameters from nonlinear fits to the input/output (I/O) functions were compared across visits. Next, the relationship between DPOAE I/O parameters and the slope of the low-level portion of the categorical loudness scaling (CLS) function (soft slope) was assessed. Correlations of 0.65, 0.74, and 0.81 at 1, 2, and 4 kHz were observed between CLS soft slope and combined DPOAE parameters. Behavioral threshold had correlations of 0.82, 0.83, and 0.88 at 1, 2, and 4 kHz with CLS soft slope. Combining DPOAEs and behavioral threshold provided little additional information. Lastly, a multivariate approach utilizing the entire DPOAE I/O function was used to predict the CLS rating for each input level (dB SPL). Standard error of the estimate when using this method ranged from 2.4 to 3.0 categorical units (CU), suggesting that DPOAE I/O functions can predict CLS measures within the CU step size used in this study (5).     

Theory of forward and reverse middle-ear transmission applied to otoacoustic emissions in infant and adult ears

The purpose of this study is to understand why otoacoustic emission (OAE) levels are higher in normal-hearing human infants relative to adults. In a previous study, distortion product (DP) OAE input/output (I/O) functions were shown to differ at f2 = 6 kHz in adults compared to infants through 6 months of age. These DPOAE I/0 functions were used to noninvasively assess immaturities in forward/reverse transmission through the ear canal and middle ear [Abdala, C., and Keefe, D. H., (2006). J. Acoust Soc. Am. 120, 3832-3842]. In the present study, ear-canal reflectance and DPOAEs measured in the same ears were analyzed using a scattering-matrix model of forward and reverse transmission in the ear canal, middle ear, and cochlea. Reflectance measurements were sensitive to frequency-dependent effects of ear-canal and middle-ear transmission that differed across OAE type and subject age. Results indicated that DPOAE levels were larger in infants mainly because the reverse middle-ear transmittance level varied with ear-canal area, which differed by more than a factor of 7 between term infants and adults. The forward middle-ear transmittance level was -16 dB less in infants, so that the conductive efficiency was poorer in infants than adults.     

Modeling the growth rate of distortion product otoacoustic emissions by active nonlinear oscillators

In this work, growth-rate curves of the 2 f1-f2 distortion product otoacoustic emission (DPOAE) are analyzed in a population of 30 noise exposed subjects, including both normal-hearing and hearing impaired subjects. A particular embedded limit-cycle oscillator equation is used to model the cochlear resonant response at the cochlear places of the primary and secondary tone frequencies (f2 and 2 f1-f2). The parameters of the oscillator equation can be directly interpreted in terms of effectiveness of the cochlear feedback mechanisms associated with the active filter amplification. A two-sources paradigm is included in the model, in agreement with experimental evidence and with the assumptions of more detailed full cochlear models based on the transmission line formalism. According to this paradigm, DPOAEs are nonlinearly generated at the cochlear place that is resonant at frequency f2, and coherently reflected at the 2 f1-f2 place. The analysis shows that the model, which had been previously used to describe the relaxation dynamics of transient evoked otoacoustic emissions (TEOAEs), also correctly predicts the observed growth rate of the DPOAE response as a function of the primary tones amplitude. A significant difference is observed between normal and impaired ears. The comparison between the growth rate curves at different frequencies provides information about the dependence of cochlear tuning on frequency.     

Development,validation and application of a generator for distortion product otoacoustic emissions

The application area of distortion product otoacoustic emissions (DPOAEs) is expanding beyond clinical routines, towards new measurement environments, protocols, wearable hardware and more robust algorithms. To enable systematic assessment of the performance of commercial and prototype OAE equipment under various measurement conditions without a need for recruitment of the test subjects, a DPOAE generator that produces a reliable and stable response is proposed. This article suggests simple design for such generator that is easy to reproduce by third parties. This design uses an approximate model for middle and inner ear dynamics focusing on typical operational conditions. The DPOAE generator is embedded in a head and torso simulator enabling testing for various probe fitting and also residual ear canal volume effects. Measurement of the DPOAE generator response with clinical equipment shows that the response obtained falls within the range of human normative data. It is also shown that the generator is applicable outside the clinical routines and is able to highlight differences in measurements obtained with different clinical OAE measurement devices.     

Sources of variability in distortion product otoacoustic emissions

The goal of this study was to determine the extent to which the variability seen in distortion product otoacoustic emissions (DPOAEs), among ears with normal hearing, could be accounted for. Several factors were selected for investigation, including behavioral threshold, differences in middle-ear transmission characteristics either in the forward or the reverse direction, and differences in contributions from the distortion and reflection sources. These variables were assessed after optimizing stimulus parameters for individual ears at each frequency. A multiple-linear regression was performed to identify whether the selected variables, either individually or in combination, explained significant portions of variability in DPOAE responses. Behavioral threshold at the f(2) frequency and behavioral threshold squared at that same frequency explained the largest amount of variability in DPOAE level, compared to the other variables. The combined model explained a small, but significant, amount of variance in DPOAE level at five frequencies. A large amount of residual variability remained, even at frequencies where the model accounted for significant amounts of variance.