Brenda L. Lonsbury-Martin

A review of otoacoustic emissions

Otoacoustic emissions measured in the external ear canal describe responses that the cochlea generates in the form of acoustic energy. For the convenience of discussing their principal features, emitted responses can be classified into several categories according to the type of stimulation used to evoke them. On this basis, four distinct but interrelated classes can be distinguished including spontaneous, transiently evoked, stimulus-frequency, and distortion-product otoacoustic emissions. The present review details the findings that have been described for each emission type according to this classification schema. Additionally, the known features of emitted responses are discussed for both normally hearing and hearing-impaired humans and experimental animals, and with respect to their potential clinical applications. The findings reviewed here clearly indicate that future studies of otoacoustic emissions will significantly increase our understanding of the basic mechanisms of cochlear function while, at the same time, provide a new and important clinical tool.

Acoustic distortion products in humans: Systematic changes in amplitude as a function of f2/f1 ratio

The effects of primary-tone separation on the amplitude of distortion-product emissions (DPEs) at the 2f1-f2 frequency were systematically examined in ten ears of five subjects. All individuals had normal hearing and middle-ear function based upon standard clinical measures. Acoustic-distortion products were elicited at 1, 2.5, and 4 kHz by equilevel primaries at 65, 75, and 85 dB SPL, while f2/f1 ratios were varied in 0.02 increments from 1.01-1.41 (4 kHz), 1.01-1.59 (2.5 kHz), or 1.01-1.79 (1 kHz). A principal outcome reflected in the detailed structure of both average and individual ratio functions was a nonmonotonic change in DPE amplitude as the ratio of f2/f1 increased. Despite the presence of amplitude nonmonotonicities, there was clearly a region of f1 and f2 separation that generated a maximum DPE. The effects of primary-tone separation on DPE amplitudes were systematically related to DPE frequency and primary-tone level. For all three levels of stimulation, the f2/f1 ratio was inversely related to DPE frequency. Thus larger ratios reflecting a greater separation of f1 and f2 were more effective in generating DPEs at 1 kHz rather than at 4 kHz. The optimal ratio for 2.5 kHz fell at an intermediate value. Conversely, acoustic distortion-product amplitude as a function of primary-tone level was directly related to the frequency separation of the primary tones. Regardless of the frequency region of the primary tones, smaller f2/f1 ratios were superior in generating DPEs in response to 65-dB stimuli, whereas larger ratios elicited bigger DPEs with primaries at 75 and 85 dB SPL. Within any specific stimulus-parameter combination, individual variability in DPE amplitude was noted. When all stimulus conditions describing the variations in frequency and level were considered, an f2/f1 ratio of 1.22 was most effective in maximizing DPE amplitude.

Acoustic distortion products in rabbit ear canal. II. Sites of origin revealed by suppression contours and pure-tone exposures.

Previous work on acoustic distortion products (DPs) recorded from the ear canal has not established unequivocally whether emitted DPs principally reflect basilar-membrane nonlinearities at the frequency sites of the primary tones, f1 and f2, or if the DP-frequency place itself makes a significant contribution to the emitted response. Results from some studies on acoustic emissions attribute generation of the emitted DP almost exclusively to the regions of maximum primary-tone interaction, while the findings of other investigations implicate reemission of the response from the DP locus as a significant contributor to response magnitude. Using suppression, interfering tones, and temporary threshold shift (TTS) procedures, the work reported here was designed to establish more definitively the precise contributions of the basilar-membrane regions involved in generating acoustic DPs in rabbits. Suppression tuning curves and interfering-tone experiments indicated that for the DP at 2f1-f2, regions near the f1 or f2 frequencies were the major contributors to the emitted response. However, for the higher-frequency DP at 2f2-f1, the basilar-membrane region just basal to the DP site was implicated as the generator. Following brief episodes of TTS at frequencies related to either the DP or the primary tones, the locus of the exposure stimulus that most effectively reduced the magnitude of the 2f1-f2 response also implicated the region of maximal primary-tone interaction in the generation of the acoustic DP. In contrast, for the DP at 2f2-f1, basilar-membrane sites nearer the DP were identified as the primary contributors to the emitted response. Both sets of results imply that different DPs recorded from the ear canal may originate from unique regions of primary-tone interaction along the basilar membrane.

Spontaneous, click-, and toneburst-evoked otoacoustic emissions from normal ears.

Evoked and spontaneous otoacoustic emissions were recorded bilaterally in a group of normal subjects (n = 14) using clicks and tonebursts at four frequencies (0.5, 1, 1.5, and 3 kHz). All ears (n = 28) demonstrated evoked emissions, but not to every stimulus type. The 0.5-kHz toneburst evoked emissions in only 10 (36%) ears, the 1.5-kHz toneburst in all ears, and the remaining stimuli in at least 80% of ears. Two distinct patterns of evoked emissions were identified. Five (18%) ears showed short, broadband click-evoked emissions lasting less than 20 ms after stimulus onset. In these ears, toneburst-evoked emissions were often more prominent than click-evoked emissions and no spontaneous emissions were detected. Twenty-three (82%) ears showed click-evoked emissions lasting longer than 20 ms poststimulus onset. Spectral analysis of these emissions demonstrated several (2-10) narrow frequency peaks. Highly similar peaks were present in the spectra of toneburst-evoked emissions within the range of toneburst spectra. Spontaneous emissions were recorded in 12 of the 23 ears. In these ears, at the frequencies of spontaneous emissions, prominent peaks in both click- and toneburst-evoked emission spectra were always present. Otoacoustic emission characteristics correlated significantly between the ears of individual subjects inferring that a symmetrical cochlear mechanism generates otoacoustic emissions.

The clinical utility of distortion-product otoacoustic emissions

Otoacoustic emissions permit, for the first time, an unbiased means of examining the preneural elements of the peripheral auditory pathway that make the initial contribution to the perception of acoustic stimuli. Distortionproduct Otoacoustic emissions (DPOAEs) represent one type of evoked emission that has significant potential for becoming an important test in the audiometrie evaluation of hearing capacity. In the present review, selected examples of several forms of sensorineural hearing loss demonstrate that DPOAEs have the ability to act as objective indicators of the frequency/level configuration of the conventional audiogram in cases in which hearing impairment results primarily from damage to the outer hair cells. In contrast, normal DPOAE functioning, in the presence of a significant hearing loss, indicates a locus of damage central to the region of the outer hair cells. Like the other emitted responses, DPOAEs can be measured noninvasively, are highly repeatable, under test-retest conditions, and are simple and rapid to detect using microcomputerbased instrumentation. Further, DPOAEs test both the “threshold” and suprathreshold levels of outer hair-cell activity in the form of response/growth functions, over a 30− to 40-dB stimulus range. In combination, these attributes indicate that DPOAEs can provide an objective and comprehensive assessment of the cochlear reserve of a given ear.

Otoacoustic emissions in ears with hearing loss

Fifty ears of 37 patients demonstrating several common types of hearing impairment were examined for the presence of spontaneous and evoked otoacoustic emissions to investigate the relationship of acoustic emissions to hearing pathology. Of the 50 ears, 44 exhibited various degrees of sensorineural hearing loss. Evoked otoacoustic emissions to clicks were detected in 34 of 35 sensorineural hearing loss ears with a subjective click threshold less than 55 dB SPL (25 dB nHL). None of nine ears with sensorineural hearing impairment and a subjective click threshold greater than 55 dB SPL demonstrated click-evoked emissions. Spectral analyses revealed that the constituent frequency components of evoked emissions were always within the frequency range where audiometric thresholds were less than 35 dB HL, and in the majority (94%) of cases, thresholds were less than 25 dB HL. In ears with relatively well-preserved hearing within the frequency range of click or 1.5-kHz toneburst stimuli, the basic features of evoked emissions were similar to those described for normal ears. Similarly, for ears demonstrating spontaneous otoacoustic emissions, estimated audiometric thresholds at the emitted frequencies were always less than 20 dB HL. The influence of the type of otologic pathology on acoustic emissions was studied in a subset of ears exhibiting typical high-frequency hearing losses. Ears with a noise-induced impairment showed a significant reduction in the incidence of both spontaneous emissions and spectral peaks in evoked emissions that was not evident in ears with similar patterns of hearing loss caused by other factors.

Acoustic distortion products in rabbit ear canal. I: Basic features and physiological vulnerability

In contrast to evoked otoacoustic emissions, acoustic distortion products (DPs) recorded from the ear canal are present at predictable frequencies with respect to their primary tones, f1 and f2. Such specificity may provide detailed frequency-place information concerning the functional state of limited regions of the organ of Corti following experimental intervention. However, to date, it is not clear whether emitted DPs solely reflect activity at the basilar-membrane regions of primary tones or if the remote DP site makes a significant contribution to the emitted signal measured in the ear canal. We have investigated a number of the general features of acoustic-DP generation in the rabbit so that, in later experiments, the contributions of specific basilar-membrane regions involved in generating these DPs can be identified using techniques designed to manipulate their normal properties. The first report describes the outcome of systematic manipulations of a number of stimulus conditions and alterations to the physiological state of the cochlea by exposure to fatiguing sound or anoxia. Experimental findings for the 2f1-f2 DP showed that, in general, the relations of the levels and frequency of the primary tones to DP magnitude were consistent with previously published data from other mammalian species. Additional observations for other odd-order intermodulation DPs at the 3f1-2f2 and 2f2-f1 frequencies suggested that the basic attributes of the acoustic DPs were similarly affected by systematic manipulation of the basic parameters of the primary tones and the general metabolic state of the cochlea. General anesthesia, however, did not affect DP amplitude. A companion paper describes the results of a series of subsequent experiments using response-suppression, interfering-tone, and temporary threshold shift techniques which address more directly the issue of which basilar-membrane sites contribute to the generation of different acoustic DPs.

Evidence for two discrete sources of 2f1−f2 distortion‐product otoacoustic emission in rabbit: I. Differential dependence on stimulus parameters

The results of studies of the physiological vulnerability of distortion-product otoacoustic emissions (DPOAEs) suggest that the DPOAE at 2f1-f2 in vertebrate ears is generated by more than one source. The principal aims of the present study were to provide independent evidence for the existence of more than one DPOAE source, and to determine the contributions of each to the ear-canal 2f1-f2 signal. To accomplish these aims, specific stimulus parameters were separately and systematically varied to provide detailed parametric information regarding 2f1-f2 DPOAE amplitude and phase in normal ears of awake rabbits. The findings indicate that two discrete sources, demonstrating differential dependence on stimulus parameters, dominate the generation of the 2f1-f2 DPOAE. One source of distortion is dominant above 60-70 dB SPL at moderate primary-frequency separations, and at all stimulus levels when the primary tones are closely spaced. The other source is dominant below 60-70 dB SPL at moderate primary-frequency separations, and may be dominant at all stimulus levels when the primary tones are widely separated in frequency. The results suggest that by varying stimulus parameters, it may be possible to independently study the two generator mechanisms.

Distortion product emissions in humans. III. Influence of sensorineural hearing loss

The realization that otoacoustic emissions are sensitive to cochlear disorders has resulted in the speculation that they may have considerable clinical potential as objective measures of hearing. To assess the clinical utility of one type of emission, the distortion product emission (DPE), a study was undertaken in individuals with hearing impairments representing a number of common otologic disorders. The results of this investigation provided evidence that tests of DPEs promise to satisfy a number of requirements important to clinical testing, including objectivity of measurement procedures, test-retest reliability, simple subject preparation, readily available instrumentation, and relatively brief examination periods. The fine resolution of DPEs within the stimulus frequency and level domains also permits an accurate confirmation of the pattern of hearing loss. For example, tests of DPEs detected a 20-dB hearing level impairment at a single frequency in an ear exhibiting early signs of noise-induced hearing loss, and a 10-dB improvement in sensitivity following ingestion of the hyperosmotic agent glycerol in an ear displaying a mild to moderate hearing loss due to Menieres disease. Finally, the application of DPEs to the objective testing of otologic disorders suggests that the ability of these responses to assess the sensory component of a sensorineural disorder may contribute to the eventual understanding of the complicated pathogenesis of many cochlear diseases. When all the positive features of DPE testing are realized, the potential contribution that these measures can make in a clinical setting becomes apparent.

Dependence of distortion‐product otoacoustic emissions on primary levels in normal and impaired ears. I. Effects of decreasing L2 below L1

The 2f1-f2 distortion-product otoacoustic emission (DPOAE) is evoked by two primary tones of frequencies f1 < f2, and levels L1 and L2. Previous reports indicate that decreasing L2 below L1 = L2 can; (1) increase DPOAE amplitude in normal ears, and (2) increase the degree to which DPOAE amplitudes are reduced by cochlear trauma. Although both of these factors could be advantageous for clinical applications of DPOAEs, neither has been explored in detail. In the present study, 2f1-f2 DPOAE-amplitude frequency functions were collected from normal and impaired ears of rabbits and humans, with L1 = L2, and with L2 < L1, at each of three values of L1. In rabbits, controlled tonal or noise overexposures were used to produce permanent reductions of DPOAE amplitudes. Comparison of pre- and postexposure DPOAE-amplitude frequency functions demonstrated that the frequency-specific reductions of DPOAEs were enhanced by decreasing L2 below L1. In humans, DPOAE-amplitude frequency functions obtained with the various L1 and L2 combinations were collected from 16 normal ears to provide preliminary normative data for each stimulus-level condition. The L1-L2 that produced the maximum DPOAE amplitude in normal ears was systematically dependent on L1. Thus at most frequencies, decreasing L2 below L1 = L2 substantially reduced mean DPOAE amplitude when L1 > or = 75 dB SPL, but increased mean DPOAE amplitudes at L1 = 65 dB SPL. However, the increase of mean DPOAE amplitude obtained by decreasing L2 below L1 = 65 dB SPL was small, being less than 3.5 dB at most frequencies. More importantly, at L1 = 65 dB SPL, L2 could be decreased considerably below L1 = L2 without reducing mean DPOAE amplitude relative to that at L1 = L2. Inspection of DPOAE-amplitude frequency functions obtained from subjects with mild or moderate sensorineural hearing losses indicated that, in frequency regions of hearing impairment, decreasing L2 below L1 can enhance the degree of reduction of DPOAEs below the corresponding normative amplitudes, without reducing the normative amplitude. It is concluded that decreasing L2 below L1 = L2 has the potential to enhance the performance of DPOAEs in clinical applications.