Patricia A. Dorn

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.

On the existence of an age/threshold/frequency interaction in distortion product otoacoustic emissions

Interactions among age, threshold, and frequency in relation to distortion product otoacoustic emissions (DPOAE) have yet to be resolved. The effects of these variables were explored by analyzing DPOAEs in ears with thresholds not exceeding 20 dB HL. Multivariate regression analyses were performed in two different ways. For data to be included in the first analysis, audiometric threshold had to be 20 dB HL or better only at the particular frequency under study, but might exceed 20 dB HL at other half-octave frequencies. Significant main effects were found for age, threshold, and frequency. There was also an age-by-frequency interaction, but a significant age-by-threshold interaction was not observed. DPOAE amplitudes decreased as either age, frequency, or threshold increased. In the second analysis, when a more stringent inclusion criterion was applied (normal thresholds at all frequencies), the main effects for age, threshold, and frequency were not significant. The significant age-by-frequency interaction remained, whereby DPOAE amplitudes decreased as age and frequency increased, but the age-by-threshold interaction again was not significant. The magnitude of DPOAE amplitude change across age, threshold, and frequency and for the age-by-frequency interaction was small but similar for both groups of subjects. Age in association with threshold did not account for observed changes in DPOAE amplitudes for either group. Importantly, the lack of a significant age-by-threshold interaction indicates that there may be processes intrinsic to aging alone that act on DPOAE generation.

Cochlear compression estimates from measurements of distortion-product otoacoustic emissions

Evidence of the compressive growth of basilar-membrane displacement can be seen in distortion-product otoacoustic emission (DPOAE) levels measured as a function of stimulus level. When the levels of the two stimulus tones (f1 and f2) are related by the formula L1 = 39 dB + 0.4 x L2 [Kummer et al., J. Acoust. Soc. Am. 103, 3431-3444 (1998)] the shape of the function relating DPOAE level to L2 is similar (up to an L2 of 70 dB SPL) to the classic Fletcher and Munson [J. Acoust. Soc. Am. 9, 1-10 (1933)] loudness function when plotted on a logarithmic scale. Explicit estimates of compression have been derived based on recent DPOAE measurements from the laboratory. If DPOAE growth rate is defined as the slope of the DPOAE I/O function (in dB/dB), then a cogent definition of compression is the reciprocal of the growth rate. In humans with normal hearing, compression varies from about 1 at threshold to about 4 at 70 dB SPL. With hearing loss, compression is still about 1 at threshold, but grows more slowly above threshold. Median DPOAE I/O data from ears with normal hearing, mild loss, and moderate loss are each well fit by log functions. When the I/O function is logarithmic, then the corresponding compression is a linear function of stimulus level. Evidence of cochlear compression also exists in DPOAE suppression tuning curves, which indicate the level of a third stimulus tone (f3) that reduces DPOAE level by 3 dB. All three stimulus tones generate compressive growth within the cochlea; however, only the relative compression (RC) of the primary and suppressor responses is observable in DPOAE suppression data. An RC value of 1 indicates that the cochlear responses to the primary and suppressor components grow at the same rate. In normal ears, RC rises to 4, when f3 is an octave below f2. The similarities between DPOAE and loudness compression estimates suggest the possibility of predicting loudness growth from DPOAEs; however, intersubject variability makes such predictions difficult at this time.

Sources of distortion product otoacoustic emissions revealed by suppression experiments and inverse fast Fourier transforms in normal ears

Primary and secondary sources combine to produce the 2f1-f2 distortion product otoacoustic emission (DPOAE) measured in the ear canals of humans. DPOAEs were obtained in nine normal-hearing subjects using a fixed-f2 paradigm in which f1 was varied. The f2 was 2 or 4 kHz, and absolute and relative primary levels were varied. Data were obtained with and without a third tone (f3) placed 15.6 Hz below 2f1-f2. The level of f3 was varied in order to suppress the stimulus frequency otoacoustic emission (SFOAE) coming from the 2f1-f2 place. These data were converted from the complex frequency domain into an equivalent time representation using an inverse fast Fourier transform (IFFT). IFFTs of unsuppressed DPOAE data were characterized by two or more peaks. Relative amplitudes of these peaks depended on overall primary level and on primary-level differences. The suppressor eliminated later peaks, but early peaks remained relatively unaltered. Results are interpreted to mean that the DPOAE measured in humans includes components from the f2 place (intermodulation distortion) and DP place (in the form of a SFOAE). These findings build on previous work by providing evidence that multiple peaks in the IFFT are due to a secondary source at the DP place.

Distortion product otoacoustic emission test performance for a priori criteria and for multifrequency audiometric standards.

OBJECTIVES 1) To describe distortion product otoacoustic emission (DPOAE) test performance when a priori response criteria are applied to a large set of DPOAE data. 2) To describe DPOAE test performance when multifrequency definitions of auditory function are used. 3) To determine DPOAE test performance when a single decision regarding auditory status is made for an ear, based on DPOAE data from several frequencies. 4) To compare univariate and multivariate test performance when multifrequency gold standard definitions and response criteria are applied to DPOAE data. DESIGN DPOAE and audiometric data were analyzed from 1267 ears of 806 subjects. These data were evaluated for three different frequency combinations (2, 3, 4 kHz; 2, 3, 4, 6 kHz; 1.5, 2, 3, 4, 6 kHz). DPOAE data were collected for each of the f2 frequencies listed above, using primary levels (L1/L2) of 65/55 dB SPL and a primary ratio (f2/f1) of 1.22. Sensitivity and specificity were evaluated for signal to noise ratios (SNRs) of 3, 6, and 9 dB, which are in common clinical use. In addition, test performance was evaluated using clinical decision theory, following the convention we have used in previous reports on otoacoustic emission test performance. Both univariate and multivariate analyses techniques were applied to the data. In addition to evaluating DPOAE test performance for the case when audiometric and f2 frequency were equal, multifrequency gold standards and multifrequency criterion responses were evaluated. Three new gold standards were used to assess test performance: average pure-tone thresholds, extrema thresholds that took into account both the magnitude of the loss and the number of frequencies at which hearing loss existed, and a combination of the two. These new gold standards were applied to each of the three frequency groups described above. RESULTS As expected, SNR criteria of 3, 6, and 9 dB never resulted in perfect DPOAE test performance. Even the most stringent of these criteria (9 dB SNR) did not result in a sensitivity of 100%. This result suggests that caution should be exercised in the interpretation of DPOAE test results when these a priori criteria are used clinically. Excellent test performance was achieved when auditory status was classified on the basis of the new gold standards and when either SNR or the output of multivariate logistic regressions (LRs) were used as criterion measures. Invariably, the LR resulted in superior test performance compared with what was achieved by the SNR. For SNR criteria of 3, 6, and 9 dB and (by definition) for the LR, specificity, in general, exceeded 80% and often was greater than 90%. Sensitivity, however, depended on the magnitude of hearing loss. Diagnostic errors, when they occurred, were more common for patients with mild hearing losses (21 to 40 dB HL); sensitivity approached 100% once the hearing loss exceeded 40 dB HL. The largest differences between test performance based on SNR or LR occurred for the ears with mild hearing loss, where the LR resulted in more accurate diagnoses. CONCLUSIONS It should not be assumed that the use of a priori response criteria, such as SNRs of 3, 6, or 9 dB, will identify all ears with hearing loss. Test performance when multifrequency gold standards are used to define an ear as normal or impaired and when data from multiple f2 frequencies are used to make a diagnosis, resulted in excellent test performance, especially when the LR was used. When predicting auditory status with multifrequency gold standards, the LR resulted in relative operating characteristic curve areas of 0.95 or 0.96. An output from the LR can be selected that results in a specificity of 90% or better. When the loss exceeded 40 dB HL, the same output from the LR resulted in test sensitivity of nearly 100%. These were the best test results that were achieved. (ABSTRACT TRUNCATED)

Distortion product otoacoustic emission test performance when both 2 f1–f2 and 2 f2–f1 are used to predict auditory status

The objective of this study was to determine whether distortion product otoacoustic emission (DPOAE) test performance, defined as its ability to distinguish normal-hearing ears from those with hearing loss, can be improved by examining response and noise amplitudes at 2 f1-f2 and 2f2-f1 simultaneously. In addition, there was interest in knowing whether measurements at both DPs and for several primary frequency pairs can be used in a multivariate analysis to further optimize test performance. DPOAE and noise amplitudes were measured at 2f1-f2 and 2 f2-f1 for 12 primary levels (L2 from 10 to 65 dB SPL in 5-dB steps) and 9 pairs of primary frequencies (0.5 to 8 kHz in 1/2-octave steps). All data were collected in a sound-treated room from 70 subjects with normal hearing and 80 subjects with hearing loss. Subjects had normal middle-ear function at the time of the DPOAE test, based on standard tympanometric measurements. Measurement-based stopping rules were used such that the test terminated when the noise floor around the 2 f1-f2 DP was < or = -30 dB SPL or after 32 s of artifact-free averaging, whichever occurred first. Data were analyzed using clinical decision theory in which relative operating characteristics (ROC) curves were constructed and areas under the ROC curves were estimated. In addition, test performance was assessed by selecting the criterion value that resulted in a sensitivity of 90% and determining the specificity at that criterion value. Data were analyzed using traditional univariate comparisons, in which predictions about auditory status were based only on data obtained when f2 = audiometric frequency. In addition, multivariate analysis techniques were used to determine whether test performance can be optimized by using many variables to predict auditory status. As expected, DPOAEs were larger for 2f1-f2 compared to 2 f2-f1 in subjects with normal hearing. However, noise amplitudes were smaller for 2f2-f1, but this effect was restricted to the lowest f2 frequencies. A comparison of signal-to-noise ratios (SNR) within normal-hearing ears showed that the 2f1-f2 DP was more frequently characterized by larger SNRs compared to 2f2-f1. However, there were several subjects in whom 2f2-f1 produced a larger SNR. ROC curve areas and specificities for a fixed sensitivity increased only slightly when data from both DPs were used to predict auditory status. Multivariate analyses, in which the inputs included both DPs for several primary frequency pairs surrounding each audiometric frequency, produced the highest areas and specificities. Thus, DPOAE test performance was improved slightly by examining data at two DP frequencies simultaneously. This improvement was achieved at no additional cost in terms of test time. When measurements at both DPs were combined with data obtained for several primary frequency pairs and then analyzed in a multivariate context, the best test performance was achieved. Excellent test performance (ROC) curve areas >0.95% and specificities >92% at all frequencies, including 500 Hz, were achieved for these conditions. Although the results described should be validated on an independent set of data, they suggest that the accuracy with which DPOAE measurements identify auditory status can be improved with multivariate analyses and measurements at multiple DPs.

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

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

Sources of DPOAEs revealed by suppression experiments, inverse fast Fourier transforms, and SFOAEs in impaired ears

DPOAE sources are modeled by intermodulation distortion generated near the f2 place and a reflection of this distortion near the DP place. In a previous paper, inverse fast Fourier transforms (IFFTs) of DPOAE filter functions in normal ears were consistent with this model [Konrad-Martin et al., J. Acoust. Soc. Am. 109, 2862-2879 (2001)]. In the present article, similar measurements were made in ears with specific hearing-loss configurations. It was hypothesized that hearing loss at f2 or DP frequencies would influence the relative contributions to the DPOAE from the corresponding basilar membrane places, and would affect the relative magnitudes of SFOAEs at frequencies equal to f2 and fDP. DPOAEs were measured with f2 = 4 kHz, f1 varied, and a suppressor near fDP. L2 was 25-55 dB SPL (L1 = L2 + 10 dB). SFOAEs were measured at f2 and at 2.7 kHz (the average fDP produced by the f1 sweep) for stimulus levels of 20-60 dB SPL. SFOAE results supported predictions of the pattern of amplitude differences between SFOAEs at 4 and 2.7 kHz for sloping losses, but did not support predictions for the rising- and flat-loss categories. Unsuppressed IFFTs for rising losses typically had one peak. IFFTs for flat or sloping losses typically have two or more peaks; later peaks were more prominent in ears with sloping losses compared to normal ears. Specific predictions were unambiguously supported by the results for only four of ten cases, and were generally supported in two additional cases. Therefore, the relative contributions of the two DPOAE sources often were abnormal in impaired ears, but not always in the predicted manner.

Evidence of upward spread of suppression in DPOAE measurements

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

Spontaneous otoacoustic emission prevalence patterns in humans

In humans the prevalence of spontaneous otoacoustic emissions (SOAEs) depends on gender, pigmentation (race), and auditory status. Potential sources for variations in SOAE prevalence may include outer/middle ear characteristics and trauma to the auditory system. To explore these variables, auditory system structure, status, and history was obtained for each subject from whom SOAE recordings were obtained. Outer ear characteristics were determined from resonance peaks in a spectrum of white noise measured in the ear canal. Middle ear characteristics were obtained with multifrequency tympanometry. Auditory system trauma was determined by assessing hearing thresholds and from reports of noise exposure, medication history, and otologic surgery/illnesses. The results will be discussed in terms of their implications for clinical applications and models of the auditory system. [Work supported by the Showalter Foundation.]