Interactive effects of the middle ear pathology and the associated hearing loss on transient-evoked otoacoustic emission measures☆☆☆★★★ (original) (raw)
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Hearing Research, 2000
Evoked otoacoustic emissions (EOAEs) are generated within the cochlea in response to external sounds, and they can be acoustically detected in the external auditory meatus after backward propagation through the middle ear. In addition to being used to probe the cochlear mechanisms, they are expected to be sensitive to minute changes in middle ear impedance. Systematic measurements of the changes in the vectorial components of EOAEs were carried out after various manipulations of the human middle ear in order to characterize the influence of stiffness and inertia of the stapes and tympanic-membrane systems. For this purpose, stapedius muscle contractions were elicited by high-level contralateral sound, controlled changes in middle ear pressure (range þ 100 daPa) were produced and the tympanic membrane was loaded with water droplets. A computer model of the middle ear network was implemented using a standard lumped-element electric analog of the middle ear (Zwislocki's model). Forward and backward transmission changes were simulated and model predictions were compared to experimental data. Apart from the case of positive middle ear pressures, a close qualitative correspondence was found between model and real-ear results. Each of the effects was characterized by a unique pattern of phase and magnitude changes as a function of frequency, in relation to the mechanical characteristics of the involved subsystem (i.e. stapes stiffness, tympanic-membrane stiffness or mass) and its resonance properties. Owing to their high sensitivity, EOAEs could be helpful for an accurate individual multifrequency analysis of middle ear impedance by comparisons under rest and test conditions. ß
Medicinski pregled, 2011
Transient-evoked otoacoustic emissions are transmitted through the middle ear. The purpose of this study was to investigate the effects of dynamic properties of the transmission system on the measurability of transient otoacoustic emissions. The authors analyzed the presence of transient otoacoustic emissions in 48 children with serous otitis media regarding the tympanogram, presence and type of effusion and pure tone average findings. The results obtained in this research show the predominant absence of transient otoacoustic emissions in patients with type B tympanogram (69.1%) especially if the effusion is mucoid (77.5%) with the hearing loss of 15 decibel hearing level. This research shows that disorders in dynamic characteristics of the middle ear in patients with serous otitis obstruct the transmission of acoustic energy and affect the measurability of transient otoacoustic emissions, especially if the effusion is mucoid and hearing loss of 15 decibel hearing level.
Otoacoustic emissions: A new method to diagnose hearing impairment in children
European Journal of Pediatrics, 1993
Otoacoustic emissions (OAEs) are epiphenomena of sensitive, amplifying processes during hearing which can be detected in persons with normal inner ear function. They originate from the cochlea and are interpreted as an energy leakage of cochlear processes, perhaps resulting from active outer hair cell movements. OAEs travel from the cochlea through the middle ear to the external auditory canal where they can be detected using sensitive miniature microphones. Transient evoked (TEOAE) tests allow to otoacoustic emissions non-invasively check the integrity of the cochlea. In the neonatal period, registration of OAEs can be accomplished during natural sleep. In infants and neonates TEOAEs can be used as screening test with a screening level at 30 dB HL in paediatric audiology. They are less time consuming and elaborate than auditory brainstem responses (ABR) and they are more sensitive than behavioral tests. TEOAEs are constant over long periods of time and they are reduced or absent due to various adverse influences in the inner ear. These latter characteristics may allow monitoring of the inner ear function over time e.g. during disease and/or during ototoxic therapeutic interventions. Limitations of this new method are due to the fact that TEOAEs are absent in patients with a more than 30 dB HL hearing loss. Thus a hearing threshold cannot be determined. Diseases of the inner ear which are common in early childhood (like otitis media) reduce the transfer of TEOAEs and may wrongly indicate a cochlear hearing disorder. New methods for evaluation and interpretation of TEOAE test results are currently developed which may allow to circumvent this problem. When used by an experienced examiner who is aware of the possibilities as well as of the limitations of this new method, registration of TEOAEs is a promising new tool which complements our current-armamentarium to diagnose hearing disorders in children.
Medical science monitor : international medical journal of experimental and clinical research, 2012
The aim of this study was to investigate the effects of sub-clinical alterations on the amplitudes and slopes of the DPOAE input-output responses from subjects with previous history of middle ear dysfunction. The study included 15 subjects with and 15 subjects without a history of otitis media in the last 10 years. All participants were assessed with acoustic immittance, pure-tone audiometry, and DPOAEs. For the later, I/O functions and I/O slopes were estimated at 1501, 2002, 3174, 4004 and 6384 Hz. No statistically significant differences were found between the 2 groups in terms of behavioral thresholds. The group with a previous history of middle ear dysfunction presented significantly lower mean DPOAE amplitudes at 2002, 3174 and 4004 Hz. In terms of DPOAE slopes, no statistically significant differences were observed at the tested frequencies, except at 3174 Hz. Middle ear pathologies can produce subclinical alterations that are undetectable with traditional pure-tone audiometr...
Cochlear Mechanisms and Otoacoustic Emissions
Journal of the Acoustical Society of America, 1991
This study aims to determine the impact of controlling cochlear-source mechanism on the accuracy with which auditory status is identified using otoacoustic emissions (OAEs) in two groups of subjects with normal hearing (NH) and subjects with mild to moderate hearing loss. Design: Data were collected from 212 subjects with NH and with mild to moderate hearing loss who fell into two categories based on a distortion product OAE (DPOAE) screening protocol: the uncertain-identification group (where errors were likely) and the certain-identification group (where errors were unlikely). DPOAE fine-structure patterns were recorded at intervals surrounding f 2 = 1, 2 and 4 kHz (f 2 /f 1 ratio = 1.22), with L 2 = 35, 45, and 55 dB SPL (L 1 /L 2 ratio = 10 dB). The discrete cosine transform was used to smooth fine structure, limiting the source contribution to the distortion source only. Reflection-source OAEs were also recorded using amplitude-modulated stimulus frequency OAEs (AM-SFOAE). Area under the relative operating characteristic (A ROC) curve was used to quantify test accuracy when the source contribution was controlled versus the condition where both sources contribute. Additionally, failure rate, fixed at 5% for NH ears, as a function of behavioral-threshold category was evaluated. Results: When data for the entire subject group were examined, reducing the reflection-source contribution to the DPOAE did not result in better test performance than the best control condition at any frequency tested. When the subjects with NH were restricted to those with confirmed fine structure, A ROC analyses indicated that reducing the reflection-source contribution resulted in several small increases in the accuracy (2%-5%) with which auditory status was identified relative to the best control condition. This improvement was observed for the lowest stimulus levels (i.e., L 2 = 35 or 45 dB SPL). In this subset of subjects, distortion-source DPOAEs resulted in more accurate identification of mild hearing loss for a fixed false-positive rate of 5% in NH ears at lower L 2 's, conditions with poor accuracy in the larger group of subjects. The impact of controlling the source contribution on the identification of moderate losses was less clear in the reduced subject group, with some conditions where the distortion-source DPOAE was more accurate than the control condition and other conditions where there was no change. There was no evidence that reflection-source AM-SFOAEs more accurately identified ears with hearing loss when compared to any of the DPOAE conditions in either the large or reduced group of subjects. Conclusion: While improvements in test accuracy were observed for some subjects and some conditions (e.g., mild hearing losses and low stimulus levels in the reduced subset of subjects), these results suggest that restricting cochlear source contribution by "smoothing" DPOAE fine structure is not expected to improve DPOAE test accuracy in a general population of subjects. Likewise, recording reflection-source OAEs using the AM-SFOAE technique would not be expected to more accurately identify hearing status compared to mixed-or single-source DPOAEs.
Otology & Neurotology, 2012
Objective: Deviant middle ear pressure has a negative effect on the forward and backward transmission of stimulus and emissions through the middle ear. Resolving this deviant middle ear pressure is expected to lead to better middle ear transmission and, as a result of this, stronger otoacoustic emissions, which are better detectable. We investigated the effect of compensation o a deviant tympanic peak pressure on click-evoked otoacoustic emissions (CEOAEs). Second, we compared patient data to model predictions made by Zwislocki's middle ear model. Setting: University Medical Center. Patients: Fifty-nine children aged between 0.5 and 9 years (mean, 4.4 yr). Intervention: Hearing investigations including CEOAE measurements at ambient and at compensated tympanic peak pressure (TPP). Main Outcome Measure: CEOAEs at ambient and compensated TPP. Results: Compensation of TPP resulted in higher emission amplitudes below 2 kHz (increase of 8Y11 dB). In addition, the compensated measurement showed an increased phase lag (up to one-fourth cycle). For ears with mild deviations of TPP, Zwislocki's model could describe these changes. Pressure compensation was well described by a compliance increase of the tympanic membrane, the malleus, and the incus. Conclusion: Compensating the ear canal pressure for negative tympanic peak pressure increased CEOAE amplitudes below 2 kHz and increased the phase lag. These changes can be predicted from an increase of the compliance of the tympanic membrane, incus, and malleus, as a consequence of the pressure compensation.
Otoacoustic Emissions in Children with Long-Term Middle Ear Disease
2020
Introduction: Otoacoustic emissions (OAEs) evaluate the functional status of the cochlea. Repeated otitis media (OM) can cause changes in the peripheral structures of the auditory system, and, in this way, middle ear infection may irreversibly damage the middle ear, or even the cochlea. Objectives: To analyze the results of transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) in individuals with a history of OM. Method: Participants with 8 to 16 years of schooling were split into two groups: a control group (CG) of 50 subjects who had no history of otological disease and an experimental group (EG) of 50 subjects who had a history of recurrent otitis in childhood and had consequently undergone myringotomy to insert bilateral ventilation tubes. All children underwent basic audiological assessment (tonal audiometry, speech audiometry, and immittance testing) and otoacoustic emission testing (TEOAEs and DPOAEs). Results: There were no s...
International journal of pediatric otorhinolaryngology, 2005
Otoacoustic emissions (OAEs) are widely used for assessing congenital and early-acquired sensorineural hearing loss in young children. Middle ear pathology has a negative effect on the presence of OAEs. In this study we investigated whether measuring OAEs at compensated middle ear pressure (CMEP) resulted in a higher pass rate than at ambient pressure. Secondly, we analysed the influence of 12 different pass definitions on the pass rates. One hundred and eleven children (age 1-7 years, mean 4 years and 5 months) were measured twice in one session: first at ambient pressure and then at CMEP. The study showed a higher pass rate of OAEs at CMEP than at ambient pressure. A two-step scenario reduced the number of fails by 18-26%, depending on the pass/fail definition used. Measuring OAEs at CMEP results in higher pass rates. Secondly, pass/fail definitions have a large influence on pass rates and this issue deserves further attention. Further studies must be done, before this method is r...