Audiological Assessment of Word Recognition Skills in Persons With Aphasia.

PURPOSE: The purpose of this study was to evaluate the ability of persons with aphasia, with and without hearing loss, to complete a commonly used open-set word recognition test that requires a verbal response. Furthermore, phonotactic probabilities and neighborhood densities of word recognition errors were assessed to explore potential underlying linguistic complexities that might differentially influence performance among groups. METHOD: Four groups of adult participants were tested: participants with no brain injury with normal hearing, participants with no brain injury with hearing loss, participants with brain injury with aphasia and normal hearing, and participants with brain injury with aphasia and hearing loss. The Northwestern University Auditory Test No. 6 (NU-6; Tillman & Carhart, 1966) was administered. Those participants who were unable to respond orally (repeating words as heard) were assessed with the Picture Identification Task (Wilson & Antablin, 1980), permitting a picture-pointing response instead. Error patterns from the NU-6 were assessed to determine whether phonotactic probability influenced performance. RESULTS: All participants with no brain injury and 72.7% of the participants with aphasia (24 out of 33) completed the NU-6. Furthermore, all participants who were unable to complete the NU-6 were able to complete the Picture Identification Task. There were significant group differences on NU-6 performance. The 2 groups with normal hearing had significantly higher scores than the 2 groups with hearing loss, but the 2 groups with normal hearing and the 2 groups with hearing loss did not differ from one another, implying that their performance was largely determined by hearing loss rather than by brain injury or aphasia. The neighborhood density, but not phonotactic probabilities, of the participants' errors differed across groups with and without aphasia. CONCLUSIONS: Because the vast majority of the participants with aphasia examined could be tested readily using an instrument such as the NU-6, clinicians should not be reticent to use this test if patients are able to repeat single words, but routine use of alternative tests is encouraged for populations of people with brain injuries.

The Effect of Stimulus Intensity and Carrier Frequency on Auditory Middle- and Long-Latency Evoked Potentials Using a Steady-State-Response Approach.

PURPOSE: The purpose of this study was to measure magnitude changes of auditory steady-state responses (ASSRs) and respective transient middle- and long-latency responses as a function of stimulus intensity and carrier frequency. The literature lacks clear consensus, including relationship to loudness. METHOD: A cohort of 48 adults with normal hearing was examined from a companion study (Tlumak, Durrant, & Delgado, 2015) on effects of aging. ASSRs were elicited by repeated tone-burst stimuli presented at rates of 40 and 0.75 Hz at 3 frequencies and 5 levels of stimulus intensity. The design also permitted scrutiny of any gender bias to the results. RESULTS: Similar to derived transient response findings, ASSR magnitude (harmonic sum) systematically increased with intensity. Input-output function only at 0.75 Hz approximated a log-log linear function. However, slopes fell well below that of doubling of loudness per 10 dB SPL. Results failed to demonstrate significance as a function of carrier frequency and gender for both repetition rates. CONCLUSION: Effects of stimulus intensity, carrier frequency, and gender on ASSRs were similar to those of their transient counterparts. Findings remain disappointing for objective loudness estimation. Results suggest only a clear linkage to the long-latency response and the 0.75-Hz magnitude but require careful consideration of limitations/underlying mechanisms when measuring loudness-related effects.

The Effect of Advancing Age on Auditory Middle- and Long-Latency Evoked Potentials Using a Steady-State-Response Approach.

PURPOSE: The purpose of the study was to objectively detect age-specific changes that occur in equivalent auditory steady-state responses (ASSRs), corresponding to transient middle- and long-latency auditory evoked potentials as a function of repetition rate and advancing age. METHOD: The study included 48 healthy hearing adults who were equally divided into 3 groups by age: 20-39, 40-59, and 60-79 years. ASSRs were recorded at 7 repetition rates from 40 down to 0.75 Hz, elicited by trains of repeated tone burst stimuli. RESULTS: Temporal analysis of middle- and long-latency equivalent ASSRs revealed no appreciable changes in the magnitudes of the response across the age groups. Likewise, the spectral analysis revealed that advancing age did not substantially affect the spectral content of the response at each repetition rate. Furthermore, the harmonic sum was not significantly different across the 3 age groups, between the younger adults versus the combined Older Group Sample 1 and Sample 2, and between the two extreme age groups (i.e., 20-39 vs. 60-79) for the middle- and long-latency equivalent ASSRs. CONCLUSION: Advancing age has no effect on the long-latency equivalent ASSRs; however, aging does affect the middle-latency equivalent ASSRs when the mean age difference is ≥ 40 years.

Will diminishing cochlear delay affect speech perception in noise?

OBJECTIVE: Normal auditory systems appear well habituated to time/phase delays inherent to sound encoding along the hearing organ, sending frequency information non-simultaneously to the central auditory system. Eliminating, or simply perturbing, the cochlear delay might be expected to decrease speech recognition ability, especially under demanding listening conditions. Resources of a larger-scale investigation permitted a preliminary examination of this issue, particularly on a relevant timescale of empirically demonstrated cochlear delays. DESIGN: In a randomized controlled trial study, word recognition was tested for mono-syllabic tokens treated digitally to exacerbate, if not diminish/nullify, such delays. Speech-weighted noise was used to interfere with listening to time-frequency reversed (nominally no delay) versus non-reversed (natural timing) transforms under three treatments of speech tokens: (1) original-digitally recorded; digitally processed to emphasize (2) transient versus (3) quasi-steady-state components. STUDY SAMPLE: Ten normal-hearing young-adult females. RESULTS: The findings failed to demonstrate statistically significant differences between delay conditions for any of the three speech-token treatments. CONCLUSIONS: An algorithm putatively diminishing frequency-dependent cochlear delays failed to systematically deteriorate performance in all subjects for the fixed time-frequency transform, stimulus parameters, and test materials employed. Yet, trends were evident such that some effect of perturbing cochlear delays could not be ruled out completely.

Rinne revisited: steel versus aluminum tuning forks.

OBJECTIVE: (1) Determine whether tuning fork material (aluminum vs stainless steel) affects Rinne testing in the clinical assessment of conductive hearing loss (CHL). (2) Determine the relative acoustic and mechanical outputs of 512-Hz tuning forks made of aluminum and stainless steel. STUDY DESIGN: Prospective, observational. SETTING: Outpatient otology clinic. SUBJECTS AND METHODS: Fifty subjects presenting May 2011 to May 2012 with negative or equivocal Rinne in at least 1 ear and same-day audiometry. Rinne test results using aluminum and steel forks were compared and correlated with the audiometric air-bone gap. Bench top measurements using sound-level meter, microphone, and artificial mastoid. RESULTS: Patients with CHL were more likely to produce a negative Rinne test with a steel fork than with an aluminum fork. Logistic regression revealed that the probability of a negative Rinne reached 50% at a 19 dB air-bone gap for stainless steel versus 27 dB with aluminum. Bench top testing revealed that steel forks demonstrate, in effect, more comparable air and bone conduction efficiencies while aluminum forks have relatively lower bone conduction efficiency. CONCLUSION: We have found that steel tuning forks can detect a lesser air-bone gap compared to aluminum tuning forks. This is substantiated by observations of clear differences in the relative acoustic versus mechanical outputs of steel and aluminum forks, reflecting underlying inevitable differences in acoustic versus mechanical impedances of these devices, and thus efficiency of coupling sound/vibratory energy to the auditory system. These findings have clinical implications for using tuning forks to determine candidacy for stapes surgery.

Children with phenylketonuria treated early: basic audiological and electrophysiological evaluation.

OBJECTIVES: Individuals with phenylketonuria (PKU) can exhibit deficits in executive functions, intelligence, attention, visual-spatial processing abilities, and efficiency stemming presumably from deficient neurotransmitter synthesis, even when the disorder is diagnosed and treated early. Basic audiological and electrophysiological evaluations were used to examine the peripheral and central auditory pathways of children with early-treated PKU, who followed adequate versus inadequate diets. Results were compared with those of age-matched children without PKU. DESIGN: The control group included 35 children aged 5 to 16 years, and the experimental group included 25 children with classic PKU, all of whom were diagnosed and treated early. The experimental group comprised children of two subgroups, divided according to their dietary control, as follows: 8 children aged 6 to 13 years with adequate diets (group A); 17 children ages 6 to 15 years demonstrating inadequate diets (group B). All participants underwent auditory evaluations, including otoscopy, pure-tone and speech audiometry, immittance testing (tympanometry and assessment of contralateral stapedial reflex thresholds), and evaluations of auditory brainstem and middle latency responses. The demographic variables and audiological examination results were analyzed for all groups. Results among groups and subgroups were compared using analysis of variance with repeated measures to test statistical significance across factors and measures at the p = 0.05 level. RESULTS: Audiometric evaluation revealed results within normal limits for all groups, except for one child from the inadequate diet group, who showed a mild bilateral conductive hearing loss. Results of speech and immittance audiometry suggested the children in group B as having poorer average speech-discrimination scores and higher stapedial reflex thresholds at 4000 Hz. Auditory brainstem response results revealed longer average latencies for waves III and V and greater interaural differences for wave V in group B, although both groups A and B showed longer average latencies for the interpeak interval I-V, compared with the control group. Middle latency responses showed no significant differences in the latencies of the Na and Pa waves or the Na-Pa amplitude for the experimental group, but electrode or ear effects were present in 87.5% of group A and 58.8% of group B. CONCLUSIONS: Overall, differences observed tended to be small (by clinical diagnostic standards), yet suggest that children with PKU exhibit some effect of this disorder on the pontine auditory pathway, even when diagnosed/treated early and independent of the appropriateness of diet. It thus seems prudent to follow PKU children with auditory processing assessments to evaluate functional implications of these findings.

Steady-state analysis of auditory evoked potentials over a wide range of stimulus repetition rates: profile in children vs. adults.

OBJECTIVE: Auditory steady-state responses (ASSR) evoked by recurrent brief tones were assessed over a wide range of stimulus repetition rates apropos the traditionally measured obligatory, transient, auditory evoked potentials. Repetition rates of ≤ 10 Hz have received little attention in the context of the ASSR stimulus-response analysis approach, speculated to provide technical advantages/additional information over more traditional transient stimulus-response paradigms. DESIGN: Magnitudes were measured at repetition rates from 0.75 to 80 Hz, using trains of repeated tone-burst stimuli. STUDY SAMPLE: Twelve normal-hearing children and a reference sample of 25 young adults. RESULTS: Results show that response magnitudes were significantly larger in children than adults at repetition rates of ≤ 5 Hz. Magnitudes were largest at the two lowest repetition rates, following the trends expected from the transient auditory evoked potential (AEP) literature. The harmonic sum is proposed as a more appropriate measure of response magnitude than amplitude of the fundamental alone. CONCLUSIONS: The analysis methods used in this paper may give information that will have applications for clinical testing. Of pragmatic importance is that the stimulus rate profile could be determined without subjective wave identification and/or interpretation, and thus by a method that is inherently more objective than conventional AEP analysis.

Steady-state analysis of auditory evoked potentials over a wide range of stimulus repetition rates in awake vs. natural sleep.

OBJECTIVE: Auditory steady-state responses (ASSR) evoked by recurrent tones were assessed over a wide range of stimulus repetition rates embracing well the traditionally measured transient AEPs. Repetition rates of ≤ 10 Hz have received little attention in the context of the ASSR stimulus-response analysis approach which is speculated to provide technical advantages, if not additional/supplemental information, over more traditional transient stimulus-response paradigms. DESIGN: Magnitudes were measured at repetition rates from 0.75 to 80 Hz, using trains of recurrent tone-burst stimuli. STUDY SAMPLE: Twenty-five normal-hearing adults during sleep and awake. RESULTS: Results show that response magnitudes for adults tested during sleep were significantly larger than those for adults while awake at repetition rates <5 Hz. Magnitudes were largest at the two lowest repetition rates, as expected from corresponding results obtained using conventional methods. CONCLUSIONS: The analysis methods used in this paper may give information that will have applications for clinical testing. Results confirm and extend knowledge of the effects of repetition rate on AEPs over a range embracing the gamut of responses as traditionally classified, specifically at the beginning stages of natural sleep.

Steady-state analysis of auditory evoked potentials over a wide range of stimulus repetition rates: profile in adults.

OBJECTIVE: Quasi-steady-state responses were assessed over a wide range of stimulus repetition rates embracing well the traditionally measured transient AEPs (obligatory auditory evoked potentials of all latencies). Repetition rates of ≤10 Hz have received little attention in the context of the ASSR stimulus-response analysis approach which is speculated to provide technical advantages, if not additional information, over more traditional transient stimulus-response paradigms. DESIGN: A measure introduced and defined as the sum of the response at the stimulus frequency and its harmonics. The magnitude of steady-state responses were measured at repetition rates from 0.75 to 80 Hz, using trains of repeated tone-burst stimuli. STUDY SAMPLE: Twenty-five normal-hearing adults. RESULTS: Results show that the magnitudes of the response across repetition rates are largest at the two lowest rates, following trends expected from the transient AEP literature. Good reliability overall was observed for the harmonic sum. CONCLUSIONS: The analysis methods used in this paper may give information that will have application for clinical testing. Of pragmatic importance is that the rate profile could be determined without subjective wave identification and/or interpretation, and thus by a method that is inherently more objective than conventional AEP tests.

Parameters to maximize 2f2-f1 distortion product otoacoustic emission levels.

PURPOSE: Past research has established parameters for the 2f1-f2 distortion product otoacoustic emissions (DPOAEs) that enhance response levels (e.g., L1 - L2 = 10 dB; f2/f1 = 1.22; L1, L2 = 65, 55 dB SPL). These same parameters do not optimize 2f2-f1 DPOAEs. Therefore, this study was conducted to evaluate more completely those parameters that produce the most robust 2f2-f1 output. METHOD: Input-output functions of the 2f2-f1 component were obtained from 20 normal-hearing adults (with f2 = 2000 Hz and 4000 Hz). Frequency ratios, level differences, and overall sound levels were manipulated with parameter combinations chosen to expand on information established in previous studies. The DPOAE signal-to-noise ratio (SNR), response presence, and output levels were measured. RESULTS: In general, mean SNRs and 2f2-f1 levels were greater, and DPOAEs were present more often for 2000 than for 4000 Hz across all parameter combinations. No single parameter combination resulted in pronounced maxima for 2f2-f1, which is consistent with past studies but is in sharp contrast to results for the more familiar 2f1-f2. CONCLUSIONS: Overall, the results suggest that to maximize the 2f2-f1 level, lower test frequencies, low frequency ratio, essentially equal levels of primary tones, and moderate stimulus levels are best, and such parameters might be important for applying DPOAE measurement to assessment of normal and impaired auditory function.

Cisplatin induces cytoplasmic to nuclear translocation of nucleotide excision repair factors among spiral ganglion neurons.

Genomic DNA is a high-affinity target for the antineoplastic molecule cisplatin. Cell survival from cisplatin DNA damage is dependent on removal of cisplatin-DNA adducts by nucleotide excision repair (NER) pathways. The rate-limiting steps in the NER pathways are DNA damage identification and verification. These steps are accomplished by xeroderma pigmentosum complementation group C and A (XPC and XPA) and RNA polymerase II. Unlike RNA polymerase II, XPC and XPA have no known cellular function beyond DNA repair. Cisplatin is known to damage spiral ganglion neurons at the basal coil of the cochlea therefore it was posited that cisplatin may target their DNA and mobilize XPC and XPA. Female Fisher344 rats were given two, four day cycles of cisplatin (2mg/kg) or saline, separated by a 10day rest period. A 2 x 3 x 2 factorial design, consisting of two treatment conditions (cisplatin and saline treatment), three survival times (5, 19 and 22 days) and two analysis methods (quantitative RT-PCR and immunohistochemistry) was employed to evaluate the expression and distribution of XPC and XPA. Quantitative RT-PCR revealed statistically significant differences in cochlear XPC and XPA mRNA levels after cisplatin treatment at all times except day 22 for XPA. Immunohistochemistry revealed that a proportion ( approximately 50%) of spiral ganglion neurons in control rats showed cytoplasmic expression of XPC and XPA. After cisplatin treatment, a similar proportion ( approximately 50%) of spiral ganglion neurons showed increased nuclear expression of XPC and XPA, which appears to represent translocation from the cytoplasm. Basal coil spiral ganglion neurons translocated XPC and XPA at later treatment cycles and with less magnitude than apical coil neurons after cisplatin treatment. Therefore, it is suggested that cisplatin treatment induces nuclear translocation of NER proteins among spiral ganglion neurons and that this nuclear translocation is less efficient at the base relative to the apex.

Call for calibration standard for newborn screening using auditory brainstem responses.

The mode of stimulation employed in newborn screening of the auditory brainstem response has evolved from the clinically standardized supraaural earphone to the tubal insert earphone, to most recently a circumaural earphone developed for this test. Considered here is the need to develop a standard for calibration of such devices for newborn screening applications, in particular. At risk is the prospect of missing the milder degrees of hearing loss, assuming a goal of detecting all clinically-significant congenital hearing losses. Two commercially manufactured test instruments for automated newborn screening were scrutinized via bench testing of sound output from their respective transducers, using a variety of measurements. By convention or design, none of the measurement approaches involved a model of the newborn ear, per se. While it was concluded that the manufacturers' method shows promise, namely as a relatively simple and potentially reliable method of calibration, concerns arose regarding output levels when measured according to both the manufacturers' and the authors' methods. Further work is needed to critically assess calibration methods and to establish, to the extent possible, appropriate norms and validation studies in newborns to provide a better understanding of the actual sound pressure level of the screening stimulus.

Meta-analysis of variables that affect accuracy of threshold estimation via measurement of the auditory steady-state response (ASSR).

Reported are the results of meta-analyses of data derived collectively from a sample of 56 published research studies on electric response audiometry (ERA) using auditory steady-state responses (ASSRs). Several specific methodological issues were examined and hypotheses were posited to rigorously test common conclusions drawn from the ASSR literature on the accuracy of ASSR-ERA. Explanatory variables for analyses were type of population (normally hearing and hearing-impaired), type of modulation, number of sweeps acquired during response analysis, electrode montage, and modulation rate (80 vs. 40 Hz). No explanatory variables were found to be significantly related to the degree of disparity between thresholds obtained by ASSR-ERA versus behavioral audiometry in the normally hearing population. Conversely, all but one explanatory variable (i.e. electrode montage) was found to be significantly related to mean threshold differences in the hearing-impaired and combined populations. Results both substantiate some of common conclusions drawn from the literature but call others into question, helping to identify those methodological issues which appear to, or not to, significantly affect the accuracy of estimating threshold using ASSR measurement. In addition to these findings, another practical outcome of this study was the development of various summary tables of the data analysed from the literature sampled.

Speech signal modification to increase intelligibility in noisy environments.

The role of transient speech components on speech intelligibility was investigated. Speech was decomposed into two components--quasi-steady-state (QSS) and transient--using a set of time-varying filters whose center frequencies and bandwidths were controlled to identify the strongest formant components in speech. The relative energy and intelligibility of the QSS and transient components were compared to original speech. Most of the speech energy was in the QSS component, but this component had low intelligibility. The transient component had much lower energy but was almost as intelligible as the original speech, suggesting that the transient component included speech elements important to speech perception. A modified version of speech was produced by amplifying the transient component and recombining it with the original speech. The intelligibility of the modified speech in background noise was compared to that of the original speech, using a psychoacoustic procedure based on the modified rhyme protocol. Word recognition rates for the modified speech were significantly higher at low signal-to-noise ratios (SNRs), with minimal effect on intelligibility at higher SNRs. These results suggest that amplification of transient information may improve the intelligibility of speech in noise and that this improvement is more effective in severe noise conditions.

80 Hz auditory steady-state responses (ASSR) at 250 Hz and 12,000 Hz.

Although measurement of the detection limits of the 80 Hz auditory steady-state response (ASSR) has proven to be a reasonably reliable tool in estimating hearing sensitivity in the mid-conventional audiometric frequencies (e.g. 1000 and 2000 Hz), results in the literature suggest potentially diminishing performance at 500 Hz and above 4000 Hz. The primary goal of this work was to examine the accuracy of threshold estimation via ASSR measurement for carriers more toward the audiometric extremes. At the same time, different stimulus and recording protocols than those commonly employed in ASSR testing were examined. Using a two-channel recording system, ASSRs were obtained from 15 normal-hearing young adults for an amplitude-modulated carrier of 250 Hz and repeated tone bursts of 10,000-16,000 Hz, gated using a Blackman window. Results attest to the ability to record ASSRs to a wide range of carrier frequencies but also suggest that accuracy of threshold estimation suffers toward the audiometric extremes. Feasibility of ASSR-based high-frequency audiometry is demonstrated in principle, but it is not clear that this method will permit adequate sensitivity and accuracy to support such applications as ototoxicity monitoring.

The impact of listening with directional microphone technology on self-perceived localization disabilities and handicaps.

The chief complaint of individuals with hearing impairment is difficulty hearing in noise, with directional microphones emerging as the most capable remediation. Our purpose was to determine the impact of directional microphones on localization disability and concurrent handicap. Fifty-seven individuals participated unaided and then in groups of 19, using omni-directional microphones, directional-microphones, or toggle-switch equipped amplification. The outcome measure was a localization disabilities and handicaps questionnaire. Comparisons between the unaided group versus the aided groups, and the directional-microphone groups versus the other two aided groups revealed no significant differences. None of the microphone schemes either increased or decreased self-perceived localization disability or handicap. Objective measures of localization ability are warranted and if significance is noted, clinicians should caution patients when moving in their environment. If no significant objective differences exist, in light of the subjective findings in this investigation concern over decreases in quality of life and safety with directional microphones need not be considered.

Reliability of electric response audiometry using 80 Hz auditory steady-state responses.

The reliability of the Auditory Steady State Response (ASSR) has not been thoroughly evaluated despite its recent application as a clinical tool for threshold estimation. The purpose of this study was to examine test-retest (TR) reliability of ASSR threshold estimates in an empirical research design. The ASSR, tested using modulation frequencies approximately 80 Hz and above, was evaluated against pure tone audiometry (PTA), and the slow vertex potential (SVP, N1-P2). Sixteen normal-hearing young female adults were tested twice, one week apart. Varying degrees of sensorineural hearing loss of a notched configuration were simulated with filtered masking noise. Test-retest reliability was assessed using Pearson-product moment correlation analysis, supplemented by other post-hoc analyses. Results demonstrated moderately strong TR reliability for ASSR at 1000, 2000 and 4000 Hz (r = 0.83-0.93); however, the reliability of ASSR at 500 Hz was weaker (r = 0.75). Results suggest that ASSR-ERA is a reliable test at mid-high frequencies, at least with the configuration and degrees of simulated sensorineural hearing loss examined in this study.

Effect of intracochlear perfusion of vanilloids on cochlear neural activity in the guinea pig.

Recent findings show that the vanilloid receptor subtype 1 (TRPV1) is expressed by cochlear outer hair cells and spiral ganglion cells, and that its expression is up-regulated in ganglion cells after aminoglycoside treatment. This study tested the hypothesis that agents that act on TRPV1 receptors affect the spectrum of ensemble background activity (EBA). Consecutive intracochlear perfusions of the TRPV1 agonist, capsaicin (CAP 0.1, 1, and 10 parts per million), as well as its antagonist capsazepine (CZP), were used to test effects of TRPV1 activation on EBA recorded from the cochlear base. Perfusion with CAP alone produced a dose-dependent increase of the 900-Hz peak ratio (power normalized re the overall spectrum) of the EBA. The CAP effect was attenuated during concurrent perfusion with CZP. These findings are consistent with the hypothesis that TRPV1 activation increases background activity of spiral ganglion cells and support a role of TRPV1 in gating spontaneous and evoked auditory nerve excitability.

Validity and accuracy of electric response audiometry using the auditory steady-state response: evaluation in an empirical design.

The validity and accuracy of the application of the auditory steady-state response (ASSR) to electric response audiometry (ERA) was tested further in a study permitting subjects to be their own controls for hearing loss. Simulated sensorineural hearing loss (SSHL) of complex configuration and varying degrees was effected using filtered masking noise. Thresholds estimated via ASSR-ERA were compared to those measured via conventional pure-tone audiometry. Further, the slow vertex potential N1-P2 was recorded to permit a comparison with an evoked-response test of common content validity and known accuracy. Results in a homogeneous subject sample demonstrated strong interest correlation and agreement within 10 dB at 1000 to 4000 Hz (on average), but not at 500 Hz. The configurations determined by ASSR-ERA followed behavioral audiometric patterns well, except for the mildest degree of SSHL tested. Consequently, limitations of ERA remain, although ASSR-ERA appears to be quite valid overall and promises (justifiably) broad clinical applicability.

Electrocochleography in the evaluation of patients with Ménière's disease/endolymphatic hydrops.

Electrocochleography (ECochG) has evolved as an important tool in the diagnosis/assessment/monitoring of Ménière's disease/endolymphatic hydrops (MD/ELH). This manuscript provides an update on the use of ECochG for these purposes. The material presented includes descriptions of the components of the electrocochleogram; ECochG recording approaches and parameters; how to prepare for an exam, including subject/patient considerations; construction and placement of a tympanic membrane recording electrode; and interpretation the electrocochleogram. Various approaches aimed at improving ECochG's sensitivity and specificity to MD/ELH also are described. These approaches go beyond simple measurement of the now-conventional summating potential (SP)/action potential (AP) magnitude ratio to include the SP magnitude to tonebursts, the SP/AP area ratio, and the AP latency difference to clicks of opposing polarity.