A new method of measuring distortion product otoacoustic emissions using multiple tone pairs: study of human adults.

OBJECTIVE: To increase the speed of a distortion product otoacoustic emissions (DPOE) test of cochlear function by employing a new multiple-tone-pair method and to validate the method. DESIGN: We used a new method of employing multiple tone pairs in measuring DPOEs proposed by Zurek and Rabinowitz and implemented in a modified Grason-Stadler Model GSI-60. We investigated the applicability of the multiple-pair method by comparing the 2f1-f2 DPOEs obtained with a 3-pair method with the conventional 1-pair results in human adults; f1 and f2 represent two frequencies of each tone pair, f1 < f2, f2/f1 = 1.2. We used two sets of 3-pair stimuli: 1) f2 at 1.5, 3, and 6 kHz; and 2) f2 at 2, 4, and 8 kHz. The 1-pair stimuli had f2 at each of the above six frequencies. The primary tone levels were L1 = 65 and L2 = 50 dB SPL re 20 microPa. RESULTS: We obtained DPOEs from 98 ears with normal hearing and 94 ears with sensorineural hearing loss in 103 human adults. We found: 1) that the DPOE levels obtained with the 3-pair method were strongly correlated with those of the 1-pair method, with correlation coefficients of 0.83 to 0.96; 2) that the mean DPOE level versus frequency functions for the normal ears were similar between the 3-pair and 1-pair methods; a 2-way analysis of variance indicated no significant difference between the two methods; 3) that the mean difference between DPOE levels obtained with the 3-pair and 1-pair methods was small (less than 1.3 dB in 11 of the 12 conditions examined, i.e., six frequencies each for normal ears and hearing-impaired ears) although the differences were significant in 6 of the 12 conditions as determined by the paired t-test; and 4) that the DPOE test performances of distinguishing normal from impaired ears were similar between the 3-pair and 1-pair tests; areas under the receiver operating characteristic curves were not significantly different between the two tests for four of the six frequencies tested as determined by a statistical procedure of Hanley and McNeil; for the remaining two frequencies where the differences were significant, each of the two tests was better than the other at one frequency. CONCLUSIONS: The 3-pair DPOE method yielded results generally in good agreement with those of the conventional 1-pair DPOE method. To our knowledge, this is the first systematic study of a multiple-pair DPOE method. Because a 3-pair method can be conducted approximately two to three times as fast as a 1-pair method, the former is advantageous, particularly for an auditory screening test.

Distortion product otoacoustic emission test of sensorineural hearing loss in humans: comparison of unequal- and equal-level stimuli.

Distortion product otoacoustic emissions (DPOEs) at the frequency of 2f1 -f2 (f1 < f2) were measured in 77 human adult ears with normal hearing or sensorineural hearing loss. The purpose of this study was to compare the performances of DPOE tests conducted with two sets of stimuli: 1) L1 = 65, L2 = 50 dB sound pressure level (SPL) re 20 microPa ("65/50"), and 2) L1 = L2 = 65 dB SPL ("65/65"). Half-octave DPOE root-mean-square levels at 1,000, 2,000, 4,000, and 6,000 Hz were computed from the initial DPOEs measured at 0.25-octave intervals. Correlation coefficient and decision-theory analyses were applied to evaluate the DPOE test performance. For both stimuli, DPOE level exhibited significant correlation with pure tone hearing threshold. When the criterion DPOE level distinguishing normal from impaired hearing was adjusted, the curves of sensitivity and specificity crossed, and the values at the crossing were higher than 80% at frequencies of 2,000 to 6,000 Hz for both stimuli. The area under the receiver operating characteristic (ROC) curve, which provides an overall evaluation of the test performance independent of the criterion DPOE level, was .90 or higher at 2,000 to 6,000 Hz for both stimuli. At 2,000 and 4,000 Hz, all measures of test performance were higher for the 65/50 stimulus than the 65/65 stimulus: area under the ROC curve (.96 to .97 versus .90 to .91, statistically significant, p < .001, Wilcoxon test), sensitivity/specificity (90% to 93% versus 80% to 85%), and correlation coefficient (.78 to .87 versus .66 to .79). At 1,000 and 6,000 Hz, the performances of the DPOE tests were similar for the two stimuli. These results support the conclusion that a DPOE test with L1 = 65 and L2 = 50 dB SPL provides a better performance than that with L1 = L2 = 65 dB SPL and recommend the use of stimuli with L1 being higher than L2 by about 15 dB. These results also support a growing view that 2f1-f2 DPOEs can be utilized clinically as a reliable method of testing human sensorineural hearing loss.

Distortion product otoacoustic emission test of sensorineural hearing loss: performance regarding sensitivity, specificity and receiver operating characteristics.

The performance of distortion product otoacoustic emissions (DPOEs) as a frequency-specific test of sensorineural hearing loss was evaluated in 142 ears of human adults with normal middle-ear function. The DPOE was measured with the stimulus levels of the two tones equal to 65 dB SPL (re 20 mu Pa) and the ratio between the two frequencies 1.2. In the DPOE test, the cochlear function of an ear at a test frequency was predicted to be normal or abnormal depending upon whether the DPOE level with the geometric mean of the two stimulus frequencies at the test frequency was greater or less than a criterion. The DPOE test outcomes were evaluated against the pure-tone hearing threshold as the standard. We found the sensitivity, specificity and predictive efficiency of the test to be 85-89% at 6000 and 4000 Hz, 82-83% at 2000 Hz and 78-79% at 1000 Hz, respectively. The performance was also evaluated using decision theory in terms of the area under the receiver operating characteristics. The latter was found to range from 0.90 (for 1000 Hz) to 0.94 (for 6000 Hz). These findings support the conclusion that the DPOEs can form a useful frequency-specific objective test of cochlear function.

Distortion-product and click-evoked otoacoustic emissions of preterm and full-term infants.

Full-term and preterm infants were evaluated with click-evoked and distortion-product otoacoustic emissions (CEOEs and DPOEs). The CEOEs and DPOEs recorded from each individual ear were analyzed by calculating the root-mean-square levels within half-octave bands. The fail criterion of the OE tests was that the half-octave RMS DPOE or CEOE levels of an ear under test were below the 10th percentile of full-term newborns in two or more bands. The DPOE data were collected from 118 ears of 61 premature babies; 80 (68%) ears passed the DPOE test, 30 (25%) ears without middle ear effusions failed the test, and 8 (7%) ears with effusions also failed. The CEOE data were collected from 128 ears of 65 premature babies; 102 (80%) ears passed the CEOE test, 18 (14%) ears without middle ear effusions failed the test, and 8 (6%) ears with effusions also failed. In 23 of 80 ears (29%) that passed the DPOE test and in 23 of 102 ears (23%) that passed the CEOE test, RMS OE levels of preterm infants were above the 90th percentile of full-term newborns. The analyses of the combined DPOE and CEOE data obtained from a group of 25 ears of full-term newborns and from a group of 72 ears of preterm babies showed statistically significant correlations between the DPOE and CEOE root-mean-square levels in each of the half-octave bands in the 1.4 to 4 kHz region. For 42 preterm infants tested with auditory brain stem response (ABR), specificity was 86% for CEOE and 74% for DPOE. All infants who failed the ABR also failed OE tests. To the best of our knowledge, this study is the first using combined DPOEs, CEOEs, and ABRs for preterm babies. It showed the feasibility of DPOEs and CEOEs for this population.

Distortion-product and click-evoked otoacoustic emissions in healthy newborns.

Distortion-product otoacoustic emissions (DPOEs) are believed to provide frequency-specific information about cochlear function. The DPOEs have been reported in the adult population but have not been reported previously in the neonatal population. We recorded DPOEs from a group of healthy full-term newborn human subjects (35 ears) to establish the characteristics of these emissions in the newborn population. To our knowledge, this is the first study of DPOEs in newborns. The "DPOE audiograms" from the newborns tested revealed characteristics qualitatively similar to those seen in adults with normal hearing. This study demonstrates the feasibility of DPOE measurements among newborns and provides a normal baseline for this age group, thus fulfilling a necessary step toward the development of an objective, noninvasive frequency-specific test of cochlear function. Click-evoked otoacoustic emissions were also recorded from the newborn population and compared with click-evoked otoacoustic emissions from adults. The spectrum of the click-evoked emissions was variable and individualistic, similar to findings previously reported in adult subjects. The click-evoked otoacoustic emissions of the newborns had a higher overall level and contained stronger high-frequency (4.5 to 6 kHz) spectral components than those of the adults. We also found that the low-frequency components of the click stimulus spectrum were attenuated in the neonatal ears exhibiting a high-pass slope below about 2.5 kHz, whereas the stimulus spectrum was nearly flat in this frequency region in adult ears.

Otoacoustic emissions in normal and hearing-impaired children and normal adults.

Although distortion-product otoacoustic emissions (DPOEs) have been studied in adults recently, there is little information regarding them in young children. DPOEs and click-evoked otoacoustic emissions (CEOEs) were measured from a same group of normal and hearing-impaired children (age 4 through 10 years) and normal adults (age 22 through 29 years). Measurements of DPOEs in 13 children's ears with normal hearing showed higher levels of emissions in the 700- to 1400-Hz and 5.7-kHz regions relative to the data obtained in 10 normal adult ears. The 22 ears of children with sensorineural hearing loss demonstrated agreement between pure-tone audiograms and "DPOE audiograms." Measurements of CEOEs revealed that the average level of emission in 15 normal-hearing children's ears was slightly lower than that previously obtained in newborns, but slightly higher than that of adults. In children, the CEOE spectral components in the 4- to 6-kHz region were lower than in newborns, but higher than in adults. These results support the view that the DPOEs and CEOEs comprise a valuable tool in assessment of cochlear function in subjects of all ages.

Distortion product otoacoustic emissions in normal and impaired adult ears.

Distortion product otoacoustic emissions (DPOEs) were recorded in a group of normally hearing subjects (29 ears) and a group of subjects whose conditions were diagnosed as sensorineural hearing loss (23 ears) to study any correlation that might exist between DPOE characteristics and hearing impairment of different configurations. Three different DPOE paradigms have been used to investigate the influence of different test parameters on the DPOE data for normal and hearing-impaired ears. All normally hearing ears demonstrated detectable DPOEs, provided that the primary tone level was above a certain value. Hearing-impaired ears produced substantially reduced DPOEs compared with normally hearing subjects when the primary frequencies f1 and f2 corresponded to the region of hearing loss. Our data also suggested that, in general, more than one f2/f1 ratio is needed to examine any particular frequency region. The DPOEs provide frequency-specific information about cochlear function, which after further development, may form a basis for a noninvasive, objective method of evaluating cochlear function.