A Clinically Viable Medial Olivocochlear Reflex Assay Using Transient-Evoked Otoacoustic Emissions.

OBJECTIVES: The contralateral medial olivocochlear reflex (MOCR) strength may indicate various auditory conditions in humans, but a clinically viable assay and equipment are needed for quick, accurate, and reliable measurements. The first experiment compared an earlier version of the assay, which used a nonlinear-mode chirp stimulus, with a new assay using a linear-mode click stimulus, designed to give reliable MOCR measurements in most normal-hearing ears. The second experiment extended the improved assay on a purpose-built binaural hardware platform that used forward-pressure level (FPL) calibration for both the stimulus and the contralateral MOCR elicitor. DESIGN: Transient-evoked otoacoustic emission (TEOAE) tests were measured with and without a 60-dB SPL MOCR-evoking contralateral broadband noise. The normalized MOCR strength (MOCR%) was derived from the TEOAE responses for each trial pair using the complex pressure difference weighted by the TEOAE magnitude. Experiment 1 compared MOCR% within-subject and across-day using two TEOAE stimuli: nonlinear-mode chirps (50 dB SPL, bandpass 1-5 kHz, 14 ms window delayed by 2 ms) and linear-mode clicks (50 dB SPL, bandpass 0.5-2.5 kHz, 13 ms window delayed by 5 ms). TEOAE responses were analyzed in the 0.5 to 2.5 kHz band. Thirty adult participants with normal hearing (30 ears) completed the study. The TEOAE stimulus was calibrated in situ using spectral flattening, and the contralateral noise was calibrated in a coupler. Twelve TEOAE trial pairs were collected for each participant and condition. Experiment 2 used a purpose-built binaural system. The TEOAE stimuli were linear-mode clicks (50 dB SPL, bandpass 1-3 kHz, 13 ms window delayed by 5 ms), analyzed in the 1 to 3 kHz band over ~12 trial pairs. After a probe refit, an additional trial pair was collected for the two early-stopping signal-to-noise ratio criteria (15 and 20 dB). They were evaluated for single-trial reliability and test time. Nineteen adult participants with normal hearing (38 ears) completed the study. The TEOAE clicks and contralateral elicitor noise were calibrated in situ using FPL and delivered with automated timing. RESULTS: MOCR% for linear-mode clicks was distinguishable from measurement variability in 98% to 100% of participants' ears (both experiments), compared with only 73% for the nonlinear-mode chirp (experiment 1). MOCR detectability was assessed using the MOCR% across-subject/within-subject variance ratio. The ratio in experiment 1 for linear-mode clicks was higher (8.0) than for nonlinear-mode chirps (6.4). The ratio for linear-mode clicks (8.9) in experiment 2 was slightly higher than for the comparable linear-mode stimulus (8.0) in experiment 1. TEOAEs showed excellent reliability with high signal-to-noise ratios in both experiments, but reliability was higher for linear-mode clicks than nonlinear-mode chirps. MOCR reliability for the two stimuli was comparable. The FPL pressure response retest reliability derived from the SPL at the microphone was higher than the SPL retest reliability across 0.4 to 8 kHz. Stable results required 2 to 3 trial pairs for the linear-mode click (experiments 1 and 2) and three for the nonlinear-mode chirp (experiment 1), taking around 2 min on average. CONCLUSIONS: The linear-mode click assay produced measurable, reliable, and stable TEOAE and MOCR results on both hardware platforms in around 2 min per ear. The stimulus design and response window ensured that any stimulus artifact in linear mode was unlikely to confound the results. The refined assay is ready to produce high-quality data quickly for clinical and field studies to develop population norms, recognize diagnostic patterns, and determine risk profiles.

Acquisition of 500 English Words through a TActile Phonemic Sleeve (TAPS).

Recently, a phonemic-based tactile speech communication system was developed with the goal to transmit speech through the skin for people with hearing impairments and those whose auditory and visual channels are overloaded or compromised. The display, called the TActile Phonemic Sleeve (TAPS), consisted of a 4-by-6 tactor array worn on the dorsal and volar surfaces of the forearm. Earlier work showed that people were able to learn the haptic symbols for 39 English phonemes and reach a mean phoneme recognition rate of 86% correct within one to four hours of training. The current research evaluated the acquisition of up to 500 words using TAPS. A total of 51 participants were trained and tested in three studies with increasing number of phonemes and vocabulary sizes. Individual achievements varied, but the results clearly demonstrate the potential of transmitting any English word using TAPS within a reasonable period of learning. Future work will include increasing the speech transmission rate with TAPS by improving the phonemic codes and reducing the inter-phoneme intervals, addressing the reception of words and sentences composed of strings of tactile phonemes, and assessing the performance of TAPS as a speech communication system for people with severe hearing impairments.

A Phonemic-Based Tactile Display for Speech Communication.

Despite a long history of research, the development of synthetic tactual aids to support the communication of speech has proven to be a difficult task. The current paper describes a new tactile speech device based on the presentation of phonemic-based tactile codes. The device consists of 24 tactors under independent control for stimulation at the forearm. Using properties that include frequency and waveform of stimulation, amplitude, spatial location, and movement characteristics, unique tactile codes were designed for 39 consonant and vowel phonemes of the English language. The strategy for mapping the phonemes to tactile symbols is described, and properties of the individual phonemic codes are provided. Results are reported for an exploratory study of the ability of 10 young adults to identify the tactile symbols. The participants were trained to identify sets of consonants and vowels, before being tested on the full set of 39 tactile codes. The results indicate a mean recognition rate of 86 percent correct within one to four hours of training across participants. Thus, these results support the viability of a phonemic-based approach for conveying speech information through the tactile sense.

Pure-Tone Audiometry With Forward Pressure Level Calibration Leads to Clinically-Relevant Improvements in Test-Retest Reliability.

OBJECTIVES: Clinical pure-tone audiometry is conducted using stimuli delivered through supra-aural headphones or insert earphones. The stimuli are calibrated in an acoustic (average ear) coupler. Deviations in individual-ear acoustics from the coupler acoustics affect test validity, and variations in probe insertion and headphone placement affect both test validity and test-retest reliability. Using an insert earphone designed for otoacoustic emission testing, which contains a microphone and loudspeaker, an individualized in-the-ear calibration can be calculated from the ear-canal sound pressure measured at the microphone. However, the total sound pressure level (SPL) measured at the microphone may be affected by standing-wave nulls at higher frequencies, producing errors in stimulus level of up to 20 dB. An alternative is to calibrate using the forward pressure level (FPL) component, which is derived from the total SPL using a wideband acoustic immittance measurement, and represents the pressure wave incident on the eardrum. The objective of this study is to establish test-retest reliability for FPL calibration of pure-tone audiometry stimuli, compared with in-the-ear and coupler sound pressure calibrations. DESIGN: The authors compared standard audiometry using a modern clinical audiometer with TDH-39P supra-aural headphones calibrated in a coupler to a prototype audiometer with an ER10C earphone calibrated three ways: (1) in-the-ear using the total SPL at the microphone, (2) in-the-ear using the FPL at the microphone, and (3) in a coupler (all three are derived from the same measurement). The test procedure was similar to that commonly used in hearing-conservation programs, using pulsed-tone test frequencies at 0.5, 1, 2, 3, 4, 6, and 8 kHz, and an automated modified Hughson-Westlake audiometric procedure. Fifteen adult human participants with normal to mildly-impaired hearing were selected, and one ear from each was tested. Participants completed 10 audiograms on each system, with test-order randomly varied and with headphones and earphones refitted by the tester between tests. RESULTS: Fourteen of 15 ears had standing-wave nulls present between 4 and 8 kHz. The mean intrasubject SD at 6 and 8 kHz was lowest for the FPL calibration, and was comparable with the low-frequency reliability across calibration methods. This decrease in variability translates to statistically-derived significant threshold shift criteria indicating that 15 dB shifts in hearing can be reliably detected at 6 and 8 kHz using FPL-calibrated ER10C earphones, compared with 20 to 25 dB shifts using standard TDH-39P headphones with a coupler calibration. CONCLUSIONS: These results indicate that reliability is better with insert earphones, especially with in-the-ear FPL calibration, compared with a standard clinical audiometer with supra-aural headphones. However, in-the-ear SPL calibration should not be used due to its sensitivity to standing waves. The improvement in reliability is clinically meaningful, potentially allowing hearing-conservation programs to more confidently determine significant threshold shifts at 6 kHz-a key frequency for the early detection of noise-induced hearing loss.

Masking release for hearing-impaired listeners: The effect of increased audibility through reduction of amplitude variability.

The masking release (i.e., better speech recognition in fluctuating compared to continuous noise backgrounds) observed for normal-hearing (NH) listeners is generally reduced or absent in hearing-impaired (HI) listeners. One explanation for this lies in the effects of reduced audibility: elevated thresholds may prevent HI listeners from taking advantage of signals available to NH listeners during the dips of temporally fluctuating noise where the interference is relatively weak. This hypothesis was addressed through the development of a signal-processing technique designed to increase the audibility of speech during dips in interrupted noise. This technique acts to (i) compare short-term and long-term estimates of energy, (ii) increase the level of short-term segments whose energy is below the average energy, and (iii) normalize the overall energy of the processed signal to be equivalent to that of the original long-term estimate. Evaluations of this energy-equalizing (EEQ) technique included consonant identification and sentence reception in backgrounds of continuous and regularly interrupted noise. For HI listeners, performance was generally similar for processed and unprocessed signals in continuous noise; however, superior performance for EEQ processing was observed in certain regularly interrupted noise backgrounds.

Level variations in speech: Effect on masking release in hearing-impaired listeners.

Acoustic speech is marked by time-varying changes in the amplitude envelope that may pose difficulties for hearing-impaired listeners. Removal of these variations (e.g., by the Hilbert transform) could improve speech reception for such listeners, particularly in fluctuating interference. Léger, Reed, Desloge, Swaminathan, and Braida [(2015b). J. Acoust. Soc. Am. 138, 389-403] observed that a normalized measure of masking release obtained for hearing-impaired listeners using speech processed to preserve temporal fine-structure (TFS) cues was larger than that for unprocessed or envelope-based speech. This study measured masking release for two other speech signals in which level variations were minimal: peak clipping and TFS processing of an envelope signal. Consonant identification was measured for hearing-impaired listeners in backgrounds of continuous and fluctuating speech-shaped noise. The normalized masking release obtained using speech with normal variations in overall level was substantially less than that observed using speech processed to achieve highly restricted level variations. These results suggest that the performance of hearing-impaired listeners in fluctuating noise may be improved by signal processing that leads to a decrease in stimulus level variations.

Otoacoustic-emission-based medial-olivocochlear reflex assays for humans.

Otoacoustic emission (OAE) tests of the medial-olivocochlear reflex (MOCR) in humans were assessed for viability as clinical assays. Two reflection-source OAEs [TEOAEs: transient-evoked otoacoustic emissions evoked by a 47 dB sound pressure level (SPL) chirp; and discrete-tone SFOAEs: stimulus-frequency otoacoustic emissions evoked by 40 dB SPL tones, and assessed with a 60 dB SPL suppressor] were compared in 27 normal-hearing adults. The MOCR elicitor was a 60 dB SPL contralateral broadband noise. An estimate of MOCR strength, MOCR%, was defined as the vector difference between OAEs measured with and without the elicitor, normalized by OAE magnitude (without elicitor). An MOCR was reliably detected in most ears. Within subjects, MOCR strength was correlated across frequency bands and across OAE type. The ratio of across-subject variability to within-subject variability ranged from 2 to 15, with wideband TEOAEs and averaged SFOAEs giving the highest ratios. MOCR strength in individual ears was reliably classified into low, normal, and high groups. SFOAEs using 1.5 to 2 kHz tones and TEOAEs in the 0.5 to 2.5 kHz band gave the best statistical results. TEOAEs had more clinical advantages. Both assays could be made faster for clinical applications, such as screening for individual susceptibility to acoustic trauma in a hearing-conservation program.

Auditory and tactile gap discrimination by observers with normal and impaired hearing.

Temporal processing ability for the senses of hearing and touch was examined through the measurement of gap-duration discrimination thresholds (GDDTs) employing the same low-frequency sinusoidal stimuli in both modalities. GDDTs were measured in three groups of observers (normal-hearing, hearing-impaired, and normal-hearing with simulated hearing loss) covering an age range of 21-69 yr. GDDTs for a baseline gap of 6 ms were measured for four different combinations of 100-ms leading and trailing markers (250-250, 250-400, 400-250, and 400-400 Hz). Auditory measurements were obtained for monaural presentation over headphones and tactile measurements were obtained using sinusoidal vibrations presented to the left middle finger. The auditory GDDTs of the hearing-impaired listeners, which were larger than those of the normal-hearing observers, were well-reproduced in the listeners with simulated loss. The magnitude of the GDDT was generally independent of modality and showed effects of age in both modalities. The use of different-frequency compared to same-frequency markers led to a greater deterioration in auditory GDDTs compared to tactile GDDTs and may reflect differences in bandwidth properties between the two sensory systems.

Auditory-filter characteristics for listeners with real and simulated hearing impairment.

Functional simulation of sensorineural hearing impairment is an important research tool that can elucidate the nature of hearing impairments and suggest or eliminate compensatory signal-processing schemes. The objective of the current study was to evaluate the capability of an audibility-based functional simulation of hearing loss to reproduce the auditory-filter characteristics of listeners with sensorineural hearing loss. The hearing-loss simulation used either threshold-elevating noise alone or a combination of threshold-elevating noise and multiband expansion to reproduce the audibility-based characteristics of the loss (including detection thresholds, dynamic range, and loudness recruitment). The hearing losses of 10 listeners with bilateral, mild-to-severe hearing loss were simulated in 10 corresponding groups of 3 age-matched normal-hearing listeners. Frequency selectivity was measured using a notched-noise masking paradigm at five probe frequencies in the range of 250 to 4000 Hz with a fixed probe level of either 70 dB SPL or 8 dB SL (whichever was greater) and probe duration of 200 ms. The hearing-loss simulation reproduced the absolute thresholds of individual hearing-impaired listeners with an average root-mean-squared (RMS) difference of 2.2 dB and the notched-noise masked thresholds with an RMS difference of 5.6 dB. A rounded-exponential model of the notched-noise data was used to estimate equivalent rectangular bandwidths and slopes of the auditory filters. For some subjects and probe frequencies, the simulations were accurate in reproducing the auditory-filter characteristics of the hearing-impaired listeners. In other cases, however, the simulations underestimated the magnitude of the auditory bandwidths for the hearing-impaired listeners, which suggests the possibility of suprathreshold deficits.

Temporal masking functions for listeners with real and simulated hearing loss.

A functional simulation of hearing loss was evaluated in its ability to reproduce the temporal masking functions for eight listeners with mild to severe sensorineural hearing loss. Each audiometric loss was simulated in a group of age-matched normal-hearing listeners through a combination of spectrally-shaped masking noise and multi-band expansion. Temporal-masking functions were obtained in both groups of listeners using a forward-masking paradigm in which the level of a 110-ms masker required to just mask a 10-ms fixed-level probe (5-10 dB SL) was measured as a function of the time delay between the masker offset and probe onset. At each of four probe frequencies (500, 1000, 2000, and 4000 Hz), temporal-masking functions were obtained using maskers that were 0.55, 1.0, and 1.15 times the probe frequency. The slopes and y-intercepts of the masking functions were not significantly different for listeners with real and simulated hearing loss. The y-intercepts were positively correlated with level of hearing loss while the slopes were negatively correlated. The ratio of the slopes obtained with the low-frequency maskers relative to the on-frequency maskers was similar for both groups of listeners and indicated a smaller compressive effect than that observed in normal-hearing listeners.

Temporal modulation transfer functions for listeners with real and simulated hearing loss.

A functional simulation of hearing loss was evaluated in its ability to reproduce the temporal modulation transfer functions (TMTFs) for nine listeners with mild to profound sensorineural hearing loss. Each hearing loss was simulated in a group of three age-matched normal-hearing listeners through spectrally shaped masking noise or a combination of masking noise and multiband expansion. TMTFs were measured for both groups of listeners using a broadband noise carrier as a function of modulation rate in the range 2 to 1024 Hz. The TMTFs were fit with a lowpass filter function that provided estimates of overall modulation-depth sensitivity and modulation cutoff frequency. Although the simulations were capable of accurately reproducing the threshold elevations of the hearing-impaired listeners, they were not successful in reproducing the TMTFs. On average, the simulations resulted in lower sensitivity and higher cutoff frequency than were observed in the TMTFs of the hearing-impaired listeners. Discrepancies in performance between listeners with real and simulated hearing loss are possibly related to inaccuracies in the simulation of recruitment.

Speech reception by listeners with real and simulated hearing impairment: effects of continuous and interrupted noise.

The effects of audibility and age on masking for sentences in continuous and interrupted noise were examined in listeners with real and simulated hearing loss. The absolute thresholds of each of ten listeners with sensorineural hearing loss were simulated in normal-hearing listeners through a combination of spectrally-shaped threshold noise and multi-band expansion for octave bands with center frequencies from 0.25-8 kHz. Each individual hearing loss was simulated in two groups of three normal-hearing listeners (an age-matched and a non-age-matched group). The speech-to-noise ratio (S/N) for 50%-correct identification of hearing in noise test (HINT) sentences was measured in backgrounds of continuous and temporally-modulated (10 Hz square-wave) noise at two overall levels for unprocessed speech and for speech that was amplified with the NAL-RP prescription. The S/N in both continuous and interrupted noise of the hearing-impaired listeners was relatively well-simulated in both groups of normal-hearing listeners. Thus, release from masking (the difference in S/N obtained in continuous versus interrupted noise) appears to be determined primarily by audibility. Minimal age effects were observed in this small sample. Observed values of masking release were compared to predictions derived from intelligibility curves generated using the extended speech intelligibility index (ESII) [Rhebergen et al. (2006). J. Acoust. Soc. Am. 120, 3988-3997].

Microglia-associated granule cell death in the normal adult dentate gyrus.

Microglial cells are constantly monitoring the central nervous system for sick or dying cells and pathogens. Previous studies showed that the microglial cells in the dentate gyrus have a heterogeneous morphology with multipolar cells in the hilus and fusiform cells apposed to the granule cell layer both at the hilar and at the molecular layer borders. Although previous studies showed that the microglia in the dentate gyrus were not activated, the data in the present study show dying granule cells apposed by Iba1-immunolabeled microglial cell bodies and their processes both at hilar and at molecular layer borders of the granule cell layer. Initially, these Iba1-labeled microglial cells surround individual, intact granule cell bodies. When small openings in the plasma membrane of granule cells are observed, microglial cells are apposed to these openings. When larger openings in the plasma membrane occur at this site of apposition, the granule cells display watery perikaryal cytoplasm, watery nucleoplasm and damaged organelles. Such morphological features are characteristic of neuronal edema. The data also show that following this localized disintegration of the granule cell's plasma membrane, the Iba1-labeled microglial cell body is found within the electron-lucent perikaryal cytoplasm of the granule cell, where it is adjacent to the granule cell's nucleus which is deformed. We propose that granule cells are dying by a novel microglia-associated mechanism that involves lysis of their plasma membranes followed by neuronal edema and nuclear phagocytosis. Based on the morphological evidence, this type of cell death differs from either apoptosis or necrosis.

Morphological and ultrastructural features of Iba1-immunolabeled microglial cells in the hippocampal dentate gyrus.

Microglia are found throughout the central nervous system, respond rapidly to pathology and are involved in several components of the neuroinflammatory response. Iba1 is a marker for microglial cells and previous immunocytochemical studies have utilized this and other microglial-specific antibodies to demonstrate the morphological features of microglial cells at the light microscopic level. However, there is a paucity of studies that have used microglial-specific antibodies to describe the ultrastructural features of microglial cells and their processes. The goal of the present study is to use Iba1 immuno-electron microscopy to elucidate the fine structural features of microglial cells and their processes in the hilar region of the dentate gyrus of adult Sprague-Dawley rats. Iba1-labeled cell bodies were observed adjacent to neurons and capillaries, as well as dispersed in the neuropil. The nuclei of these cells had dense heterochromatin next to the nuclear envelope and lighter chromatin in their center. Iba1-immunolabeling was found within the thin shell of perikaryal cytoplasm that contained the usual organelles, including mitochondria, cisternae of endoplasmic reticulum and Golgi complexes. Iba1-labeled cell bodies also commonly displayed an inclusion body. Iba1-labeled cell bodies gave rise to processes that often had a small side branch arise within 5 mum of the microglial cell body. These data showing "resting" Iba-1 labeled microglial cells in the normal adult rat dentate gyrus provide a basis for comparison with the morphology of microglial cells in disease and injury models where they are activated or phagocytotic.