Assessing Sensorineural Hearing Loss Using Various Transient-Evoked Otoacoustic Emission Stimulus Conditions

Abstract

Objectives An important clinical application of transient-evoked otoacoustic emissions (TEOAEs) is to evaluate cochlear outer hair cell function for the purpose of detecting sensorineural hearing loss (SNHL). Double-evoked TEOAEs were measured using a chirp stimulus, in which the stimuli had an extended frequency range compared to clinical tests. The present study compared TEOAEs recorded using an unweighted stimulus presented either at ambient pressure or tympanometric peak pressure (TPP) in the ear canal, and TEOAEs recorded using a power-weighted stimulus at ambient pressure. The unweighted stimulus had approximately constant incident pressure magnitude across frequency, and the power-weighted stimulus had approximately constant absorbed sound power across frequency. The objective of this study was to compare TEOAEs from 0.79 to 8 kHz using these three stimulus conditions in adults to assess test performance in classifying ears as either having normal hearing or SNHL. Design Measurements were completed on 87 adult participants. Eligible participants had either normal hearing (N=40; M|F=16|24; Mean Age=30 y) or SNHL (N=47; M|F=20|27; Mean Age=58 y), and normal middle-ear function as defined by standard clinical criteria for 226-Hz tympanometry. Clinical audiometry, immittance, and an experimental wideband test battery, which included reflectance and TEOAE tests presented for one-minute durations, were completed for each ear on all participants. All tests were then repeated one to two months later. TEOAEs were measured by presenting the stimulus in the three stimulus conditions. TEOAE data were analyzed in each hearing group in terms of the half-octave averaged signal-to-noise ratio (SNR) and the coherence synchrony measure (CSM) at frequencies between 1 and 8 kHz. The test-retest reliability of these measures was calculated. The area under the receiver operating characteristic curve (AUC) was measured at audiometric frequencies between 1 and 8 kHz to determine TEOAE test performance in distinguishing SNHL from normal hearing. Results Mean TEOAE SNR was ≥8.7 dB for normal-hearing ears and ≤6 dB for SNHL ears for all three stimulus conditions across all frequencies. Mean test-retest reliability of TEOAE SNR was ≤4.3 dB for both hearing groups across all frequencies, although it was generally less (≤3.5 dB) for lower frequencies (1 to 4 kHz). AUCs were between 0.85 and 0.94 for all three TEOAE conditions at all frequencies, except for the ambient TEOAE condition at 2 kHz (0.82) and for all TEOAE conditions at 5.7 kHz with AUCs between 0.78 and 0.81. Power-weighted TEOAE AUCs were significantly higher (p<0.05) than ambient TEOAE AUCs at 2 and 2.8 kHz, as was the TPP TEOAE AUC at 2.8 kHz when using CSM as the classifier variable. Conclusions TEOAEs evaluated in an ambient condition, at TPP and in a power-weighted stimulus condition had good test performance in identifying ears with SNHL based on SNR and CSM in the frequency range from 1 to 8 kHz, and showed good test-retest reliability. Power-weighted TEOAEs...

Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

“…The TEOAE results in the Normal group were similar to normal ears tested in Putterman et al (2017), who used the same TEOAE measurement system as in the present study. The relative absence of TEOAEs in the Otosclerosis and Surgery groups replicated past studies, and extended this feature to higher frequencies (5.7-8 kHz).…”

“…The rationale for measuring TEOAEs with a chirp stimulus rather than a click stimulus is that, for the same total energy in the stimuli, the peSPL of the chirp is much lower than that of the click, for example, the peSPL of the chirp was 11.8 dB lower than that of the click in Keefe et al (2016). The chirp stimuli used in this study were identical to those used in Putterman et al (2017), for which the mean peSPL in normal adult ears was 76.4 dB. Because it is the peak levels that generate system distortion, the chirp stimulus is advantageous as it spreads out the energy in time, whereas a click stimulus concentrates the same energy in a brief time interval.…”

“…The signal to noise ratio (SNR; in dB) of the TEOAE spectrum was analyzed over the bandwidth from 0.7 to 8 kHz and octave-averaged at center frequencies from 1 to 8 kHz. The TEOAE test procedures using this measurement system are described with normative adult data in Keefe et al (2016), and the performance of these test procedures in classifying ears with normal hearing or a sensorineural hearing loss are described in Putterman et al (2017).…”

Pressurized transient otoacoustic emissions measured using click and chirp stimuli

“…In tandem with other studies (Putterman et al, 2017;Garinis et al, 2017) using the present measurements system, the present work extended pressurized measurements of TEOAEs in adult ears up to a stimulus frequency of 8 kHz, which allowed the study of pressurization effects at higher frequencies compared to previous studies (as reviewed in Sec. I, previous studies extended to 5 kHz).…”

“…Other studies have used the pressurized chirp TEOAE system described in the present work, although with less description of methodology. Putterman et al (2017) found that TEOAEs recorded at ambient and TPP conditions performed equally in classifying ears as having normal hearing or a sensorineural hearing loss. The inclusion criteria for their study was based on ages between 18 and 89 yrs, normal otoscopy, normal 226 Hz tympanometry including a TPP within 6100 daPa, and air-bone gaps of 10 dB or less between 0.5 and 4 kHz.…”