Normative Wideband Reflectance, Equivalent Admittance at the Tympanic Membrane, and Acoustic Stapedius Reflex Threshold in Adults

Feeney, M. Patrick; Keefe, Douglas H.; Hunter, Lisa L.; Fitzpatrick, Denis; Garinis, Angela C.; Putterman, Daniel; McMillan, Garnett P.

doi:10.1097/aud.0000000000000399

Cited by 78 publications

(68 citation statements)

References 45 publications

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“…Group results were obtained and analyzed in the multi-year study that included this ASRT test in combination with other tests for the clinical diagnosis and monitoring of middle-ear and cochlear function. These group results in adult ears with normal function are described in Feeney et al (2016). Group results obtained in infant ears with normal function and with hearing loss are described in Hunter et al (2016).…”

Section: Discussionmentioning

confidence: 99%

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Aural Acoustic Stapedius-Muscle Reflex Threshold Procedures to Test Human Infants and Adults

Keefe

Feeney

Hunter

et al. 2016

JARO

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Power-based procedures are described to measure acoustic stapedius-muscle reflex threshold and supra-threshold responses in human adult and infant ears at frequencies from 0.2 to 8 kHz. The stimulus set included five clicks in which four pulsed activators were placed between each pair of clicks, with each stimulus set separated from the next by 0.79 s to allow for reflex decay. Each click response was used to detect the presence of reflex effects across frequency that were elicited by a pulsed broadband-noise or tonal activator in the ipsilateral or contralateral test ear. Acoustic reflex shifts were quantified in terms of the difference in absorbed sound power between the initial baseline click and the later four clicks in each set. Acoustic reflex shifts were measured over a 40-dB range of pulsed activators, and the acoustic reflex threshold was objectively calculated using a maximum 10 likelihood procedure. To illustrate the principles underlying these new reflex tests, reflex shifts in absorbed sound power and absorbance are presented for data acquired in an adult ear with normal hearing and in two infant ears in the initial and follow-up newborn hearing screening exams, one with normal hearing and the other with a conductive hearing loss. The use of absorbed sound power was helpful in classifying an acoustic reflex shift as present or absent. The resulting reflex tests are in use in a large study of wideband clinical diagnosis and monitoring of middle-ear and cochlear function in infant and adult ears.

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Section: Discussionmentioning

confidence: 99%

“…Group results using this new ASR test are described in Hunter et al (2016) for infant ears and in Feeney et al (2016) for adult ears with normal function.…”

Section: Introductionmentioning

confidence: 99%

Aural Acoustic Stapedius-Muscle Reflex Threshold Procedures to Test Human Infants and Adults

Keefe

Feeney

Hunter

et al. 2016

JARO

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“…Normative measurements of reflectance and admittance in a group of adult subjects with normal hearing are described in (Feeney et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

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

Putterman

Keefe²,

Hunter

et al. 2017

Ear &Amp; Hearing

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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...

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“…While the spectra do become more stereotypical when using absorbed power changes or absorbance changes to quantify the MEMR , the low-frequency end shows considerable variability in spectral shape across subjects and is also noisier. Indeed, Feeney et al (2017) showed that wideband measurements allow for detection of an MEMR at lower elicitor levels compared to classic 226 Hz tone-based measurement, suggesting greater resistance to measurement noise and spectral profile variations. These observations suggest that wideband measurements should be preferred when using the MEMR as an assay of synaptopathy where the MEMR spectra can be summarized by averaging over a broader range of frequencies to reduce the effects of individual spectral-profile peculiarities.…”

Section: Immittance and Reflex Spectramentioning

confidence: 99%

Non-Invasive Assays of Cochlear Synaptopathy -- Candidates and Considerations

Bharadwaj¹,

Alexandra²,

Simpson³

et al. 2019

Preprint

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Studies in multiple species, including in post-mortem human tissue, have shown that normal aging and/or acoustic overexposure can lead to a significant loss of afferent synapses innervating the cochlea. Hypothetically, this cochlear synaptopathy can lead to perceptual deficits in challenging environments and can contribute to central neural effects such as tinnitus. However, because cochlear synaptopathy can occur without any measurable changes in audiometric thresholds, synaptopathy can remain hidden from standard clinical diagnostics. To understand the perceptual sequelae of synaptopathy and to evaluate the efficacy of emerging therapies, sensitive and specific non-invasive measures at the individual patient level need to be established. Pioneering experiments in specific mice strains have helped identify many candidate assays. These include auditory brainstem responses, the middle-ear muscle reflex, envelope-following responses, and extended high-frequency audiograms. Unfortunately, because these non-invasive measures can be also affected by extraneous factors other than synaptopathy, their application and interpretation in humans is not straightforward. Here, we systematically examine six extraneous factors through a series of interrelated human experiments aimed at understanding their effects. Using strategies that may help mitigate the effects of such extraneous factors, we then show that these suprathreshold physiological assays exhibit across-individual correlations with each other indicative of contributions from a common physiological source consistent with cochlear synaptopathy. Finally, we discuss the application of these assays to two key outstanding questions, and discuss some barriers that still remain.

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Normative Wideband Reflectance, Equivalent Admittance at the Tympanic Membrane, and Acoustic Stapedius Reflex Threshold in Adults

Cited by 78 publications

References 45 publications

Aural Acoustic Stapedius-Muscle Reflex Threshold Procedures to Test Human Infants and Adults

Aural Acoustic Stapedius-Muscle Reflex Threshold Procedures to Test Human Infants and Adults

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

Non-Invasive Assays of Cochlear Synaptopathy -- Candidates and Considerations

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