Distortion Product Otoacoustic Emission Levels and Input/Output-Growth Functions in Normal-Hearing Individuals with Tinnitus and/or Hyperacusis

ABSTRACT

The purpose of this study was to determine whether distortion product otoacoustic emissions (DPOAEs) can be used to distinguish among four groups with audiometrically normal-hearing sensitivity: (1) control adults without tinnitus or hyperacusis, (2) patients with tinnitus alone, (3) patients with hyperacusis alone, and (4) patients with both tinnitus and hyperacusis. Two types of DPOAE measures were evaluated: (1) the distortion product- (DP-) gram measured with fixed primary levels as a function of frequency, and (2) DPOAE input/output (I/O) functions for a range of primary levels between 45 and 70 dB sound pressure level (SPL) at 1000, 2000, and 4000 Hz. DP-grams did not clearly distinguish between the control and patient groups. There was, however, a consistent trend for the three patient groups to have decreased average DP levels at 4000 and 6000 Hz; this notch in the DP-gram was not observed in the response configuration for the control group. In the three patient groups, 51 to 74% of these individuals had DP levels that were outside of the 95% confidence range for the control group. The average slopes of the I/O growth functions for each of the patient groups were consistently steeper than those for the control group; however, the slope values were indistinguishable among the patient groups. About 60% of the patients' DPOAE responses (in each group) were categorized as abnormal based on their slope values. Thus, DPOAE measures can be used with at least partial success to distinguish controls from patients with tinnitus, hyperacusis, or both tinnitus and hyperacusis, but not to discriminate among the respective patient groups. These findings suggest that the pathology represented among the patient groups is consistent at the level of the cochlea; however, diagnostic tests targeted at higher centers of processing are needed if the individuals in these groups are to be distinguished among themselves.

Tinnitus - hyperacusis - distortion product otoacoustic emissions - DPOAE

REFERENCES

• 1 Gorga M P, Neely S T, Bergman B et al.. Otoacoustic emissions from normal-hearing and hearing-impaired subjects: distortion product responses.  J Acoust Soc Am. 1993;  93 2050-2060
• 2 Lonsbury-Martin B L, Martin G K. The clinical utility of distortion-product otoacoustic emissions.  Ear Hear. 1990;  11 144-154
• 3 Lonsbury-Martin B L, Martin G K. Otoacoustic emissions and tinnitus. In: Snow JB Jr Tinnitus: Theory and Management. London, UK; BC Decker 2004: 69-78
• 4 Brownell W E. Outer hair cell electromotility and otoacoustic emissions.  Ear Hear. 1990;  11 82-92
• 5 Dorn P A, Konrad-Martin D, Neely S T, Keefe D, Cyr E, Gorga M P. Distortion product otoacoustic emission input/output functions in normal-hearing and hearing-impaired human ears.  J Acoust Soc Am. 2001;  110 3119-3131
• 6 Gorga M P, Neely S T, Ohlrich B, Hoover B, Redner J, Peters J. From laboratory to clinic: a large-scale study of distortion product otoacoustic emissions in ears with normal hearing and ears with hearing loss.  Ear Hear. 1997;  18 440-455
• 7 Lonsbury-Martin B L, McCoy M J, Whitehead M L, Martin K M. Clinical testing of distortion-product otoacoustic emissions.  Ear Hear. 1993;  14 11-22
• 8 Dorn P A, Piskorski P, Gorga M P, Neely S T, Keefe D H. Predicting audiometric status from distortion product otoacoustic emissions using multivariate analyses.  Ear Hear. 1999;  20 149-163
• 9 Bartnik G, Fabijanska A, Raj-Koziak D, Borawska B, Rogowski M, Skarzynski H. The correlation between the pitch of tinnitus and DP-gram and audiogram.  Audiofonologia (Polish). 2001;  XX 133-141
• 10 Bartnik G, Rogowski M, Fabijańska A, Raj-Koziak D, Borawska B. DPOAE assessment of cochlear function in tinnitus patients with normal hearing. In: Patuzzi R Proceedings of VIIth International Tinnitus Seminar. Crawley, Australia; University of Western Australia 2002: 45-47
• 11 Clark W W, Kim D O, Zurek P M, Bohne B A. Spontaneous otoacoustic emissions in chinchilla ear canals: correlation with histopathology and suppression by external tones.  Hear Res. 1984;  16 299-314
• 12 Hazell J W. Models of tinnitus: generation, perception, clinical implications. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 57-69
• 13 Jastreboff P J. Phantom auditory perception (tinnitus): mechanisms of generation and perception.  Neurosci Res. 1990;  8 221-254
• 14 Tonndorf J. The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 237-255
• 15 Zenner H P, Ernst A. Cochlear motor tinnitus, transduction tinnitus, and signal transfer tinnitus: three models of cochlear tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 237-255
• 16 Janssen T, Kummer P, Arnold W. Growth behavior of the 2f1-f2 distortion product otoacoustic emission in tinnitus.  J Acoust Soc Am. 1998;  103 3418-3430
• 17 Stypulkowski P H. Physiological Mechanisms of Salicylate Ototoxicity. Storrs, CT; University of Connecticut 1989: 1-176
• 18 Risey J A, Guth P S, Amedee R G. Furosemide distinguished central and peripheral tinnitus.  Int Tinnitus J. 1995;  1 99-103
• 19 Tyler R S. Comment on animal models of tinnitus. In: Evered D, Lawrenson G Tinnitus. London, UK; Pitman Books 1981: 136-137
• 20 Jastreboff P J. Tinnitus as a phantom perception. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 73-93
• 21 Meikle M B. The interaction of central and peripheral mechanisms in tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 181-206
• 22 Møller A R. Pathophysiology of tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 207-217
• 23 Brummet R E. A mechanism for tinnitus?. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 7-10
• 24 Mühlau M, Rauschecker J P, Oestreicher E et al.. Structural brain changes in tinnitus.  Cereb Cortex. 2006;  16 1283-1288
• 25 Hazell J W, Sheldrake J B. Hyperacusis and tinnitus. In: Aran JM, Dauman R Proceedings of the IVth International Tinnitus Seminar. Amsterdam, The Netherlands; Kugler 1992: 245-248
• 26 Formby C, Gold S L. Modification of loudness discomfort level: evidence for adaptive chronic auditory gain and its clinical relevance.  Semin Hear. 2002;  23 21-34
• 27 Marriage J, Barnes N M. Is central hyperacusis a symptom of 5-hydroxytryptamine (5-HT) dysfunction?.  J Laryngol Otol. 1995;  109 915-921
• 28 Hesse G, Masri S, Nelting M, Brehmer D. Hypermotility of outer hair cells: DPOAE findings with hyperacusis patients. In: Hazell J Proceedings of the VIth International Tinnitus Seminar. London, UK; The Tinnitus and Hyperacusis Centre 1999: 342-344
• 29 Jastreboff P J. Tinnitus habituation therapy (THT) and tinnitus retraining therapy (TRT). In: Tyler R Tinnitus Handbook. San Diego, CA; Singular 2000: 357-376
• 30 Gerken G M. Central auditory processing: alterations produced by factors involving the cochlea. In: Dancer A, Henderson D, Salvi R, Hamermik RP Effects of Noise on the Auditory System. Philadelphia, PA; Mosby 1992: 146-155
• 31 Gerken G M. Alteration of central auditory processing of brief stimuli: a review and a neural model.  J Acoust Soc Am. 1993;  93 2038-2049
• 32 McFadden S L, Kasper C, Ostrowski J, Ding D, Salvi R J. Effects of inner hair cell loss on inferior colliculus evoked potential thresholds, amplitudes and forward masking functions in chinchillas.  Hear Res. 1998;  120 121-132
• 33 Qiu C, Salvi R, Ding D, Burkard R. Inner hair cell loss leads to enhanced response amplitudes in auditory cortex of unanesthetized chinchillas: evidence for increased system gain.  Hear Res. 2000;  139 153-171
• 34 Salvi R J, Wang J, Ding D. Auditory plasticity and hyperactivity following cochlear damage.  Hear Res. 2000;  147 261-274
• 35 Coles R A. Psychophysiological dimensions of tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 1-6
• 36 Penner M J. Psychophysical observations and the origin of tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 219-230
• 37 Hall III J W. Handbook of Otoacoustic Emissions. San Diego, CA; Singular 1999
• 38 Lepage E L. A model for cochlear origin of subjective tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 115-147
• 39 Janssen T, Arnold W. Growth function of distortion product otoacoustic emissions in cochlear tinnitus.  Otorhinolaryngol Nova. 1995;  5 127-144
• 40 Mitchell C, Lilly D J, Henry J. Otoacoustic emissions in subjects with tinnitus and normal hearing. In: Reich G, Vernon J Proceedings of the Vth International Tinnitus Seminar. Portland, OR; American Tinnitus Association 1995: 180-185
• 41 Norton S J, Schmidt A R, Stover L J. Tinnitus and otoacoustic emissions: is there a link?.  Ear Hear. 1990;  11 159-166
• 42 Shiomi Y, Tsuji J, Naito Y, Fujiki N, Yamamoto N. Characteristics of DPOAE audiogram in tinnitus patients.  Hear Res. 1997;  108 83-88
• 43 Gaskill S A, Brown A M. The behavior of the acoustic distortion product, 2f1-f2, from the human ear and its relation to auditory sensitivity.  J Acoust Soc Am. 1990;  88 821-839
• 44 Popelka G R, Osterhammel P A, Nielsen L H, Rasmussen A N. Growth of distortion product otoacoustic emissions with primary-tone level in humans.  Hear Res. 1993;  71 12-22
• 45 Hughson W, Westlake H. Manual for program outline for rehabilitation of aural casualties, both military and civilian.  Trans Am Acad Ophthalmol Otolaryngol. 1944;  48(suppl) 1-15
• 46 International Organization for Standardization 389-1 .Acoustics-Reference for the Calibration of Audiometric Equipment. Part 1: Reference Equivalent Threshold Sound Pressure Levels for Pure Tones and Supra-Aural Earphones. Geneva, Switzerland; International Organization for Standardization 1989
• 47 Feldman H. Mechanisms of tinnitus. In: Vernon J, Møller A Mechanisms of Tinnitus. Boston, MA; Allyn & Bacon 1995: 35-49
• 48 Stypulkowski P H. Mechanisms of salicylate ototoxicity.  Hear Res. 1990;  46 113-145
• 49 Ruggero M A, Rich N C, Recio A, Narayan S S, Robles L. Basilar-membrane responses to tones at the base of chinchilla cochlea.  J Acoust Soc Am. 1997;  101 2151-2163
• 50 Liberman M C. Rapid assessment of sound-evoked olivocochlear feedback: suppression of compound action potentials by contralateral sound.  Hear Res. 1989;  38 47-56
• 51 Brown M C. Morphology and response properties of single olivocochlear fibers in the guinea pig.  Hear Res. 1989;  40 93-110
• 52 Formby C, Gold S L, Keaser M, Block K L, Hawley M L. A secondary benefit from tinnitus retraining therapy (TRT): clinically significant increases in loudness discomfort level and in the auditory dynamic range.  Semin Hear. 2007;  28 227-260
• 53 Lukashkin A N, Russell I J. Modification of a signal saturating non-linearity account for post-onset changes in 2f1-f2 distortion product otoacoustic emission.  J Acoust Soc Am. 2002;  112 1561-1568
• 54 Mills D. Interpretation of standard distortion product otoacoustic emission measurements in light of the complete parametric response.  J Acoust Soc Am. 2002;  112 1545-1560
• 55 Whitehead M L. Species differences of distortion-product otoacoustic emissions: comment on “Interpretation of distortion product otoacoustic emission measurement. I. Two stimulus tones”.  J Acoust Soc Am. 1998;  103 2740-2742
• 56 He N J, Schmiedt R A. Fine structure of the 2f1-f2 acoustic distortion product: changes with primary level.  J Acoust Soc Am. 1993;  94 2659-2669