Clinical Studies of Medial Olivocochlear Function

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Clinical Studies of Medial Olivocochlear Function

• Charles I. Berlin, PhD
• Linda Hood PhD
• Thierry Morlet, PhD
• Shanda Brashears, MCD
• LSUHSCs Kresge Hearing Research Laboratory of
  the South, Dept ORL and Head and Neck Surgery
• 533 Bolivar Street NO LA 70112
• www.kresgelab.org
• Phone [phone] Fax [phone]
• Support is acknowledged from NIH, and the
  Oberkotter, Marriott, HFSP, Kams Fund and LSU
  Foundations.

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Clinical Studies of the MOCS using TEOAEs

• quantification of TEOAE suppression in
  intensity, frequency and phase using ECHOMASTER
  (see www. Kresgelab.org)
• results with continuous contralateral noise vs.
  forward masking paradigms.
• Binaural vs. ipsi vs. contra suppression in
  forward masking paradigms by intensity, spectral
  level, correlation and time.
• four click train vs. single click data
  addressing ipsilateral suppression effects.

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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Earlier Studies from our lab using non-linear
clicks and only contralateral noise

• Wide band noise the best suppressors
• Narrow band next best
• Tones the poorest suppressors
• Suppression measured at first in the aggregate
  using Kemp ILO system substractions.

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TEOAE Measurement

• Non-linear clicks control for stimulus echo
  artifact.

10dB re triad above
Time
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Subsequent studies use

• Low-level (usually 60 dB peak SP) Linear Clicks
• Low level noise (usually 65 dB SP)
• Forward Masking
• Echomaster system for analysis

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Or
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Clinical Studies of the MOCS using TEOAEs

• quantification of TEOAE suppression in
  intensity, frequency and phase using ECHOMASTER
  (see www. Kresgelab.org)
• results with continuous contralateral noise vs.
  forward masking paradigms.
• Binaural vs. ipsi vs. contra suppression in
  forward masking paradigms by intensity, spectral
  level, correlation and time.
• four click train vs. single click data
  addressing ipsilateral suppression effects.

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How do we quantify EFFERENT SUPPRESSION OF TEOAES
in amplitude, frequency and phase.

• The Echomaster System shown in action. Designed
  for ILO systems.
• Results expressed in dB, spectral levels, phase
  and in time segments.
• Available free from our Web Pagewww.kresgelab.org
  under Computer Programs, Echomaster.
• Designed and Developed by Han Wen (ARO 1992).

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Analysis of two like conditions
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Comparison of without and with low level
contralateral noise
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Clinical Studies of the MOCS using TEOAEs

• quantification of TEOAE suppression in
  intensity, frequency and phase using ECHOMASTER
  (see www. Kresgelab.org)
• results with continuous contralateral noise vs.
  forward masking paradigms.
• Binaural vs. ipsi vs. contra suppression in
  forward masking paradigms by intensity, spectral
  level, correlation and time.
• four click train vs. single click data
  addressing ipsilateral suppression effects.

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Where we give a single number for Overall Results
using low level linear clicks they represent the
average data over

• 8-18 msecs

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Predicting the amount of suppression by whether
the suppressor is

• Binaural
• Ipsilateral
• Or Contralateral to the click stimulus.

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TEOAE Suppression
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MOCS Emission Suppression as a function of
Binaural Noise Duration
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Clinical Studies of the MOCS using TEOAEs

• quantification of TEOAE suppression in
  intensity, frequency and phase using ECHOMASTER
  (see www. Kresgelab.org)
• results with continuous contralateral noise vs.
  forward masking paradigms.
• Binaural vs. ipsi vs. contra suppression in
  forward masking paradigms by intensity, spectral
  level, correlation and time.
• four click train vs. single click data
  addressing ipsilateral suppression effects.

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Binaural Noise is three times more effective than
Contralateral Noise in Suppressing Otoacoustic
Emissions (Berlin et al. Hear. Res. 1995)
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Clinical Studies of the MOCS using TEOAEs

• quantification of TEOAE suppression in
  intensity, frequency and phase using ECHOMASTER
  (see www. Kresgelab.org)
• results with continuous contralateral noise vs.
  forward masking paradigms.
• Binaural vs. ipsi vs. contra suppression in
  forward masking paradigms by intensity, spectral
  level, correlation and time.
• four click train vs. single click data
  addressing ipsilateral suppression effects.

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Does it make a difference if you use a four-click
train or a single click?

• Using A Labview emulation of the ILO88 (Wen et
  al. ARO) the data are essentially the same.

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Temporal Paradigm with one or four linear click
onset at 10, 20, 50 and 100 msecs from end of 400
msec white noise
Or\
Or..
400 msecs white noise
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Efferent emission suppression by a binaural 400
msec white noise burst preceding an 80 usec pulse
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TEOAE Suppression
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TEOAE Suppression
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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Development of Efferent Suppression

• Morlet et al., 1993, 1999 Ryan and Piron, 1994
  Goforth et al., 1997, 2000
• Efferent suppression is not present at birth in
  all infants
• About 2/3 of term infants show efferent
  suppression of TEOAEs
• Only one-third of pre-term infants demonstrate
  efferent suppression of TEOAEs

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MOCS development of Contralateral Suppression
only.Morlet et al.Hearing Research 1999
Under 36 weeks CA, MOCS function appears
statistically symmetrical in both ears In
older neonates (i.e., CAgt36 wks), the
suppression is significantly greater the RE than
in the LE. This is observed into adulthood.
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Aging and Efferent Suppression

• Castor et al., 1994 - decreases in contralateral
  suppression
• Hood et al., 1997 - binaural, ipsilateral and
  contralateral suppression
• Suppression decreased as a function of age from
  10 to 80 years.
• Greatest decreases were observed for binaural
  suppressors.
• These results may be relevant to studies showing
  a loss of binaural advantage with age.

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Suppression Versus Age - Right Ear 1.5 kHz Band
Binaural, Ipsilateral and Contralateral Noise
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Binaural Right vs. Left Ear Suppression by Age
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Ipsilateral Suppression changes with age.
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Contralateral suppression declines with age
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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Right Ear Advantage

• The human auditory system shows functional
  asymmetries, in favor of the right ear. The right
  ear advantage (REA) especially in Dichotic
  Listening is usually interpreted as a reflection
  of the dominance of the left hemisphere for
  processing speech and language and of the
  inhibition of ipsilateral auditory pathways.
• At the cochlear level, there are significant
  differences in OAEs (Burns et al., 1992 Kei et
  al., 1997 Khalfa et al., 1997 Kok et al., 1993
  Morlet et al., 1995 Newmark et al., 1997) in
  adults, infants and both full-term and pre-term
  neonates.
• Asymmetries are observed along the afferent
  pathways as well as for the efferent fibres. The
  MOCS appears to be more efficient in RE than in
  LE (Khalfa and Collet, 1996).

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Efferent Suppression Pre-FFW
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Efferent Suppression PostFFW
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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy/Dys-synchrony.
• parents who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Auditory Neuropathy/Dys-synchrony

• Normal Emissions.
• No ABR to clicks usually associated with large
  ringing cochlear microphonic easily discriminated
  from true neural response by comparing one
  condensation to one rarefaction click average.
• Disturbed speech perception inconsistent with
  audiogram.
• No middle ear muscle reflex.
• No MLD
• No MOCS suppression.

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Patient with profound behavioral deafness but
normal emissions.
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A normal ABR on the left with click inversion, an
Auditory Neuropathy on the right. No click
inversion on right.
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Rarefaction vs. Condensation click averages
Note polarity inversion and no latency
shift showing this to be a CM.
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Efferent Suppression in Patients with Neural
Disorders

• Patients with auditory neuropathy/dys-synchrony
  do not show efferent suppression (Berlin et al.,
  1993 Starr et al., 1991 1996).
• Patients with 8th nerve tumors who have OAEs show
  no suppression (Maurer et al., 1992).
• Patients with vestibular neurectomy show reduced
  or no suppression (Williams et al., 1993, 1994).
• Patients with Petrous Pyramid Granulomas show no
  unilateral suppression despite normal emissions
  (Hurley at al. 2002)

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Auditory Neuropathy Patient
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AN/AD PATIENTS SHOW VIRTUALLY NO SUPPRESSION
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Is this an afferent or efferent failure?

• Efferent suppression is present binaurally as
  long as the good ear is being stimulated, and
  absent whenever the bad ear is stimulated.
• Unilateral AN/AD patients teach us that this is
  primarily an Afferent failure of synchronyone of
  the many reasons we have for suggesting the
  utility of a semantic index of Auditory
  Dys-synchrony to describe what effects various
  etiologies might have in this condition.

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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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DPOAEs in Usher Carriers
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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Musicians in the LPO

• Have Binaural Suppression of 4-7 dB in contrast
  to 2-to-3 dB in age-matched normals.
• May differ by instrument (eg violinists and left
  ears.)
• Preliminary data funded by Grammy group,
  collected by S. Brashears.

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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Suppression and Hyperacusis
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Efferent Suppression in Hyperacusics
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More results in MOCS Studies

• Development and Aging
• .Gender and laterality effectschanges in
  laterality after Fast ForWord
• absence of suppression in patients with
  Auditory Neuropathy.
• patients who are obligate carriers of genes for
  deafness (See Hood et al Poster later today)
  Differences in Suppression as well as DPOAE
  characteristics.
• tough ears of musicians.
• medicolegal applications in patients with
  Hyperacusis
• autistic patients who complain of extreme
  hearing sensitivity (Berard/Tomatis targets).

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Efferent Suppression in Hyperacusics vs Autistics
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Berlin CI, Hood LJ, Hurley A, Wen H. 1994.
Contralateral suppression of otoacoustic
emissions An index of the function of the
medial olivocochlear system. Otolaryngol-Head
Neck Surg 1003-21.   Berlin CI, Hood, LJ, Hurley
A, Wen H, Kemp DT. 1995. Binaural noise
suppresses click-evoked otoacoustic emissions
more than ipsilateral or contralateral noise.
Hear Res 8796-103.   Hood LJ, Berlin CI, Hurley
A, Wen H. 1996. Suppression of otoacoustic
emissions in normal hearing individuals. Chapter
in Berlin CI (Ed), Hair Cells and Hearing Aids.
San Diego Singular Press.   Hood LJ, Berlin CI,
Hurley A, Cecola RP, Bell B. 1996.
Contralateral suppression of click-evoked
otoacoustic emissions Intensity effects. Hear
Res 101113-118.   Hood LJ, Berlin CI,
Goforth-Barter L, Bordelon J, Wen H. 1999.
Recording and analyzing efferent suppression of
transient-evoked otoacoustic emissions. In
Berlin CI The Efferent Auditory System. San
Diego Singular Publishing Group.   Hood LJ,
Berlin CI. 2001. Efferent suppression in
patients with auditory neuropathy. In Starr A
and Sininger YS. Auditory Neuropathy. San
Diego Singular Publishing Group.     Wen H,
Berlin C, Hood L, Jackson D, Hurley A. 1993. A
program for quantification and analysis of
transient evoked otoacoustic emissions. ARO
Abstracts 16102.   Hood LJ, Berlin CI, Wakefield
L, Hurley A. 1995. Noise duration affects
suppression of transient-evoked otoacoustic
emissions. ARO Abstracts 19123.   Goforth L,
Hood LJ, Berlin CI. 1997. Efferent suppression
of transient-evoked otoacoustic emissions in
human infants. ARO Abstracts , 20166.   Hood
LJ, Hurley AE, Goforth L, Bordelon J, Berlin CI.
1997. Aging and efferent suppression of
otoacoustic emissions. ARO Abstracts ,
20167.   Hood LJ, Goforth L, Bordelon J, Hurley
A, Berlin CI. 1998. Suppression of transient
evoked otoacoustic emissions using frequency
limited stimuli. ARO Abstracts ,
21153.   Goforth L, Hood LJ, Berlin CI. 1998.
Development of efferent function in neonates.
ARO Abstracts , 21152.   Berlin CI,
Goforth-Barter L, Hood LJ. 1998. Some
hyperacusics show abnormally strong efferent
suppression of TEOAEs. ARO Abstracts ,
21153.   Hood LJ, Berlin CI, Bordelon J,
Goforth-Barter L, Hurley A, Tedesco S. 2000.
Patients with auditory neuropathy lack efferent
suppression of evoked otoacoustic emissions. ARO
Abstracts 23.   Hood LJ, Berlin CI, Tedesco S,
Brashears S, Jeanfreau J, Keats B, Morlet T.
2001. Otoacoustic emissions in carriers of genes
for hearing loss. ARO Abstracts 24.    
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Thanks to other collaborators not listed as full
co-authors, including Kelly Rose, Leah Barter,
Han Wen, and Pat Cecola MD. This entire
presentation will be available on our Web Page.

• www.kresgelab.org