Transcript Clinical Application of Efferent Suppression Studies

Clinical Studies of Medial
Olivocochlear Function
Charles I. Berlin, PhD
Linda Hood PhD
Thierry Morlet, PhD
Shanda Brashears, MCD
LSUHSC’s Kresge Hearing Research Laboratory
of the South, Dept ORL and Head and Neck
Surgery
533 Bolivar Street NO LA 70112
www.kresgelab.org
Phone: 504-568-4785 Fax: 504-568-4460
Support is acknowledged from NIH, and the Oberkotter,
Marriott, HFSP, Kam’s Fund and LSU Foundations.
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.
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
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.
TEOAE Measurement
• “Non-linear” clicks control for stimulus
echo artifact.
+10dB re:
Time
triad above
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
Or……
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.
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
Page…www.kresgelab.org under
Computer Programs, Echomaster.
• Designed and Developed by Han Wen
(ARO 1992).
How we quantify the efferent
reflex using TEOAEs (Wen et al. 1993)
The thic k gree n li ne represents the RM S
differences betwe en control vs. “wit h noi se”
condi ti ons, in 2 m sec ste ps. Note arrow
at 12 msec s whic h shows a 7.49 dB di ffere nc e
bet we en t ra ces in t hi s c ontra lat eral t ria l.
Analysis of two like conditions
Comparison of without and with low level
contralateral noise
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.
Where we give a single number
for Overall Results using low
level linear clicks they represent
the average data over
8-18 msecs
Predicting the amount of
suppression by whether the
suppressor is…
• Binaural
• Ipsilateral
• Or Contralateral… to the click
stimulus.
TEOAE Suppression
MOCS Emission Suppression as
a function of Binaural Noise
Duration
2.5
2
1.5
Duration of Noise
1
0.5
0
80
160 240 320 400 480 560
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.
Binaural Noise is three times more effective than
Contralateral Noise in Suppressing Otoacoustic Emissions
(Berlin et al. Hear. Res. 1995)
3
2
dB
1
Contra
Ipsi
0
10
msec
20
msec
50
msec
100
msec
Time from noise offset
BIN
BIN
Ipsi
Contra
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.
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.
Temporal Paradigm with one or
four linear click onset at 10, 20,
50 and 100 msecs from end of
400 msec white noise
400 msecs white noise
O
r
\
Or..
Efferent emission suppression by a binaural 400
msec white noise burst preceding an 80 usec pulse
3
2
dB
1
0
10 msec 20 msec 50 msec
100
msec
Time from noise offset
LV
1
LV
4
ILO
4
LV 1
LV 4
ILO 4
TEOAE Suppression
TEOAE Suppression
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
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
MOCS development
of Contralateral Suppression only.
Morlet et al.Hearing Research 1999
4
LE CA<36wks
RE CA<36wks
RMS (dB)
3
2
1
0
-1
3
5
7
9
4
11 13 15 17 19
Time (ms)
3
RMS (dB)
Under 36 weeks CA, MOCS function
appears statistically symmetrical
in both ears
2
In older neonates
(i.e., CA>36 wks),
the suppression is
significantly greater the RE than
in the LE.
1
LE CA>36wks
RE CA>36wks
0
-1
2
4
6
8
10 12 14 16 18 20
Time (ms)
This is observed
into adulthood.
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.
Suppression Versus Age - Right Ear
1.5 kHz Band: Binaural, Ipsilateral and Contralateral Noise
Suppression in dB
2
0
Right Binaural
-2
Right Ipsilateral
-4
Right Contralateral
-6
-8
15
25
35
45
55
65
Average Age in Years
75
Binaural Right vs. Left Ear
Suppression by Age
6
5
4
Rt. Bin
Lt. Bin
3
2
1
0
15
25
35
45
55
65
75
Ipsilateral Suppression changes
with age.
3.5
3
2.5
2
RIPSI
Lipsi
1.5
1
0.5
0
15
25
35
45
55
65
75
Contralateral suppression
declines with age
2.5
2
1.5
R cont
Lcont
1
0.5
0
15
25
35
45
55
65
75
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
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).
Efferent Suppression Pre-FFW
Severely
0.5
Lightly
1.0
Severely
1.5
Lightly
Suppression (dB)
2.0
0.0
Left Ear
Right Ear
Contr
Cont
Efferent Suppression PostFFW
Severely
0.5
Severely
1.0
Lightly
1.5
Lightly
Suppression (dB)
2.0
0.0
Left Ear
Right Ear
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
Auditory Neuropathy/Dyssynchrony
• 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.
Patient with profound behavioral
deafness but normal emissions.
A normal ABR on the left with
click inversion, an Auditory
Neuropathy on the right. No click
inversion on right.
Rarefaction vs. Condensation click
averages
Note
polarity
inversion
and no
latency
shift
showing
this to be
a CM.
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)
Auditory Neuropathy Patient
AN/AD PATIENTS SHOW
VIRTUALLY NO
SUPPRESSION
3
2.5
2
Normals
Auditory Neuropathy
1.5
1
0.5
0
Overall Binaural Suppression
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 synchrony…one of
the many reasons we have for suggesting the
utility of a semantic index of Auditory Dyssynchrony to describe what effects various
etiologies might have in this condition.
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
DPOAEs in Usher Carriers
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
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.
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
Suppression and Hyperacusis
Efferent Suppression in
Hyperacusics
0
-1
-2
-3
-4
-5
-6
-7
-8
-9
Mean Suppression in
Age Matched Normals
Mean Suppression in 6
Hyperacusic Ears to
Binaural Noise
8-10 10-12 12-14 14-16 16-18
msecs msecs msecs msecs msecs
More results in MOCS Studies
• …Development and Aging
• ….Gender and laterality effects…changes 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).
Efferent Suppression in
Hyperacusics vs Autistics
0
-1
-2
-3
-4
-5
-6
-7
-8
-9
Mean Suppression in
Age Matched Normals
Mean Suppression in 6
Hyperacusic Ears to
Binaural Noise
Mean Suppression in
AUTISTICS
8-10 10-12 12-14 14-16 16-18
msecs msecs msecs msecs msecs
Berlin CI, Hood LJ, Hurley A, Wen H. 1994. Contralateral suppression of otoacoustic emissions: An index of the function of the medial olivocochlear system. OtolaryngolHead Neck Surg 100:3-21.
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
87:96-103.
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 101:113-118.
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 16:102.
Hood LJ, Berlin CI, Wakefield L, Hurley A. 1995. Noise duration affects suppression of transient-evoked otoacoustic emissions. ARO Abstracts 19:123.
Goforth L, Hood LJ, Berlin CI. 1997. Efferent suppression of transient-evoked otoacoustic emissions in human infants. ARO Abstracts , 20:166.
Hood LJ, Hurley AE, Goforth L, Bordelon J, Berlin CI. 1997. Aging and efferent suppression of otoacoustic emissions. ARO Abstracts , 20:167.
Hood LJ, Goforth L, Bordelon J, Hurley A, Berlin CI. 1998. Suppression of transient evoked otoacoustic emissions using frequency limited stimuli. ARO Abstracts , 21:153.
Goforth L, Hood LJ, Berlin CI. 1998. Development of efferent function in neonates. ARO Abstracts , 21:152.
Berlin CI, Goforth-Barter L, Hood LJ. 1998. Some hyperacusics show abnormally strong efferent suppression of TEOAEs. ARO Abstracts , 21:153.
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.
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