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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

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Clinical studies of medial olivocochlear function l.jpg

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 l.jpg
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 l.jpg
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 l.jpg
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 only contralateral noise

  • “Non-linear” clicks control for stimulus echo artifact.

+10dB re: triad above

Time


Subsequent studies use l.jpg
Subsequent studies use… only contralateral noise

  • Low-level (usually 60 dB peak SP) Linear Clicks

  • Low level noise (usually 65 dB SP)

  • Forward Masking

  • Echomaster system for analysis


Slide7 l.jpg

Or…… only contralateral noise


Slide8 l.jpg

Clinical Studies of the MOCS using TEOAEs only contralateral noise

  • …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 l.jpg
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).


Slide11 l.jpg

Analysis of two like conditions amplitude, frequency and phase.



Slide13 l.jpg

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.


Slide14 l.jpg

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 l.jpg
Predicting the amount of suppression by whether the suppressor is…

  • Binaural

  • Ipsilateral

  • Or Contralateral… to the click stimulus.


Teoae suppression l.jpg
TEOAE Suppression suppressor is…



Clinical studies of the mocs using teoaes18 l.jpg
Clinical Studies of the MOCS using TEOAEs Duration

  • …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.


Slide19 l.jpg

Binaural Noise is three times more effective than Contralateral Noise in Suppressing Otoacoustic Emissions (Berlin et al. Hear. Res. 1995)


Clinical studies of the mocs using teoaes20 l.jpg
Clinical Studies of the MOCS using TEOAEs Contralateral Noise in Suppressing Otoacoustic Emissions (Berlin et al.

  • …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 l.jpg

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.


Slide22 l.jpg
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


Slide23 l.jpg

Efferent emission suppression by a binaural 400 msec white noise burst preceding an 80 usec pulse


Teoae suppression24 l.jpg
TEOAE Suppression noise burst preceding an 80 usec pulse


Teoae suppression25 l.jpg
TEOAE Suppression noise burst preceding an 80 usec pulse


More results in mocs studies26 l.jpg
More results in MOCS Studies noise burst preceding an 80 usec pulse

  • …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 l.jpg
Development of Efferent Suppression noise burst preceding an 80 usec pulse

  • 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


Slide28 l.jpg

MOCS development noise burst preceding an 80 usec pulseof 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., CA>36 wks),

the suppression is

significantly greater the RE than

in the LE.

This is observed

into adulthood.


Aging and efferent suppression l.jpg
Aging and Efferent Suppression noise burst preceding an 80 usec pulse

  • 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.


Slide30 l.jpg

Suppression Versus Age - Right Ear noise burst preceding an 80 usec pulse

1.5 kHz Band: Binaural, Ipsilateral and Contralateral Noise


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Binaural Right vs. Left Ear Suppression by Age noise burst preceding an 80 usec pulse


Ipsilateral suppression changes with age l.jpg
Ipsilateral Suppression changes with age. noise burst preceding an 80 usec pulse


Contralateral suppression declines with age l.jpg
Contralateral suppression declines with age noise burst preceding an 80 usec pulse


Slide34 l.jpg

More results in MOCS Studies noise burst preceding an 80 usec pulse

  • …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).


Slide35 l.jpg

Right Ear Advantage noise burst preceding an 80 usec pulse

  • 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).


Slide38 l.jpg

Efferent Suppression Pre-FFW noise burst preceding an 80 usec pulse


Slide39 l.jpg

Efferent Suppression PostFFW noise burst preceding an 80 usec pulse


More results in mocs studies40 l.jpg
More results in MOCS Studies noise burst preceding an 80 usec pulse

  • …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 dys synchrony l.jpg
Auditory Neuropathy/Dys-synchrony noise burst preceding an 80 usec pulse

  • 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.


Slide42 l.jpg

Patient with profound behavioral noise burst preceding an 80 usec pulse

deafness but normal emissions.


Slide43 l.jpg

A normal ABR on the left with click inversion, an Auditory Neuropathy on the right. No click inversion on right.


Slide44 l.jpg

Rarefaction vs. Condensation click averages Neuropathy on the right. No click inversion on right.

Note

polarity

inversion

and no

latency

shift

showing

this to be

a CM.


Efferent suppression in patients with neural disorders l.jpg
Efferent Suppression in Patients with Neural Disorders Neuropathy on the right. No click inversion on right.

  • 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 l.jpg
Auditory Neuropathy Patient Neuropathy on the right. No click inversion on right.


An ad patients show virtually no suppression l.jpg
AN/AD PATIENTS SHOW VIRTUALLY NO SUPPRESSION Neuropathy on the right. No click inversion on right.


Is this an afferent or efferent failure l.jpg
Is this an afferent or efferent failure? Neuropathy on the right. No click inversion on right.

  • 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 Dys-synchrony to describe what effects various etiologies might have in this condition.


More results in mocs studies49 l.jpg
More results in MOCS Studies Neuropathy on the right. No click inversion on right.

  • …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 l.jpg
DPOAEs in Usher Carriers Neuropathy on the right. No click inversion on right.


Slide51 l.jpg

More results in MOCS Studies Neuropathy on the right. No click inversion on right.

  • …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 l.jpg
Musicians in the LPO Neuropathy on the right. No click inversion on right.

  • 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.


Slide53 l.jpg

More results in MOCS Studies Neuropathy on the right. No click inversion on right.

  • …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 l.jpg
Suppression and Hyperacusis Neuropathy on the right. No click inversion on right.


Slide55 l.jpg

Efferent Suppression in Hyperacusics Neuropathy on the right. No click inversion on right.


More results in mocs studies56 l.jpg
More results in MOCS Studies Neuropathy on the right. No click inversion on right.

  • …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).


Slide57 l.jpg

Efferent Suppression in Hyperacusics vs Autistics Neuropathy on the right. No click inversion on right.


Slide58 l.jpg

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 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. HearRes 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.


Slide59 l.jpg

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


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