Clinical Studies of Medial Olivocochlear Function by sammyc2007

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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
   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                                                        BIN
dB                                                            Ipsi
     1                                               Contra   Contra
     0                                        Ipsi
          10     20      50       100   BIN
         msec   msec    msec     msec
            Time from noise offset
   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
                          O
  400 msecs white noise       Or..
                          r
                          \
 Efferent emission suppression by a binaural 400
msec white noise burst preceding an 80 usec pulse




     3

     2                                                    LV 1
dB                                                        LV 4
     1                                              ILO
                                                     4    ILO 4
                                               LV
     0
         10 msec 20 msec 50 msec    100   LV    4
                                   msec    1
              Time from noise offset
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

                                                           Under 36 weeks CA, MOCS function
           4
                                                             appears statistically symmetrical
                                LE CA<36wks
           3
                                RE CA<36wks                            in both ears
RMS (dB)




           2

           1

           0                                                         In older neonates
           -1                                                       (i.e., CA>36 wks),
                    3   5   7    9   11 13 15 17 19
           4                     Time (ms)
                                                                     the suppression is
           3
                                                            significantly greater the RE than
                                                                          in the LE.
RMS (dB)




           2

           1

           0                LE CA>36wks
                                                                      This is observed
           -1
                            RE CA>36wks                                into adulthood.
                2   4   6    8    10 12 14 16 18 20
                                Time (ms)
  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

                          2


                          0
      Suppression in dB




                          -2                                       Ri ght Bi naural

                                                                   Ri ght Ipsi l ateral
                          -4
                                                                   Ri ght Con tralateral

                          -6


                          -8
                               15    25   35   45   55   65   75

                                    Average Age in Years
    Binaural Right vs. Left Ear
       Suppression by Age
6

5

4

3                                      Rt. Bin
                                       Lt. Bin
2

1

0
    15   25   35   45   55   65   75
Ipsilateral Suppression changes
            with age.
3.5

 3

2.5

 2
                                         RIPSI
1.5                                      Lipsi
 1

0.5
 0
      15   25   35   45   55   65   75
      Contralateral suppression
         declines with age
2.5

 2

1.5
                                         R cont
 1                                       Lcont

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


                   2.0
Suppression (dB)




                   1.5              Severely
                         Lightly




                   1.0




                                                         Severely
                                               Lightly
                   0.5


                   0.0
                             Left Ear           Right Ear
                           Contr
                           Cont
Efferent Suppression PostFFW


                   2.0
Suppression (dB)




                   1.5




                                                         Severely
                   1.0




                                               Lightly
                                    Severely
                         Lightly




                   0.5


                   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/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.
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

1.5                                   Normals
                                      Auditory Neuropathy
 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 Dys-
  synchrony 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                                   Mean Suppression in
-4                                   Age Matched Normals
-5
-6                                   Mean Suppression in 6
-7                                   Hyperacusic Ears to
                                     Binaural Noise
-8
-9
     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                                   Mean Suppression in
-3                                   Age Matched Normals
-4
                                     Mean Suppression in 6
-5
                                     Hyperacusic Ears to
-6                                   Binaural Noise
-7                                   Mean Suppression in
-8                                   AUTISTICS
-9
     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. 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. 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

								
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