The assessment of olivocochlear function in neonates with real‐time distortion product otoacoustic emissions
Identifieur interne : 000383 ( Istex/Corpus ); précédent : 000382; suivant : 000384The assessment of olivocochlear function in neonates with real‐time distortion product otoacoustic emissions
Auteurs : Adrian L. JamesSource :
- The Laryngoscope [ 0023-852X ] ; 2011-01.
English descriptors
- KwdEn :
Abstract
Objectives/Hypothesis:: Otoacoustic emissions (OAE) can be suppressed with activation of the medial olivocochlear neural pathway by stimulation of the contralateral ear. The primary objective of this study was to assess the feasibility of using olivocochlear mediated OAE suppression to test neonatal hearing with a novel device that detects changes in distortion product (DP)OAE level with high temporal resolution. The secondary objective was to investigate whether temporal parameters of the response can be determined with this technique and used in the assessment of neonates at risk of auditory neuropathy spectrum disorder (ANSD). Study Design:: Prospective translational study of novel hearing assessment technique. Methods:: There were 46 neonates tested in a clinic or neonatal intensive care unit (NICU). DPOAE were recorded in real time with narrow band pass digital filtering (1 ms temporal resolution) during presentation of an intermittent contralateral broadband noise stimulus. Magnitude and latency of the contralateral suppression response were compared with hearing outcome (auditory brainstem response screen and clinical follow‐up) and risk factors for hearing loss, particularly hyperbilirubinemia as a risk factor for ANSD. Results:: Contralateral suppression was identified in all of 38 neonates with detectable DPOAE and normal hearing, most reliably at f2 = 4.4 kHz (average values = 1 dB suppression from DP level of 14 dB SPL using 0.55 s contralateral stimulus at 50 dB SPL). Sensorineural hearing loss was identified in three cases (6.5%) and ANSD in five cases (11% of all neonates tested). Contralateral suppression was absent in two of the ANSD cases (one associated with cochlear nerve aplasia, the other with hyperbilirubinemia) and present in three. The median latency for onset of contralateral suppression was 60 ms and offset latency 83 ms. The latency for offset of suppression was longer in neonates who required treatment for hyperbilirubinemia at 123 ms (P = .02, Mann‐Whitney rank sum test). Latency measurements were determined with high intraobserver reliability (Pearson product moment correlation coefficient > 0.96). Conclusions:: Contralateral suppression of real‐time DPOAE can reliably be identified in neonates. This is likely a manifestation of olivocochlear activity, although middle ear muscle reflexes might contribute to suppression in some circumstances. The technique provides a feasible objective test of hearing in neonates that can be applied in the NICU setting without sedation. The presence of a response indicates detection of sound by the contralateral ear and effective brainstem transmission of neural signals, therefore providing a more sensitive test of hearing than OAE alone. The high temporal resolution of the technique allows measurement of latency of the response. These benefits help to identify neonates at risk of ANSD and have the potential to provide prognostic information that will assist in the management of this unpredictable disorder. Further development of the technique is indicated with regard to determination of hearing threshold, frequency specific testing, and automation of response detection. Laryngoscope, 2011
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DOI: 10.1002/lary.21078
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<front><div type="abstract" xml:lang="en">Objectives/Hypothesis:: Otoacoustic emissions (OAE) can be suppressed with activation of the medial olivocochlear neural pathway by stimulation of the contralateral ear. The primary objective of this study was to assess the feasibility of using olivocochlear mediated OAE suppression to test neonatal hearing with a novel device that detects changes in distortion product (DP)OAE level with high temporal resolution. The secondary objective was to investigate whether temporal parameters of the response can be determined with this technique and used in the assessment of neonates at risk of auditory neuropathy spectrum disorder (ANSD). Study Design:: Prospective translational study of novel hearing assessment technique. Methods:: There were 46 neonates tested in a clinic or neonatal intensive care unit (NICU). DPOAE were recorded in real time with narrow band pass digital filtering (1 ms temporal resolution) during presentation of an intermittent contralateral broadband noise stimulus. Magnitude and latency of the contralateral suppression response were compared with hearing outcome (auditory brainstem response screen and clinical follow‐up) and risk factors for hearing loss, particularly hyperbilirubinemia as a risk factor for ANSD. Results:: Contralateral suppression was identified in all of 38 neonates with detectable DPOAE and normal hearing, most reliably at f2 = 4.4 kHz (average values = 1 dB suppression from DP level of 14 dB SPL using 0.55 s contralateral stimulus at 50 dB SPL). Sensorineural hearing loss was identified in three cases (6.5%) and ANSD in five cases (11% of all neonates tested). Contralateral suppression was absent in two of the ANSD cases (one associated with cochlear nerve aplasia, the other with hyperbilirubinemia) and present in three. The median latency for onset of contralateral suppression was 60 ms and offset latency 83 ms. The latency for offset of suppression was longer in neonates who required treatment for hyperbilirubinemia at 123 ms (P = .02, Mann‐Whitney rank sum test). Latency measurements were determined with high intraobserver reliability (Pearson product moment correlation coefficient > 0.96). Conclusions:: Contralateral suppression of real‐time DPOAE can reliably be identified in neonates. This is likely a manifestation of olivocochlear activity, although middle ear muscle reflexes might contribute to suppression in some circumstances. The technique provides a feasible objective test of hearing in neonates that can be applied in the NICU setting without sedation. The presence of a response indicates detection of sound by the contralateral ear and effective brainstem transmission of neural signals, therefore providing a more sensitive test of hearing than OAE alone. The high temporal resolution of the technique allows measurement of latency of the response. These benefits help to identify neonates at risk of ANSD and have the potential to provide prognostic information that will assist in the management of this unpredictable disorder. Further development of the technique is indicated with regard to determination of hearing threshold, frequency specific testing, and automation of response detection. Laryngoscope, 2011</div>
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<abstract xml:lang="en"><p>Objectives/Hypothesis:: Otoacoustic emissions (OAE) can be suppressed with activation of the medial olivocochlear neural pathway by stimulation of the contralateral ear. The primary objective of this study was to assess the feasibility of using olivocochlear mediated OAE suppression to test neonatal hearing with a novel device that detects changes in distortion product (DP)OAE level with high temporal resolution. The secondary objective was to investigate whether temporal parameters of the response can be determined with this technique and used in the assessment of neonates at risk of auditory neuropathy spectrum disorder (ANSD). Study Design:: Prospective translational study of novel hearing assessment technique. Methods:: There were 46 neonates tested in a clinic or neonatal intensive care unit (NICU). DPOAE were recorded in real time with narrow band pass digital filtering (1 ms temporal resolution) during presentation of an intermittent contralateral broadband noise stimulus. Magnitude and latency of the contralateral suppression response were compared with hearing outcome (auditory brainstem response screen and clinical follow‐up) and risk factors for hearing loss, particularly hyperbilirubinemia as a risk factor for ANSD. Results:: Contralateral suppression was identified in all of 38 neonates with detectable DPOAE and normal hearing, most reliably at f2 = 4.4 kHz (average values = 1 dB suppression from DP level of 14 dB SPL using 0.55 s contralateral stimulus at 50 dB SPL). Sensorineural hearing loss was identified in three cases (6.5%) and ANSD in five cases (11% of all neonates tested). Contralateral suppression was absent in two of the ANSD cases (one associated with cochlear nerve aplasia, the other with hyperbilirubinemia) and present in three. The median latency for onset of contralateral suppression was 60 ms and offset latency 83 ms. The latency for offset of suppression was longer in neonates who required treatment for hyperbilirubinemia at 123 ms (P = .02, Mann‐Whitney rank sum test). Latency measurements were determined with high intraobserver reliability (Pearson product moment correlation coefficient > 0.96). Conclusions:: Contralateral suppression of real‐time DPOAE can reliably be identified in neonates. This is likely a manifestation of olivocochlear activity, although middle ear muscle reflexes might contribute to suppression in some circumstances. The technique provides a feasible objective test of hearing in neonates that can be applied in the NICU setting without sedation. The presence of a response indicates detection of sound by the contralateral ear and effective brainstem transmission of neural signals, therefore providing a more sensitive test of hearing than OAE alone. The high temporal resolution of the technique allows measurement of latency of the response. These benefits help to identify neonates at risk of ANSD and have the potential to provide prognostic information that will assist in the management of this unpredictable disorder. Further development of the technique is indicated with regard to determination of hearing threshold, frequency specific testing, and automation of response detection. Laryngoscope, 2011</p>
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<caption>Supporting Figure S4.</caption>
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<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig5"></mediaResource>
<caption>Supporting Figure S5.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig6"></mediaResource>
<caption>Supporting Figure A6.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig7"></mediaResource>
<caption>Supporting Figure A7.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig8"></mediaResource>
<caption>Supporting Figure A8.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig9"></mediaResource>
<caption>Supporting Figure A9.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig10"></mediaResource>
<caption>Supporting Figure A10.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppFig11"></mediaResource>
<caption>Supporting Figure A11.</caption>
</supportingInfoItem>
<supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:0023852X:media:lary21078:LARY_21078_sm_SuppMaterials"></mediaResource>
<caption>Supporting Information Materials.</caption>
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<abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title>
<section xml:id="abs1-1"><title type="main">Objectives/Hypothesis:</title>
<p>Otoacoustic emissions (OAE) can be suppressed with activation of the medial olivocochlear neural pathway by stimulation of the contralateral ear. The primary objective of this study was to assess the feasibility of using olivocochlear mediated OAE suppression to test neonatal hearing with a novel device that detects changes in distortion product (DP)OAE level with high temporal resolution. The secondary objective was to investigate whether temporal parameters of the response can be determined with this technique and used in the assessment of neonates at risk of auditory neuropathy spectrum disorder (ANSD).</p>
</section>
<section xml:id="abs1-2"><title type="main">Study Design:</title>
<p>Prospective translational study of novel hearing assessment technique.</p>
</section>
<section xml:id="abs1-3"><title type="main">Methods:</title>
<p>There were 46 neonates tested in a clinic or neonatal intensive care unit (NICU). DPOAE were recorded in real time with narrow band pass digital filtering (1 ms temporal resolution) during presentation of an intermittent contralateral broadband noise stimulus. Magnitude and latency of the contralateral suppression response were compared with hearing outcome (auditory brainstem response screen and clinical follow‐up) and risk factors for hearing loss, particularly hyperbilirubinemia as a risk factor for ANSD.</p>
</section>
<section xml:id="abs1-4"><title type="main">Results:</title>
<p>Contralateral suppression was identified in all of 38 neonates with detectable DPOAE and normal hearing, most reliably at f<sub>2</sub>
= 4.4 kHz (average values = 1 dB suppression from DP level of 14 dB SPL using 0.55 s contralateral stimulus at 50 dB SPL). Sensorineural hearing loss was identified in three cases (6.5%) and ANSD in five cases (11% of all neonates tested). Contralateral suppression was absent in two of the ANSD cases (one associated with cochlear nerve aplasia, the other with hyperbilirubinemia) and present in three. The median latency for onset of contralateral suppression was 60 ms and offset latency 83 ms. The latency for offset of suppression was longer in neonates who required treatment for hyperbilirubinemia at 123 ms (<i>P</i>
= .02, Mann‐Whitney rank sum test). Latency measurements were determined with high intraobserver reliability (Pearson product moment correlation coefficient > 0.96).</p>
</section>
<section xml:id="abs1-5"><title type="main">Conclusions:</title>
<p>Contralateral suppression of real‐time DPOAE can reliably be identified in neonates. This is likely a manifestation of olivocochlear activity, although middle ear muscle reflexes might contribute to suppression in some circumstances. The technique provides a feasible objective test of hearing in neonates that can be applied in the NICU setting without sedation. The presence of a response indicates detection of sound by the contralateral ear and effective brainstem transmission of neural signals, therefore providing a more sensitive test of hearing than OAE alone. The high temporal resolution of the technique allows measurement of latency of the response. These benefits help to identify neonates at risk of ANSD and have the potential to provide prognostic information that will assist in the management of this unpredictable disorder. Further development of the technique is indicated with regard to determination of hearing threshold, frequency specific testing, and automation of response detection. Laryngoscope, 2011</p>
</section>
</abstract>
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<noteGroup><note xml:id="fn1"><p>This work was supported by grants from the Connaught Fund from the University of Toronto and the Hearing Research Foundation of Canada. The author has no other funding, financial relationships, or conflicts of interest to disclose.</p>
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<mods version="3.6"><titleInfo lang="en"><title>The assessment of olivocochlear function in neonates with real‐time distortion product otoacoustic emissions</title>
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<titleInfo type="abbreviated" lang="en"><title>Olivocochlear Function in Neonates</title>
</titleInfo>
<titleInfo type="alternative" contentType="CDATA" lang="en"><title>The assessment of olivocochlear function in neonates with real‐time distortion product otoacoustic emissions</title>
</titleInfo>
<name type="personal"><namePart type="given">Adrian L.</namePart>
<namePart type="family">James</namePart>
<namePart type="termsOfAddress">DM, FRCS(ORL‐HNS)</namePart>
<affiliation>Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada</affiliation>
<affiliation>Current Address: Triological Society Annual Meeting, Las Vegas, Nevada, U.S.A., April 28–May 1, 2010; (Mosher Award winning thesis)</affiliation>
<description>Correspondence: Department of Otolaryngology–Head and Neck Surgery, Hospital for Sick Children, 555 University Avenue, Toronto ON, M5G 1X8 Canada</description>
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<dateIssued encoding="w3cdtf">2011-01</dateIssued>
<dateCaptured encoding="w3cdtf">2010-03-16</dateCaptured>
<dateValid encoding="w3cdtf">2010-05-12</dateValid>
<copyrightDate encoding="w3cdtf">2011</copyrightDate>
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<abstract lang="en">Objectives/Hypothesis:: Otoacoustic emissions (OAE) can be suppressed with activation of the medial olivocochlear neural pathway by stimulation of the contralateral ear. The primary objective of this study was to assess the feasibility of using olivocochlear mediated OAE suppression to test neonatal hearing with a novel device that detects changes in distortion product (DP)OAE level with high temporal resolution. The secondary objective was to investigate whether temporal parameters of the response can be determined with this technique and used in the assessment of neonates at risk of auditory neuropathy spectrum disorder (ANSD). Study Design:: Prospective translational study of novel hearing assessment technique. Methods:: There were 46 neonates tested in a clinic or neonatal intensive care unit (NICU). DPOAE were recorded in real time with narrow band pass digital filtering (1 ms temporal resolution) during presentation of an intermittent contralateral broadband noise stimulus. Magnitude and latency of the contralateral suppression response were compared with hearing outcome (auditory brainstem response screen and clinical follow‐up) and risk factors for hearing loss, particularly hyperbilirubinemia as a risk factor for ANSD. Results:: Contralateral suppression was identified in all of 38 neonates with detectable DPOAE and normal hearing, most reliably at f2 = 4.4 kHz (average values = 1 dB suppression from DP level of 14 dB SPL using 0.55 s contralateral stimulus at 50 dB SPL). Sensorineural hearing loss was identified in three cases (6.5%) and ANSD in five cases (11% of all neonates tested). Contralateral suppression was absent in two of the ANSD cases (one associated with cochlear nerve aplasia, the other with hyperbilirubinemia) and present in three. The median latency for onset of contralateral suppression was 60 ms and offset latency 83 ms. The latency for offset of suppression was longer in neonates who required treatment for hyperbilirubinemia at 123 ms (P = .02, Mann‐Whitney rank sum test). Latency measurements were determined with high intraobserver reliability (Pearson product moment correlation coefficient > 0.96). Conclusions:: Contralateral suppression of real‐time DPOAE can reliably be identified in neonates. This is likely a manifestation of olivocochlear activity, although middle ear muscle reflexes might contribute to suppression in some circumstances. The technique provides a feasible objective test of hearing in neonates that can be applied in the NICU setting without sedation. The presence of a response indicates detection of sound by the contralateral ear and effective brainstem transmission of neural signals, therefore providing a more sensitive test of hearing than OAE alone. The high temporal resolution of the technique allows measurement of latency of the response. These benefits help to identify neonates at risk of ANSD and have the potential to provide prognostic information that will assist in the management of this unpredictable disorder. Further development of the technique is indicated with regard to determination of hearing threshold, frequency specific testing, and automation of response detection. Laryngoscope, 2011</abstract>
<note type="content">*This work was supported by grants from the Connaught Fund from the University of Toronto and the Hearing Research Foundation of Canada. The author has no other funding, financial relationships, or conflicts of interest to disclose.</note>
<subject lang="en"><genre>keywords</genre>
<topic>Neonatal hearing test</topic>
<topic>olivocochlear</topic>
<topic>otoacoustic emission</topic>
<topic>contralateral suppression</topic>
<topic>auditory neuropathy</topic>
<topic>Level of Evidence: 2b.</topic>
</subject>
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<note type="content"> Additional Supporting Information may be found in the online version of this article.Supporting Info Item: Supporting Figure A1. - Supporting Figure A2. - Supporting Figure S3. - Supporting Figure S4. - Supporting Figure S5. - Supporting Figure A6. - Supporting Figure A7. - Supporting Figure A8. - Supporting Figure A9. - Supporting Figure A10. - Supporting Figure A11. - Supporting Information Materials. - </note>
<subject><genre>article-category</genre>
<topic>Pediatric Ears/Otology</topic>
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<identifier type="ISSN">0023-852X</identifier>
<identifier type="eISSN">1531-4995</identifier>
<identifier type="DOI">10.1002/(ISSN)1531-4995</identifier>
<identifier type="PublisherID">LARY</identifier>
<part><date>2011</date>
<detail type="volume"><caption>vol.</caption>
<number>121</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>1</number>
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<extent unit="pages"><start>202</start>
<end>213</end>
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