Reliable Long-Term Serial Evaluation of Cochlear Function Using Pulsed Distortion-Product Otoacoustic Emissions: Analyzing Levels and Pressure Time Courses.

Objectives: To date, there is no international standard on how to use distortion-product otoacoustic emissions (DPOAEs) in serial measurements to accurately detect changes in the function of the cochlear amplifier due, for example, to ototoxic therapies, occupational noise, or the development of regenerative therapies. The use of clinically established standard DPOAE protocols for serial monitoring programs appears to be hampered by multiple factors, including probe placement and calibration effects, signal-processing complexities associated with multiple sites of emission generation as well as suboptimal selection of stimulus parameters.

Design: Pulsed DPOAEs were measured seven times within 3 months for f2 = 1 to 14 kHz and L2 = 25 to 80 dB SPL in 20 ears of 10 healthy participants with normal hearing (mean age = 32.

Test-retest reliability of distortion-product thresholds compared to behavioral auditory thresholds.

When referred to baseline measures, serial monitoring of pure-tone behavioral thresholds and distortion-product otoacoustic emissions (DPOAEs) can be used to detect the progression of cochlear damage. Semi-logarithmic DPOAE input-output (I/O) functions enable the computation of estimated distortion-product thresholds (EDPTs) by means of linear regression, a metric that provides a quantitative estimate of hearing loss due to cochlear-amplifier degradation. DPOAE wave interference and a suboptimal choice of stimulus levels limit the accuracy of EDPTs.

Derivation of input-output functions from distortion-product otoacoustic emission level maps.

Distortion-product otoacoustic emissions (DPOAEs) emerge from the cochlea when elicited with two tones of frequencies f and f. DPOAEs mainly consist of two components, a nonlinear-distortion and a coherent-reflection component. Input-output (I/O) functions of DPOAE pressure at the cubic difference frequency, f=2f-f, enable the computation of estimated distortion-product thresholds (EDPTs), offering a noninvasive approach to estimate auditory thresholds.