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Contralateral Ear Occlusion for Improving the Reliability of Otoacoustic Emission Screening Tests

DOI: 10.1155/2014/248187

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Newborn hearing screening is an established healthcare standard in many countries and testing is feasible using otoacoustic emission (OAE) recording. It is well documented that OAEs can be suppressed by acoustic stimulation of the ear contralateral to the test ear. In clinical otoacoustic emission testing carried out in a sound attenuating booth, ambient noise levels are low such that the efferent system is not activated. However in newborn hearing screening, OAEs are often recorded in hospital or clinic environments, where ambient noise levels can be 60–70?dB SPL. Thus, results in the test ear can be influenced by ambient noise stimulating the opposite ear. Surprisingly, in hearing screening protocols there are no recommendations for avoiding contralateral suppression, that is, protecting the opposite ear from noise by blocking the ear canal. In the present study we have compared transient evoked and distortion product OAEs measured with and without contralateral ear plugging, in environmental settings with ambient noise levels <25?dB SPL, 45?dB SPL, and 55?dB SPL. We found out that without contralateral ear occlusion, ambient noise levels above 55?dB SPL can significantly attenuate OAE signals. We strongly suggest contralateral ear occlusion in OAE based hearing screening in noisy environments. 1. Introduction Audiometric testing in general is best carried out in a low noise environment. Indeed most clinical testing is done in sound attenuating booths, where background noise levels are typically below 20?dB SPL (for frequencies of audiometric interest). For performing behavioral (pure tone and speech audiometry) and physiological tests (auditory evoked potentials and OAEs) the focus has been on maintaining a good signal to noise ratio for the test signals presented. The issue addressed in the present study pertains not to the test ear but to the contralateral ear that may or may not be occluded. In neonatal or newborn hearing screening with OAEs most protocols do not specify any occlusion or plugging of the nontest ear (e.g., [1–11]). However, such screening tests are routinely carried out in a noisy hospital or clinic environments. Newborn babies may be screened in patient’s rooms, clinical areas, or a neonatal intensive care unit (NICU), where ambient sound levels can be as high as 60–70?dB SPL (e.g., [12–16]). The American Academy of Pediatrics recommends that sound levels in an NICU should not exceed 45?dB, but most often this is not the case. Indeed a review by Konkani and Oakley reveals that ambient noise levels in typical NICUs can exceed 80?dB


[1]  American Academy of Pediatrics, Joint Committee on Infant Hearing, “Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs,” Pediatrics, vol. 120, no. 4, pp. 898–921, 2007.
[2]  H. D. Nelson, C. Bougatsos, and P. Nygren, “Universal newborn hearing screening: systematic review to update the 2001 US preventive services task force recommendation,” Pediatrics, vol. 122, no. 1, pp. e266–e276, 2008.
[3]  W. D. Eiserman, D. M. Hartel, L. Shisler, J. Buhrmann, K. R. White, and T. Foust, “Using otoacoustic emissions to screen for hearing loss in early childhood care settings,” International Journal of Pediatric Otorhinolaryngology, vol. 72, no. 4, pp. 475–482, 2008.
[4]  T. Foust, W. Eiserman, L. Shisler, and A. Geroso, “Using otoacoustic emissions to screen young children for hearing loss in primary care settings,” Pediatrics, vol. 132, no. 1, pp. 118–123, 2013.
[5]  M. J. Barker, E. K. Hughes, and M. Wake, “NICU-only versus universal screening for newborn hearing loss: population audit,” Journal of Paediatrics and Child Health, vol. 49, no. 1, pp. E74–E79, 2013.
[6]  V. S. de Freitas, K. de Freitas Alvarenga, M. C. Bevilacqua, M. A. N. Martinez, and O. A. Costa, “Critical analysis of three newborn hearing screening protocols,” Pro-Fono, vol. 21, no. 3, pp. 201–206, 2009.
[7]  S. Hatzopoulos, J. Petruccelli, A. Ciorba, and A. Martini, “Optimizing otoacoustic emission protocols for a UNHS program,” Audiology and Neurotology, vol. 14, no. 1, pp. 7–16, 2008.
[8]  M. Ptok, “Fundamentals of hearing screening in neonates (standard of care),” Zeitschrift fur Geburtshilfe und Neonatologie, vol. 207, no. 5, pp. 194–196, 2003.
[9]  S. Bansal, A. Gupta, and A. Nagarkar, “Transient evoked otoacoustic emissions in hearing screening programs-Protocol for developing countries,” International Journal of Pediatric Otorhinolaryngology, vol. 72, no. 7, pp. 1059–1063, 2008.
[10]  G. Pastorino, P. Sergi, M. Mastrangelo et al., “The Milan Project: a newborn hearing screening programme,” Acta Paediatrica, vol. 94, no. 4, pp. 458–463, 2005.
[11]  D. J. MacKenzie and L. G. U. Galbrun, “Noise levels and noise sources in acute care hospital wards,” Building Services Engineering Research and Technology, vol. 28, no. 2, pp. 117–131, 2007.
[12]  E. McLaren and C. Maxwell-Armstrong, “Noise pollution on an acute surgical ward,” Annals of the Royal College of Surgeons of England, vol. 90, no. 2, pp. 136–139, 2008.
[13]  W. B. Carvalho, M. L. G. Pedreira, and M. A. L. De Aguiar, “Noise level in a pediatric intensive care unit,” Jornal de Pediatria, vol. 81, no. 6, pp. 495–498, 2005.
[14]  J. L. Darbyshire and J. D. Young, “An investigation of sound levels on intensive care units with reference to the WHO guidelines,” Critical Care, vol. 17, no. 5, p. R187, 2013.
[15]  C. Tegnestedt, A. Günther, A. Reichard et al., “Levels and sources of sound in the intensive care unit—an observational study of three room types,” Acta Anaesthesiologica Scandinavica, vol. 57, no. 8, pp. 1041–1050, 2013.
[16]  A. Konkani and B. Oakley, “Noise in hospital intensive care units—a critical review of a critical topic,” Journal of Critical Care, vol. 27, no. 5, pp. 522.e1–522.e9, 2012.
[17]  D. T. Kemp, “Stimulated acoustic emissions from within the human auditory system,” Journal of the Acoustical Society of America, vol. 64, no. 5, pp. 1386–1391, 1978.
[18]  J. H. Siegel and D. O. Kim, “Effect neural control of cochlear mechanics? Olivocochlear bundle stimulation affects cochlear biomechanical nonlinearity,” Hearing Research, vol. 6, no. 2, pp. 171–182, 1982.
[19]  M. C. Liberman, “Rapid assessment of sound-evoked olivocochlear feedback: suppression of compound action potentials by contralateral sound,” Hearing Research, vol. 38, no. 1-2, pp. 47–56, 1989.
[20]  E. H. Warren III and M. C. Liberman, “Effects of contralateral sound on auditory-nerve responses. I. Contributions of cochlear efferents,” Hearing Research, vol. 37, no. 2, pp. 89–104, 1989.
[21]  M. C. Liberman, S. Puria, and J. J. Guinan Jr., “The ipsilaterally evoked olivocochlear reflex causes rapid adaptation of the 2f1-f2 distortion product otoacoustic emission,” Journal of the Acoustical Society of America, vol. 99, no. 6, pp. 3572–3584, 1996.
[22]  J. J. Guinan Jr., “Olivocochlear efferents: anatomy, physiology, function, and the measurement of efferent effects in humans,” Ear and Hearing, vol. 27, no. 6, pp. 589–607, 2006.
[23]  A. L. James, R. V. Harrison, M. Pienkowski, H. R. Dajani, and R. J. Mount, “Dynamics of real time DPOAE contralateral suppression in chinchillas and humans,” International Journal of Audiology, vol. 44, no. 2, pp. 118–129, 2005.
[24]  J. B. Mott, S. J. Norton, S. T. Neely, and W. B. Warr, “Changes in spontaneous otoacoustic emissions produced by acoustic stimulation of the contralateral ear,” Hearing Research, vol. 38, no. 3, pp. 229–242, 1989.
[25]  L. Collet, D. T. Kemp, E. Veuillet, R. Duclaux, A. Moulin, and A. Morgon, “Effect of contralateral auditory stimuli on active cochlear micro-mechanical properties in human subjects,” Hearing Research, vol. 43, no. 2-3, pp. 251–261, 1990.
[26]  J.-L. Puel and G. Rebillard, “Effect of contralateral sound stimulation on the distortion product 2F1-F2: evidence that the medial efferent system is involved,” Journal of the Acoustical Society of America, vol. 87, no. 4, pp. 1630–1635, 1990.
[27]  E. Veuillet, L. Collet, and R. Duclaux, “Effect of contralateral acoustic stimulation on active cochlear micromechanical properties in human subjects: dependence on stimulus variables,” Journal of Neurophysiology, vol. 65, no. 3, pp. 724–735, 1991.
[28]  A. Moulin, L. Collet, and R. Duclaux, “Contralateral auditory stimulation alters acoustic distortion products in humans,” Hearing Research, vol. 65, no. 1-2, pp. 193–210, 1993.
[29]  C. I. Berlin, L. J. Hood, A. Hurley, and H. Wen, “Contralateral suppression of otoacoustic emissions: an index of the function of the medial olivocochlear system,” Otolaryngology—Head and Neck Surgery, vol. 110, no. 1, pp. 3–21, 1994.
[30]  D. M. Williams and A. M. Brown, “The effect of contralateral broad-band noise on acoustic distortion products from the human ear,” Hearing Research, vol. 104, no. 1-2, pp. 127–146, 1997.
[31]  A. L. Giraud, J. Wable, A. Chays, L. Collet, and S. Chéry-Croze, “Influence of contralateral noise on distortion product latency in humans: is the medial olivocochlear efferent system involved?” Journal of the Acoustical Society of America, vol. 102, no. 4, pp. 2219–2227, 1997.
[32]  S. Maison, C. Micheyl, G. Andéol, S. Gallégo, and L. Collet, “Activation of medial olivocochlear efferent system in humans: influence of stimulus bandwidth,” Hearing Research, vol. 140, no. 1-2, pp. 111–125, 2000.
[33]  A. L. James, R. J. Mount, and R. V. Harrison, “Contralateral suppression of DPOAE measured in real time,” Clinical Otolaryngology and Allied Sciences, vol. 27, no. 2, pp. 106–112, 2002.
[34]  J. J. Guinan Jr., B. C. Backus, W. Lilaonitkul, and V. Aharonson, “Medial olivocochlear efferent reflex in humans: otoacoustic emission (OAE) measurement issues and the advantages of stimulus frequency OAEs,” Journal of the Association for Research in Otolaryngology, vol. 4, no. 4, pp. 521–540, 2003.
[35]  R. V. Harrison, A. Sharma, T. Brown, S. Jiwani, and A. L. James, “Amplitude modulation of DPOAEs by acoustic stimulation of the contralateral ear,” Acta Oto-Laryngologica, vol. 128, no. 4, pp. 404–407, 2008.
[36]  A. L. James, “The assessment of olivocochlear function in neonates with real-time distortion product otoacoustic emissions,” Laryngoscope, vol. 121, no. 1, pp. 202–213, 2011.
[37]  J. T. Jacobson, “The effects of noise in transient EOAE newborn hearing screening,” International Journal of Pediatric Otorhinolaryngology, vol. 29, no. 3, pp. 235–248, 1994.
[38]  B. O. Olusanya, “Ambient noise levels and infant hearing screening programs in developing countries: an observational report,” International Journal of Audiology, vol. 49, no. 8, pp. 535–541, 2010.
[39]  A. Shnerson, C. Devigne, and R. Pujol, “Age-related changes in the C57BL/6J mouse cochlea. II. Ultrastructural findings,” Brain Research, vol. 254, no. 1, pp. 77–88, 1981.
[40]  D. D. Simmons, “Development of the inner ear efferent system across vertebrate species,” Journal of Neurobiology, vol. 53, no. 2, pp. 228–250, 2002.
[41]  A. V. Bulankina and T. Moser, “Neural circuit development in the mammalian cochlea,” Physiology, vol. 27, no. 2, pp. 100–112, 2012.
[42]  Y. Narui, A. Minekawa, T. Iizuka et al., “Development of distortion product otoacoustic emissions in C57BL/6J mice,” International Journal of Audiology, vol. 48, no. 8, pp. 576–581, 2009.
[43]  R. Chabert, M. J. Guitton, D. Amram et al., “Early maturation of evoked otoacoustic emissions and medial olivocochlear reflex in preterm neonates,” Pediatric Research, vol. 59, no. 2, pp. 305–308, 2006.
[44]  C. Abdala, E. Ma, and Y. S. Sininger, “Maturation of medial efferent system function in humans,” Journal of the Acoustical Society of America, vol. 105, no. 4, pp. 2392–2402, 1999.
[45]  T. Morlet, A. Hamburger, J. Kuint et al., “Assessment of medial olivocochlear system function in pre-term and full-term newborns using a rapid test of transient otoacoustic emissions,” Clinical Otolaryngology and Allied Sciences, vol. 29, no. 2, pp. 183–190, 2004.


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