Routine use of cochlear audiometry in infants with uncertain diagnosis.
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Biomedical subjects
Publications and source records attributed to H Sohmer.
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Experiments were conducted to determine whether a consistent pattern of auditory nerve brain-stem evoked synaptic lesion model in cats (elevated levels of the lesion model in cats (elevated levels of the barbiturate thiopental). The ABP in response to low (10/sec) and high (80/sec) stimulus rates was recorded. In order to differentiate between the effects of the elevated drug levels on axonal propagation and on synaptic transmission, the early components of the somatosensory evoked potential (SEP) were also recorded, with particular attention to the first SEP wave, which is solely an axonal event without any intervening synapse. Calculations showed that the effect on synapses was 3.0-9.5 times greater than the effect of the drug on axonal propagation. As the level of barbiturates increased (representing a more severe synaptic lesion), the interpeak latencies of the ABP and the SEP became progressively prolonged, more so than the dependence of the first waves of both the ABP and the SEP on drug level. In general, amplitudes were not affected. At progressively elevated drug levels, higher stimulus repetition rates did not have an increasingly greater effect than lower rates on evoked response latencies and amplitudes so that this study also shows that the use of elevated stimulus rates does not hold much promise in the diagnosis of synaptic lesions.
Auditory nerve brain-stem (ABR) and somatosensory evoked responses (SER) were recorded in cats as body temperature was uniformly lowered from 37 to 27 degrees C. Analysis of the results showed that the alterations in the evoked responses were due to disturbances induced both in axonal propagation and synaptic transmission by the hypothermia. By studying the first wave of the SER, which is solely an axonal event, and by assuming reasonable values for the total synaptic delay and axonal propagation times along the ABR pathway, it was concluded that this lesion model induced an effect on synaptic transmission 1.3-1.7 times greater than that on axonal propagation. There was a strong inverse correlation between wave latency and body temperature, with slightly steeper slopes for the longer latency waves. Wave amplitudes were not correlated with temperature. Furthermore, the wave latencies and amplitudes were generally not dependent on stimulus rate.
Auditory brain-stem evoked responses were recorded in normal neonates and infants ranging in age from less than 1 h to 5.5 months. The average threshold in neonates 0-5 h old was 29 dB greater than that in adults, reaching the adult threshold range within 2 weeks. The latency of wave I in 0-5 h neonates was 1.81 msec and reached the adult range within 2 weeks. The V-I interpeak latency in 0-5 h neonates was 5.3 msec and did not reach adult values within the period of this study.
We have succeeded in recording short and middle latency vestibular evoked responses in human subjects. The head was held rigidly in a special, patented head holder, constructed individually for each subject, which gripped the teeth of the upper jaw. The stimulus consisted of 2/sec steps of angular acceleration impulses produced by a special motor with intensities of about 10,000 degrees/sec 2 and with a rise time of 1-2 msec. The electrical activity was recorded as the potential difference between special forehead and mastoid electrodes having a large, secure contact area with the skin. The activity was digitally filtered and averaged in 2 separate channels by means of a Microshev 2000 evoked response system. The short latency responses, with peaks at about 3.5 msec (forehead positive), 6.0 msec (forehead negative) and 8.4 msec (forehead positive; bandpass: 200-2000 Hz; average of 1024 trials), had amplitudes of about 0.5 microV. The middle latency responses had peaks at about 8.8 msec (forehead positive), 18.8 msec (forehead negative) and 26.8 msec (forehead positive; 30-300 Hz; N = 128 trials), with larger amplitudes (about 15 microV). These responses were consistently recorded in the same subject at different times and were similar in different normal subjects. Strenuous control experiments were conducted in order to ensure that these responses are not artefacts due to the movement of conducting media (head, electrodes and leads) in the electromagnetic field of the motor and are elicited by activation of normal labyrinths.(ABSTRACT TRUNCATED AT 250 WORDS)
Short latency vestibular evoked potentials (VsEPs) to angular acceleration impulses (maximal intensity 20,000 degrees/sec2, rise time 1.5-3 msec) were recorded by skin electrodes in cats before and after various surgical procedures. Under general anesthesia, the animals underwent unilateral labyrinthectomy and the VsEPs in response to stimulation of the remaining inner ear in the plane of the lateral semicicular canal (SCC) with the head flexed 20 degrees-25 degrees were recorded as a baseline. The lateral SCC was then selectively obliterated near its ampulla. This induced major changes in the VsEPs recorded in response to stimulation of the remaining inner ear in this plane: the first 2 VsEP waves were absent, and only longer latency, smaller amplitude waves were present in response to both clockwise and counterclockwise stimulation. On the other hand, obliteration of the anterior and posterior SCCs and, in addition, destruction of both maculae were without major effects on the first 2 VsEP waves in response to excitatory stimulation. The results confirm that when the head is flexed 20 degrees-25 degrees and stimulated with angular acceleration impulses in the horizontal plane, the major site of initiation of the VsEPs in cats and probably in man is the crista ampullaris of the lateral SCC.
Cochlear microphonic potentials (CM) were recorded, by means of surface electrodes, before, during and after white-noise-induced temporary threshold shifts (TTS) in human volunteers. The behavioural threshold shift was not accompanied by a change in amplitude of CM. These findings indicate that in humans, the site affected by the noise exposure and which probably gives rise to the TTS is central to the site of generation of CM. In a previous study, the compound action potential generated in the auditory nerve was found to be of lower amplitude and longer latency during TTS, and it is thus proposed that the site affected is peripheral to the generation of conducted action potentials. The synapse between hair cells and the auditory nerve fibres is the most likely candidate to be the affected site.
Otoacoustic emissions (OAEs) represent acoustic energy generated by the cochlear amplifier which contributes to auditory sensitivity and frequency discrimination. Therefore the OAEs can serve as a noninvasive tool to study the cochlear amplifier. While transient evoked OAEs (TEOAEs) are generally recorded clinically in man, it has been difficult to record them in animals and instead cubic distortion product OAEs (DPOAEs) have been experimentally studied in animals. In a previous study, we perfected a method of recording TEOAEs routinely in rats and this technique was used here to study the development of OAEs in neonatal rats. TEOAEs were recorded and compared to the DPOAEs on several postnatal days. With increasing postnatal age, TEOAE peak-to-peak amplitude and spectral energy in the 2- to 4-kHz band increased, their threshold decreased and their input-output functions became less monotonic with a change in slope (notch and/or plateau) in the mid-intensity region. The DPOAEs to higher frequencies appeared first, then the TEOAEs, followed by the DPOAEs to lower frequencies. With age, their amplitude also increased, thresholds decreased and a notch appeared in their input-output functions. The TEOAEs were measurable during the continuum of the appearance of the DPOAEs and the developmental sequences of both types of OAEs were similar. This may be evidence that similar mechanisms account for their maturation which probably initially involves a reduction in the air-bone gap with maturation of the outer and middle ears, and then elevation of the endocochlear potential and additional micromechanical maturations.
In order to study the energy dependence of the cochlear amplifier, transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were recorded in rats during gradual cooling to 27 degrees C and heating to 40 degrees C. In the range 33-39 degrees C, the TEOAEs and DPOAEs were maximal in amplitude and almost insensitive to temperature. However, they were significantly depressed (reversibly) at higher and lower temperatures. Intensity functions were plotted at 37, 27 and 40 degrees C for both types of oto-acoustic emissions. At 37 degrees C intensity functions were nonlinear, with a notch at mid-intensity regions. At 27 degrees C, the magnitudes were depressed more at the lower intensities and threshold elevations were observed. As a result, the intensity functions were more linear and the notch was no longer seen. This result provides further evidence for a more active, energy-dependent component of the otoacoustic emissions at lower intensities for both TEOAEs and DPOAEs. The cooling probably affects the lower intensity otoacoustic emissions by inducing a depression in the endocochlear potential, by reducing the motility of the outer hair cells and by introducing a small conductive hearing loss.
There have been reports that the developing ear is more sensitive than the adult ear to noise-induced hearing loss. This was investigated by testing auditory function in rats, both electrophysiologically and histologically, following exposure to broad-band noise (12 h/day for 15 days) at different stages of auditory development (neonates and adults), and also in age-matched controls. An exposure of 90 dB SPL broad-band noise caused no long-term change in auditory function in either age group. A higher exposure (102 dB SPL) caused greater long-term changes in hearing in the adult compared to the young noise-exposed rats, although histology showed greater damage to hair cells in the younger animals. Therefore, functionally, the developing ear does not seem more vulnerable than the developed ear to acoustic trauma.
This study was designed to investigate the effect of various durations of noise exposure in animals on physiological responses from the cochlea which are also used clinically in humans: auditory brainstem response (ABR), transient evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs). Rats were exposed to 113 dB SPL broad-band noise (12 h on/12 h off) for durations of 3, 6, 9, 12, 15 and 21 days, and tested 24 h after cessation of the noise and again after a period of 6 weeks. ABR threshold to click stimuli and to a 2-kHz tone burst (TB), TEOAE energy content and DPOAE amplitude in the exposed rats were compared to those in a group of control rats not exposed to noise. ABR thresholds (click and TB) were significantly elevated in all exposure duration groups compared to control rats. DPOAE amplitudes and TEOAE energy content were significantly reduced. The mean ABR thresholds following 21 days exposure were significantly greater (click = 100 dB pe SPL; TB = 115 dB pe SPL) than those following 3 days exposure (click = 86 dB pe SPL; TB = 91 dB pe SPL). Linear regression analysis between recorded responses and duration of noise exposure (days) showed a significant increase in ABR thresholds of approximately 0.8-- 1.4 dB/day. TEOAE and DPOAE responses showed no such dependence on noise duration and were already maximally reduced after only 3 days of exposure. This can be explained by the possibility that short noise exposures may cause damage to the early, more active stages of cochlear transduction (as shown by TEOAEs and DPOAEs). As the noise exposure continues, further damage may be induced at additional, later stages of the cochlear transduction cascade (as shown by ABR). Thus, ABR seems more sensitive to noise duration than OAE measures.
The human fetus in utero is able to respond to sounds in the amniotic fluid enveloping the fetus after about 20 weeks gestation. The pathway by which sound reaches and activates the fetal inner ear is not entirely known. It has been suggested that in this total fluid environment, the tympanic membrane and the round window membrane become 'transparent' to the sound field, enabling the sounds to reach the inner ear directly through the tympanic membrane and the round window membrane. It is also possible that sounds reach the inner ear by means of tympanic membrane--ossicular chain--stapes footplate conduction (as in normal air conduction). There is also evidence that sounds reach the fetal inner ear by bone conduction. Several animal and human models of the fetus in utero were studied here in order to investigate the pathway enabling sounds to reach and activate the fetal inner ear. This included studying the auditory responses to sound stimuli of animals and humans under water. It was clearly shown in all the models that the dominant mechanism was bone conduction, with little if any contribution from the external and middle ears. Based on earlier experiments on the mechanism and pathway of bone conduction, the results of this study lead to the suggestion that the skull bone vibrations induced by the sound field in the amniotic fluid enveloping the fetus probably give rise to a sound field within the fetal cranial cavity (brain and CSF) which reaches the fetal inner ear through fluid communication channels connecting the cranial cavity and the inner ear.
Postnatal functional changes in the activity of the ear and auditory pathway in neonatal guinea pigs [from day of birth (postnatal day, PND = 0), PNDs 1-4, 7 and then weekly up to 7 weeks] were studied as a model of maturation of hearing in human neonates. On the day of birth there were signs of a conductive hearing loss: negative middle ear pressure, auditory nerve brainstem evoked response (ABR) threshold elevation, ABR wave 1 latency prolongation and low amplitude otoacoustic emissions. The conductive hearing loss is probably a result of the (amniotic) fluid found in the neonatal middle-ear cavity. Over the next PNDs, this conductive hearing loss was resolved. In order to confirm this neonatal conductive hearing loss and its resolution, saline was instilled into the middle ear of guinea pigs. This induced signs of a conductive hearing loss similar to those seen in the neonatal guinea pigs which disappeared with clearance of this fluid. Therefore it may be concluded that most of the changes in auditory function seen over the first PNDs are due to absorption of amniotic fluid from the middle-ear cavity.
It seems that many auditory maturational events are regulated by thyroid hormone since elevation in thyroid hormone level always precedes the onset of hearing in the fetus-neonate; low thyroid activity in the developing human fetus or rat neonate leads to hearing loss; earlier, elevated thyroid levels in rat neonate lead to earlier onset of hearing. The hormone, bound to its receptors in the nucleus, acts as a transcription factor activating genes which lead to the synthesis of several proteins and enzymes involved in the structural and functional development of many tissues (e.g. brain, heart, kidney, skeletal muscle) including the ear. Several types of congenital hearing loss of unexplained etiology may be due to abnormalities in one or more stages of this gene cascade since several types of congenital hearing loss have been shown to involve defects in genes related to these events.