Professional Documents
Culture Documents
Otoacoustic Emissions
Thomas Gold (1948)
Suggested active elements related to hair cells and feedback system could produce emissions
If the ear canal is blocked with cerumen or vernix, may not be able to record OAE even though it was produced by the cochlea .
must rule out middle ear dysfunction if OAE is abnormal negative pressure,retracted TM, excessive compliance of m.e. system, fixation of ossicles, otitis media The anatomy of the middle ear is helpful for inward propagation of sound only. There is about a 15 dB loss of intensity for outward propagation of sound in the normal ear.
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
The outer hair cells are the source of OAEs. Shearing effect causes receptor potentials to trigger ionic changes. The cells respond by lengthening and shortening at the frequency of the stimulus. This is what we record. Complete loss of OHC elevates threshold 4050 dB. OHC are susceptible to inflammation, ototoxicity, trauma, acoustic trauma. ototoxic drugs (Remember, this is a test of outer hair cell function only, some KUNNAMPALLIL GEJO JOHN, BASLP,MASLP ototoxic drugs affect only inner hair cells)
provides energy to cochlea Decreased blood supply affects OHC motility. Some drugs (e.g. lasix) affect stria vascularis.
Inhibitory system Stimulating the efferent fibers suppresses OHC activity. OAE may be larger in infants than adults because the efferent nervous system is not mature yet.
produced by click or tone burst produced by continuous pure tone produced by 2 continuous pure tones
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
Stimulus frequency
Distortion product
Measurement Techniques
Measurement Techniques
Distortion Product Otoacoustic Emissions (DPOAE)
DPOAE/TEOAE
DPOAE measurement
Stimulus- two pure tones presented simultaneously producing intermodulary distortion F1 is the lower frequency (more apical). L1 is intensity of F1. F2 is the higher frequency (more basal). L2 is intensity of F2.
Frequency F2;F1 Use a ratio which produces the highest amplitude of the DPOAE response e.g. F2/F1= 1.2 Measure the DPOAE at 2F1-F2. e.g. F1= 2,000, F2 =2,400 DP= 1,600 2(2,000) - 2,400=1,600 upper limits DPOAE: can test up to 10,000 Hz (F2) testing with F2 below 1,000 Hz is difficult due to physiological noise. Remember, DP is measured at a lower frequency than F2 KUNNAMPALLIL GEJO JOHN,
BASLP,MASLP
Intensity L2;L1
L1 and L2 must be at moderate intensity level Avoid high intensity (>70dB) which will cause false negative due to passive distortion of the BM best responses recorded when L2 is about 10 dB less than L1 recommendation: L1=65 dB, L2= 55 dB
DPOAE Analysis
DPOAE analysis
For an intensity ratio of F1=F2+10 dB, the response from the cochlea is generated at the F2. So, use F2 as horizontal axis on the DP gram For an intensity ratio of F1=F2, the response from the cochlea is generated near the geometric mean of F1 and F2 So, use geometric mean as horizontal axis on the DP gram.
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
DPOAE analysis
DP should exceed noise floor by at least 6 dB to be valid. absolute value of normal DP varies by frequency (see normative data in OAE program) When comparing DPOAE to an audiogram, try to obtain F2 as close to audiometric frequency as possible, can use more points/octave.
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
TEOAE collection
Collection
TEOAE analysis
reproducability- related to TE-NF
overall by frequency band may set up pass refer criteria based on reproducability
Beginning to test
Test procedure Reduce noise in test area as much as possible. If possible, perform otoscopic exam (probably not possible in neonates). If patient is old enough to follow instructions, ask patient to remain quiet and still. Clip probe to patients clothing or other stationary object to cut down on noise. Insert probe in ear canal as deeply as possible (be careful not to canal probe). ...
Test procedure(cont.)
do not need to test in sound booth, but environmental noise ldo not need to test in sound booth, but environmental noise levels should be as low as possible can test with patent PE tubes, helpful to have patient hold their breath during the test levels should be as low as possible can test with patent PE tubes, helpful to have patient hold their breath during the test
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
Patient Information
Reset hardware
(optional)
Begin Collection
Setup
Select Protocol
Superimposed
Separate
File names
example 98J20D00
98= year J= 10th month (Oct.) 20= date D= distortion product otoacoustic emission
Pass/ Refer
Reference Data
TE Screen Protocol
Practice
Practice Information
Troubleshooting
Confirm that actual stimulus intensities plotted are close to target stimulus intensities. If not, be sure probe is still in ear and tubes are attached between speaker and mike assemblies. Check spectrum of stimulus in ear to be sure that there are no large dips in ear canal acoustics. If there large dips in stimulus spectrum that the system cannot compensate for, try refitting probe in ear. if no sound or very low intensity sound is emitted from probe, clean probe by removing mike from back of probe and insert cleaning tool in mike port and 2 speaker ports
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
Age/Gender
Neonates have larger OAEs till one year after birth At 30 weeks gestational age cochlea is mature (assuming normal development) Advancing age does not affect OAE (corrected for hearing loss) Gender a factor only for Transients or Spontaneous, but not Distortion Products but not Distortion Products(females stronger TEOAEs than KUNNAMPALLIL males) GEJO JOHN,
BASLP,MASLP
Applications
Neonatal hearing screening Preschool and school age hearing screening Ototoxicity Functional hearing loss Cochlear v.s. Retro-cochlear Monitoring noise exposure Tinnitus (confirms cochlear dysfunction)
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
92587 Evoked Otoacoustic emissions, limited (single stimulus level, either transient and/or distortion products 92588 Evoked Otoacoustic emissions, comprehensive or diagnostic evaluation (comparison of transient and/ or distortion product Otoacoustic emissions at multiple levels and frequencies contact insurance companies to see what they reimburse in your area
KUNNAMPALLIL GEJO JOHN, BASLP,MASLP
CPT codes
AuDx Link
Select file
YES