Distortion-product otoacoustic emissions in middle-aged subjects with normal versus potentially presbyacusic high-frequency hearing loss.

Distortion-product otoacoustic emissions (DPOAEs) are still undergoing evaluation for clinical use. Although the effects of ageing on otoacoustic emissions have been studied quite extensively in the past, DPOAE response-growth or input-output (I-O) measures, which are well suited as an objective method for monitoring cochlear function at specific frequencies, have been less thoroughly examined. The aim of the present study was to assess the 2f1-f2 DPOAEs in a clinical setting in order to examine the response of 20 normally hearing middle-aged adults and to compare the results with those of 20 people of the same age with ears of sensorineural high-frequency hearing loss (HL). The experiment consisted of two stages. First, the DPOAE-gram was recorded in 1-4-octave steps at a stimulus level of 70 dB SPL over a frequency range of the f2 primary tone which extended from 1.001 to 6.299 kHz. Secondly, in order to elicit DPOAE I-O functions, the two primary stimuli were presented at equilevel intensities ranging from 20 to 71 dB SPL. The stimulus-level step size was 3 dB. The I-O functions were recorded at five separate DPOAE frequencies, with the f2 frequency most closely related to the clinical audiogram (f2 = 1.0, 1.5, 2.0, 4.0 and 6.0 kHz). Two clearly separated portions in the form of the I-O function for normally hearing ears were found. The first portion, in response to primary levels of 60 dB SPL and below, showed a plateau (saturating) behaviour. If primary levels exceeded 60 dB SPL, I-O functions became more linear. The attenuation of the saturation portion of the I-O function in ears with high-frequency HL across the frequency-test range is difficult to explain because elevated behavioural thresholds were observed only for frequencies > 1.5 kHz. Thus, the more linear I-Os associated with the hearing-loss frequencies may indicate deficiencies in the active properties of outer hair cells (OHCs), whereas those for I-Os < 1.5 kHz, where hearing was normal, may indicate a beginning of damage to active OHC micromechanical processes prior to their clinical manifestation. DPOAE recordings from people with high-frequency HL, possibly age-related, supplement recordings of TEOAEs and give complementary information on degenerative changes in the outer hair-cells. DPOAE I-O functions may reveal discrete pathological alterations both in the active cochlear signal processing and in the passive mechanisms of the cochlea prior to their detection by clinical audiometric tests.