OtoAcoustic Emissions (OAE’s)

Phenomenon and applications in audiological diagnostics

Measurement procedures
TEOAE and DPOAE
Physiological backgound, functional models

Acknowledgment: several illustrations and diagrams are taken from a

tutorial presentation of Prof. Sebastian Hoth, Heidelberg
Otoacoustic emissions (Dillier:
lecture Medical Acoustics)
Differentiation and quantification
of hearing disorders

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Advantages of OAE
measurement in audiology
 Objective response
 Response specific for cochlea
 Sensitive test
 Short test procedure
 Only passive cooperation required

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Clinical applications
 Detection of hearing disorder (newborn
screening, babies, children, adults with
suspected aggravation, functional hearing
loss)
 Monitoring of cochlear function (ototoxic
drugs, noise, degenerative processes,
intraoperative monitoring)
 Audiological differential diagnostics: specific
for cochlear lesions

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Types of otoacoustic
emissions
 Spontaneous otoacoustic emissions
(SOAE)
 Transitory evoked otoacoustic emissions
(TEOAE)
 Distortion product emissions (DPOAE)
 Stimulus frequency emissions (SFOAE)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

 Otoacoustic emissions (OAE)

Spontaneous
otoacoustic
emissions Evoked otoacoustic emissions (EOAE)
(SOAE)

Poststimulatory OAE Perstimulatory OAE

Transitory Stimulus frequency Otoacoustic

evoked OAE otoacoustic emissions distortion products
(TEOAE) (SFOAE) (DPOAE)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Otoacoustic emissions
Measurement equipment for
OAE recordings

Th. Janssen, in
Praxis der
Audiometrie
(Lehnhardt &
Otoacoustic emissions (Dillier: lecture Medical Acoustics) Laszig, 2000)
 Principle of evoked otoacoustic
emission measurements (EOAE)

Stimulus

Response

Amplitude Amplitude

Time Frequency
TEOAE DPOAE
Delayed OAE Distortion products
Transitory Evoked OtoAcoustic Emissions Distortion Product OtoAcoustic Emissions
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
TEOAE: Transitory (short stimulus, e.g. click)
Evoked OtoAcoustic Emissions

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

OAE: verification/optimization of stimulus/measurement conditions

1. Probe
Cerumen
Patency?
Orientation
Leakage
Stability

2. Stimulus
Level
Ear canal response

Remote from tympanic membrane

3. Environment 4. Patient
Ambient noise Respiration
Sound attenuation Movements
Room acoustics Cables
Ear plugs
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Probe related sources of error

Th. Janssen, in
Praxis der
Audiometrie
Otoacoustic emissions (Dillier: lecture Medical Acoustics) (Lehnhardt &
Laszig, 2000)
Improvement of signal/noise relation by 3-fold summation:

Emission Noise

3-fold test signal amplitude 1,7-fold

Otoacoustic emissions (Dillier: noise signal amplitude
lecture Medical Acoustics)
 SNR improvement is only dependent on number
of averages (n):

SNR improvement (Gain G):

S N ( n) A (n) AN (n) (c ⋅ n ) (c N ⋅ n ) n
G = 20 ⋅ log = 20 ⋅ log S = 20 ⋅ log s = 20 ⋅ log = 10 ⋅ log n
S N (1) AS (1) Otoacoustic
AN (1) emissions (Dillier: lecture Medical
cS cAcoustics)
N n
TEOAE: documentation of measurement and result

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

 Properties of
„true“ OAE?

Good measurement
conditions
Stimulus
STABILITY
A - B DIFF
reproducible
response
REPRO > 60%
SNR > 6 dB
Typical response properties:
• Emission amplitude between 0 and 25 dB SPL
• Emission duration > 6 ms
• Initially fast, later slower oscillations
• Amplitude decreases with increasing delay
• Amplitude decreases for higher
Otoacoustic frequencies
emissions (Dillier: lecture Medical Acoustics)
Polarity averaging and Binomial statistics:
What is the percentage of a positive amplitude at a fixed
temporal interval of a random signal?
Binomial distribution:
Polarity average

Meas. signal with

n>5: Gaussian distribution

Polarity average
Meas. signal

with
and

If the polarity average reaches a

Polarity average
value of α n, the signal is probably
not a random process (sig. level 1-α)
Time Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Nonlinearity and distortion

Amplitude
Output (linear)

Time

Input (linear)

Original signal
Intensity

Linear Amplification

Nonlinear amplification

Additional frequencies
Frequency

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Schematic diagram
Effect of cubic terms in the transfer function

Input u1(t) Nonlinear system Output u2(t)

u1 (t ) = c(sin ω1t + sin ω 2t ) u2 (t ) = a1u1 (t ) + a2u12 (t ) + a3u13 (t ) + ...

Quadratic distortions:

u12 (t ) = ... cos(ω 2 − ω1 )t + sin 2ω1t + cos(ω1 + ω 2 )t + sin 2ω 2t

Cubic distortions:
3ω1
u13 (t ) = ... sin( 2ω 2 − ω1 )t + sin( 2ω1 − ω 2 )t + terms with 2ω1 + ω 2
2ω 2 + ω1
3ω 2

„Distortion product“
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Equipment to measure distortion
products (DPOAE’s)

Th. Janssen, in
Praxis der
Audiometrie
Otoacoustic emissions (Dillier: lecture Medical Acoustics) (Lehnhardt &
Laszig, 2000)
 Stimulation using two sinewaves:
Superposition of the primary travelling waves and origin of
distortion products

stimulus f1 L1 = 70 dB SPL

stimulus f2 = 1.2 * f1 L2 = 70 dB SPL

DP 2f1-f2

f2
Base Apex
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Stimulation using two sinewaves:
Superposition of travelling waves

f1

f2

Base Apex

f2 f1

Base Apex

Overlap: maximum very close to f2

Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Spectrum
of DPOAE-
signal

Th. Janssen, in
Praxis der
Audiometrie
(Lehnhardt & Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Laszig, 2000)
 Audiological interpretation of OAE:

OAE‘s are results of the active cochlear

amplification
The more effective this amplification is...
1. ... the more sensitive the hearing
2. ... the larger the emissions

The OAE amplitude is inversely

proportional to the hearing threshold

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

 TEOAE or DPOAE?

Advantages of TEOAE Advantages of DPOAE

Smaller probe Less measurement noise

Up to 30 dB hearing Up to 50 dB hearing loss

loss

Technical artefacts Automatic interpretation

relatively ease to avoid

Suitable for screening Systematic inner ear diagnostics

If possible both TEOAE and DPOAE!

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

 TEOAE-Measurement at day 2 or 3

„pass“ „refer“

repeat

„refer“

ABR
etc.

„pass“

HI or
CI
Ok
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
DPOAE Screening device
(BioLogic)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

OAE-Echoscreen (Mack GmbH)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

OAE Screener Echocheck/Echosensor
(Otodynamics Ltd)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

GSI 60 DPOAE (Grason Stadler)

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

What does an alerting screening result mean?

development)
Hearing loss prevalence (language development)......: 3 : 1000
Sensitivity
Sensitivity.......................................................... : 100 %
Specifity
Specifity............................................................. : 92 %

What is the probability that a child with positive screening

result at the first OAE test session has indeed a hearing
loss?

Out of 1000 tested normal hearing

children 80 will show an alerting
screening result
Only in 3 out of 1000
children is a hearing disorder
to be expected

3 / 83 = 0,0361
Positive predictive value.......................................
value : 3,61 %

According to T. Steffens, Regensburg

Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Nonlinear cochlear mechanics:
Sensitivity and frequency selectivity at low stimulation levels

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Johnstone BM, Patuzzi R, Yates GK (1986) Basilar membrane measurements and the travelling wave. Hear Res 22: 147-153
Structure and function of outer hair cells
Tectorial membrane
Fast motility: transversal
K+
force on the hair bundle.
Active amplification?
Cuticular plate

Slow motility: longitudinal

force under efferent control.
Adaptation at high levels?
Electrical tuning

Deiters cells
efferent

afferent

Otoacoustic emissions (Dillier: lecture Medical Acoustics)

After Kim 1986
Cochlear Micromechanics

Amplification and sharpening of basilar

membrane vibrations through
• nonlinearity
• electromotility of outer hair cells

amplification

feedback nonlinearity

Preyer 1996 Otoacoustic emissions (Dillier: lecture Medical Acoustics)

Cochlear sound processing and generation of OAE

Threshold 0 dB

Threshold ~ 50 dB
Otoacoustic emissions (Dillier: lecture Medical Acoustics)
Active filter mechanisms