David M. Mills

The purpose of this study was to further investigate the possibility of developing noninvasive methods of differential diagnosis of hearing disorders through the study of experimental animals with induced lesions. In particular, it was desired to compare distortion product otoacoustic emission (DPOAE) responses and auditory brain stem response (ABR) thresholds in Mongolian gerbils having either acoustic or strial damage, using as a reference the same responses measured in a control group of normal young adult gerbils. The goal was to evaluate the potential clinical application of this approach to determining the dominant contribution to sensorineural hearing loss in individual human subjects. DPOAE input-output functions and ABR thresholds were measured over a wide range of stimulus frequencies for three groups: (1) a reference group of normal young adult gerbils; (2) a group in which acoustic damage had been induced 2 wk earlier; (3) a group in which damage to the stria vascularis was induced by a series of furosemide injections. The responses in the experimental groups relative to the normal means were compared to determine which combinations of responses were effective in discriminating between animals with different lesions. Three measures were evaluated in detail: the ABR threshold, the emission threshold at a criterion emission amplitude, and the emission amplitude at a high stimulus level. Considering cases with significant hearing loss (ABR thresholds elevated by 20 dB or more), the best method for distinguishing between the two lesions involved a two-dimensional plot comparing emission and ABR thresholds at the same stimulus frequencies. Acoustic damage cases were found in a broad region where the emission and ABR thresholds were roughly equal, whereas strial damage cases were found in a narrower region where the emission threshold was about 0.4 times the ABR threshold (both in dB). These two cases were compared with a third case introduced by definition, that is, damage to inner hair cell or neural systems resulting in an increase in audiometric threshold but no change in emission responses (e.g., auditory neuropathy). The responses for these three cases were found to lie in different regions of the two-dimensional plot comparing emission and ABR thresholds, provided only that ABR thresholds were elevated 20 dB or more. This diagram also revealed cases of preclinical acoustic damage, in which the ABR threshold was shifted less than 20 dB but where the emission threshold was significantly elevated. The results clearly demonstrate the possibility of developing a clinical method of noninvasive differential diagnosis of hearing loss. The method demonstrated was to add to a standard audiometric evaluation the measurement of DPOAE growth functions over the range of frequencies where these emissions were relatively easy to measure and consistent. The DPOAE stimulus frequencies were chosen to match the audiometric frequencies, and the corresponding emission and audiometric thresholds were compared on a threshold-threshold plot for each individual at a number of stimulus frequencies. Responses in different regions in this plot were found to correspond to different types of sensorineural hearing loss.

Distortion product otoacoustic emissions and auditory brainstem responses (ABRs) were measured in neonatal gerbils at three ages: at 15-16 days after birth (dab), near the onset of hearing when the endocochlear potential (EP) is known to be still immature; at 22 dab, when the EP first reaches mature levels; and at 30 dab. Comparing individual 15-16 dab animals to the 22 dab group, ABR threshold changes were typically larger than those for cubic distortion tone (CDT, 2f1-f2) emission thresholds which were, in turn, larger than those for the simple difference tone (DT, f2-f1). In contrast, from 22 to 30 dab there were no important changes in CDT or DT emission thresholds. Observed threshold-change relationships were very similar to those found in differential diagnosis investigations, where the EP was experimentally decreased using a chronic furosemide application. Therefore, most of the change in cochlear function over the two week period studied could be attributed to the maturation of EP during the first week. Model calculations further show that relative changes in CDT and DT emission thresholds are compatible with a movement of the operating point of the cochlear amplifier toward its symmetrical "central" point as the EP reaches mature levels.

Auditory characteristics of metabolic or strial presbycusis were investigated using an animal model in which young adult Mongolian gerbils (Meriones unguiculates) were implanted with an osmotic pump supplying furosemide continuously to the round window. This model causes chronic lowering of the endocochlear potential (EP) and results in auditory responses very similar to those seen in quiet-aged gerbils (Schmiedt et al., J. Neurosci. 22:9643–9650, 2002). Auditory function was examined up to one week post-implant by measurement of auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs). Emission “threshold” was defined as the stimulus level required to reach a criterion emission amplitude. Comparing all responses on a “threshold-shift diagram,” where emission threshold increases were plotted versus ABR threshold increases, the following results were obtained: (1) On average, the increase of the emission threshold was about 55% of the increase in ABR threshold, with comparatively little scatter. (2) The main dysfunction in metabolic presbycusis appears to be a decrease in the gain of the cochlear amplifier, combined with an additional, smaller increase in neural threshold, both effects caused by a chronically low EP. (3) For ABR threshold increases over 20 dB, the points for the chronic low-EP condition were largely separate from those previously found for permanent acoustic damage. The threshold-shift diagram therefore provides a method for noninvasive differential diagnosis of two common hearing dysfunctions.

The auditory function of four wild-caught echidnas was measured using distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABRs). Emission audiograms were constructed by finding the stimulus levels required to produce a criterion emission amplitude at a given stimulus frequency. For an emission amplitude of -10 dB SPL, the median "best threshold" was 28 dB SPL, and this minimum threshold occurred between 4 and 8 kHz for all animals. The relative effective range of auditory function was defined by the frequencies at which the audiogram was 30 dB above its best threshold. For the emission audiograms, the median lower-frequency limit was 2.3 kHz, the upper limit was 18.4 kHz, and the effective range was 2.7 octaves. The audiogram as measured by ABR was also found to be strongly "U" shaped with similar low- and high-frequency limits, i.e., from 1.6 to 13.9 kHz, with an effective range of 3.1 octaves. These results suggest that the echidna has a behavioral hearing sensitivity comparable to that of typical therian mammals (e.g., rabbits and gerbils) but with a significantly narrower frequency range. DPOAE responses were also measured in selected animals as a function of the variation of all four stimulus parameters (frequencies and intensities of both stimulus tones). Overall, the measured emission responses establish that the echidna does have a cochlear amplifier, and that it could be the same type as in therian mammals. The amplification mechanism in the echidna, currently unidentified, clearly operates to frequencies above 20 kHz, higher than the hearing function observed in any birds or reptiles but lower than for typical therian mammals. This raises the possibility that at least some aspects of the mammalian cochlear amplifier developed early in evolution, before the divergence of the monotremes (echidna and platypus) from the mainstream therian mammals (marsupials and placentals). In this respect, the presence or absence of outer hair cell electromotility in monotremes would have important consequences for understanding the function and evolution of the vertebrate inner ear.