Advanced Detection and Differential Diagnosis of Hearing Loss Using Otoacoustic Emissions

项目摘要 大多数感觉性听力损失的诊断和治疗几乎没有区别。的确，“感觉神经性听力损失” 是一个包罗万象的术语。然而，过去几年令人振奋的结果表明，耳声发射 (OAEs)可以区分通过听力图看起来相似的感觉性听力损失。OAE是非 可以在正常听者和有耳聋的人身上记录到的耳蜗健康和功能障碍的侵入性指标 最高可达中度听力障碍。尽管它们提供了一个非侵入性的，前神经窗口来了解 在过去的二十年里，它们在听力学临床上的应用一直停滞不前，尽管 实验室方面的进展。目前耳声发射的临床应用只包括听力损失的检测；没有 一旦检测到听力损失的原因，就会了解到。该项目建议将其转化为 听力学诊所一种快速、研究证明的技术，可以用扫频音调唤起耳声发射，允许 高效、近乎同时记录两个基本的耳声发射类别：耳蜗声发射 非线性，如失真产物耳声发射(DPOAE)，以及由耳蜗反射产生的非线性，如 作为刺激频率的耳声发射(SFOAE)。这两种类型的发射阐明了不同的耳蜗属性， 而且每个人对不同的听觉病理和病因都是独特的敏感。分析组合的OAE 结果产生新的关系指标，利用两者提供的唯一诊断信息，这 启动感觉性听力损失的鉴别诊断。此外，我们先进的OAE系统具有 结合创新的校准技术，减轻耳道驻波干扰的影响， 一个令人不快的变化无常的已知来源。这些高级校准提高了测试和重测的可靠性 发射，允许更准确地连续监测听力状态和扩展高频 测试靶场。在这个项目中，我们将：1)集成现有的校准、测量和分析软件模块 将扫描音调的OAE转换为内聚的、用户友好的软件程序，用于DPOAE的交错记录 2)联合分析DPOAE和SFOAE的测量结果，以检测和监测听力 对已确定病因的听力损害进行鉴别诊断；3)战略性削减 降低合并后的OAE配置文件，并在独立的参与者组中验证其性能 制作一种用于诊断感觉性听力损失的简化临床测试。这些步骤将使现代化和 使耳声发射评估远远超出检测听力损失的基本目标，并提供一定程度的 有助于对听力损失患者进行个性化干预的诊断特异性。

Project Summary Most sensory hearing loss is diagnosed and treated with little distinction. Indeed, ”sensorineural hearing loss” is a catch-all term. However, promising results over the last few years suggest that otoacoustic emissions (OAEs) can distinguish among sensory hearing losses that appear similar by audiogram. OAEs are non- invasive indicators of cochlear health and dysfunction that can be recorded in normal hearers and those with up to moderate degrees of hearing impairment. Though they offer a non-invasive, pre-neural window into the cochlea, their application in the audiology clinic has stagnated over the last two decades despite significant advances in the laboratory. Current clinical utility of OAEs includes only the detection of hearing loss; nothing is learned about the etiology of the hearing loss once detected. This project proposes to translate into the audiology clinic a rapid, research-proven technique to evoke OAEs with sweeping tones, allowing for the efficient, near-simultaneous recording of the two basic OAE classes: emissions produced by cochlear nonlinearities such as the distortion-product OAE (DPOAE), and those produced by cochlear reflections such as the stimulus-frequency OAE (SFOAE). These two types of emissions elucidate distinct cochlear properties, and each is uniquely sensitive to different auditory pathologies and etiologies. Analyzing combined OAE outcomes produces new relational metrics that exploit the unique diagnostic information offered by both, which initiates differential diagnosis of sensory hearing loss. Additionally, our advanced OAE system has incorporated innovative calibration techniques that mitigate the effects of ear-canal standing-wave interference, a known source of undesirable variability. These advanced calibrations improve the test-retest reliability of emissions, which allows for more accurate serial monitoring of hearing status and an expanded high-frequency test range. In this project, we will: 1) integrate existing software modules that calibrate, measure, and analyze swept-tone OAEs into a cohesive and user-friendly software program for the interleaved recording of DPOAEs and SFOAEs; 2) analyze DPOAE and SFOAE measures in a combined fashion to detect and monitor hearing loss and perform differential diagnosis for hearing impairments of confirmed etiology; and 3) strategically pare down the Combined-OAE Profile and validate its performance in an independent group of participants to produce an abbreviated clinical test for the diagnosis of sensory hearing loss. These steps will modernize and advance OAE assessment well beyond the rudimentary goal of detecting hearing loss and provide a degree of diagnostic specificity that will facilitate personalized intervention for individuals with hearing loss.