Background: Multidrug-resistant tuberculosis (MDR-TB) patients receive aminoglycosides as part of their treatment. These drugs are ototoxic, and can cause permanent damage to the cochlea, resulting in a debilitating hearing loss, which has a negative impact on an individual's quality of life. Early detection and management of an ototoxic hearing loss can minimise the impact of the hearing loss on the person's social, emotional, and vocational wellbeing. While patients with MDR-TB are often very ill, it might be ideal to use an objective test that does not require active participation from the patient. In this way, the reliability and validity of the test will not be affected by the patient's state. Distortion product otoacoustic emissions (DPOAEs) at 2f1-f2 are a viable option, as it evaluates cochlear function, specifically the outer hair cells, which are affected first by ototoxic medication. Method: This thesis used a sequential study design aimed to determine the DPOAE stimulus parameters that yield (a) the highest level and the most reliable, sensitive and specific DPOAEs reported in the literature, (b) the highest level and the most reliable DPOAEs in healthy, normally hearing adults, and (c) the most sensitive and specific DPOAEs in participants with MDR-TB patients receiving ototoxic medication. High frequency pure tone audiometry (defined in this thesis as frequencies > 8 kHz) was used as the gold standard. Descriptive statistics, the intraclass correlation coefficient, Pearson's correlation coefficient and mixed model analyses were used to analyse the data. Results: Systematic review: The results of the systematic review indicated an L1/L2 setting of 75/75 dB SPL and f2/f1 value from 1.20 to 1.22 yielded the highest level DPOAEs. The systematic review results for stimulus parameters that yielded the highest test-retest reliability, sensitivity and specificity were inconclusive. Preliminary study with healthy normal hearing participants: The results of the preliminary study in healthy, normal-hearing participants indicated that the highest levels of DPOAEs were elicited with L1/L2 intensity levels of 65/65 and 65/55 dB SPL, and f2/f1 ratios of 1.18, 1.20 and 1.22, as determined by mixed model analyses (p < 0.05). These same stimulus parameters yielded the most reliable DPOAEs in both ears, as determined by intraclass correlation coefficient analysis. Main study with healthy, normal-hearing participants: Descriptive statistics and mixed model analysis showed stimulus intensity levels L1/L2 of 65/55 dB SPL, and f2/f1 ratios of 1.18 and 1.20, elicited the largest DPOAEs. The ratio of 1.20 yielded the largest DPOAEs < 5000 Hz and f2/f1 ratio of 1.18 the largest DPOAEs ≥ 5000 Hz. The second highest DPOAE levels were elicit by L1/L2 = 65/65 dB SPL and f2/f1 = 1.18. The test-retest reliability in this sample was not influenced by changing the stimulus parameters, and DPOAEs were only unreliable at an f2 frequency of 8 000 Hz. Study in participants with MDR-TB: Results in participants with MDR-TB receiving ototoxic medication indicated that the highest levels of DPOAEs were elicited with L1/L2 = 65/55 and an f2/f1 ratio of 1.18 at f2 ≥ 5000 Hz, followed by 65/65 and 1.18. For f2 < 5000 Hz, stimulus intensities of L1/L2 = 65/55 and an f2/f1 ratio of 1.20 yielded the largest DPOAE levels. Relating to sensitivity and specificity, the stimulus parameter combination of 65/55 dB and 1.18 detected the highest number of ears with outer hair cell damage in participants with MDR-TB receiving ototoxic medication. Conclusion: It should be considered to use an f2/f1 ratio of 1.18 for f2 ≥ 5000 Hz and 1.20 for f2 < 5000 Hz when monitoring for ototoxicity, to assist with early identification of outer hair cell damage, in conjunction with high frequency pure tone audiometry. This finding needs to be confirmed in a larger sample of participants with MDR-TB receiving ototoxic medication.

Objective: This study aimed to systematically review and analyse the available peer-reviewed literature reporting on the results of distortion product otoacoustic emissions (DPOAEs), transient evoked otoacoustic emissions (TEOAEs) and click auditory brainstem responses (c-ABRs) in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM). Method: A comprehensive literature search was conducted across three electronic databases to identify English; peer-reviewed articles that included results of OAEs (DPOAEs and TEOAEs) and c-ABR tests in adult subjects with DM. Articles were selected according to predetermined selection criteria and critically reviewed independently by two researchers. Results: 15 studies met the inclusion criteria for the systematic review while nine articles qualified for inclusion in the meta-analysis. DPOAE studies reported significantly reduced amplitudes with only one study reporting larger amplitudes. Abnormal TEOAEs were reported in all TEOAE studies, although these abnormalities were not always significant. Significantly delayed c-ABRs were reported in all ABR studies. Analysis of c-ABR mean wave latencies identified longer latencies for DM subjects, particularly for wave III and V, as well as for IPL I-III and I-V. Conclusions: Subjects with T1DM and T2DM may present with clinical or subclinical impairment of the cochlear outer hair cells and both the peripheral and central auditory pathway. / Dissertation (MA)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / MA / Unrestricted

Background: Distortion product otoacoustic emissions (DPOAEs) are a promising screening technique for the early detection of subtle noise induced cochlear function changes. Objectives: To determine the applicability of DPOAEs as a health surveillance technique for the early detection of noise induced hearing loss (NIHL) in workers at a steel manufacturing industry. Methods: DPOAEs were recorded in 20 participants with no history of occupational noise exposure and 20 participants exposed to noise in the steel manufacturing industry. Participants were not exposed to noise for at least 48 hours prior to testing. All participants were male with normal audiometric thresholds of ?15 dB HL. The DPOAE presence and response amplitude levels for different frequencies were compared between the two groups. The study further evaluated the short-term test-retest repeatability of DPOAE measurements, and also compared the total test duration of performing DPOAEs to the duration of screening audiometry. Results: The noise exposed group had statistically significantly lower DPOAE response amplitudes than the control group for all the tested frequencies; (p&#0600.001) at 2002 to 4004 Hz, and (p=0.01, p=0.001) at 6348 and 7996 Hz respectively, suggesting more cochlear damage in the noise exposed group due to early outer hair cell damage. DPOAEs showed very good reproducibility, and the average duration of performing a set of DPOAEs was significantly shorter (461 ± 68.2 seconds) than the duration of performing audiometry (591 ± 76.9 seconds), p&#0600.001. Conclusion: DPOAEs appeared to be a sensitive technique in detecting noise induced subtle cochlear function changes. DPOAEs could be used as a health surveillance technique for the early detection of NIHL in the steel manufacturing industry. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / M Communication Pathology / Unrestricted

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KwaZulu-Natal has been ranked as having the fourth highest incidence of transmitted Multiple Drug Resistant-Tuberculosis (MDR-TB) in sub-Saharan Africa. Substantial literature exists indicating the permanent damage that MDR-TB medication has on hearing abilities. The purpose of this study was to describe the hearing function of adults on long term MDR-TB treatment from Murchison Hospital MDR-TB unit in the Ugu District in rural KwaZulu-Natal. The primary aim of the study was to review the possible changes in hearing function in a group of adults on long-term treatment for MDR-TB. Secondly, the study aimed to estimate the number of adults who may present with changes following MDR-TB treatment and establish if relationships exist between the audiological findings and factors such as age and gender. The design of the study was a retrospective comparative data review of 68 patient records, all of which underwent audiological investigations from the start of MDR-TB treatment over a five-month period. The study made use of descriptive and inferential statistics to analyse the data. Specific inferential statistical analysis included analysis of covariance as well as regression analysis. Results from the study showed changes in hearing function in Distortion Product Otoacoustic Emissions (DPOAEs) and Pure Tone Audiometry (PTA) results at all five audiological sessions and across a range of frequencies. 84% of the total sample presented with overall refer readings for DPOAEs and 98.53% of the group of adults presented with criteria indicative of ototoxic hearing loss, specifically a bilateral mild-profound sloping SNHL on clinical PTA results. In the total sample of patient records reviewed in this study, all 68 records showed a change in hearing function, be that changes in DPOAE function and/or changes in PTA thresholds, following long-term treatment for MDR-TB. Variations in the effects of gender and ear difference were minimal and non-significant in all results. Similar presentation, to ototoxic hearing loss, of other degenerative conditions exists; however these conditions were accounted for as exclusion criteria in this study. Therefore the only remaining cause of possible hearing deficit was that of ototoxicity. The study provided valuable data regarding hearing function in a population of adults on long-term MDR-TB treatment in South Africa. Furthermore, the study has highlighted the need for the establishment of standardised audiological monitoring programmes sensitive to ototoxic hearing loss, within the South African context where the incidence of Tuberculosis (TB) and MDR-TB is reportedly high.

L'audiométrie tonale liminaire est l'outil de référence pour évaluer le fonctionnement auditif, mais c'est un outil subjectif qui mesure des élévations de seuils témoignant de dégâts irréversibles sur le système auditif. La mesure des produits de distorsions acoustiques (PDAs), reflet du fonctionnement cochléaire, permet de dépister précocement des altérations de l'oreille interne causées par le bruit ou certains solvants ototoxiques. A partir d'un paradigme de mesure basé sur un enregistrement continu du PDA cubique (2f1-f2) et une stimulation controlatérale, nous avons pu expliquer, chez le rat, les effets pharmacologiques du toluène. Ce solvant aromatique agirait en particulier sur les centres nerveux impliqués dans le réflexe de protection acoustique de l'oreille moyenne. Devant les résultats obtenus chez l'animal, un prototype d'appareil adapté à l'homme a été mis au point, baptisé EchoScan. L'EchoScan a été testé sur 50 volontaires sains normo-entendant lors d'un premier protocole de recherche clinique pour vérifier la reproductibilité des mesures. Un second protocole a ensuite été conduit pour tester l'outil chez des salariés en entreprise, selon plusieurs conditions d'exposition : témoins non exposés, salariés exposés au bruit, exposés aux solvants, exposés au bruit et aux solvants. Les résultats des deux premières conditions sont présentés dans ce mémoire. Ils confirment la pertinence de la mesure du seuil du réflexe de l'oreille moyenne pour évaluer les effets de l'exposition au bruit. Les résultats des sujets exposés aux solvants évalueront la sensibilité de l'EchoScan dans la détection, voir la caractérisation des effets pharmacologiques de substances chimiques (inclusions en cours). Si l'avenir de l'EchoScan apparaît prometteur en médecine du travail, d'autres applications sont envisagées, comme l'étude des effets pharmacologiques des anesthésiques sur le réflexe de l'oreille moyenne / The pure-tone audiometry is a reference tool to assess auditory function but it is able to measure only threshold elevations showing irreversible damages. Measurement of distortion products oto-acoustic emissions (DPOAEs), reflecting the cochlear function, allows early detection of alterations in the inner ear caused by noise or some ototoxic solvents. From paradigm based on a continuous record of cubic DPOAEs (2f1-f2) and a contralateral stimulation triggering the middle-ear reflex, we could explain, in rats, the pharmacological effects of toluene. This aromatic solvent can act on the centers involved in the middle-ear acoustic protection reflex. With the results obtained in animals, a device adapted to humans has been developed, called EchoScan. The EchoScan was tested on 50 healthy volunteers with normal hearing in a first clinical research protocol to verify in particular the reproducibility of its measurements. A second research protocol was then conducted to test this tool among company employees, according to several exposure conditions: unexposed controls, workers exposed to noise, exposed to solvents, exposed to noise and solvents. The results of the first two conditions are presented in this thesis. They confirm the relevance of the measurement of the middle ear reflex threshold in assessing the effects of noise exposure. The results of subjects exposed to solvents will further evaluate the sensitivity of EchoScan in detection of the pharmacological effects, and even in the characterization of chemical substances exposure (in progress). In the future, EchoScan should be particularly promising in occupational medicine, but other applications are already considered, such as the study of pharmacological effects of anesthetics on the middle ear reflex

Abstract is available through the XX IERASG Biennial Symposium.

Previous studies have shown that supplemental magnesium administered prior to exposure to noise has an alleviating effect on temporary threshold shift (TTS). These studies have only used audiometric thresholds to demonstrate changes in the auditory system. However, to help determine the effects on outer hair cells (OHCs), a more sensitive measure should be used. The purpose of this study was to determine if supplemental magnesium administration prior to noise exposure has a beneficial effect on acoustic overexposure using a double-blind research design. This was determined by measuring distortion product otoacoustic emissions (DPOAEs) to determine any changes in cochlear OHC function. DPOAE amplitude and signal-to-noise ratio (SNR) measurements were analyzed for two groups of twenty participants (an experimental group and a control group). The experimental group received 150 mg of magnesium gluconate one hour prior to noise exposure. The control group received a placebo pill that was identical in appearance to the magnesium pill. Following noise exposure, the greatest changes in DPOAE amplitude and SNR occurred for the frequencies that were one-half to one octave above the frequency of the stimuli used. The greatest changes in DPOAE measurements were present immediately post TTS-inducing stimulus, with only slight changes present after 30 minutes and no difference between 30 minutes and 60 minutes post-exposure. These results were the same for both groups. It was concluded that this dosage of supplemental magnesium had no apparent protective effect on DPOAEs following intense noise exposure.

This study aimed to investigate the effectiveness of the Quiet earplug noise protectors worn by a group of South African industrial workers exposed to excessive noise in the workplace. This was achieved by investigating the prevalence and amplitudes of distortion product otoacoustic emissions (DPOAEs), as they have been found to be sensitive to the effects of noise on the cochlea (Vinck, Van Cauwenberge, Leroy,&Corthals, 1999, p. 52). DPOAEs were recorded before and after noise exposure and were compared in order to determine whether the earplugs are providing sufficient protection against cochlear damage. DPOAEs were recorded using a test protocol where the primaries are fixed at L1 = 60dB SPL and L2 = 35dB SPL (L1 - L2 = 25dB) with an f2/f1 ratio of 1.18. The f2 frequencies were selected to correspond closely to the audiometric test frequencies of 2000Hz, 3000Hz, 4000Hz, 6000Hz and 8000Hz. The study found the prevalence of DPOAEs to be statistically stable and repeatable. This was true for DPOAEs measured successively during the same test sitting, as well as comparing prevalence determined before and after exposure to eight hours of noise. DPOAE prevalence alone was therefore not found to be a good indication of the temporary threshold shift (TTS) associated with the effects of noise on the cochlea. However, a significant finding of the study was that normal DPOAEs were recorded in only six right ears (24%) and seven left ears (28%) before noise exposure, even though all the subjects presented with hearing thresholds better than 25dB SPL. This may mean that cochlear pathology is already evident in some of the subjects tested. Further results of the study showed DPOAE amplitudes to be sensitive to the negative effects of excessive noise, as there was a significant difference between DPOAE amplitudes measured before and after the noise exposure. DPOAE amplitudes, specifically in the frequencies that are known to be affected by noise such as 4000Hz and 6000Hz, measured after the work-shift were significantly smaller than those measured before exposure to noise. Although correct usage of the earplugs could not be controlled for the duration of the noise exposure, each subject was instructed on the correct usage of the hearing protection before entering the noise zone. Bearing this limitation of the study in mind, because DPOAE amplitudes were reduced the implication is that the Quiet earplugs are not providing sufficient protection against the harmful effects of noise. / Dissertation (M (Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / Unrestricted

Made available in DSpace on 2016-04-27T18:11:46Z (GMT). No. of bitstreams: 1 VanessaSinelliPinto.pdf: 2216187 bytes, checksum: a967a05c6a769a97c9e8960060d16e6c (MD5) Previous issue date: 2005-08-23 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Introduction The distortion product otoacoustic emission has been used because its specific features evaluate high frequencies and can identify hearing losses in initials stages. It is an important tool to neonatal hearing screening and test battery that includes audiologic assessment in infants. Therefore, there is a necessity to set up parameters to analyse DPOAE records in infants in order to be used as clinic criterion in audiologic assessment. Objective To describe the findings of DPOAE records in infants from birth to two months old, through analysis of response level, the noise level and the signal to noise ratio in all frequencies; the analysis of response level according to variables: age in days, gender, timpanometry pression peak, infant state during test and distribution of percentile from the response level. Methodology 138 infants were evaluated, being all full term, without risk indicators to hearing loss and who passed in hearing screening. The parameters used in this record were: L1= 65 dBSPL and L2= 50 dBSPL in equipment ILO292 Otodynamic. Results 70 male infants and 68 female infants were evaluated, with ages between 6 to 65 days. The medians from DPOAE level were: 6,7 dBSPL to f2 1001 Hz; 11,5 dBSPL to f2 1257 Hz; 14,2 dBSPL to f2 1587 Hz; 14,2 dBSPL to f2 2002 Hz; 13,7 dBSPL to f2 2515 Hz; 13,7 dBSPL to f2 3174 Hz; 15,5 dBSPL to f2 4004 Hz; 16,3 dBSPL to f2 5042 Hz e 6,0 dBSPL to f2 6348 Hz. The medians from the noise level were: 4,9 dBSPL to f2 1001 Hz; 5,9 dBSPL to f2 1257 Hz; 6,0 dBSPL to f2 1587 Hz; -2,1 dBSPL to f2 2002 Hz; -12,5 dBSPL to f2 2515 Hz; -5,6 dBSPL to f2 3174 Hz; -8,9 dBSPL to f2 4004 Hz; -9,5 dBSPL to f2 5042 Hz e -4,4 dBSPL to f2 6348 Hz. The medians from the signal to noise ratio were: 1,5 dBSPL to f2 1001 Hz; 5,4 dBSPL to f2 1257 Hz; 7,7 dBSPL to f2 1587 Hz; 16,4 dBSPL to f2 2002 Hz; 18,9 dBSPL to f2 2515 Hz; 19,3 dBSPL to para f2 3174 Hz; 24,2 dBSPL to f2 4004 Hz; 25,5 dBSPL to f2 5042 Hz e 10,5 dBSPL to f2 6348 Hz. Conclusions There was a tendency to decrease from the response level around 30 days of life, being more evident in 2002 Hz frequency (f2). The timpanometry pression peak defined by three groups (among -50 and +50 daPa; <-50 daPa and >+50 daPa) showed no influence on records from the response level. There was no statistically significant difference between genders and between ears to the response level. The baby state (light sleep, deep sleep and alert) had influence on signal to noise ratio in deep sleep state. The findings of percentile were similar to the ones found in the literature, therefore for clinical interpretation, the percentile 5 can suggest hearing loss and the percentile 95 can suggest a normal hearing, so the results of the two percentiles, a place uncertainty refering to hearing losses / Introdução A emissão otoacústica-produto de distorção tem sido utilizada devido às suas características específicas de avaliar bandas de freqüências altas e de detectar perdas auditivas em estágios iniciais, sendo essencial na triagem auditiva neonatal e na bateria de testes que envolvem a avaliação audiológica infantil. Portanto, há uma necessidade de se estabelecer parâmetros para análise do registro das EOAPD em lactentes, com a finalidade de utilizá-los como critério clínico na avaliação audiológica. Objetivo Descrever os achados do registro das emissões otoacústicas-produto de distorção em lactentes de até dois meses de idade por meio da análise do nível de resposta, do nível de ruído e da relação sinal/ruído em todas as bandas de freqüências; da análise do nível de resposta em relação às variáveis: dias de vida, gênero, pico de pressão na timpanometria e estado do lactente durante o exame e da distribuição do percentil do nível de resposta. Metodologia Foram avaliados 138 lactentes, todos nascidos a termo, sem indicadores de risco para perda auditiva e que passaram na triagem auditiva. Os parâmetros utilizados para este registro foram: L1= 65 dBNPS e L2= 50 dBNPS no equipamento ILO292 Otodynamic. Resultados Foram avaliados 70 lactentes do gênero masculino e 68 do feminino, com idade variando de 6 a 65 dias de vida. As medianas do nível de resposta das EOAPD para cada freqüência (f2) foram de: 6,7 dBNPS para 1001 Hz; 11,5 dBNPS para 1257 Hz; 14,2 dBNPS para 1587 Hz; 14,2 dBNPS para 2002 Hz; 13,7 dBNPS para 2515 Hz; 13,7 dBNPS para 3174 Hz; 15,5 dBNPS para 4004 Hz; 16,3 dBNPS para 5042 Hz e 6,0 dBNPS para 6348 Hz. As medianas do nível de ruído para cada freqüência (f2) foram de: 4,9 dBNPS para 1001 Hz; 5,9 dBNPS para 1257 Hz; 6,0 dBNPS para 1587 Hz; -2,1 dBNPS para 2002 Hz; -12,5 dBNPS para 2515 Hz; -5,6 dBNPS para 3174 Hz; -8,9 dBNPS para 4004 Hz; -9,5 dBNPS para 5042 Hz e -4,4 dBNPS para 6348 Hz. As medianas da relação sinal/ruído para cada freqüência (f2) foram de: 1,5 dBNPS para 1001 Hz; 5,4 dBNPS para 1257 Hz; 7,7 dBNPS para 1587 Hz; 16,4 dBNPS para 2002 Hz; 18,9 dBNPS para 2515 Hz; 19,3 dBNPS para 3174 Hz; 24,2 dBNPS para 4004 Hz; 25,5 dBNPS para 5042 Hz e 10,5 dBNPS para 6348 Hz. Conclusões Houve uma tendência de diminuição do nível de resposta a partir dos 30 dias de vida. O pico de pressão na timpanometria definido por três grupos (entre -50 e +50 daPa; <-50 daPa e >+50 daPa) não influenciou no registro do nível de resposta. Não houve diferença estatisticamente significante entre gêneros e entre orelhas para o nível de resposta. O estado do lactente influenciou na relação sinal/ruído, sendo a melhor relação sinal/ruído no estado sono profundo. Os achados do percentil foram semelhantes aos encontrados na literatura. Portanto, para uma interpretação clínica, o percentil 5 pode sugerir perda auditiva e o percentil 95 pode sugerir audição dentro da normalidade, sendo os resultados entre esses dois percentis uma região de incerteza quanto às perdas auditivas