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Grâce à la miniaturisation de la technologie ainsi qu'a l'augmentation constante des capacités de calcul numérique, les méthodes objectives et les appareils de mesures de la physiologie auditive évoluent. C'est dans l'optique de créer de nouveaux outils diagnostics que la société Echodia a été créée en 2009. Celle-ci finance aujourd'hui mes recherches sous convention CIFRE.Les présents travaux proposent, dans une première partie, de présenter comment deux méthodes de mesures non invasives ont été mises en oeuvre pour être applicables au diagnostic de l'hydrops cochléaire. Les méthodes sont basées sur le fait que les réponses des cellules ciliées de la cochlée à des stimuli sonores dépendent de la position au repos de leur touffe de stéréocils. Or, l'hydrops cochléaire, l'une des principales caractéristiques de la maladie de Menière, est susceptible de venir perturber cet environnement. Une variation chimique ou mécanique de celui-ci peut ainsi être mise en évidence par différentes méthodes d'exploration objectives. La première est basée sur un enregistrement électrophysiologique. En étudiant le Potentiel de sommation (SP) de l'ÉlectroCochléoGraphie (ECochG), nous allons recueillir une image du tour basal de la cochlée. La deuxième méthode est basée sur un enregistrement acoustique dans le méat acoustique externe. En monitorant le déphasage des Produits de distorsion desoto-émissions acoustiques (DPOAE), nous allons enregistrer les réponses du tour apical de la cochlée.La deuxième partie est consacrée à une étude au cours de laquelle nous avons enregistré de manière concomitante le SP (basal) ainsi que le DPOAE (apical) chez 73 patients souffrant de vertiges de Menière, à proximité d'une attaque (n = 40) ou entre les attaques, sans symptômes cliniques (n = 33). Dans le cas des DPOAE, c'est la phase du produit de distorsion (PDA) à 2*f1-f2 qui a été étudiée en réponse à des sons stimulants de fréquence f1 = 1 kHz et f2 = 1,2 kHz. La puissance des deux fondamentaux a été fixée entre 70 et 75dB SPL en fonction du niveau du DPOAE. Le rapport entre SP et le Potentiel d’action global (AP) a, quant à lui, été mesuré de manière extra-tympanique en réponse à des clics de 95dB nHL. Ces deux mesures ont été effectuées plusieurs fois pendant un test de posture afin d'évaluer leur stabilité.Les limites normales de déphasage du DPOAE en réponse à la posture [-18 °, +38 °] ont été dépassées chez 75% des patients étant venus consulter à proximité d'une crise. Sur ces mêmes sujets, l'étude du ratio entre SP et AP a dépassé la valeur normale (<0,40) dans 60% des cas. De plus, chez les patients à proximité d'une crise de vertige, les deux types de mesures révèlent des fluctuations entre deux répétitions. Ces écarts mettent en évidence combien l'hydrops entrave le bon fonctionnement de la mécanique cochléaire. Le fait de constater des variations sur des échelles de temps aussi courtes pourrait expliquer la sensibilité imparfaite des tests diagnostics. En effet, les protocoles de mesure du SP ou des DPOAE nécessitent un moyennage des acquisitions qui, par définition, a tendance à niveler les fluctuations transitoires. / Thanks to technology miniaturization as well as digital computing abilities steadily increasing, objective measurement methods and their related devices evolve. Echodia company was created in 2009 with the goal to create new diagnostic tools. The company currently supports my research work through a CIFRE convention.The first part of this thesis presents two non-invasive measurement methods that have been implemented to the diagnosis of cochlear hydrops. The methods are based on the responses of cochlear hair cells to sound stimuli, depending themselves on the resting position of their stereocilia bundles. Cochlear hydrops, a hallmark of Meniere's disease, is likely to disturb this environment. A chemical or mechanical variation of this environment may be observed by various objective exploration methods. The first method is based on an electrophysiological recording. By studying the Summating Potential (SP) of the Electrocochleography (ECOG) we will register activity in the basal part of the cochlea. The second method is based on a sound recording in the external acoustic meatus. By monitoring the phase shifts of Distortion-Product OtoAcoustic Emissions (DPOAE), we will record the apical responses of the cochlea.The second part of this thesis focuses on a study in which we recorded concomitantly the SP (basal) and the DPOAE (apical) in 73 patients with Menière's disease, close to an attack (n = 40) or between attacks without clinical symptoms (n = 33). In the case of DPOAE, the phase at 2*f1-f2 has been studied in response to pure sinusoidal sounds at frequency f1 = 1 kHz and f2 = 1,2 kHz. The power of the two primary was set between 70 and 75dB SPL based on the level of the DPOAE. The SP to Action Potential (AP) ratio has been measured by extra-tympanic electrode in response to 95dB nHL clicks. These two measurements were performed several times during a postural test to evaluate their stability.The normal limit of the phase shift of the DPOAE during a postural test [-18 °, +38 °] was exceeded in 75% of patients near an attack. On these subjects, the study of the SP/AP ratio exceeded the normal value (<0.40) in 60% of cases. In addition, the two types of measurements made on patients near a vertigo attack reveal fluctuations between reiteration. These differences highlight how hydrops hinders the proper functioning of the cochlear mechanics. This short time scales fluctuations might explain the imperfect diagnostic sensitivity of SP and DPOAE tests, as averaging procedures would tend to level out transient fluctuations characteristic of hydrops.

Background: Iron deficiency, anemia, and iron excess have been associated with altered hearing functions in children and adults. Animal studies suggest that iron deficiency during pregnancy negatively affect fetal auditory development. The relationship between maternal iron status and auditory functions in healthy term newborns has not been clearly elucidated among humans. The goal of this pilot study was to determine the relationship between markers of iron status during pregnancy and brainstem auditory function in healthy neonates. Methods: Pregnant women who gave birth at the Montfort Hospital were recruited to take part in this study (n=6). Within two weeks after birth, their newborn’s hearing function was assessed by wave amplitude, latency and inter-latency from the Auditory Brainstem Response (ABR) test. Markers of iron status, namely hemoglobin (Hb) and mean corpuscular volume (MCV), were collected retrospectively for the first and second trimester from the women’s medical chart. Results: Overall, no significant relationship was observed between maternal Hb and MCV concentrations and newborns auditory function. Although two significant Spearman correlations were observed (MCV and inter-latency I-V; r=0.87; p=0.005 and Hb and amplitude V; r=0.89; p=0.04), these findings may be due to chance because of multiple testing and the small sample size. Conclusion: Although iron is a key nutrient involved in the brain and auditory system development, we were not able to demonstrate a relationship between iron status during pregnancy and newborn hearing function. Prospective or intervention studies with a larger sample size and with more specific iron markers (ex. ferritin) are required to confirm these findings.

In the evaluation of special populations, such as neonates, infants and malingerers, audiologist often have to rely heavily on objective measurements to assess hearing ability. Current objective audiological procedures such as tympanometry, the acoustic reflex, auditory brainstem response and transient evoked otoacoustic emissions, however, have certain limitations, contributing to the need of an objective, non¬invasive, rapid, economic test of hearing that evaluate hearing ability in a wide range of frequencies. The purpose of this study was to investigate distortion product otoacoustic emissions (DPOAEs) as an objective test of hearing. The main aim was to attempt to predict hearing ability at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz with DPOAEs and artificial neural networks (ANNs) in normal and hearing-impaired ears. Other studies that attempted to predict hearing ability with DPOAEs and conventional statistical methods were only able to distinguish between normal and impaired hearing. Back propagation neural networks were trained with the pattern of all present and absent DPOAE responses of 11 DPOAE frequencies of eight DP Grams and pure tone thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. The neural network used the learned correlation between these two data sets to predict hearing ability at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Hearing ability was not predicted as a decibel value, but into one of several categories spanning 10-15dB. Results indicated that prediction accuracy of normal hearing was 92% at 500 Hz, 87% at 1000 Hz, 84% at 2000 Hz and 91% at 4000 Hz. The prediction of hearing-impaired categories was less satisfactory, due to insufficient data for the ANNs to train on. The variables age and gender were included in some of the neural network runs to determine their effect on the distortion product. Gender had only a minor positive effect on prediction accuracy, but age affected prediction accuracy considerably in a positive way. The effect of the amount of data that the neural network had to train on was also investigated. A prediction versus ear count correlation strongly suggested that the inaccurate predictions of hearing-impaired categories is not a result of an inability of DPOAEs to predict pure tone thresholds in hearing impaired ears, but a result of insufficient data for the neural network to train on. This research concluded that DPOAEs and ANNs can be used to accurately predict hearing ability within 10dB in normal and hearing-impaired ears from 500 Hz to 4000 Hz for hearing losses of up to 65dB HL. / Dissertation (MCommunication Pathology)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / unrestricted

BACKGROUND: The aim of this study was to evaluate distortion product otoacoustic emissions (DPOAEs) and extended high-frequency (EHF) thresholds in a control group and in patients with normal hearing sensitivity in the conventional frequency range and reporting unilateral tinnitus. MATERIAL/METHODS: Seventy patients were enrolled in the study: 47 patients with tinnitus in the left ear (Group 1) and 23 patients with tinnitus in the right ear (Group 2). The control group included 60 otologically normal subjects with no history of pathological tinnitus. Pure-tone thresholds were measured at all standard frequencies from 0.25 to 8 kHz, and at 10, 12.5, 14, and 16 kHz. The DPOAEs were measured in the frequency range from approximately 0.5 to 9 kHz using the primary tones presented at 65/55 dB SPL. RESULTS: The left ears of patients in Group 1 had higher median hearing thresholds than those in the control subjects at all 4 EHFs, and lower mean DPOAE levels than those in the controls for almost all primary frequencies, but significantly lower only in the 2-kHz region. Median hearing thresholds in the right ears of patients in Group 2 were higher than those in the right ears of the control subjects in the EHF range at 12.5, 14, and 16 kHz. The mean DPOAE levels in the right ears were lower in patients from Group 2 than those in the controls for the majority of primary frequencies, but only reached statistical significance in the 8-kHz region. CONCLUSIONS: Hearing thresholds in tinnitus ears with normal hearing sensitivity in the conventional range were higher in the EHF region than those in non-tinnitus control subjects, implying that cochlear damage in the basal region may result in the perception of tinnitus. In general, DPOAE levels in tinnitus ears were lower than those in ears of non-tinnitus subjects, suggesting that subclinical cochlear impairment in limited areas, which can be revealed by DPOAEs but not by conventional audiometry, may exist in tinnitus ears. For patients with tinnitus, DPOAE measures combined with behavioral EHF hearing thresholds may provide additional clinical information about the status of the peripheral hearing.

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Made available in DSpace on 2016-04-27T18:12:29Z (GMT). No. of bitstreams: 1 Cristiane Bolzachini Santoni.pdf: 934977 bytes, checksum: bee3fb27cb9f3fae28c2855452c296e7 (MD5) Previous issue date: 2008-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Purpose: The aim of the present study was to evaluate hearing and assess the satisfaction provided by the use hearing protectors in pop-rock musicians. Background: Studies have shown evidences of the risk of pop-rock musicians to develop hearing loss and other symptoms related to amplified music, as well as to adopt preventive measurements to protect their hearing. Method: It was evaluated 24 pop-rock musicians, male gender and ages between 25 to 45 years old, with professional experience between 3 to 21 years. It was accomplished: anamnesis, audiometric evaluation, transient otoacoustic emission (TEOAE), distortion product otoacoustic emission (DPOAE) and also was applied an ear protective devices satisfaction assessment questionnaire. Results: The prevalence of noise-induced hearing loss was 20.8%. In normal audiograms, there was a notch in high-frequencies in 58.4%, in at least one ear. The responses of TEOAEs were absent in 45.8% of the musicians and DPOAEs were absent in 58.4%. Concerning to satisfaction with the ear protective devices usage, 75.0% of the musicians evaluated them above grade 7.0. Conclusions: There was a high prevalence of hearing losses as well as alterations in TEOAEs and DPOAEs responses. Therefore, it is fundamental to develop and implement hearing loss preventive programs for musicians. There was a positive tendency towards the use of the ear protective devices / Objetivo: Avaliar a audição e o uso de protetores auditivos em músicos de bandas de pop-rock. Justificativa: Estudos demonstram evidências dos músicos de pop-rock apresentarem risco para o desenvolvimento de perda auditiva e outros efeitos associados à exposição à música amplificada, bem como a necessidade de adotar medidas de proteção à audição desses profissionais. Método: Foram avaliados 24 músicos de pop-rock, do sexo masculino, com idades entre 25 e 45 anos e com tempo de profissão entre três e 21 anos. Os sujeitos responderam a uma anamnese, realizaram avaliação audiométrica, realizaram os testes de emissões otoacústicas evocadas por estímulo transiente (EOAET) e emissões otoacústicas produto de distorção (EOAPD) e preencheram um questionário sobre a satisfação após o uso do protetor auditivo. Resultados: A prevalência de perdas auditivas sugestivas de PAIR foi de 20,8%. Dentre os audiogramas classificados como normais 58,4% apresentaram entalhe audiométrico em pelo menos uma orelha. No teste de emissões otoacústicas, 45,8% dos músicos tiveram respostas ausentes nas EOAET e 58,4% nas EOAPD. 75,0% dos músicos forneceram nota maior do que 7,0 para refletir sua satisfação no uso do protetor auditivo. Conclusões: Tanto a prevalência de perdas auditivas, quanto o número de ausências nos testes de EOAET e EOAPD foram elevados. Assim sendo, é necessária a implementação de um programa de prevenção de perdas auditivas com músicos. Houve uma tendência favorável à aceitação do protetor auditivo

Intratympanic injection of various otoprotectants through the round window membrane (RWM) might become available in the near future as an alternative to the currently available medical and surgical methods used to treat several inner ear diseases. The most common outcome of such diseases is sensorineural hearing loss (SNHL). Two examples of  these otoprotectants are Edaravone and Brain-Derived Neurotrophic Factor (BDNF), both of which have already proved effective against  noise-induced hair cell loss, barotrauma  and ototoxicity caused by cisplatin. In four different studies we used two electrophysiological methods, auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE), to study the effects of tobramycin and Pseudomonas aeruginosa exotoxin A (PaExoA) on the inner ears of 129 male Sprague-Dawley rats. In two investigations, not only the otoprotective effects of Edaravone on tobramycin-induced ABR threshold shifts and PaExoA-induced DPOAE  threshold changes, were studied but even different application times, in order to establish in which interval it was still possible to achieve effective otoprotection.We found that Edaravone gave otoprotection from tobramycin when injected simultaneously or within 7 days, but it had only a limited effect on the changes in DPOAE thresholds caused by PaExoA when injected 1, 2, or 4 hours after the exotoxin. The effect of BDNF on PaExoA-induced ABR threshold shifts was investigated in two studies, where different doses of intratympanically injected PaExoA were used and where BDNF was applied simultaneously, 12 or 72 hours efter exotoxin instillation. We found that BDNF had an otoprotective effect on SNHL induced by different doses PaExoA when injected simultaneously or with no more than 12 hours delay.

The field of early detection and intervention of hearing loss in neonates and infants has been marked by a growing international body of research investigating hearing screening programmes, protocols and outcomes of early detection for hearing loss. In South Africa, screening for neonates and infants in general and particularly for hearing loss is not common practice and is not meeting the needs of the South African population, with very few infants identified with hearing loss early in life. The Year 2002 Hearing Screening Position Statement recommends an intermediate step toward universal screening in the form of Targeted Newborn Hearing Screening (TNHS) as an option for developing countries with limited resources. The Neonatal Intensive Care Unit (NICU) provides a starting point for TNHS because it encompasses a number of risk factors for hearing loss. A combined descriptive and exploratory research methodology was followed to provide a comprehensive perspective on longitudinal hearing screening for NICU neonates and infants at a provincial hospital in South Africa. The quantitative methods included a structured interview to compile risk factor information. Immittance measurements used included acoustic reflex measurements, 226 Hz and 1000 Hz tympanometry. Automated Otoacoustic Emission (AOAE) as well as Automated Auditory Brainstem Response (AABR) screening was conducted. Routine follow-up visits at three month intervals were booked if a subject passed the screen and a follow-up screening for further testing was booked if a subject referred the screening. A total of 49 neonates and infants as well as mothers were enrolled in the first year and followed up for the second year of data collection period. The results indicated that the NICU had potential as platform for TNHS in South Africa. The high incidence of risk factors reported is more when compared with developed countries and highlights the importance of hearing screening in the at risk population for a developing country. The results confirmed reports that 226 Hz probe tone tympanometry produces erroneous responses in young infants. A high correspondence between high frequency tympanometry and AOAE results was found and underlines the need for differential diagnosis to accurately detect middle ear effusion and/or sensorineural hearing loss in neonates and infants. The unilateral AOAE refer rate (7%) was within range of the reported values for initial screening at discharge from the NICU. AABR results indicated a relatively high unilateral refer result (24%) and may be attributed to irritability and restlessness. The highest referral rates in the current study were recorded during the second and third visit and may be attributed to the presence of middle-ear pathology in older infants. The perceptions of mothers emphasized the lack of awareness regarding hearing and hearing loss in South Africa. Lack of knowledge may be a contributing actor to poor compliance with screening follow-up. Despite prevailing challenges, such as a low follow-up return rate, lack of awareness regarding the benefits of early detection of hearing loss, the effect of middle ear effusion on screening results, the cost of hearing screening and different priorities of the national healthcare system, such as Human Immunodeficiency Virus, demonstrated the NICU promise as platform for TNHS in South Africa. TNHS programmes may serve as starting point to direct universal neonatal hearing screening programmes in South Africa. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / MComm Path / unrestricted