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Otoacoustic Emissions in Monitoring NIHL for Professional Musicians: A 2-Year Follow-up Study Annual NHCA Conference, 20 February 2016 Hilde Eising, MSc. Hiske W. Helleman, MSc. Prof. Wouter A. Dreschler Academic Medical Centre, Amsterdam, The Netherlands [email protected] linical & Experimental Audiology Content Professional musicians from 3 symphonic orchestras 2 years of (music) noise exposure Audiometry Otoacoustic emissions (OAEs) linical & Experimental Audiology Content Background • Otoacoustic emissions (OAEs) • Noise exposure in a symphonic orchestra What do we know from literature? • OAEs versus audiometry OAEs in monitoring NIHL for professional musicians: • Research questions • Preliminary results Discussion linical & Experimental Audiology Background - Noise induced hearing loss Noise effects outer hair cells first ‘Noise notch’ around 4-6 kHz visible in the audiogram Often accompanied by tinnitus linical & Experimental Audiology Background - Otoacoustic emissions (OAE) Gives information about functioning of outer hair cells Neonatal hearing screening (PASS / REFER) Requires ‘clear’ signal above noise floor speaker microphone linical & Experimental Audiology Background - Otoacoustic emissions (OAE) Now: audiometry is gold standard OAEs in occupational hearing programs? Why OAEs? Objective ? ? Detect pre-clinical damage? Fast Easy to operate Predict individual susceptibility to NIHL? linical & Experimental Audiology Background – Noise exposure of musicians ~80 dB(A) Average daily noise exposure: ~85 dB(A) Depends on factors like repertoire, arrangement, acoustical circumstances, conductor Exceeds the European guidelines for exposure to sound in a professional environment Source: ‘Onderzoek schadelijk geluid orkesten’, Peutz & Associés, 2003. linical & Experimental Audiology ~88 dB(A) Background – Noise exposure of musicians Audiograms show notches • Corrected for age and gender (ISO 7029) Jansen E.J. et al 2009. Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras. Int Arch Occup Environ Health, 82, 2, 153–164. linical & Experimental Audiology Background – Noise exposure of musicians Audiograms show notches Complaints about tinnitus (51%) and hyperacusis (79%) • More than could be expected in the general population Jansen E.J. et al 2009. Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras. Int Arch Occup Environ Health, 82, 2, 153–164. linical & Experimental Audiology Background – Noise exposure of musicians Audiograms show notches Complaints about tinnitus (51%) and hyperacusis (79%) Regular use of (mostly disposable) hearing protection during: • Orchestra repetitions: 52% • Concerts: 29% Jansen E.J. et al 2009. Noise induced hearing loss and other hearing complaints among musicians of symphony orchestras. Int Arch Occup Environ Health, 82, 2, 153–164. linical & Experimental Audiology OAEs: What do we know from literature? Longitudinal studies • No clear relation between changes in audiometry and OAE • e.g. Moukos et al. 2014, Helleman et al. 2012, Marshall et al. 2009, Lapsley-Miller et al. 2006 Low-level, absent or abnormal OAEs might indicate an increased risk of future NIHL Lapsley-Miller et al. 2006, Shupak et al. 2007, Duvdevany et al. 2007, Job et al. 2009, Marshall et al. 2009 linical & Experimental Audiology In progress: systematic literature review Why? Limited amount of longitudinal studies Published literature is inconsistent • Study duration • OAE stimulus parameters • Study population • … However, OAEs are promoted in occupational health programs.. ‘Otoacoustic emissions: a new gold standard for early detection of hearing loss’ linical & Experimental Audiology In progress: systematic literature review Duplicates removed Inclusion criteria • Subjects exposed to noise • OAE and audiometry measured at baseline 639 abstracts screened 525 excluded 114 full text screened 63 excluded and at least 1 follow-up ‘long term effects’ (permanent threshold shifts, PTS) 51 included In review ‘short term effects’ (temporary threshold shifts, TTS) Prospero registration nr.: CRD42015027111 linical & Experimental Audiology 14 ‘long-term’ effects 37 ‘short-term’ effects Otoacoustic Emissions in Monitoring NIHL for Professional Musicians: A 2-Year Follow-up Study Work in progress linical & Experimental Audiology Method 60 professional musicians from 3 symphonic orchestras • 34 Male, 26 Female • Median age: 42, range 24-64 2 measurements, ~2 years apart • Baseline • Follow-up Audiometry (250 Hz - 8 kHz), air conduction TEOAE (5 frequency bands: 1-4 kHz) DPOAE (27 frequencies: 0.8-8 kHz, 1/8 oct) Tympanometry / otoscopic inspection All tests performed at audiological department of AMC linical & Experimental Audiology Research questions 1. Is the effect of approximately two years of noise (music) exposure measurable using audiometry, TEOAE and DPOAE 2. Are individual cases of noise induced audiometric threshold shift associated with emission shift? 3. Are we able to predict which persons have increased risk of future hearing loss based on initial OAEs? linical & Experimental Audiology Research questions 1. Is the effect of approximately two years of noise (music) exposure measurable using audiometry, TEOAE and DPOAE 2. Are individual cases of noise induced audiometric threshold shift associated with emission shift? 3. Are we able to predict which persons have increased risk of future hearing loss based on initial OAEs? linical & Experimental Audiology Preliminary remark How you usually look at an audiogram linical & Experimental Audiology Preliminary remark How you usually look at an audiogram linical & Experimental Audiology Preliminary remark How I will show you this audiogram today linical & Experimental Audiology Mean results at baseline – right versus left Right Left At baseline: • Audiometry: the left ear is slightly worse than right at high frequencies linical & Experimental Audiology Mean results at baseline – right versus left Right Left At baseline: • Audiometry: the left ear is slightly worse than right at high frequencies • OAEs: left ear has lower amplitudes in mid frequencies linical & Experimental Audiology Mean results at baseline and follow-up Baseline Follow-up Group results show changes in audiometry, TEOAE and DPOAE linical & Experimental Audiology Mean change – group Change Deterioration Audiometry -Overall trend decrease -Deterioration mostly at 4-8 kHz TEOAE -Deterioration at mid frequencies (~2 kHz) DPOAE -Deterioration mid frequencies (~2-4 kHz) -Improvement low/high Audiometry compared to OAE: different frequency area linical & Experimental Audiology Research questions 1. Is the effect of approximately two years of noise (music) exposure measurable using audiometry, TEOAE and DPOAE 2. Are individual cases of noise induced audiometric threshold shift associated with emission shift? 3. Are we able to predict which persons have increased risk of future hearing loss based on initial OAEs? linical & Experimental Audiology Threshold shift versus emission shift Audiometry Shift Audiometry: 4-6 kHz TEOAE: overall Relation between threshold shift and emission shift? linical & Experimental Audiology TEOAE Threshold shift versus emission shift linical & Experimental Audiology TS- No TS- Threshold shift versus emission shift linical & Experimental Audiology Threshold shift versus emission shift TS- No TS- ES- linical & Experimental Audiology No ES- Threshold shift versus emission shift No TS- ES- No ES- TS- & ES- linical & Experimental Audiology TS- No TS- No ES- Threshold shift versus emission shift ES- sensitivity of OAE’s? No TS- Enhanced No ES- TS- & ES- linical & Experimental Audiology TS- No TS- No ES- Threshold shift versus emission shift ES- No ES- sensitivity of OAE’s? No TS- Enhanced Were OAEs already decreased? No ES- TS- & ES- linical & Experimental Audiology TS- No TS- Threshold shift versus emission shift Overall observations: Small number of threshold or emission shifts No clear relation between changes in audiometry and OAE linical & Experimental Audiology Threshold shift versus emission shift No TS- ES- TS- Predict? linical & Experimental Audiology No ES- Research questions 1. Is the effect of approximately two years of noise (music) exposure measurable using audiometry, TEOAE and DPOAE 2. Are individual cases of noise induced audiometric threshold shift associated with emission shift? 3. Are we able to predict which persons have increased risk of future hearing loss based on initial OAEs? linical & Experimental Audiology Individual threshold shifts How to define individual threshold shift? linical & Experimental Audiology Individual threshold shifts Two groups: ‘Change’. linical & Experimental Audiology Mean age: 42 (range 24-64). Change N=17 Right Left Total N=10 N=7 N=17 Individual threshold shifts Two groups: ‘Change’. Mean age: 42 (range 24-64). N=17 ‘No change’. Mean age: 46 (range 32-64). N=103 linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 ‘No change’ – shift linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 ‘Change’ versus ‘No Change’ – shift Audiometry: • Clear difference between groups TEOAE Largest shift ~2 kHz DPOAE Largest shift 2.5 6 kHz. Very low and high frequencies less reliable linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 ‘Change’ versus ‘No Change’ – at baseline Did these groups differ at baseline? linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 ‘Change’ versus ‘No Change’ – at baseline Audiometry: • No difference between groups linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 ‘Change’ versus ‘No Change’ – at baseline Audiometry: • No difference between groups OAEs • ‘Change group’ shows higher amplitudes ~12.5 kHz and lower amplitudes in high frequency range. • Different ‘shape’ of OAE amplitude spectra linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 Take home messages 1. 2. 3. Group results • Small but consistent differences between baseline and follow-up • OAEs show changes in other frequency area than PTA Individual results • Small number of ears with emission shift or threshold shift • No clear relation between emission shift and threshold shift Predictive value • We observe intriguing differences in baseline OAEs when comparing groups of ears with and without threshold shift • Future (statistical) analysis will clarify whether OAEs have a predictive value in individual cases of NIHL linical & Experimental Audiology Acknowledgements The participants from 5 Dutch symphonic orchestras • Koninklijk Concertgebouworkest • Nederlands Philharmonisch Orkest • Holland Symfonia • Het Gelders Orkest • Residentie Orkest Colleagues at AMC linical & Experimental Audiology Thank you for you attention! Questions? linical & Experimental Audiology Hilde Eising, MSc. [email protected] Method Audiometry • Interacoustics AC40 audiometer with TDH39 headphones • Calibrated according to ISO 389 • Sound–isolated booth TEOAE (Otodynamics ILO 292) • 80 dB SPL click • Non-linear • Half-octave frequency band (1, 1.5, 2, 4 and 4 kHz) DPOAE (Otodynamics ILO 292) • L1=75 dB SPL, L2=70 dB SPL at follow-up also L1=65 dB SPL and L2=55 dB SPL • f2/f1=1.22 • Measured at 27 f2 frequencies (815 to 8000 Hz) • (8 points per octave) linical & Experimental Audiology Statistical analysis Goal: to describe the observed effects in a correct way Linear mixed effects model • Controlling for ear, age, gender, hearing threshold at baseline linical & Experimental Audiology OAEs: What do we know from literature? Cross-sectional studies • Lower OAE levels associated with poorer audiometric thresholds • e.g. Attias et al. 2001, Mansfield et al. 1999 Noise exposed people have lower OAE amplitudes than non-exposed people with similar audiometric thresholds e.g. Murray et al. 1993, Attias et al. 2001, Desai et al. 1999 What are ‘similar thresholds’? linical & Experimental Audiology ‘Change’ versus ‘No Change’ – at follow-up linical & Experimental Audiology Right Left Total Change N=10 N=7 N=17 No change N=50 N=53 N=103 Mean results baseline – male versus female Male Female • Male: better thresholds <3 kHz. • Female: generally higher OAE amplitudes linical & Experimental Audiology Only NH ears - baseline No change Change Total NH N=62 N=20 N=82 linical & Experimental Rest N=28 N=10 N=38 Audiology Total N=90 N=30 N=120 Only NH ears - change linical & Experimental Audiology Case study – patient nr. 58531 linical & Experimental Audiology