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Nowadays OAE have a special role in electrophysiological examinations and also remarkable application in infants&apos hearing screening test. In the current article we have focused attention on the physiological fundamentals of OAE and tried to explain the trends in physiological studies that finally led to discovering the acoustic radiations by "David Kemp". By studying this article we can conclude that inner ear cannot be pondered just as a transformer that change the movements of the inner ear&aposs fluid to the neural signal, rather it should be considered as an active organ that can produce energy and also control the other active mechanisms involved in hearing.

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Recent studies have demonstrated that outer hair cells play two functional roles in the ear: one is the sensory function and the other is motor one. The function of OHCs in being trigered with very poor signals can not be overlooked. This mechanism would lead in improving the sensitivity of the ear. As stimulus intensity increases, little by little, OHC will reach its saturation level and finally the amplification effect decreases.Otoacoustic emissions could be reverberations produced by the responses of outer hair cells .Any decrease in the number of OHCs can cause a mechanical split in the fine tuning mechanism of the organ of corti and result in hearing loss.

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OAEs are sound founds in the external aditory meatus that originate in the cochlea. OAEs are generated only when the organ of corti is in near normal condition and They can be detected only when the middle ear system is operating normally. The sound generated by the cochlea are small but  potentially audible, sometimes as much as 30 dBSPL. They can emerge spontaneously in the cochlea, but more commonly OAEs follow acoustic stimulation. No electrod are needed to  observe OAEs. In fact, microphone are used to detect them.

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In addition to Stimulus frequuncy and level, emitting Inner ear structurs status, OAEs parameters depend on conductive sound pathways charactristics, so abnormal OAEs donot always represent cochlear abnormality. Middle ear transmites Vibrations in two directions: forward and backward. Middle ear pathologies affect both forward and backward transmission.In this paper, The purpose is investigation of immediate effects of tympanic over - and under - pressure on click evoked Otoacoustic Emissions (CEOAEs) in healthy individuals. Healthy subjects with normal hearing and middle ear were exposed to ambient pressure changes in a pressure champer. The pressure was progressively changed in 100 dapa steps to accomplish on increase and decrease  in tympanic pressure. Pressure equilibration of the middle ear was avoided. The relative tympanic over-and under - pressure (+/-320 dapa) was monitored by tympanometry and CEOAEs recorded at every step of tympanic pressure change. The CEOAEs recorded during progressive tympanic over-and under- pressure had reduced amplitude and shorter latencies that were most pronounced in the 750 to 3000 Hz frequency bands.

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Method & Material: This study was performed on 36 normal-hearing subjects aged 18-25 years for survey of temporary threshold shift (TTS) by transient evoked otoacoustic emissions. Finding: Noise can affect the pure-tone thresholds and (TEOAEs) amplitudes. When cochlea affected by noise, evaluating TEOAE is more suitable than pure-tone audiometry. Because of this test, is objective an unaffected by attention and alertness and can be evaluated in difficult to test subject and also have high carefulness and can be performed in a quiet, but not sound-proof room.

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Objective: OAE an audiologic study for diagnosis of exteracochlear auditory neuropathy.
Method & Material: Immitance audiometry, OAE and ABR and rehabilitation Intervention was performed for 3 children suffered from kernictrus.
Conclusion: 1) OAE in the from of screening, distorted product and transient evoked-otoacoustic emission has to be added to our audiology test battery. 2) OAE studies have their own merit when we are clinically involved with the diagnosis of especial clinical entities like neonatal hypoxia, kernicterus, multiple sclerosis, meningitides and meningoencephalitis. 3) Case selection for cochlear implantation needs a knowledge of patients' OAE results. 4) In the case of intracerebral auditory neuropathy the need for other rehabilitative measures will be better understood.

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Objective : To assess neonates and children suffering from meningitis , during the critical and recovery periods , using ABR , EOAE and Behavioral Audiometry.
Method and Material: 40 neonates to 12-year-old children were assessed. Using ABR test, the hearing of these cases was evaluated during the critical period-that is , 24-72 hours following the diagnosis. This test was repeated when patients recovered from meningitis-that is 24 hours before discharge (recovery period) Hearing function , again , was assessed 7-14 days following discharge through Immittance Audiometry, Behavioral Audiometry (PTA , SF and BOA). And EOAE (TEOAE and DPOAE) tests procedures.Findings: During the critical period , ABR test revealed normal hearing in 35 patients (87.5%) and severe to profound sensorineural hearing loss (unilateral and bilateral) in 5 patients (12.5%-girl=4, boy=1). The same result were obtained in re-evaluation in the recovery period. On the other hand , 7-14 days after of discharge , Immittance Audiometry and Behavioral Audiometry (including PTA , S.F and BOA tests), confirmed the mentioned results (cross - gcheck). EOAE test (DPOAE and TEOAE) in 35 normal hearing patients (according to ABR test) , showed normal cochlear function. 2 out of 5 cases suffering from severe to profound sensorineural hearing loss revealed normal cochlear function. According to EOAE results , abnormal cochlear function was evident in 3 patients.
Conclusion: ABR , EOAE tests , and Behavioral Audiometry in children meningitis during the critical period and recovery period can be used to diagnose any degree of hearing loss with a high level accuracy. The results of persent study is confirmed by previous investigations.

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Background and Aim: Hearing sensitivity is so vital for musicians as loud music can cause hearing loss. The aim of this study was to assess hearing sensitivity of musicians in order to determine the effects of music exposure on hearing organ.
Materials and Methods: This case-control study  was conducted on 15 string musicians with musicianship history of more than 10 years and 15 normal hearing subjects. They all were male and 20-30 years old. TEOAEs and DPOAEs performed after otoscopy , immittance and pure tone audiometry in octave frequencies between 250 to 16000 Hz.
Results: There is not significant difference between pure tone thresholds of two groups for all frequencies.A significant difference of TEOAE is found between two groups for total response and amplituds of TEOAEs . DPOAEs amplituds are not significantly different between two groups .
Conclusion: Musicianship may  affect TEOAEs amplitudes , but cannot affect results of PTA and DPOAEs. Therefore this can be useful to detect cochlear lesions secondary to music exposure and also as a tool in hearing protection program.

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Background and Aim: Hyperbilirubinemia is one of the most common abnormalities during the neonatal period. Approximately 60% full-term and 80% preterm neonates suffer from hyperbilirubinemia. Hearing loss is one of the most prevalent side-effects of hyperbilirubinemia. This happens when the serum concentration of indirect bilirubin increases dramatically. The main purpose of this study is to evaluate the hearing status and to diagnose the probable site of lesion in affected children.
Materiads and Methods: In this cross-sectional study, 33 newborn to two year old subjects uffering from hyperbilirubinemia were evaluated using auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests In the Audiology department of the Faculty of Rehabilitation Sciences Iran University of Medical Sciences sampling method was accessible.
Results: 21% of the subjects had severe to profound hearing loss and 9% of subjects had mild to moderate hearing loss. In 51% of the subjects there was no response to ABR and TEOAE tests indicating cochlear and/or retrocochlear lesion. The other 15% manifest only abnormal ABR test indicating the presence of the auditory neuropathy.
Conclusion: TEOAEs test has its own limitations in these subjects, that is the hearing status of such patients can not be completely evaluated by using just TEOAE test. Therefore, to detect hearing loss both ABR and TEOAE tests must be performed in these subjects.

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Background and Aim: One of the most significant complaints of children with learning disability (LD) is difficulty in understanding speech in the presence of background noise. Different studies have shown that the medial olivocochlear bundle(MOCB) may play a role in hearing in noise. The MOCB function can be evaluated by the contralateral suppression of tone burst evoked otoacoustic emissions (TBEOAEs).The aim of the present study was to evaluate frequency specifications of MOCB by the contralateral suppression of TBEOAEs at 1,2,3 and 4 KHz in response to contralateral white noise in LD students.
Materials and Methods: This case-control study was conducted on 34 LD students aged 7-11 years and 31 normal students matched for age.The contralateral suppression of TBEOAEs was evaluated by comparing TBEOAEs amplitudes with and without contralateral white noise.
Results: In the absence of noise there was no significant difference between TBEOAEs amplitudes of two groups. In the presence of noise significant decrease was seen in TBEOAEs amplitudes at 1,2,3 and 4 KHz in both groups. In LD students the amount of this decrement at 1,2 and 4 KHz was lower than in the normal students.
Conclusion: A significant diminished suppression effect at 1,2 and 4 KHz in LD students indicates that at these frequency regions MOCB function was reduced. Therefore its suggested that the assessment of MOCB by evaluating the suppression effect of TBEOAEs included in the test battery approach used in the diagnostic of LD students.

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Background and Aim: A common complaint of children with learning disability (LD) is difficulty in understanding speech in the presence of background noise. Evidence from animal and human studies has indicated that the medial olivocochlear bundle (MOCB) play a role in hearing in the presence of noise. The MOCB function can be evaluated by the suppression effect of the click evoked otoacoustic emission (CEOAEs) in response to contralateral white noise. The present study was conducted to compare the suppression effect of CEOAEs between LD and normal students.

Materials and Method: This research is an analytic-interventional study. The study group consisted of 20 learning disabled and 20 normal male students. The suppression effect of CEOAEs was evaluated by a comparison between CEOAEs levels in two conditions- with and without presentation of contralateral white noise.

Results: In the absence of noise there was no significant difference between CEOAEs amplitudes of two groups while there was significant difference between CEOAEs of two groups in the presence of noise. The suppression effect of CEOAEs in normal students had significant difference with LD students.

Conclusion: The reduced suppression effect in LD students indicates the reduced activity of the MOCB function and efferent pathway in LD students which affect their ability to hear in the presence of background noise. Consequently, the suppression effect of CEOAEs can be used in the test battery approach of LD children.

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Background and Aim: Physiologic measures of cochlear and auditory nerve function may be of assistance in distinguishing between hearing disorders due primarily to auditory nerve impairment from those due primarily to cochlear hair cells dysfunction. The goal of present study was to measure of cochlear responses (otoacoustic emissions and cochlear microphonics) and auditory brainstem response in some adults with auditory neuropathy/ dys-synchrony and subjects with normal hearing.
Materials and Methods: Patients were 16 adults (32 ears) in age range of 14-30 years with auditory neuropathy/ dys-synchrony and 16 individuals in age range of 16-30 years from both sexes. The results of transient otoacoustic emissions, cochlear microphonics and auditory brainstem response measures were compared in both groups and the effects of age, sex, ear and degree of hearing loss were studied.
Results: The pure-tone average was 48.1 dB HL in auditory neuropathy/dys-synchrony group and the frequency of low tone loss and flat audiograms were higher among other audiogram&aposs shapes. Transient otoacoustic emissions were shown in all auditory neuropathy/dys-synchrony people except two cases and its average was near in both studied groups. The latency and amplitude of the biggest reversed cochlear microphonics response were higher in auditory neuropathy/dys-synchrony patients than control people significantly. The correlation between cochlear microphonics amplitude and degree of hearing loss was not significant, and age had significant effect in some cochlear microphonics measures. Auditory brainstem response had no response in auditory neuropathy/dys-synchrony patients even with low stimuli rates.
Conclusion: In adults with speech understanding worsen than predicted from the degree of hearing loss that suspect to auditory neuropathy/ dys-synchrony, the frequency of low tone loss and flat audiograms are higher. Usually auditory brainstem response is absent in this patients and use of both otoacoustic emissions and cochlear microphonics responses to measure cochlear hair cells function are suggested in them.

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Background and Aim: Matching a mother wavelet to class of signals can be of interest in signal analysis and denoising based on wavelet multiresolution analysis and decomposition. As transient evoked otoacoustic emissions (TEOAES) are contaminated with noise, the aim of this work was to provide a quantitative approach to the problem of matching a mother wavelet to TEOAE signals by using tuning curves and to use it for analysis and denoising TEOAE signals. Approximated mother wavelet for TEOAE signals was calculated using an algorithm for designing wavelet to match a specified signal.
Materials and Methods: In this paper a tuning curve has used as a template for designing a mother wavelet that has maximum matching to the tuning curve. The mother wavelet matching was performed on tuning curves spectrum magnitude and phase independent of one another. The scaling function was calculated from the matched mother wavelet and by using these functions, lowpass and highpass filters were designed for a filter bank and otoacoustic emissions signal analysis and synthesis. After signal analyzing, denoising was performed by time windowing the signal time-frequency component.
Results: Aanalysis indicated more signal reconstruction improvement in comparison with coiflets mother wavelet and by using the purposed denoising algorithm it is possible to enhance signal to noise ratio up to dB.
Conclusion: The wavelet generated from this algorithm was remarkably similar to the biorthogonal wavelets. Therefore, by matching a biorthogonal wavelet to the tuning curve and using wavelet packet analysis, a high resolution time-frequency analysis for the otoacoustic emission signals is possible.

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Background and Aim: Hyperbilirubinemia during the neonatal period is known to be an important risk factor for neonatal auditory impairment, and may reveal as a permanent brain damage, if no proper therapeutic intervention is considered. In the present study some electroacoustic and electrophysiologic tests were used to evaluate function of auditory system in a group of children with severe neonatal Jaundice.
Materials and Methods: Forty five children with mean age of 16.1 14.81 months and 17 mg/dl and higher bilirubin level were studied, and the transient evoked otoacoustic emission, acoustic reflex, auditory brainstem response and auditory steady-state response tests were performed for them.
Results: The mean score of bilirubin was 29.37± 8.95 mg/dl. It was lower than 20 mg/dl in 22.2%, between 20-30 mg/dl in 24.4% and more than 30 mg/dl in 48.0% of children. No therapeutic intervention in 26.7%, phototherapy in 44.4%, and blood exchange in 28.9% of children were reported. 48.9% hypoxia and 26.6% preterm birth history was shown too. TEOAEs was recordable in 71.1% of cases. The normal result in acoustic reflex, ABR and ASSR tests was shown just in 11.1% of cases. The clinical symptoms of auditory neuropathy were revealed in 57.7% of children.
Conclusion: Conducting auditory tests sensitive to hyperbilirubinemia place of injury is necessary to inform from functional effect and severity of disorder. Because the auditory neuropathy/ dys-synchrony is common in neonates with hyperbilirubinemic, the OAEs and ABR are the minimum essential tests to identify this disorder.

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Background and Aim: Tinnitus is the consciousness of sound that arises in the ear or head without any external sound origin. The efficacies of transmeatal low-level laser irradiation for tinnitus treatment were reported before. The aim of this study was to evaluate the effectiveness of low level laser therapy on tinnitus and ECochG and DPOAEs parameters.
Materials and Methods: The study design was prospective, quasi experimental. This investigation conducted on 16 ears (10 patients) with disabling tinnitus. All patients underwent ENT examination, complete audiological evaluation, tinnitus study, ECochG and DPOAEs, and finally completing tinnitus data sheet. The results were compared before and after irradiation.
Results: Means of tinnitus loudness (LMT) and CAP amplitudes were significant different before and after irradiation (p<0.005). There was no any other significant difference before and after low level laser irradiation in subjective loudness, pitch matching annoyance grade of tinnitus and DPOAEs and other ECochG parameters.
Conclusion: Transmeatal low-power laser irradiation with 200 mW seems not to be effective for treatment of tinnitus. This paper is the research brief report. In clinical point of view, this study should be repeated with a greater sample size although our results were statistically important.

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Background and Aim: One of the chemical pollutions which is frequently common in industry-other than noise is carbon monoxide. The present study aimed to assess the putative protective effect of N-acetylcysteine on the function of outer hair cells of rabbits exposed simultaneously to noise and carbon monoxide.
Methods: 24 male rabbits are entered in this interventional study. After obtaining baseline distortion product otoacoustic emissions, rabits were randomely devided into four groups. The groups Included: exposed with noise and received saline, exposed with noise and carbon monoxide and received saline, exposed with noise and received N-acetylcysteine, and exposed with noise and carbon monoxide and received N-acetylcysteine. Subsequently, they were evaluated again with distortion product otoacoustic emissions in two stages (two hours and one week after the exposure). Data were recorded and analyzed using paired and independent sample t-tests.
Results: Exposure to noise, and also simultaneous exposure to noise and carbon monoxide, and moreover using N-acetylcysteine in both groups, produced significant changes in distortion product otoacoustic emissions amplitudes (p<0.005).
Conclusion: The findings of the present research reveal that simultaneous exposure to noise and carbon monoxide may potentiate noise induced hearing loss. In addition, utilizing N-acetylcysteine can be used as a preventive agent for noise induced hearing loss and to avoid its potentiation with carbon monoxide.

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Background and Aim: Noise-induced hearing loss is the most common problem in industrial areas. This study aimed to determine effects of excessive noise exposure on measurable characteristics of distortion product otoacoustic emissions (DPOAEs) in rabbits.
Methods: The study was carried out on 12 adult male New Zealand White rabbits including case group - exposed to 500-8000 Hz broadband white noise with 100 dBA SPL for 8 hours per day in 5 consecutive days - and control group. After three days period of acclimatization to the experimental condition, rabbits&apos hearing status in each group were measured by distortion product otoacoustic emissions on days zero means before the study was initiated as a baseline, eight, one hour after the latest exposure to noise, and ten. The recorded results were analyzed using SPSS software.
Results: Highest mean distortion product otoacoustic emissions amplitudes in case group were allocated to frequencies of 5888.50 Hz, 8166.50 Hz, 9855.00 Hz, 3956.00 Hz, and 3098.50 Hz, respectively. However, the lowest mean distortion product otoacoustic emissions amplitude was related to frequency of 588.00 Hz (p=0.001).
Conclusion: This study revealed that distortion product otoacoustic emissions amplitude shifts due to noise occur first in high and then in middle frequencies. Additionally, exposure to noise can decrease distortion product otoacoustic emissions amplitudes. We conclude that distortion product otoacoustic emissions can be a reliable test for estimating personal susceptibility to noise-induced hearing loss.

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Background and Aim: To date, the function of auditory efferent system remains unclear. There is evidence that medial olivocochlear bundle receives descending input from the cortex. In this study, the effect of auditory selective attention on stimulus-frequency otoacoustic emissions (SFOAE) was analyzed to investigate the modification of peripheral auditory system by auditory cortex activity in frequency specific mode.
Methods: Thirty-six normal hearing adult subjects with their age ranging from 18 to 30 years (mean age: 21.9 years) participated in this cross-sectional study. Contralateral suppression of stimulus-frequency otoacoustic emissions was recorded in the right ear at 2 KHz. In order to eliminate the auditory attention, subjects were instructed to read a text. Besides, in order to evaluate the effect of auditory attention on contralateral suppression, subjects were instructed to detect target tones in background noise at 1000, 2000, and 4000 KHz.
Results: A significant increase at contralateral suppression of stimulus-frequency otoacoustic emissions was observed in auditory selective attention conditions (p≤0.001). The largest magnitude of stimulus-frequency otoacoustic emissions suppression was seen at 2 KHz.
Conclusion: The results of this study indicated that the activities of medial olivocochlear bundle enhanced by contralateral auditory selective attention increase the magnitude of stimulus-frequency otoacoustic emissions suppression. In fact, these results provided evidence for influence of auditory cortex on the peripheral auditory system via corticofugal pathways in a frequency specific way.

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Background and Aim: Contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) test evaluates the efferent auditory system. In this test, acoustic reflex is an important confounding variable. In recent years, application of this test is growing especially in children suspect to central auditory processing disorder. Therefore, the magnitude of influence of this confounding variable on the suppression of TEOAEs should be made clear. The aim of this study was to investigate the impact of acoustic reflex on contralateral suppression of TEOAEs.
Methods: This research was performed on 39 normal-hearing adults of both sexes and of 18-26 years of age. Tests were used for the determination of interaural attenuation (IA), acoustic reflex, TEOAEs and contralateral suppression of TEOAEs.
Results: TEOAEs amplitudes and their contralateral suppression were significantly higher in females and males respectively (p=0.01). The amount of TEOAEs suppression before reflex activity ranged between 2000 to 3000 Hz. Activation of acoustic reflex significantly increased the magnitude of suppression in all frequency bands (p≤0.01) and maximum suppression occurred in 500 to 1000 Hz.
Conclusion: For achieving accuracy of clinical findings, clinicians should always use suppressant levels lower than the acoustic reflex threshold. It is recommended that different norms for males and females be used in contralateral suppression of TEOAEs.

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Background and Aim: Subjective tinnitus etiology has not been fully understood. Recently, in normal hearing subject one of the tinnitus theories, more specifically the medial olivocochlear tract, is related to the dysfunction of the efferent auditory system. The aim of this study was to determine the potential contribution of a defective cochlear efferent innervations to the chronic tinnitus in patients with normal hearing and determine the relation between tinnitus loudness and the amount of suppression of the transient evoked otoacoustic emission. Methods: This study was conducted on 20 tinnitus patients aged between 20-45 years and 20 controls matched for age and gender in School of Rehabilitation, Tehran University of Medical Sciences. Transient otoacoustic emission testing without and with contralateral white noise at 55 and 65 dB was performed on each subject. Results: The amplitudes of the emissions in the two groups was significantly different (p=0.001), but no correlation between tinnitus loudness and the amplitudes of the emissions in the presence (p=0.3) and absence (p=0.06) of contralateral noise. Conclusion: The suppression of the transient evoked otoacoustic emission by contralateral white noise did not reach statistically significant levels in tinnitus patients while the amplitude in control group reduced significantly.