Clinical monitoring using otoacoustic emissions

Damaging influences to the cochlea are a leading cause of sensorineural hearing loss. Examples include acute or chronic noise exposure and cochleotoxic drugs such as aminoglycosides. Typically, once damage has occurred, the cochlea cannot recover. Therefore, prevention is critical. If damaging influences cannot be avoided, then secondary prevention or early detection of cochlear hearing loss becomes important. Ideally, methods for the detection of cochlear damage should be as specific and as sensitive as possible. Otoacoustic emissions satisfy these criteria and offer a means of testing aspects of cochlear function in a non-invasive and objective way. Evoked otoacoustic emissions measured either after transient stimuli or during two-tone stimulation (distortion-product otoacoustic emissions) are the types most commonly used for clinical purposes. They are stable over time within individual ears and their repeatability has been established under conditions of clinical testing using commercial equipment. Thus, they are well suited as an effective means of monitoring subtle changes in cochlear status. The possibility of making non-invasive repeated measures of cochlear function has led to the widespread use of otoacoustic emissions in animal experiments. Influences of development, anoxia, anaesthesia, noise, and drugs have been monitored. Preliminary studies in humans demonstrate that cochlear damage due to ototoxic drugs such as aminoglycosides or cisplatin and due to noise exposure can be detected using otoacoustic emissions. Comparison of such results to those available using pure-tone audiometry indicates a greater sensitivity of otoacoustic emissions for detecting early cochlear damage.(ABSTRACT TRUNCATED AT 250 WORDS)