The Effect of Otoacoustic Emission Stimulus Level on the Strength and Detectability of the Medial Olivocochlear Reflex.

Previous work demonstrates the importance of a high signal to noise ratio (SNR) when using transient evoked otoacoustic emissions (TEOAEs) to assay the medial olivocochlear reflex (MOCR). Increasing stimulus level provides one means to increase TEOAE SNR. However, this may come at the expense of a smaller MOCR effect. It is not clear whether the gain in SNR associated with the use of higher stimulus levels outweighs the disadvantage of a potentially smaller MOCR effect. The present study investigated the strength and detectability of the MOCR when assayed using TEOAEs at different stimulus levels. The hypothesis was that although the strength of the MOCR decreases with increasing stimulus level, the occurrence of statistically significant MOCR effects increases due to an increase in TEOAE SNR. Twenty-five young adult females with normal hearing participated in the study. TEOAEs were measured in the right ear with and without broadband noise presented in the left ear. The strength of the MOCR was quantified as the percent difference in the TEOAE between the contralateral noise and quiet conditions. Statistical bootstrapping was used to detect significant MOCR effects in individual subjects across different frequency bands and stimulus levels. The relationship between a detectable MOCR (response variable) and frequency, stimulus level, TEOAE SNR, MOCR strength, and subject (predictor variables) was evaluated using generalized linear mixed-effect models. The number of statistically significant MOCR effects increased with stimulus level at all frequencies. Occurrence was highest for the 2-kHz TEOAE frequency band and lowest for the 4-kHz frequency band. The strength of the MOCR decreased with increasing click level. TEOAE SNR, MOCR strength, and stimulus level were significant predictors of a detectable MOCR: The likelihood of a detectable MOCR increased with TEOAE SNR, MOCR strength, and stimulus level. Despite a reduction in the strength of the MOCR with increasing stimulus level, the detectability of the MOCR increased. This is due, in part, to an increase in TEOAE SNR with stimulus level. For clinical implementation of TEOAE-based MOCR assays, achieving a high SNR is necessary to permit the detection of the MOCR in individual patients.