Yvonne Sininger

University of California, Los Angeles | UCLA · Department of Head and Neck Surgery

Importance Prenatal smoking is a known modifiable risk factor for stillbirth; however, the contribution of prenatal drinking or the combination of smoking and drinking is uncertain. Objective To examine whether prenatal exposure to alcohol and tobacco cigarettes is associated with the risk of stillbirth. Design, Setting, and Participants The Safe...

Prenatal exposures to alcohol (PAE) and tobacco (PTE) are known to produce adverse neonatal and childhood outcomes including damage to the developing auditory system. Knowledge of the timing, extent, and combinations of these exposures on effects on the developing system is limited. As part of the physiological measurements from the Safe Passage St...

Background: Audiologists often lack confidence in results produced by current protocols for diagnostic electrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols which extend the time needed to complete the testing and consequently delay fitting of amplification. A recent publication (Sininger et al, 2018)...

Background: Audiologists often lack confidence in results produced by current protocols for diagnosticelectrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols whichextend the time needed to complete the testing and consequently delay fitting of amplification. A recentpublication (Sininger et al, 2018) has...

Objectives: The first objective of this study was to compare the predicted audiometric thresholds obtained by auditory steady state response (ASSR) and auditory brainstem response (ABR) in infants and toddlers when both techniques use optimal stimuli and detection algorithms. This information will aid in determining the basis for large discrepanci...

Background: The Prenatal Alcohol and Sudden Infant Death Syndrome and Stillbirth Network, known as the "Safe Passage Study," enrolled approximately 12,000 pregnant women from the United States and South Africa and followed the development of their babies through pregnancy and the infant's first year of life to investigate the role of prenatal alco...

Limited data suggest that enhanced self-knowledge from genetic information related to non-medical traits can have a positive impact on psychological well-being. Deaf individuals undertake genetic testing for deaf genes to increase self-knowledge. Because deafness is considered a non-medical trait by many individuals, we hypothesized that deaf indiv...

Individuals with autism spectrum disorders (ASD) frequently demonstrate preserved or enhanced frequency perception but impaired timing perception. The present study investigated the processing of spectral and temporal information in 12 adolescents with ASD and 15 age-matched controls. Participants completed two psychoacoustic tasks: one determined...

Laterality (left-right ear differences) of auditory processing was assessed using basic auditory skills: (1) gap detection, (2) frequency discrimination, and (3) intensity discrimination. Stimuli included tones (500, 1000, and 4000 Hz) and wide-band noise presented monaurally to each ear of typical adult listeners. The hypothesis tested was that pr...

Background: Numerous studies have shown preserved or enhanced frequency perception in individuals with autism spectrum disorders (ASD; e.g. Bonnel et al., 2003; Heaton, 2003, Järvinen-Pasley & Heaton, 2007). For perception of auditory timing, however, there is evidence of impairment (Alcántara et al., 2003; Groen et al., 2009), and Boucher (2001) p...

This article examines the relationship between cultural affiliation and deaf adults’ motivations for genetic testing for deafness in the first prospective, longitudinal study to examine the impact of genetic counseling and genetic testing on deaf adults and the deaf community. Participants (n = 256), classified as affiliating with hearing, Deaf, or...

The purpose of this study was to determine the influence of selected predictive factors, primarily age at fitting of amplification and degree of hearing loss, on auditory-based outcomes in young children with bilateral sensorineural hearing loss. Forty-four infants and toddlers, first identified with mild to profound bilateral hearing loss, who wer...

There are limited data on the impact of incorporating genetic counseling and testing into the newborn hearing screening process. We report on results from a prospective, longitudinal study to determine the impact of genetic counseling and GJB2/GJB6 genetic testing on parental knowledge, attitudes, and beliefs about genetic testing. One hundred thir...

Newborn Hearing Screening (NHS) programs aim to reduce the age of identification and intervention of infants with hearing loss. It is generally accepted that NHS programs achieve that outcome, but few studies have compared children who were screened to those not screened in the same study and during the same time period. This study takes advantage...

Following Sininger and Cone-Wesson [Science 305, 1581], Sininger and Cone-Wesson [Hear. Res. 212, 203-211], Keefe et al. [J. Acoust. Soc. Am. 123(3), 1504-1512] described ear asymmetries in middle ear, cochlear, and brainstem responses of infants. Keefe et al. state that their data do not support the findings of Sininger and Cone-Wesson [Science 30...

Previous studies of connexin-related hearing loss have typically reported on mixed age groups or adults. To further address epidemiology and natural history of connexin-related hearing loss, we conducted a longitudinal study in an ethnically diverse cohort of infants and toddlers under 3 years of age. Our study compares infants with and without con...

In general, auditory cortex on the left side of the brain is specialized for processing of acoustic stimuli with complex temporal structure including speech, and the right hemisphere is primary for spectral processing and favors tonal stimuli and music. This asymmetry in processing is further emphasized when hemisphere-favored stimuli are presented...

As genetic testing becomes an integral part of the evaluation of deaf infants and children, it is important to understand parental views on genetic testing. The purpose of this study is to examine parental reasons for, and beliefs about, genetic testing for deafness in early-identified infants, and to determine if they differ as a function of ethni...

To make the audiologic community aware of a technical issue with potential for misunderstanding that could affect the design, calibration, and use of auditory brainstem response (ABR) systems. Two international standards published in 2007 relating to the stimuli commonly used in ABR tests were studied and the behavior of a commercially available AB...

We examined two commonly used dichotic listening tests for measuring the degree of hemispheric specialization for language in individuals who had undergone cerebral hemispherectomy: the consonant-vowel (CV) nonsense syllables and the fused words (FW) tests, using the common laterality indices f and lambda. Hemispherectomy on either side resulted in...

Lateralized processing of auditory stimuli occurs at the level of the auditory cortex but differences in function between the left and right sides are not clear at lower levels of the auditory system. The current study is designed to (1) investigate asymmetric auditory function at the ear and brainstem in human infants and (2) investigate possible...

Newborn hearing screening is currently being implemented in the United States and other countries, allowing early identification of and intervention for hearing loss in neonates. Also, genetic testing is clinically available for the GJB2 gene, which codes for the connexin 26 protein, and the results have begun to explain the cause of a significant...

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Genetic testing within the early hearing detection and intervention (EHDI) process, combined with genetic counseling and genetic evaluation, may define the cause of hearing loss, facilitate case management, and contribute to habilitation decisions. One gene, called GJB2, accounts for up to 50% of non-syndromic sensorineural hearing loss. Our early...

Otoacoustic emissions or OAEs (reflections of cochlear energy produced during the processing of sound) were measured in response to two types of stimuli, rapid clicks and sustained tones, in each ear of neonates. OAEs were larger to tones when elicited in the left ear and to clicks when elicited in the right. This finding is similar to those of enh...

The purpose of this review is to provide the reader with current information regarding the standards for audiologic assessment of infants and very young children. The nature of the appropriate test battery and the need for adjusting test procedures to meet the specific needs of infants and toddlers are emphasized. The basic measures in the audiolog...

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Auditory neuropathy (AN) is distinct from sensory hearing loss in several ways. The degree of hearing in AN loss is not related to hair cell damage. Speech perception in patients with AN is poor and not predicted by degree of loss. Auditory brainstem response (ABR) results are always poor and are not related to hearing thresholds in patients with A...

Auditory neuropathy (AN) is a term used to describe an auditory disorder in which there is evidence of normal outer hair cell function (otoacoustic emissions and/or cochlear microphonics) and poor function of the auditory nerve (absent or highly distorted auditory brain stem response starting with wave I). Many of these patients have evidence of ge...

To define both auditory nerve and cochlear receptor functions in subjects with auditory neuropathy (AN). We tested 33 AN subjects (66 ears) and compared them with 21 healthy subjects (28 ears). In AN subjects, the average pure-tone (1, 2, and 4 kHz) threshold loss was 57 dB HL. Click stimuli were used to elicit transient evoked otoacoustic emission...

The objective of this experiment was to address: 1) whether normal efferent system function is required for normal cochlear tuning as measured by distortion product otoacoustic emission (DPOAE) suppression in humans and 2) whether cochlear function, assessed by DPOAE suppression tuning, is normal in a small group of patients with auditory neuropath...

This article describes the design of a multicenter study sponsored by the National Institutes of Health. The purpose of this study was to determine the accuracy of three measures of peripheral auditory system status (transient evoked otoacoustic emissions, distortion product otoacoustic emissions, and auditory brain stem responses) applied in the p...

The purposes of this article are to describe the overall protocol for the Identification of Neonatal Hearing Impairment (INHI) project and to describe the management of the data collected as part of this project. A well-defined protocol and database management techniques were needed to ensure that data were 1) collected accurately and in the same w...

1) To describe distortion product otoacoustic emission (DPOAE) levels, noise levels and signal to noise ratios (SNRs) for a wide range of frequencies and two stimulus levels in neonates and infants. 2) To describe the relations between these DPOAE measurements and age, test environment, baby state, and test time. DPOAEs were measured in 2348 well b...

1) To describe transient evoked otoacoustic emission (TEOAE) levels, noise levels and signal to noise ratios (SNRs) for a range of frequency bands in three groups of neonates who were tested as a part of the Identification of Neonatal Hearing Impairment multi-center consortium project. 2) To describe the relations between these TEOAE measurements a...

The purpose of this study is to describe the recruitment and retention strategies as well as the sample demographics for families with infants completing the neonatal examination and returning for follow-up. These data are compared to those infants inactivated from the study. This study was a prospective, randomized clinical study. All infants who...

1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sa...

This article describes the audiologic findings and medical status of infants who were found to have hearing loss, detected as part of the Identification of Neonatal Hearing Impairment (INHI) project. In addition, the neonatal and maternal health variables for the group of infants who could not be tested with visual reinforcement audiometry (VRA) du...

This article summarizes the results of a multi-center study, "Identification of Neonatal Hearing Impairment," sponsored by the National Institutes of Health. The purpose of this study was to determine the performance characteristics of three measures of peripheral auditory system status, transient evoked otoacoustic emissions (TEOAEs), distortion p...

The objective of this study was to describe the demographic data, medical status, and incidence of risk factors for hearing impairment in the neonatal intensive care unit (NICU) and well-baby populations in a multicenter prospective study designed to assess neonatal hearing impairment and to evaluate factors that might affect neonatal hearing test...

1) To describe the auditory brain stem response (ABR) measurement system and optimized methods used for study of newborn hearing screening. 2) To determine how recording and infant factors related to the screening, using well-defined, specific ABR outcome measures. Seven thousand one hundred seventy-nine infants, 4478 from the neonatal intensive ca...

The purpose of this study was to compare the performance of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABRs) as tools for identification of neonatal hearing impairment. A total of 4911 infants including 4478 graduates of neonatal intensive care units, 353 we...

Auditory neuropathy (AN) is a hearing disorder that presents with a grossly abnormal or absent neural response as measured by evoked potentials in the presence of normal outer hair cell function evidenced by present otoacoustic emissions or cochlear microphonics. Rehabilitation for patients with AN is challenging due to abnormal temporal encoding a...

Auditory neuropathy (AN) was initially described as impairment of auditory neural function, with preserved cochlear hair cell function. In this report, 67 patients with audiological and neurophysiological criteria for hearing loss due to auditory neuropathy are described. Reviewing this large body of patients, AN appears to consist of a number of v...

Auditory neuropathy affects the normal synchronous activity in the auditory nerve, without affecting the amplification function in the inner ear. Patients with auditory neuropathy often complain that they can hear sounds, but cannot understand speech. Here we report psychophysical tests indicating that these patients' poor speech recognition is due...

Members of a Roma (Gypsy) family with hereditary motor and sensory peripheral neuropathy (HMSN) and concomitant auditory and vestibular cranial neuropathies were identified in Kocevje, Slovenia. The illness begins in childhood with a severe and progressive motor disability and the deafness is delayed until the second decade. There are no symptoms o...

Members of a Roma (Gypsy) family with hereditary motor and sensory peripheral neuropathy (HMSN) and concomitant auditory and vestibular cranial neuropathies were identified in Kocevje, Slovenia. The illness begins in childhood with a severe and progressive motor disability and the deafness is delayed until the second decade. There are no symptoms o...

Otoacoustic emissions are typically reduced in amplitude when broadband noise is presented to the contralateral ear. This contralateral suppression is attributed to activation of the medial olivocochlear system, which has an inhibitory effect on outer hair-cell activity. By studying the effects of contralateral noise on cochlear output at different...

Human infants spend the first year of life learning about their environment through experience. Although it is not visible to observers, infants with hearing are learning to process speech and understand language and are quite linguistically sophisticated by 1 year of age. At this same time, the neurons in the auditory brain stem are maturing, and...

Threshold measures of auditory brainstem response (ABR) were generated in 72 full-term newborn infants in response to clicks and tone burst stimuli between 500 and 8000 Hz as detailed in a previous study. These results were further analyzed for differences in response related to ear (lateral asymmetry) and subject gender. Thresholds obtained in mal...

Auditory neuropathy is a recently described disorder in which patients demonstrate hearing loss for pure tones, impaired word discrimination out of proportion to pure tone loss, absent or abnormal auditory brainstem responses, and normal outer hair cell function as measured by otoacoustic emissions and cochlear microphonics. We have identified eigh...

Objectives: Auditory neuropathy is a recently described disorder in which patients demonstrate hearing loss for pure tones, impaired word discrimination out of proportion to pure tone loss, absent or abnormal auditory brainstem responses, and normal outer hair cell function as measured by otoacoustic emissions and cochlear microphonics. We have ide...

To define mechanisms accounting for transient deafness in three children (two siblings, ages 3 and 6, and an unrelated child, age 15) when they become febrile. Audiometric tests (pure-tone audiometry, speech and sentence comprehension), tympanometry, middle ear muscle reflex thresholds, otoacoustic emissions (OAEs), and electrophysiological methods...

The absolute auditory sensitivity of the human newborn infant was investigated using auditory brainstem response thresholds (ABR). ABRs were elicited with clicks and tone-bursts of 0.5, 1.5, 4.0 and 8.0 kHz, embedded in notched noise, in healthy, full-term human neonates and young adults with known, normal-hearing sensitivity. Stimuli were calibrat...

The objectives of this study were: 1) to evaluate the maturity of cochlear frequency resolution in human neonates, and 2) to further elucidate the differential time course for development of frequency resolution at the cochlear and auditory-neural levels of the auditory system. This paper describes a relatively new technique using distortion produc...

This article evaluates the concept of auditory threshold and discusses the limitations of assessing threshold in human neonates. The advantages and limitations of assessing neonatal threshold by means of auditory brain stem response (ABR) are discussed, and data from several studies of newborn ABR threshold are compared. The authors report data fro...

Distortion product otoacoustic emission (DPOAE) iso-suppression tuning curves (STC) were generated in 15 normal-hearing adults and 16 healthy term-born neonates for three f2 frequencies. The 2f1-f2 DPOAE was elicited using f2/f1 = 1.2, LI = 1.2, LI = 65 and L2 = 50 dB SPL. A suppressor tone was presented at frequencies ranging from 1 octave below t...

Filtering of electrode-recorded activity before averaging is used in evoked-potential measurements to reduce background noise under the assumption that unwanted spectral components will be suppressed without substantially altering neural activity. Desired filter characteristics depend on signal and noise spectra and filter choice can affect the val...

The auditory brain stem response (ABR) is felt to be an objective technique for predicting hearing thresholds because a voluntary response is not required from the subject. However, determination of ABR threshold can be a subjective process. This article discusses a technique, termed Fsp, which adds objectivity to ABR threshold detection by creatin...

A vertical recording montage (Cz to the seventh cervical vertebra or C7) has been shown to yield significantly lower auditory brainstem response (ABR) threshold when compared with a horizontal or anterior-posterior montage (Sininger & Don, 1989). The present study further examines the relationship between electrode placement and the amplitude of th...

An 11-yr-old girl had an absence of sensory components of auditory evoked potentials (brainstem, middle and long-latency) to click and tone burst stimuli that she could clearly hear. Psychoacoustic tests revealed a marked impairment of those auditory perceptions dependent on temporal cues, that is, lateralization of binaural clicks, change of binau...

This study investigated the effects of click polarity on threshold detectability (threshold level in dB SL) of the auditory brain stem response (ABR). ABRs were obtained from 10 normally hearing adult subjects in response to rarefaction and condensation clicks presented from 0 to 10 dB SL in 2 dB steps. An objective response signal-to-noise estimat...

This study evaluated the effects of stimulus presentation rate and electrode orientation on ABR threshold. Six normal-hearing adults served as subjects. ABRs were recorded from three orthogonal electrode pairs in response to click stimuli at rates of 48 and 21/s. Psychophysical thresholds were determined for each of these stimuli, and ABRs were rec...

Twelve students from classrooms for children with severe language disorders and 12 age-matched controls were evaluated for short-term memory scanning speed using the Sternberg task. Sets of two, three, and four digits were presented via earphones as memory sets, followed by single-probe digits. Reaction time was measured for a verbal response of "y...

Auditory brain-stem response (ABR) recorded from 3 orthogonally placed electrode pairs reveals a voltage-voltage-voltage plot of activity known as the 3-channel Lissajous' trajectory (3-CLT). ABR 3-CLT responses have been recorded from 9 human subjects in response to monaural, 70 dB nHL clicks. Responses were simultaneously recorded from 3 electrod...

Two discrete studies of lesions (sectioning the auditory nerve and mid-sagittal brain-stem) were performed in 5 adult cats to determine the relationship between planar-segment formation and underlying generator activity.The experiments gave 2 major results: (1) Section of the VIII nerve at the brain-stem resulted in loss of potentials after wave II...

The etiology of an incidentally discovered temporary threshold shift observed in an experimental animal (Harley guinea pig) is discussed with its potential implications for auditory research.