Comparing responses with positive versus negative polarity clicks may help separate ABRs from cochlear potentials and alert clinicians to the possibility of an auditory neuropathy. Therefore, absent or abnormal ABRs in the presence of normal otoacoustic emissions need not always implicate a purely "central disorder," but might be consistent with dysfunction between outer hair cells and primary afferent fibers.

Function of the olivocochlear reflex, measured by suppression of transient evoked otoacoustic emissions, is assessed in nine patients with bilateral auditory neuropathy/dys-synchrony and compared to matched control subjects with normal auditory function. TEOAEs were acquired using 65 dB peak sound pressure linear clicks with and without the presence of broad-band noise presented binaurally, ipsilaterally, or contralaterally in a forward masking paradigm. Efferent suppression differed significantly between subject groups (p < .0001). Mean suppression was less than 0.22 dB across all suppressor noise conditions for the auditory neuropathy/dys-synchrony subjects. TEOAE suppression averaged 4.47 (binaural), 2.41 (ipsilateral), and 1.52 (contralateral) dB in the control subjects. Suppression characteristics across the three suppressor conditions were also assessed in one patient with unilateral auditory neuropathy/dys-synchrony. The results suggest that poor efferent responses are related to compromised afferent input to the OCR pathway and support the use of efferent suppression of otoacoustic emissions as a differential measure of auditory function in patients with auditory neuropathy/dys-synchrony.