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DPOAEs are sensitive to cochlear amplification processes, while HTs are additionally dependent upon inner hair cells, synaptic junctions, and the auditory nervous system. These distinctions between DPOAEs and HTs might help differentially diagnose auditory dysfunctions. This study aims to differentially diagnose auditory dysfunctions underlying tinnitus, firearm use, and high lifetime noise exposure (LNE) using HTs, DPOAEs, and a derived metric comparing HTs and DPOAEs, in a sample containing overlapping subgroups of 133 normal-hearing young adults (56 with chronic tinnitus). A structured interview was used to evaluate LNE and firearm use. Linear regression was used to model the relationship between HTs and DPOAEs, and their regression residuals were used to quantify their relative agreement. Participants with chronic tinnitus showed significantly elevated HTs, yet DPOAEs remained comparable to those without tinnitus. In contrast, firearm users revealed elevated HTs and significantly lower DPOAEs than predicted from HTs. High LNE was associated with elevated HTs and a proportional decline in DPOAEs, as predicted from HTs. We present a theoretical model to interpret the findings, which suggest neural (or synaptic) dysfunction underlying tinnitus and disproportional mechanical dysfunction underlying firearm use.<\/jats:p>","DOI":"10.1121\/10.0019880","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T17:58:17Z","timestamp":1689962297000},"page":"418-432","update-policy":"https:\/\/doi.org\/10.1063\/aip-crossmark-policy-page","source":"Crossref","is-referenced-by-count":9,"title":["Influence of tinnitus, lifetime noise exposure, and firearm use on hearing thresholds, distortion product otoacoustic emissions, and their relative metric"],"prefix":"10.1121","volume":"154","author":[{"given":"Ishan Sunilkumar","family":"Bhatt","sequence":"first","affiliation":[{"name":"Department of Communication Sciences & Disorders, University of Iowa 1 , Iowa City, Iowa 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery","family":"Lichtenhan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of South Florida 2 , Tampa, Florida 33612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Tyler","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences & Disorders, University of Iowa 1 , Iowa City, Iowa 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences & Disorders, University of Iowa 1 , Iowa City, Iowa 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"231","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"2023072111153257800_c1","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1097\/00003446-200012000-00002","article-title":"Distortion product otoacoustic emission suppression in subjects with auditory neuropathy","volume":"21","year":"2000","journal-title":"Ear Hear."},{"key":"2023072111153257800_c2","first-page":"1066","article-title":"Evaluation of noise-induced hearing loss with audiometer and distortion product otoacoustic emissions","volume":"91","year":"2008","journal-title":"J. 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