Suppression of tinnitus by cochlear implantation

Mechanical Effects of Medical Device Attachment to Human Tympanic Membrane

PURPOSE

Several treatment methods for hearing disorders rely on attaching medical devices to the tympanic membrane. This study aims to systematically analyze the effects of the material and geometrical properties and location of the medical devices attached to the tympanic membrane on middle-ear vibrations.

METHODS

A finite-element model of the human middle ear was employed to simulate the effects of attachment of medical devices. Various types of material and geometrical properties, locations, and modeling scenarios were investigated for the medical device.

RESULTS

The attachment of the device magnifies the effects of anti-resonances of the middle ear. Additionally, the variations of the material properties of the device significantly alter the middle-ear resonance frequency while changes in the umbo and stapes footplate motions are negligible at frequencies above 5 kHz. Furthermore, modeling the device as a point mass cannot accurately represent the implanted middle-ear behavior. The variations of the diameter and height of the medical device have negligible effects on the middle-ear vibrations at frequencies below 200 Hz but can have considerable impacts at higher frequencies. The effects of changing the device height were negligible at frequencies above 2 kHz. We also discuss the effects of medical device attachment on the vibration patterns of the tympanic membrane as well as the impacts of the variations of the location of the device on the stapes footplate responses.

CONCLUSION

The findings of our study aid the development and optimization of new therapeutic devices, attached to the tympanic membrane, to have the least adverse effects on middle-ear vibrations.

Changes in Tinnitus Characteristics and Residual Inhibition following Cochlear Implantation: A Prospective Analysis

This study aims to explore the effect of cochlear implantation on tinnitus perception. A prospective study was conducted on 72 adult hearing-impaired patients to evaluate tinnitus perception before and after cochlear implantation, using standardized tinnitus questionnaires (the tinnitus sample case-history questionnaire, tinnitus functional index (TFI), and tinnitus handicap inventory (THI)). A large variety of demographic and hearing- and implant-related data was collected from patient hospital records to explore possible associations with the implantation effect. The prevalence of tinnitus complaints before implantation was 58.3%. The temporary induction or aggravation of tinnitus immediately after surgery was noted in 20% and 46.7% of patients, respectively. When evaluated 3 months after implantation, 60% of tinnitus patients experienced a clinically significant reduction in their complaints; most of the improvements were experienced immediately after activation of the implant. Only the scores for TFI and THI at baseline were found to be significantly correlated with a reduction in TFI scores after implantation. In 80% of tinnitus patients, the tinnitus remained suppressed for some time after taking off the device. The large subset of patients with residual inhibition supports the involvement of central pathophysiological processes in implantation effects on tinnitus, which are explored in this paper.

Assessment of middle ear structure and function with optical coherence tomography

BACKGROUND

Current clinical tests for middle ear (ME) injuries and related conductive hearing loss (CHL) are lengthy and costly, lacking the ability to noninvasively evaluate both structure and function in real time. Optical coherence tomography (OCT) provides both, but its application to the audiological clinic is currently limited.

OBJECTIVE

Adapt and use a commercial Spectral-Domain OCT (SD-OCT) to evaluate anatomy and sound-evoked vibrations of the tympanic membrane (TM) and ossicles in the human ME.

MATERIALS AND METHODS

SD-OCT was used to capture high-resolution three-dimensional (3D) ME images and measure sound-induced vibrations of the TM and ossicles in fresh human temporal bones.

RESULTS

The 3D images provided thickness maps of the TM. The system was, with some software adaptations, also capable of phase-sensitive vibrometry. Measurements revealed several modes of TM vibration that became more complex with frequency. Vibrations were also measured from the incus, through the TM. This quantified ME sound transmission, which is the essential measure to assess CHL.

CONCLUSION AND SIGNIFICANCE

We adapted a commercial SD-OCT to visualize the anatomy and function of the human ME. OCT has the potential to revolutionize point-of-care assessment of ME disruptions that lead to CHL which are otherwise indistinguishable via otoscopy.

Experience of tinnitus in adults who have severe-to-profound hearing loss: A scoping review

Background

Tinnitus is defined as the subjective perception of sound in the absence of an external stimulus, and tinnitus disorder becomes relevant when it is associated with emotional distress, cognitive dysfunction, and/or autonomic arousal. Hearing loss is recognized as the main risk factor for the pathogenesis of tinnitus. However, clinical guidelines for tinnitus disorder provide little direction for those who have severe-to-profound hearing loss including those who are pre-lingually Deaf. The aim of this scoping review was to catalogue what is known from the existing literature regarding the experience and management of tinnitus in adults who have a severe-to-profound hearing loss.

Summary

A scoping review was conducted following the Preferred Reporting Item for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Records were included if they reported an evaluation of tinnitus in adults who had severe-to-profound hearing loss. The online databases Ovid (MEDLINE, EMBASE and PsycINFO), CINAHL, ProQuest, Scopus, and Google Scholar were searched using the search terms ‘tinnitus’ (as a MESH term) and ‘deaf’ OR ‘profound hearing loss. Thirty-five records met the inclusion criteria for this review and were cataloged according to three major themes: Impact of tinnitus in deaf adults; Primary treatment of tinnitus in deaf adults; and Cochlear implant studies where tinnitus was a secondary outcome. Tinnitus symptom severity was assessed before and after intervention using tinnitus validated questionnaires in 29 records, with six further records using other assessment tools to measure tinnitus severity. Participants using cochlear implants were included in 30 studies. Medication, repetitive transcranial magnetic stimulation (rTMS), electrical promontory stimulation, and behavioral self-control therapy were each reported in single records.

Key messages

This scoping review cataloged the experience, assessment, and treatment of tinnitus in adults who have severe-to-profound hearing loss. It is shown that there is very limited research reported in this field. Although this review included many records, most focused on the provision of cochlear implants for severe-to-profound hearing loss, with assessment and measurement of tinnitus as a baseline or secondary outcome. Largely missing in the literature are empirical studies that seek firstly to understand the nature of the experience of tinnitus by people with no or little residual access to external sound.

Experience of adult cochlear implantation at a tertiary hospital

BACKGROUND

The prevalence of adult cochlear implant (CI) surgery is increasing. However, the relevant adult CI data in Taiwan are insufficient due to the relatively small number of adult implant patients. The two main factors hindering adult implantation are the high cost of the surgery itself and inadequate knowledge regarding the effectiveness of CI for hearing and suppression of tinnitus. Here, we present data regarding adult CI outcomes from a single tertiary hospital.

METHODS

A total of 116 consecutive adult CI recipients (≥18 years old) who completed at least 12 months of speech perception tests (words and sentences) between January 1999 and December 2020 were enrolled in this retrospective population-based cohort study. Thirty patients completed speech perception (words and sentences) testing as well as three questionnaires relating to quality of life, and 71 completed full tinnitus suppression studies. Subjects' pre- and post-CI questionnaires were evaluated to assess overall CI outcome.

RESULTS

For auditory evaluation, the scores of easy sentences (ES), difficult sentences (DS), and phonetically balanced (PB) word recognition tests reached a plateau at 3 months post-CI (p = 0.005, 0.001, and 0.004, respectively) in most subjects. The post-CI scores of bodily pain, mental health, and social role functioning were significantly higher than corresponding pre-CI scores on the SF-36 Health Survey-Taiwan version (p = 0.036, 0.019, and 0.002, respectively). Furthermore, the post-CI scores of basic sound perception, speech production, and advanced sound perception were significantly higher than the corresponding pre-CI scores on the Nijmegen Cochlear Implant Questionnaire (p < 0.001, 0.013, and <0.001, respectively). Self-esteem was significantly correlated with the Categories of Auditory Performance scale and Speech Intelligibility Rating scale at 3, 6, and 9 months post-CI. CI improved tinnitus in approximately 65.1% of 71 adults. Based on the Tinnitus Handicap Inventory, 66.7% of patients were in grade 3-5 before surgery. However, after CI, only 34.4% of patients remained in THI grade 3-5.

CONCLUSION

This study confirmed that CI can improve speech perception (words and sentences), physical health, mental health, social interaction, and self-esteem in adult patients with profound hearing loss. CI also significantly alleviated tinnitus. The outcomes of ES, DS, and PB tests at 3 months post-CI were non-inferior to other longer post-CI periods and could be utilized as references for recovery and evaluation of prognosis.

A comparative study of eight human auditory models of monaural processing

A number of auditory models have been developed using diverging approaches, either physiological or perceptual, but they share comparable stages of signal processing, as they are inspired by the same constitutive parts of the auditory system. We compare eight monaural models that are openly accessible in the Auditory Modelling Toolbox. We discuss the considerations required to make the model outputs comparable to each other, as well as the results for the following model processing stages or their equivalents: Outer and middle ear, cochlear filter bank, inner hair cell, auditory nerve synapse, cochlear nucleus, and inferior colliculus. The discussion includes a list of recommendations for future applications of auditory models.

Systematic Review on Intra- and Extracochlear Electrical Stimulation for Tinnitus

Several electrical stimulation patterns of the auditory nerve have been described for tinnitus relief, but there is no consensus on the most effective stimulation pattern. Therefore, we aim to systematically review the literature on the effect of intra- and extracochlear electrical stimulation patterns as a treatment option for patients with tinnitus. Only studies on intra- and extracochlear electrical stimulation for patients with tinnitus were included if the stimulation used did not concern standardized CI stimulation patterns to primarily rehabilitate hearing loss as intervention. A total of 34 studies met the inclusion criteria, with 10 studies (89 patients) on intracochlear electrical stimulation and 25 studies on extracochlear electrical stimulation (1109 patients). There was a high to medium risk of bias in 22 studies, especially due to lack of a non-exposed group and poor selection of the exposed group. All included studies showed subjective tinnitus improvement during or after electrical stimulation, using different stimulation patterns. Due to methodological limitations and low reporting quality of the included studies, the potential of intra- and extracochlear stimulation has not been fully explored. To draw conclusions on which stimulation patterns should be optimized for tinnitus relief, a deeper understanding of the mechanisms involved in tinnitus suppression is needed.

Perceptual similarity between piano notes: Simulations with a template-based perception model

In this paper, the auditory model developed by Dau, Kollmeier, and Kohlrausch [(1997). J. Acoust. Soc. Am. 102, 2892-2905] was used to simulate the perceptual similarity between complex sounds. As complex sounds, a set of piano recordings was used, whose perceptual similarity has recently been measured by Osses, Kohlrausch, and Chaigne [(2019). J. Acoust. Soc. Am. 146, 1024-1035] using a three-alternative forced-choice discrimination task in noise. To simulate this discrimination task, the auditory model required a new back-end stage, the central processor, which is preceded by several processing stages that are to a greater or lesser extent inspired by physiological aspects of the normal-hearing system. Therefore, a comprehensive review of the model parameters as used in the literature is given, indicating the fixed set of parameter values that is used in all simulations. Due to the perceptual relevance of the piano note onsets, this review includes an in-depth description of the auditory adaptation stage, the adaptation loops. A moderate to high correlation was found between the simulation results and existing experimental data.

What's the buzz? The neuroscience and the treatment of tinnitus

Tinnitus is a pervasive public health issue that affects ∼15% of the United States population. Similar estimates have also been shown on a global scale, with similar prevalence found in Europe, Asia, and Africa. The severity of tinnitus is heterogeneous, ranging from mildly bothersome to extremely disruptive. In the United States, ∼10-20% of individuals who experience tinnitus report symptoms that severely reduce their quality of life. Due to the huge personal and societal burden, in the last 20 yr a concerted effort on basic and clinical research has significantly advanced our understanding and treatment of this disorder. Yet, neither full understanding, nor cure exists. We know that tinnitus is the persistent involuntary phantom percept of internally generated nonverbal indistinct noises and tones, which in most cases is initiated by acquired hearing loss and maintained only when this loss is coupled with distinct neuronal changes in auditory and extra-auditory brain networks. Yet, the exact mechanisms and patterns of neural activity that are necessary and sufficient for the perceptual generation and maintenance of tinnitus remain incompletely understood. Combinations of animal model and human research will be essential in filling these gaps. Nevertheless, the existing progress in investigating the neurophysiological mechanisms has improved current treatment and highlighted novel targets for drug development and clinical trials. The aim of this review is to thoroughly discuss the current state of human and animal tinnitus research, outline current challenges, and highlight new and exciting research opportunities.

The stochastic resonance model of auditory perception: A unified explanation of tinnitus development, Zwicker tone illusion, and residual inhibition

Stochastic resonance (SR) has been proposed to play a major role in auditory perception, and to maintain optimal information transmission from the cochlea to the auditory system. By this, the auditory system could adapt to changes of the auditory input at second or even sub-second timescales. In case of reduced auditory input, somatosensory projections to the dorsal cochlear nucleus would be disinhibited in order to improve hearing thresholds by means of SR. As a side effect, the increased somatosensory input corresponding to the observed tinnitus-associated neuronal hyperactivity is then perceived as tinnitus. In addition, the model can also explain transient phantom tone perceptions occurring after ear plugging, or the Zwicker tone illusion. Vice versa, the model predicts that via stimulation with acoustic noise, SR would not be needed to optimize information transmission, and hence somatosensory noise would be tuned down, resulting in a transient vanishing of tinnitus, an effect referred to as residual inhibition.

Functional rate-code models of the auditory brainstem for predicting lateralization and discrimination data of human binaural perception

This paper presents a rate-code model of binaural interaction inspired by recent neurophysiological findings. The model consists of a peripheral part and a binaural part. The binaural part is composed of models of the medial superior olive (MSO) and the lateral superior olive (LSO), which are parts of the auditory brainstem. The MSO and LSO model outputs are preprocessed in the interaural time difference (ITD) and interaural level difference (ILD) central stages, respectively, which give absolute values of the predicted lateralization at their outputs, allowing a direct comparison with psychophysical data. The predictions obtained with the MSO and LSO models are compared with subjective data on the lateralization of pure tones and narrowband noises, discrimination of the ITD and ILD, and discrimination of the phase warp. The lateralization and discrimination experiments show good agreement with the subjective data. In the case of the phase-warp experiment, the models agree qualitatively with the subjective data. The results demonstrate that rate-code models of MSO and LSO can be used to explain psychophysical data considering lateralization and discrimination based on binaural cues.

Tinnitus Suppression in Cochlear Implant Patients Using a Sound Therapy App

PURPOSE

The use of acoustic stimuli to reduce the prominence of tinnitus has been used for decades. Counseling and tinnitus sound therapy options are not currently widespread for cochlear implant (CI) users. The goal of this study was to determine whether tinnitus therapy sounds created for individuals with acoustic hearing may also benefit CI users.

METHOD

Sixteen sounds from the ReSound Relief app (Version 3.0) were selected for the study. Sixteen participants were asked to rate the overall acceptability of each sound and to write the description of the sound they perceived. Sounds were streamed from an Apple™ iPod (6th generation) to the CI using a Cochlear™ Wireless Mini Microphone 2+. Thirteen participants then completed a 5-min trial where they rated their pretrial and posttrial tinnitus and the acceptability of a subset of preferred sounds. Ten out of these 13 participants completed a 2-week home trial with a preferred sound after which they answered an online tinnitus questionnaire and rated the effectiveness of the sound therapy.

RESULTS

Individual differences were large. Results from the 5-min trial showed that sounds perceived as rain, music, and waves were rated the most acceptable. For all of the participants, the posttrial tinnitus loudness rating was lower than the pretrial rating, with some participants experiencing greater difference in their tinnitus loudness than others. At the end of the 2-week home trial, 3 of 10 participants rated the effectiveness of sound therapy 70% or higher.

CONCLUSION

The results suggest that the use of tinnitus therapy sounds delivered through a CI can be acceptable and provides relief for some tinnitus sufferers.

Middle-ear function in the chinchilla: Circuit models and comparison with other mammalian species

The middle ear efficiently transmits sound from the ear canal into the inner ear through a broad range of frequencies. Thus, understanding middle-ear transmission characteristics is essential in the study of hearing mechanics. Two models of the chinchilla middle ear are presented. In the first model, the middle ear is modeled as a lumped parameter system with elements that represent the ossicular chain and the middle-ear cavity. Parameters of this model are fit using available experimental data of two-port transmission matrix parameters. In an effort to improve agreement between model simulations and the phase of published experimental measurements for the forward pressure transfer function at high frequencies, a second model in which a lossless transmission line model of the tympanic membrane is appended to the original model is proposed. Two-port transmission matrix parameter results from this second model were compared with results from previously developed models of the guinea pig, cat, and human middle ears. Model results and published experimental data for the two-port transmission matrix parameters are found to be qualitatively similar between species. Quantitative differences in the two-port transmission matrix parameters suggest that the ossicular chains of chinchillas, cats, and guinea pigs are less flexible than in humans.

Differential Intracochlear Sound Pressure Measurements in Human Temporal Bones with an Off-the-Shelf Sensor

The standard method to determine the output level of acoustic and mechanical stimulation to the inner ear is measurement of vibration response of the stapes in human cadaveric temporal bones (TBs) by laser Doppler vibrometry. However, this method is reliable only if the intact ossicular chain is stimulated. For other stimulation modes an alternative method is needed. The differential intracochlear sound pressure between scala vestibuli (SV) and scala tympani (ST) is assumed to correlate with excitation. Using a custom-made pressure sensor it has been successfully measured and used to determine the output level of acoustic and mechanical stimulation. To make this method generally accessible, an off-the-shelf pressure sensor (Samba Preclin 420 LP, Samba Sensors) was tested here for intracochlear sound pressure measurements. During acoustic stimulation, intracochlear sound pressures were simultaneously measurable in SV and ST between 0.1 and 8 kHz with sufficient signal-to-noise ratios with this sensor. The pressure differences were comparable to results obtained with custom-made sensors. Our results demonstrated that the pressure sensor Samba Preclin 420 LP is usable for measurements of intracochlear sound pressures in SV and ST and for the determination of differential intracochlear sound pressures.

STUDY ON THE ROLE OF OSSICULAR JOINT USING FINITE ELEMENT METHOD

The lever ratio, the vibration mode and the stiffness of the ossicular joints were studied using the finite element (FE) analysis of the response of human ear under the outer ear sound excitation. The three-dimensional FE model was constructed based on serial micro CT images of a temporal bone block, and validated through comparison with the experimental data from previous literatures. The displacements of the umbo and stapes footplate and the vibration mode of the ossicles under different grades of stiffness of middle ear components were derived. It is suggested that the flexible ossicular joint combined with the shift of rotation axis causes the increase of lever ratio at high frequency. In addition, the flexible incudostapedial joint (ISJ) can reduce sound transmission especially at high frequency, meanwhile it also permits more vibration energy transmitted to the piston-like directions.

The role of spectral detail in the binaural transfer function on perceived externalization in a reverberant environment

Individual binaural room impulse responses (BRIRs) were recorded at a distance of 1.5 m for azimuth angles of 0° and 50° in a reverberant room. Spectral details were reduced in either the direct or the reverberant part of the BRIRs by averaging the magnitude responses with band-pass filters. For various filter bandwidths, the modified BRIRs were convolved with broadband noise and listeners judged the perceived position of the noise when virtualized over headphones. Only reductions in spectral details of the direct part obtained with filter bandwidths broader than one equivalent rectangular bandwidth affected externalization. Reductions in spectral details of the reverberant part had only little influence on externalization. In both conditions, externalization was not as pronounced at 0° as at 50°. To characterize the auditory processes that may be involved in the perception of externalization, a quantitative model is proposed. The model includes an echo-suppression mechanism, a filterbank describing the frequency selectivity in the cochlea and a binaural stage that measures the deviations of the interaural level differences between the considered input and the unmodified input. These deviations, integrated across frequency, are then mapped to a value that corresponds to the perceived externalization.

Suppression of Tinnitus in Chinese Patients Receiving Regular Cochlear Implant Programming

Objective:

To assess the clinical effect of cochlear implant programming on tinnitus.

Methods:

Tinnitus patients (n = 234) were divided into 3 groups: (1) preoperative tinnitus (n = 108), (2) postoperative tinnitus occurring before implant switch-on at week 4 (n = 88), and (3) tinnitus occurring more than 1 year postoperatively (n = 44). Patients in each group were randomly allocated into a programming subgroup that received programming for 12 weeks postoperatively or after tinnitus occurrence or a control subgroup. Impedance testing and the Tinnitus Handicap Inventory (THI) were performed preoperatively and at 4, 6, 8, and 12 weeks postoperatively (groups 1 and 2) or after tinnitus occurrence (group 3). Comparisons were performed using t tests and chi-square tests.

Results:

Impedance was significantly lower in the programming subgroup than in the control subgroup in groups 1 and 2 at 8 and 12 weeks and in group 3 at 12 weeks. The THI scores decreased in both programming and control subgroups in all groups. However, this decrease was pronounced in the programming subgroup, whereas in the control subgroup, it occurred slowly over time.

Conclusion:

Cochlear implant programming decreases impedance and improves tinnitus symptoms.

A Series of Case Studies of Tinnitus Suppression With Mixed Background Stimuli in a Cochlear Implant

PURPOSE

Background sounds provided by a wearable sound playback device were mixed with the acoustical input picked up by a cochlear implant speech processor in an attempt to suppress tinnitus.

METHOD

First, patients were allowed to listen to several sounds and to select up to 4 sounds that they thought might be effective. These stimuli were programmed to loop continuously in the wearable playback device. Second, subjects were instructed to use 1 background sound each day on the wearable device, and they sequenced the selected background sounds during a 28-day trial. Patients were instructed to go to a website at the end of each day and rate the loudness and annoyance of the tinnitus as well as the acceptability of the background sound. Patients completed the Tinnitus Primary Function Questionnaire (Tyler, Stocking, Secor, & Slattery, 2014) at the beginning of the trial.

RESULTS

Results indicated that background sounds were very effective at suppressing tinnitus. There was considerable variability in sounds preferred by the subjects.

CONCLUSION

The study shows that a background sound mixed with the microphone input can be effective for suppressing tinnitus during daily use of the sound processor in selected cochlear implant users.

Tinnitus Suppression by Intracochlear Electrical Stimulation in Single-Sided Deafness: A Prospective Clinical Trial - Part I

Cochlear implantation is a viable treatment option for tinnitus, but the underlying mechanism is yet unclear. Is the tinnitus suppression due to the reversal of the assumed maladaptive neuroplasticity or is it the shift in attention from the tinnitus to environmental sounds and therefore a reduced awareness that reduces tinnitus perception? In this prospective trial, 10 patients with single-sided deafness were fitted with a cochlear implant to investigate the effect of looped intracochlear electrical stimulation (i.e. stimulation that does not encode environmental sounds) on tinnitus, in an effort to find optimal stimulation parameters. Variables under investigation were: amplitude (perceived stimulus loudness), anatomical location inside the cochlea (electrode/electrodes), amplitude modulation, polarity (cathodic/anodic first biphasic stimulation) and stimulation rate. The results suggest that tinnitus can be reduced with looped electrical stimulation, in some cases even with inaudible stimuli. The optimal stimuli for tinnitus suppression appear to be subject specific. However, medium-to-loud stimuli suppress tinnitus significantly better than soft stimuli, which partly can be explained by the masking effect. Although the long-term effects on tinnitus would still have to be investigated and will be described in part II, intracochlear electrical stimulation seems a potential treatment option for tinnitus in this population.

Nonlinear Vibration Response Measured at Umbo and Stapes in the Rabbit Middle ear

Using laser vibrometry and a stimulation and signal analysis method based on multisines, we have measured the response and the nonlinearities in the vibration of the rabbit middle ear at the level of the umbo and the stapes. With our method, we were able to detect and quantify nonlinearities starting at sound pressure levels of 93-dB SPL. The current results show that no significant additional nonlinearity is generated as the vibration signal is passed through the middle ear chain. Nonlinearities are most prominent in the lower frequencies (125 Hz to 1 kHz), where their level is about 40 dB below the vibration response. The level of nonlinearities rises with a factor of nearly 2 as a function of sound pressure level, indicating that they may become important at very high sound pressure levels such as those used in high-power hearing aids.

Elastic Properties of the Annular Ligament of the Human Stapes--AFM Measurement

Elastic properties of the human stapes annular ligament were determined in the physiological range of the ligament deflection using atomic force microscopy and temporal bone specimens. The annular ligament stiffness was determined based on the experimental load-deflection curves. The elastic modulus (Young's modulus) for a simplified geometry was calculated using the Kirchhoff-Love theory for thin plates. The results obtained in this study showed that the annular ligament is a linear elastic material up to deflections of about 100 nm, with a stiffness of about 120 N/m and a calculated elastic modulus of about 1.1 MPa. These parameters can be used in numerical and physical models of the middle and/or inner ear.

Human middle-ear model with compound eardrum and airway branching in mastoid air cells

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25-13 kHz), equivalent input impedance at the eardrum (0.25-11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1-11 kHz), and reverse middle-ear impedance (0.25-8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold.

Acoustical transmission-line model of the middle-ear cavities and mastoid air cells

An acoustical transmission line model of the middle-ear cavities and mastoid air cell system (MACS) was constructed for the adult human middle ear with normal function. The air-filled cavities comprised the tympanic cavity, aditus, antrum, and MACS. A binary symmetrical airway branching model of the MACS was constructed using an optimization procedure to match the average total volume and surface area of human temporal bones. The acoustical input impedance of the MACS was calculated using a recursive procedure, and used to predict the input impedance of the middle-ear cavities at the location of the tympanic membrane. The model also calculated the ratio of the acoustical pressure in the antrum to the pressure in the middle-ear cavities at the location of the tympanic membrane. The predicted responses were sensitive to the magnitude of the viscothermal losses within the MACS. These predicted input impedance and pressure ratio functions explained the presence of multiple resonances reported in published data, which were not explained by existing MACS models.

The envoy® totally implantable hearing system, st. Croix medical

The Totally Implantable Envoy® System is currently undergoing clinical trials in both the United States and Europe. The fully implantable hearing device is intended for use in patients with sensorineural hearing loss. The device employs piezoelectric transducers to sense ossicle motion and drive the stapes. Programmable signal processing parameters include amplification, compression, and variable frequency response. The fully implantable attribute allows users to take advantage of normal external ear resonances and head-related transfer functions, while avoiding undesirable earmold effects. The high sensitivity, low power consumption, and high fidelity attributes of piezoelectric transducers minimize acoustic feedback and maximize battery life (Gyo, 1996; Yanagihara, (1987) and 2001). The surgical procedure to install the device has been accurately defined and implantation is reversible.

A three-dimensional finite element model of round window membrane vibration before and after stapedotomy surgery

Piston stapes prostheses are implanted in patients with refractory conductive or mixed hearing loss due to stapes otosclerosis to stimulate the perilymph with varying degrees of success. The overclosure effect described by the majority of researchers affects mainly low and medium frequencies, and a large number of patients report a lack of satisfactory results for frequencies above 2 kHz. The mechanics of perilymph stimulation with the piston have not been studied in a systematic manner. The objective of this study was to assess the influence of stapedotomy surgery on round window membrane vibration and to estimate the postoperative outcomes using the finite element (FE) method. The study hypothesis is that the three-dimensional FE model developed of the human inner ear, which simulates the round window (RW) membrane vibration, can be used to assess the influence of stapedotomy on auditory outcomes achieved after the surgical procedure. An additional objective of the study was to enable the simulation of RW membrane vibration after stapedotomy using a new type of stapes prosthesis currently under investigation at Warsaw University of Technology. A three-dimensional finite element (FE) model of the human inner ear was developed and validated using experimental data. The model was then used to simulate the round window membrane vibration before and after stapedotomy surgery. Functional alterations of the RW membrane vibration were derived from the model and compared with the results of experimental measurements from temporal bones of a human cadaver. Piston stapes prosthesis implantation causes an approximately fivefold (14 dB) lower amplitude of the RW membrane vibrations compared with normal anatomical conditions. A satisfactory agreement between the FE model and the experimental data was found. The new prosthesis caused an increase of 20–30 dB in the RW displacement amplitude compared with the 0.4-mm piston prosthesis. In all frequencies, the FE model predicted a RW displacement curve that was above the experimental curves for the normal ear. The stapedotomy can be well simulated by the FE model to predict the auditory outcomes achieved following this otosurgery procedure. The 3D FE model developed in this study may be used to optimize the geometry of a new type of stapes prosthesis in order to achieve a similar sound transmission through the inner ear as for a normal middle ear. This should provide better auditory outcomes for patients with stapedial otosclerosis.

Wave motion on the surface of the human tympanic membrane: holographic measurement and modeling analysis

Sound-induced motions of the surface of the tympanic membrane (TM) were measured using stroboscopic holography in cadaveric human temporal bones at frequencies between 0.2 and 18 kHz. The results are consistent with the combination of standing-wave-like modal motions and traveling-wave-like motions on the TM surface. The holographic techniques also quantified sound-induced displacements of the umbo of the malleus, as well as volume velocity of the TM. These measurements were combined with sound-pressure measurements near the TM to compute middle-ear input impedance and power reflectance at the TM. The results are generally consistent with other published data. A phenomenological model that behaved qualitatively like the data was used to quantify the relative magnitude and spatial frequencies of the modal and traveling-wave-like displacement components on the TM surface. This model suggests the modal magnitudes are generally larger than those of the putative traveling waves, and the computed wave speeds are much slower than wave speeds predicted by estimates of middle-ear delay. While the data are inconsistent with simple modal displacements of the TM, an alternate model based on the combination of modal motions in a lossy membrane can also explain these measurements without invoking traveling waves.

Modeling the eardrum as a string with distributed force

In this paper, an analytical model of the tympanic membrane is introduced where the two-dimensional tympanic membrane is reduced to a one-dimensional string. It is intended to bridge the gap between lumped-element models and finite-element models. In contrast to known lumped-element models, the model takes the distributed effect of the sound field on the tympanic membrane into account. Compared to finite-element models, it retains the advantage of a low number of parameters. The model is adjusted to forward and reverse transfer functions of the guinea-pig middle ear. Although the fitting to experimental data is not perfect, important conclusions can be drawn. For instance, the model shows that the delay of surface waves on the tympanic membrane can be different from the signal transmission delay of the tympanic membrane. In a similar vein, the standing wave ratio on the tympanic membrane and within the ear canal can considerably differ. Further, the model shows that even in a low-loss tympanic membrane the effective area, which commonly is associated with the transformer ratio in a lumped-element and some hybrid circuit models, not only is frequency-dependent, but also different for forward and reverse transduction.

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation.

Isoresponse versus isoinput estimates of cochlear filter tuning

The tuning of a linear filter may be inferred from the filter's isoresponse (e.g., tuning curves) or isoinput (e.g., isolevel curves) characteristics. This paper provides a theoretical demonstration that for nonlinear filters with compressive response characteristics like those of the basilar membrane, isoresponse measures can suggest strikingly sharper tuning than isoinput measures. The practical significance of this phenomenon is demonstrated by inferring the 3-dB-down bandwidths (BW(3dB)) of human auditory filters at 500 and 4,000 Hz from behavioral isoresponse and isoinput measures obtained with sinusoidal and notched noise forward maskers. Inferred cochlear responses were compressive for the two types of maskers. Consistent with expectations, low-level BW(3dB) estimates obtained from isoresponse conditions were considerably narrower than those obtained from isolevel conditions: 69 vs. 174 Hz, respectively, at 500 Hz, and 280 vs. 464 Hz, respectively, at 4,000 Hz. Furthermore, isoresponse BW(3dB) decreased with increasing level while corresponding isolevel estimates remained approximately constant at 500 Hz or increased slightly at 4 kHz. It is suggested that comparisons between isoresponse supra-threshold human tuning and threshold animal neural tuning should be made with caution.

Tinnitus and cochlear implantation

Tinnitus is a common experience, but there is very marked heterogeneity of aetiology, perception and the extent of distress among individuals who experience tinnitus. In view of this, a modern approach to tinnitus should consider homogeneous groups of individuals. This review considers tinnitus experiences in patients undergoing cochlear implantation, this being of interest because the prevalence of tinnitus in this patient group prior to surgery may shed some light on the link between cochlear dysfunction and tinnitus Second, any change in tinnitus experience as a result of electrode placement surgery or cochlear implant activation has relevance for patient counselling and informed consent. Finally, in recent tinnitus retraining therapy literature there has been the suggestion that unilateral sound therapy for tinnitus patients may set up an unhelpful asymmetry of input to the auditory system, with possible exacerbation of contralateral tinnitus. Unilateral cochlear implant use represents the most dramatic asymmetry possible and hence is a test of that hypothesis. Relevant papers (n = 32) were identified from literature databases. The standard of reporting tinnitus results was inconsistent. Tinnitus is experienced by up to 86% of adult cochlear implant candidates, but is not universal and is only troublesome in a small proportion (reported as 27% in one study). Electrode insertion may induce tinnitus in a small (up to 4%) number of patients, but this is rare. Cochlear implant device use is associated with reduction of tinnitus intensity and awareness in up to 86% of patients, and rarely with exacerbation (up to 9%). There are some indications in the literature that the more complex the simulation strategy, the larger that effect. Specifically, unilateral cochlear implant use was generally associated with reduction of contralateral tinnitus (in up to 67% of individuals) rather than exacerbation, and so the assertion that unilateral sound therapy for tinnitus is contraindicated is not proven.

Ossicular resonance modes of the human middle ear for bone and air conduction

The mean resonance frequency of the human middle ear under air conduction (AC) excitation is known to be around 0.8-1.2 kHz. However, studies suggest that the mean resonance frequency under bone conduction (BC) excitation is at a higher frequency around 1.5-2 kHz. To identify the cause for this difference, middle-ear responses to both AC and BC excitations were measured at the umbo and lateral process of the malleus using five human cadaver temporal bones. The resonance modes identified from these measurements, along with finite element analysis results, indicate the presence of two ossicular modes below 2 kHz. The dominant mode under AC excitation is the first mode, which typically occurs around 1.2 kHz and is characterized by a "hinging" ossicular motion, whereas the dominant mode under BC excitation is the second mode, which typically occurs around 1.7 kHz and is characterized by a "pivoting" ossicular motion. The results indicate that this second mode is responsible for the translational component in the malleus handle motion. The finding is also consistent with the hypothesis that a middle-ear structural resonance is responsible for the prominent peak seen at 1.5-2 kHz in BC limit data.

Electrical Stimulation of the Cochlea to Reduce Tinnitus

This article reviews possible neural correlates of tinnitus, including an increase in rate, a decrease in rate, periodic activity, synchronous activity across neurons, and an edge between active and inactive neurons. We make some suggestions regarding how electrical current might alter these patterns of neural activity. For example, if tinnitus were represented with periodic neural activity, then electrical stimulation would need to disrupt this periodicity. Some cases of cochlear electrical stimulation are reviewed that show the tinnitus can be reduced or eliminated with cochlear electrical stimulation although it varies across individuals. Finally, after summarizing some key observations, we suggest some next steps to bring this into a clinical application.

Effect of absence of malleus on ossiculoplasty in human temporal bones

OBJECTIVE: We evaluated the effect of malleus presence or absence on middle ear sound transmission after middle ear reconstruction in a temporal bone model.

STUDY DESIGN: Human cadaveric temporal bone study.

METHODS: The velocity of the stapes footplate was measured using a laser Doppler vibrometer. After baseline measurements in eight intact temporal bones, reconstructed middle ear transmission with and without the malleus was analyzed. Furthermore, to assess the influence of interposed cartilage, cartilage pieces of three different diameters were inserted and the three test conditions compared.

RESULTS: Reconstruction without a malleus tended to be slightly worse at 0.6 to 3.0 kHz. However, these differences were not statistically significant. In the cartilage experiments, the large-diameter cartilage was the worst at 0.25 kHz and 0.5 kHz but was better than the medium-diameter cartilages at 3.0 kHz and 4.0 kHz ( P < 0.05).

CONCLUSION: Absence of the malleus impaired middle ear sound transmission slightly in the mid frequencies compared to reconstruction with the malleus present; the differences were not statistically significant.

A computational model of human auditory signal processing and perception

A model of computational auditory signal-processing and perception that accounts for various aspects of simultaneous and nonsimultaneous masking in human listeners is presented. The model is based on the modulation filterbank model described by Dau et al. [J. Acoust. Soc. Am. 102, 2892 (1997)] but includes major changes at the peripheral and more central stages of processing. The model contains outer- and middle-ear transformations, a nonlinear basilar-membrane processing stage, a hair-cell transduction stage, a squaring expansion, an adaptation stage, a 150-Hz lowpass modulation filter, a bandpass modulation filterbank, a constant-variance internal noise, and an optimal detector stage. The model was evaluated in experimental conditions that reflect, to a different degree, effects of compression as well as spectral and temporal resolution in auditory processing. The experiments include intensity discrimination with pure tones and broadband noise, tone-in-noise detection, spectral masking with narrow-band signals and maskers, forward masking with tone signals and tone or noise maskers, and amplitude-modulation detection with narrow- and wideband noise carriers. The model can account for most of the key properties of the data and is more powerful than the original model. The model might be useful as a front end in technical applications.

Middle-ear circuit model parameters based on a population of human ears

Middle-ear circuit model parameters are selected to produce overall magnitude and phase agreement with pressure to stapes velocity transfer function measurements made on 16 human temporal bones, up to approximately 12 kHz. The circuit model, which was previously used for the cat, represents the tympanic membrane (TM) as a distributed parameter acoustic transmission line, and ossicular chain and cochlea as a network of lumped circuit elements. For some ears the TM transmission line primarily affects the magnitude of the response, while for others it primarily affects the phase. Model responses also compare favorably with velocity ratio data between the umbo and stapes footplate as well as between the umbo and incus, and exhibit similar characteristics to three previous input impedance measurements, including two from living ears. Similarities are also shown between the model magnitude and adjusted pressure to stapes velocity measurements from living ears, suggesting that the model may suitably approximate the behavior of living ears. In addition to fitting individual measurements, a set of parameters is selected to produce agreement with the mean of the 16 measurements up to 10 kHz, to allow the main features of the ensemble to be reproduced from a single parameter set.

Transmission matrix analysis of the chinchilla middle ear

Despite the common use of the chinchilla as an animal model in auditory research, a complete characterization of the chinchilla middle ear using transmission matrix analysis has not been performed. In this paper we describe measurements of middle-ear input admittance and stapes velocity in ears with the middle-ear cavity opened under three conditions: intact tympano-ossicular system and cochlea, after the cochlea has been drained, and after the stapes has been fixed. These measurements, made with stimulus frequencies of 100-8000 Hz, are used to define the transmission matrix parameters of the middle ear and to calculate the cochlear input impedance as well as the middle-ear output impedance. This transmission characterization of the chinchilla middle ear will be useful for modeling auditory sensitivity in the normal and pathological chinchilla ear.

Vibration characteristics of grafts for the tympanic membrane

Perforation of the tympanic membrane occurs frequently as a result of infection, external trauma, and high-level impulsive sound pressure, such as that associated with an explosion. Many different surgical techniques can be used to repair the tympanic membrane and ossicles. Clinical operations such as tympanoplasty are undertaken to repair the damaged tympanic membrane and ossicles, thus improving hearing and reducing the chance of infection. The membrane is repaired or replaced with the use of graft materials, either from the patient's body or from artificial sources. The selection of graft material is very important because, as much as possible, it must exhibit the same dynamic behavior as the natural membrane. To compare various allograft materials, investigators developed a model of the ear on which different graft materials can be replaced. Three different membrane materials - irradiated allograft dura (Tutoplast Dura; IOP Inc., Costa Mesa, Calif), irradiated allograft fascia lata (Tutoplast Fascia Lata; IOP Inc.), and irradiated allograft fascia temporalis (Tutoplast Fascia Temporalis; IOP Inc.) - were used. Vibration responses of these membrane materials produced by defined sound signals with different frequencies were recorded by a small strain gauge; the spectra of sound for various corresponding input signals were recorded, and the results were compared with those of the sample graft material. Tutoplast Fascia Lata accomplished the best dynamic performance in vitro. Additional clinical and experimental data are needed, however, to determine which of these materials provides the best audiological and clinical performance.

Middle ear cavity and ear canal pressure-driven stapes velocity responses in human cadaveric temporal bones

Drive pressure to stapes velocity (V(st)) transfer function measurements are collected and compared for human cadaveric temporal bones with the drive pressure alternately on the ear canal (EC) and middle ear cavity (MEC) sides of the tympanic membrane (TM), in order to predict the performance of proposed middle-ear implantable acoustic hearing aids, as well as provide additional data for examining human middle ear mechanics. The chief finding is that, in terms of the V(st) response, MEC stimulation performs at least as well as EC stimulation below 8 kHz, provided that the EC is unplugged. Plugging the EC causes a reduced response for MEC drive below 2 kHz, due to a corresponding reduction of the pressure difference between the two sides of the TM. Between 8 and 11 kHz, the MEC drive transfer functions feature an approximately 17 dB drop in magnitude below the EC drive case, the cause of which remains unknown. The EC drive transfer functions reported here feature significantly less magnitude roll-off above 1 kHz than previous studies [with a slope of -2.3 vs -6.7 dB/octave for Aibara et al., Hear. Res. 152, 100-109 (2001)], and significantly more phase group delay (134 vs 62 micros for Aibara et al.).

Development of tinnitus-related neuronal hyperactivity through homeostatic plasticity after hearing loss: a computational model

Tinnitus, the perception of a sound in the absence of acoustic stimulation, is often associated with hearing loss. Animal studies indicate that hearing loss through cochlear damage can lead to behavioral signs of tinnitus that are correlated with pathologically increased spontaneous firing rates, or hyperactivity, of neurons in the auditory pathway. Mechanisms that lead to the development of this hyperactivity, however, have remained unclear. We address this question by using a computational model of auditory nerve fibers and downstream auditory neurons. The key idea is that mean firing rates of these neurons are stabilized through a homeostatic plasticity mechanism. This homeostatic compensation can give rise to hyperactivity in the model neurons if the healthy ratio between mean and spontaneous firing rate of the auditory nerve is decreased, for example through a loss of outer hair cells or damage to hair cell stereocilia. Homeostasis can also amplify non-auditory inputs, which then contribute to hyperactivity. Our computational model predicts how appropriate additional acoustic stimulation can reverse the development of such hyperactivity, which could provide a new basis for treatment strategies.

Lumped parametric model of the human ear for sound transmission

A lumped parametric model of the human auditoria peripherals consisting of six masses suspended with six springs and ten dashpots was proposed. This model will provide the quantitative basis for the construction of a physical model of the human middle ear. The lumped model parameters were first identified using published anatomical data, and then determined through a parameter optimization process. The transfer function of the middle ear obtained from human temporal bone experiments with laser Doppler interferometers was used for creating the target function during the optimization process. It was found that, among 14 spring and dashpot parameters, there were five parameters which had pronounced effects on the dynamic behaviors of the model. The detailed discussion on the sensitivity of those parameters was provided with appropriate applications for sound transmission in the ear. We expect that the methods for characterizing the lumped model of the human ear and the model parameters will be useful for theoretical modeling of the ear function and construction of the ear physical model.

Bioengineering Solutions for Hearing Loss and Related Disorders

Advances in digital signal processing, microelectronics, and power technology have produced devices that have contributed significantly to the quality of life and communication abilities of individuals with hearing impairment and tinnitus. Future technological developments will expand the benefits of current devices and offer new treatments for otologic disorders.

Experimental study of an adjustable-length prosthesis in a temporal bone model

CONCLUSIONS

This prosthesis has the advantage of rapid adjustment at the time of insertion in order to achieve optimal tension and, as a result, optimal sound transmission.

OBJECTIVE

To test the acoustic performance of a new, adjustable incus replacement prosthesis in a human temporal bone model.

MATERIAL AND METHODS

Experiments were performed in seven human temporal bones, before and after removal of the incus and insertion of the prosthesis. The input comprised 406 pure tones ranging in frequency between 0.1 and 10 kHz at an intensity of 80 dB SPL at the tympanic membrane. The output measurement was stapes footplate displacement, determined by means of a laser Doppler vibrometer. Three lengths of the prosthesis were investigated: optimal, optimal +0.2 mm and optimal +0.4 mm.

RESULTS

The optimal-length prosthesis produced similar results to those of an intact middle ear. The slightly longer prostheses decreased middle ear sound transmission at all test frequencies, except those near 1.5 kHz.