1
|
Lewis JD, Rutherford A, Stanford KE. Differential effects of mass-loading the eardrum and stiffening the middle ear on wideband absorbance. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:3615-3626. [PMID: 38833283 DOI: 10.1121/10.0026224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
The current work investigated the effects of mass-loading the eardrum on wideband absorbance in humans. A non-invasive approach to mass-loading the eardrum was utilized in which water was placed on the eardrum via ear canal access. The mass-loaded absorbance was compared to absorbance measured for two alternative middle ear states: normal and stiffened. To stiffen the ear, subjects pressurized the middle ear through either exsufflation or insufflation concurrent with Eustachian tube opening. Mass-loading the eardrum was hypothesized to reduce high-frequency absorbance, whereas pressurizing the middle ear was hypothesized to reduce low- to mid-frequency absorbance. Discriminant linear analysis classification was performed to evaluate the utility of absorbance in differentiating between conditions. Water on the eardrum reduced absorbance over the 0.7- to 6-kHz frequency range and increased absorbance at frequencies below approximately 0.5 kHz; these changes approximated the pattern of changes reported in both hearing thresholds and stapes motion upon mass-loading the eardrum. Pressurizing the middle ear reduced the absorbance over the 0.125- to 4-kHz frequency range. Several classification models based on the absorbance in two- or three-frequency bands had accuracy exceeding 88%.
Collapse
Affiliation(s)
- James D Lewis
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
| | - Alicia Rutherford
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
- Knoxville Veterans Affairs, Audiology, Knoxville, Tennessee 37919, USA
| | - Kathleen E Stanford
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
- Greater Knoxville Ear, Nose, and Throat, Powell, Tennessee 37849, USA
| |
Collapse
|
2
|
Hannon C, Lewis JD. Effects of Tympanic Membrane Electrodes on Sound Transmission From the Ear Canal to the Middle and Inner Ears. Ear Hear 2024:00003446-990000000-00276. [PMID: 38764148 DOI: 10.1097/aud.0000000000001524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVES The first objective of the study was to compare approaches to eardrum electrode insertion as they relate to the likelihood of introducing an acoustic leak between the ear canal and eartip. A common method for placing a tympanic membrane electrode involves securing the electrode in the canal by routing it underneath a foam eartip. This method is hypothesized to result in a slit leak between the canal and foam tip due to the added bulk of the electrode wire. An alternative approach involves creating a bore in the wall of the foam tip that the electrode can be threaded through. This method is hypothesized to reduce the likelihood of a slit leak before the electrode wire is integrated into the foam tip. The second objective of the study was to investigate how sound transmission in the ear is affected by placing an electrode on the eardrum. It was hypothesized that an electrode in contact with the eardrum increases the eardrum's mass, with the potential to reduce sound transmission at high frequencies. DESIGN Wideband acoustic immittance and distortion product otoacoustic emissions (DPOAEs) were measured in eight human ears. Measurements were completed for five different conditions: (1) baseline with no electrode in the canal, (2) dry electrode in the canal but not touching the eardrum, secured underneath the eartip, (3) dry electrode in the canal not touching the eardrum, secured through a bore in the eartip (subsequent conditions were completed using this method), (4) hydrated electrode in the canal but not touching the eardrum, and (5) hydrated electrode touching the eardrum. To create the bore, a technique was developed in which a needle is heated and pushed through the foam eartip. The electrode is then thread through the bore and advanced slowly by hand until contacting the eardrum. Analysis included comparing absorbance, admittance phase angle, and DPOAE levels between measurement conditions. RESULTS Comparison of the absorbance and admittance phase angle measurements between the electrode placement methods revealed significantly higher absorbance and lower admittance phase angle from 0.125 to 1 kHz when the electrode is routed under the eartip. Absorbance and admittance phase angle were minimally affected when the electrode was inserted through a bore in the eartip. DPOAE levels across the different conditions showed changes approximating test-retest variability. Upon contacting the eardrum, the absorbance tended to decrease below 1 kHz and increase above 1 kHz. However, changes were within the range of test-retest variability. There was evidence of reduced levels below 1 kHz and increased levels above 1 kHz upon the electrode contacting the eardrum. However, differences between conditions approximated test-retest variability. CONCLUSIONS Routing the eardrum electrode through the foam tip reduces the likelihood of incurring an acoustic leak between the canal walls and eartip, compared with routing the electrode under the eartip. Changes in absorbance and DPOAE levels resulting from electrode contact with the eardrum implicate potential stiffening of eardrum; however, the magnitude of changes suggests minimal effect of the electrode on sound transmission in the ear.
Collapse
Affiliation(s)
- Cailin Hannon
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee, USA
| | | |
Collapse
|
3
|
Chen CK, Lai YH, Hsieh LC, Tsui PH. Quantitative transmastoid ultrasound for detecting middle ear effusion in pediatric patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 236:107557. [PMID: 37100023 DOI: 10.1016/j.cmpb.2023.107557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrasound has emerged as a promising modality for detecting middle ear effusion (MEE) in pediatric patients. Among different ultrasound techniques, ultrasound mastoid measurement was proposed to allow noninvasive detection of MEE by estimating the Nakagami parameters of backscattered signals to describe the echo amplitude distribution. This study further developed the multiregional-weighted Nakagami parameter (MNP) of the mastoid as a new ultrasound signature for assessing effusion severity and fluid properties in pediatric patients with MEE. METHODS A total of 197 pediatric patients (n = 133 for the training group; n = 64 for the testing group) underwent multiregional backscattering measurements of the mastoid for estimating MNP values. MEE, the severity of effusion (mild to moderate vs. severe), and the fluid properties (serous and mucous) were confirmed through otoscopy, tympanometry, and grommet surgery and were compared with the ultrasound findings. The diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS The training dataset revealed significant differences in MNPs between the control and MEE groups, between mild to moderate and severe MEE, and between serous and mucous effusion were observed (p < 0.05). As with the conventional Nakagami parameter, the MNP could be used to detect MEE (AUROC: 0.87; sensitivity: 90.16%; specificity: 75.35%). The MNP could further identify effusion severity (AUROC: 0.88; sensitivity: 73.33%; specificity: 86.87%) and revealed the possibility of characterizing fluid properties (AUROC: 0.68; sensitivity: 62.50%; specificity: 70.00%). The testing results demonstrated that the MNP method enabled MEE detection (AUROC = 0.88, accuracy = 88.28%, sensitivity = 92.59%, specificity = 84.21%), was effective in assessing MEE severity (AUROC = 0.83, accuracy = 77.78%, sensitivity = 66.67%, specificity = 83.33%), and showed potential for characterizing fluid properties of effusion (AUROC = 0.70, accuracy = 72.22%, sensitivity = 62.50%, specificity = 80.00%). CONCLUSIONS Transmastoid ultrasound combined with the MNP not only leverages the strengths of the conventional Nakagami parameter for MEE diagnosis but also provides a means to assess MEE severity and effusion properties in pediatric patients, thereby offering a comprehensive approach to noninvasive MEE evaluation.
Collapse
Affiliation(s)
- Chin-Kuo Chen
- Department of Otolaryngology-Head and Neck Surgery and Communication Enhancement Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yan-Heng Lai
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chun Hsieh
- Department of Otolaryngology-Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan; Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
4
|
Won J, Monroy GL, Khampang P, Barkalifa R, Hong W, Chaney EJ, Aksamitiene E, Porter RG, Novak MA, Spillman DR, Kerschner JE, Boppart SA. In Vivo Optical Characterization of Middle Ear Effusions and Biofilms During Otitis Media. J Assoc Res Otolaryngol 2023; 24:325-337. [PMID: 37253962 PMCID: PMC10335988 DOI: 10.1007/s10162-023-00901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/15/2023] [Indexed: 06/01/2023] Open
Abstract
Otitis media (OM), a common ear infection, is characterized by the presence of an accumulated middle ear effusion (MEE) in a normally air-filled middle ear cavity. While assessing the MEE plays a critical role in the overall management of OM, identifying and examining the MEE is challenging with the current diagnostic tools since the MEE is located behind the semi-opaque eardrum. The objective of this cross-sectional, observational study is to non-invasively visualize and characterize MEEs and bacterial biofilms in the middle ear. A portable, handheld, otoscope-integrated optical coherence tomography (OCT) system combined with novel analytical methods has been developed. In vivo middle ear OCT images were acquired from 53 pediatric subjects (average age of 3.9 years; all awake during OCT imaging) diagnosed with OM and undergoing a surgical procedure (ear tube surgery) to aspirate the MEE and aerate the middle ear. In vivo middle ear OCT acquired prior to the surgery was compared with OCT of the freshly extracted MEEs, clinical diagnosis, and post-operative evaluations. Among the subjects who were identified with the presence of MEEs, 89.6% showed the presence of the TM-adherent biofilm in in vivo OCT. This study provides an atlas of middle ear OCT images exhibiting a range of depth-resolved MEE features, which can only be visualized and assessed non-invasively through OCT. Quantitative metrics of OCT images acquired prior to the surgery were statistically correlated with surgical evaluations of MEEs. Measurements of MEE characteristics will provide new readily available information that can lead to improved diagnosis and management strategies for the highly prevalent OM in children.
Collapse
Affiliation(s)
- Jungeun Won
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Guillermo L Monroy
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Pawjai Khampang
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Ronit Barkalifa
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Wenzhou Hong
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Eric J Chaney
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Edita Aksamitiene
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Ryan G Porter
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL, 61801, USA
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
| | - Michael A Novak
- Department of Otolaryngology, Carle Foundation Hospital, Urbana, IL, 61801, USA
| | - Darold R Spillman
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Division of Otolaryngology and Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Stephen A Boppart
- Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Beckman Institute for Advanced Science and Technology, 405 N Mathews Ave, Urbana, IL, 61801, USA.
- Department of Electrical and Computer Engineering, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
- NIH/NIBIB P41 Center for Label-free Imaging and Multiscale Biophotonics (CLIMB), University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| |
Collapse
|
5
|
Anastasios G, Kostis G. The possible relation of ventilation ear tubes with nocturnal noise-induced discoordination of the stress response axis – anatomical and physiological considerations. Med Hypotheses 2023. [DOI: 10.1016/j.mehy.2023.111063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
6
|
Flaherty SM, Russell IJ, Lukashkin AN. Drug distribution along the cochlea is strongly enhanced by low-frequency round window micro vibrations. Drug Deliv 2021; 28:1312-1320. [PMID: 34176371 PMCID: PMC8238068 DOI: 10.1080/10717544.2021.1943059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The cochlea’s inaccessibility and complex nature provide significant challenges to delivering drugs and other agents uniformly, safely and efficiently, along the entire cochlear spiral. Large drug concentration gradients are formed along the cochlea when drugs are administered to the middle ear. This undermines the major goal of attaining therapeutic drug concentration windows along the whole cochlea. Here, utilizing a well-known physiological effect of salicylate, we demonstrate a proof of concept in which drug distribution along the entire cochlea is enhanced by applying round window membrane low-frequency micro vibrations with a probe that only partially covers the round window. We provide evidence of enhanced drug influx into the cochlea and cochlear apical drug distribution without breaching cochlear boundaries. It is further suggested that ossicular functionality is not required for the effective drug distribution we report. The novel method presented here of local drug delivery to the cochlea could be implemented when ossicular functionality is absent or impeded and can be incorporated in clinically approved auditory protheses for patients who suffer with conductive, sensorineural or mixed hearing loss.
Collapse
Affiliation(s)
- Samuel M Flaherty
- Sensory Neuroscience Research Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.,Centre for Regenerative Medicine and Devices, University of Brighton, Brighton, UK
| | - Ian J Russell
- Sensory Neuroscience Research Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Andrei N Lukashkin
- Sensory Neuroscience Research Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK.,Centre for Regenerative Medicine and Devices, University of Brighton, Brighton, UK
| |
Collapse
|
7
|
Ravicz ME, Chien WW, Rosowski JJ. Restoration of middle-ear input in fluid-filled middle ears by controlled introduction of air or a novel air-filled implant. Hear Res 2015; 328:8-23. [PMID: 26121946 DOI: 10.1016/j.heares.2015.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/01/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022]
Abstract
The effect of small amounts of air on sound-induced umbo velocity in an otherwise saline-filled middle ear (ME) was investigated to examine the efficacy of a novel balloon-like air-filled ME implant suitable for patients with chronically non-aerated MEs. In this study, air bubbles or air-filled implants were introduced into saline-filled human cadaveric MEs. Umbo velocity, a convenient measure of ME response, served as an indicator of hearing sensitivity. Filling the ME with saline reduced umbo velocity by 25-30 dB at low frequencies and more at high frequencies, consistent with earlier work (Ravicz et al., Hear. Res. 195: 103-130 (2004)). Small amounts of air (∼30 μl) in the otherwise saline-filled ME increased umbo velocity substantially, to levels only 10-15 dB lower than in the dry ME, in a frequency- and location-dependent manner: air in contact with the tympanic membrane (TM) increased umbo velocity at all frequencies, while air located away from the TM increased umbo velocity only below about 500 Hz. The air-filled implant also affected umbo velocity in a manner similar to an air bubble of equivalent compliance. Inserting additional implants into the ME had the same effect as increasing air volume. These results suggest these middle-ear implants would significantly reduce conductive hearing loss in patients with chronically fluid-filled MEs.
Collapse
Affiliation(s)
- Michael E Ravicz
- Eaton-Peabody Laboratory, Massachusetts Eye & Ear Infirmary, 243 Charles St., Boston, MA 02114, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
| | - Wade W Chien
- Eaton-Peabody Laboratory, Massachusetts Eye & Ear Infirmary, 243 Charles St., Boston, MA 02114, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - John J Rosowski
- Eaton-Peabody Laboratory, Massachusetts Eye & Ear Infirmary, 243 Charles St., Boston, MA 02114, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
8
|
Zhang X, Guan X, Nakmali D, Palan V, Pineda M, Gan RZ. Experimental and modeling study of human tympanic membrane motion in the presence of middle ear liquid. J Assoc Res Otolaryngol 2014; 15:867-81. [PMID: 25106467 DOI: 10.1007/s10162-014-0482-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/18/2014] [Indexed: 10/24/2022] Open
Abstract
Vibration of the tympanic membrane (TM) has been measured at the umbo using laser Doppler vibrometry and analyzed with finite element (FE) models of the human ear. Recently, full-field TM surface motion has been reported using scanning laser Doppler vibrometry, holographic interferometry, and optical coherence tomography. Technologies for imaging human TM motion have the potential to lead to using a dedicated clinical diagnosis tool for identification of middle ear diseases. However, the effect of middle ear fluid (liquid) on TM surface motion is still not clear. In this study, a scanning laser Doppler vibrometer was used to measure the full-field surface motion of the TM from four human temporal bones. TM displacements were measured under normal and disease-mimicking conditions with different middle ear liquid levels over frequencies ranging from 0.2 to 8 kHz. An FE model of the human ear, including the ear canal, middle ear, and spiral cochlea was used to simulate the motion of the TM in normal and disease-mimicking conditions. The results from both experiments and FE model show that a simple deflection shape with one or two major displacement peak regions of the TM in normal ear was observed at low frequencies (1 kHz and below) while complicated ring-like pattern of the deflection shapes appeared at higher frequencies (4 kHz and above). The liquid in middle ear mainly affected TM deflection shapes at the frequencies higher than 1 kHz.
Collapse
Affiliation(s)
- Xiangming Zhang
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK, 73019, USA,
| | | | | | | | | | | |
Collapse
|
9
|
Guan X, Chen Y, Gan RZ. Factors affecting loss of tympanic membrane mobility in acute otitis media model of chinchilla. Hear Res 2014; 309:136-46. [PMID: 24406734 DOI: 10.1016/j.heares.2013.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/18/2013] [Accepted: 12/26/2013] [Indexed: 11/20/2022]
Abstract
Recently we reported that middle ear pressure (MEP), middle ear effusion (MEE), and ossicular changes each contribute to the loss of tympanic membrane (TM) mobility in a guinea pig model of acute otitis media (AOM) induced by Streptococcus pneumoniae (Guan and Gan, 2013). However, it is not clear how those factors vary along the course of the disease and whether those effects are reproducible in different species. In this study, a chinchilla AOM model was produced by transbullar injection of Haemophilus influenzae. Mobility of the TM at the umbo was measured by laser vibrometry in two treatment groups: 4 days (4D) and 8 days (8D) post inoculation. These time points represent relatively early and later phases of AOM. In each group, the vibration of the umbo was measured at three experimental stages: unopened, pressure-released, and effusion-removed ears. The effects of MEP and MEE and middle ear structural changes were quantified in each group by comparing the TM mobility at one stage with that of the previous stage. Our findings show that the factors affecting TM mobility do change with the disease time course. The MEP was the dominant contributor to reduction of TM mobility in 4D AOM ears, but showed little effect in 8D ears when MEE filled the tympanic cavity. MEE was the primary factor affecting TM mobility loss in 8D ears, but affected the 4D ears only at high frequencies. After the release of MEP and removal of MEE, residual loss of TM mobility was seen mainly at low frequencies in both 4D and 8D ears, and was associated with middle ear structural changes. Our findings establish that the factors contributing to TM mobility loss in the chinchilla ear were similar to those we reported previously for the guinea pig ears with AOM. Outcomes did not appear to differ between the two major bacterial species causing AOM in these animal models.
Collapse
Affiliation(s)
- Xiying Guan
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, USA
| | - Yongzheng Chen
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, USA
| | - Rong Z Gan
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, USA.
| |
Collapse
|
10
|
Shaver MD, Sun XM. Wideband energy reflectance measurements: effects of negative middle ear pressure and application of a pressure compensation procedure. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2013; 134:332-341. [PMID: 23862811 DOI: 10.1121/1.4807509] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The wideband energy reflectance (ER) technique has become popular as a tool for evaluating middle ear function. Negative middle ear pressure (MEP) is a prevalent form of middle ear dysfunction, which may impact application of ER measurements in differential diagnosis. A negative MEP may be countervailed by application of an equivalent negative ear canal pressure. The present study examined ER in the same ears under normal and experimentally induced negative MEP conditions. Thirty-five subjects produced at least one negative MEP each (-40 to -225 daPa). Negative MEP significantly altered ER in a frequency-specific manner that varied with MEP magnitude. ER increased for low- to mid-frequencies with the largest change (~0.20 to 0.40) occurring between 1 and 1.5 kHz. ER decreased for frequencies above 3 kHz with the largest change (~-0.10 to -0.25) observed between 4.5 and 5.5 kHz. Magnitude of changes increased as MEP became more negative, as did the frequencies at which maximum changes occurred, and the frequency at which enhancement transitioned to reduction. Ear canal pressure compensation restored ER to near baseline values. This suggests that the compensation procedure adequately mitigates the effects of negative MEP on ER. Theoretical issues and clinical implications are discussed.
Collapse
Affiliation(s)
- Mark D Shaver
- Department of Communication Sciences and Disorders, Wichita State University, 1845 Fairmount Street, Wichita, Kansas 67260-0075, USA
| | | |
Collapse
|
11
|
Mechanisms of tympanic membrane and incus mobility loss in acute otitis media model of guinea pig. J Assoc Res Otolaryngol 2013; 14:295-307. [PMID: 23483330 DOI: 10.1007/s10162-013-0379-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 02/15/2013] [Indexed: 10/27/2022] Open
Abstract
Acute otitis media (AOM) is a rapid infection of middle ear due to bacterial or viral invasion. The infection commonly leads to negative pressure and purulent effusion in the middle ear. To identify how these changes affect tympanic membrane (TM) mobility or sound transmission through the middle ear, we hypothesize that pressure, effusion, and structural changes of the middle ear are the main mechanisms of conductive hearing loss in AOM. To test the hypothesis, a guinea pig AOM model was created by injection of Streptococcus pneumoniae. Three days post inoculation, vibration of the TM at umbo in response to input sound in the ear canal was measured at three experimental stages: intact, pressure-released, and effusion-drained AOM ears. The vibration of the incus tip was also measured after the effusion was removed. Results demonstrate that displacement of the TM increased mainly at low frequencies when pressure was released. As the effusion was removed, the TM mobility increased further but did not reach the level of the normal ear at low frequencies. This was caused by middle ear structural changes or adhesions on ossicles in AOM. The structural changes also affected movement of the incus at low and high frequencies. The results provide new evidence for understanding the mechanism of conductive hearing loss in AOM.
Collapse
|
12
|
Alicandri-Ciufelli M, Gioacchini FM, Marchioni D, Genovese E, Monzani D, Presutti L. Mastoid: A vestigial function in humans? Med Hypotheses 2012; 78:364-6. [DOI: 10.1016/j.mehy.2011.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 12/13/2011] [Indexed: 11/26/2022]
|
13
|
Ear Canal Pressure Variations Versus Negative Middle Ear Pressure: Comparison Using Distortion Product Otoacoustic Emission Measurement in Humans. Ear Hear 2012; 33:69-78. [DOI: 10.1097/aud.0b013e3182280326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Qin Z, Wood M, Rosowski JJ. Measurement of conductive hearing loss in mice. Hear Res 2010; 263:93-103. [PMID: 19835942 PMCID: PMC2866764 DOI: 10.1016/j.heares.2009.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 10/07/2009] [Accepted: 10/09/2009] [Indexed: 11/24/2022]
Abstract
In order to discriminate conductive hearing loss from sensorineural impairment, quantitative measurements were used to evaluate the effect of artificial conductive pathology on distortion-product otoacoustic emissions (DPOAEs), auditory brainstem responses (ABRs) and laser-Doppler vibrometry (LDV) in mice. The conductive manipulations were created by perforating the pars flaccida of the tympanic membrane, filling or partially filling the middle-ear cavity with saline, fixing the ossicular chain, and interrupting the incudo-stapedial joint. In the saline-filled and ossicular-fixation groups, averaged DPOAE thresholds increased relative to the control state by 20-36 and 25-39 dB, respectively with the largest threshold shifts occurring at frequencies less than 20kHz, while averaged ABR thresholds increased 12-19 and 12-25 dB, respectively without the predominant low-frequency effect. Both DPOAE and ABR thresholds were elevated by less than 10 dB in the half-filled saline condition; no significant change was observed after pars flaccida perforation. Conductive pathology generally produced a change in DPOAE threshold in dB that was 1.5-2.5 times larger than the ABR threshold change at frequencies less than 30 kHz; the changes in the two thresholds were nearly equal at the highest frequencies. While mild conductive pathology (ABR threshold shifts of <10 dB) produced parallel shifts in DPOAE growth with level functions, manipulations that produced larger conductive hearing losses (ABR threshold shifts >10 dB) were associated with significant deceases in DPOAE growth rate. Our LDV measurements are consistent with others and suggest that measurements of umbo velocity are not an accurate indicator of conductive hearing loss produced by ossicular lesions in mice.
Collapse
MESH Headings
- Acoustic Impedance Tests
- Animals
- Audiometry/methods
- Auditory Threshold/physiology
- Diagnosis, Differential
- Disease Models, Animal
- Evoked Potentials, Auditory, Brain Stem/physiology
- Hearing Loss, Conductive/diagnosis
- Hearing Loss, Conductive/physiopathology
- Hearing Loss, Sensorineural/diagnosis
- Hearing Loss, Sensorineural/physiopathology
- Mice
- Mice, Inbred CBA
- Movement/physiology
- Otoacoustic Emissions, Spontaneous/physiology
- Tympanic Membrane/injuries
- Tympanic Membrane/physiopathology
- Vibration
Collapse
Affiliation(s)
- Zhaobing Qin
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | | | | |
Collapse
|
15
|
Efficacy of transnasal nebulized surfactant on experimental otitis media with effusion in guinea pig. Int J Pediatr Otorhinolaryngol 2010; 74:71-4. [PMID: 19931924 DOI: 10.1016/j.ijporl.2009.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 10/21/2009] [Accepted: 10/21/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Recently experimental trials have demonstrated that nebulized natural surfactant is effective in the treatment of experimental otitis media with effusion (OME). Two methodologically incomplete studies using animal models of induced OME have reported that nebulized surfactant can improve Eustachian tube function. There have been no reports that investigated the efficacy of the nebulized surfactant for OME using analysis of tympanic membrane vibration. In this study, we evaluated the therapeutic effect of nebulized natural surfactant by investigation of tympanic membrane vibration. MATERIALS AND METHODS The guinea pigs (n=20) were divided into three groups. Four normal guinea pigs without any treatment were used as normal controls. Sixteen pigs were given experimental OME in both ear and then divided into two groups. The OME model of guinea pig was created by transbullar injection 10 microl of lipopolysaccharide in saline. Experimental group 1 (n=8) was nebulized phosphate buffered saline (PBS). Experimental group 2 (n=8) was nebulized natural bovine surfactant. The transnasal nebulization was repeated for 7 days in both experimental groups. On the 8th day, both experimental groups and normal control group were measured the tympanic membrane vibration by laser Doppler vibrometer (LDV), and additionally histopathologic observation was performed by scanning electron microscope (SEM). RESULTS The TM vibration velocity in nebulized PBS group showed significantly reduced mainly at low frequencies. However, nebulized natural surfactant group recovered the reduction of tympanic membrane vibration. In nebulized PBS group, SEM showed severe thickened subepithelial layer and hyperplasia of gland structure. However, in nebulized natural surfactant group, SEM showed the reduced the thickness of subepithelial layer and the loss of glandular hyperplasia. CONCLUSION From our results, the nebulized natural surfactant is postulated to be effective in the treatment of intractable OME in animal model. The measurement of tympanic membrane vibration for analysis of middle ear mechanics was significantly corresponding to the middle ear mucosal changes. LDV is a useful tool for investigate the therapeutic effect of nebulized surfactant in experimental OME. With supporting clinical studies, nebulization of natural surfactant may become noninvasive treatment of OME in future.
Collapse
|
16
|
Zhao F, Koike T, Wang J, Sienz H, Meredith R. Finite element analysis of the middle ear transfer functions and related pathologies. Med Eng Phys 2009; 31:907-16. [PMID: 19643654 DOI: 10.1016/j.medengphy.2009.06.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 06/18/2009] [Accepted: 06/25/2009] [Indexed: 11/30/2022]
Affiliation(s)
- Fei Zhao
- Centre for Hearing and Balance Studies, University of Bristol, 5th Floor, 8 Woodland Road, Bristol BS8 1TN, UK.
| | | | | | | | | |
Collapse
|
17
|
Dai C, Gan RZ. Change in cochlear response in an animal model of otitis media with effusion. Audiol Neurootol 2009; 15:155-67. [PMID: 19776565 PMCID: PMC2853584 DOI: 10.1159/000241096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 06/12/2009] [Indexed: 11/19/2022] Open
Abstract
Our previous studies confirm that middle ear mobility is reduced in the presence of otitis media with effusion (OME). Variations in middle ear function may result in changes in cochlear response in OME ears. With the long-term goal of evaluating cochlear function in OME ears, the aim of this study was to measure the displacement of the basilar membrane (BM) in guinea pig ears with OME. Vibrations of the BM at the apex and basal turn were measured in an in vitro preparation extracted 3 and 14 days after injection of lipopolysaccharide in the middle ear of guinea pigs. The results show that the displacement sensitivity of the BM at the apex and the basal turn to sound pressure in the ear canal was reduced up to 25 dB at their characteristic frequencies, respectively. Cochlear gain with respect to umbo movement was also changed in ears with OME in both groups. This study provides data for analysis of the change of BM vibration in a guinea pig OME model.
Collapse
|
18
|
Change of middle ear transfer function in otitis media with effusion model of guinea pigs. Hear Res 2008; 243:78-86. [PMID: 18586077 DOI: 10.1016/j.heares.2008.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 05/05/2008] [Accepted: 05/23/2008] [Indexed: 11/22/2022]
Abstract
Otitis media with effusion (OME) is an inflammatory disease of the middle ear that causes most cases of conductive hearing loss observed in the pediatric population. With the long term goal of evaluating middle ear function with OME, the aim of the current study was to create an animal model of OME in which middle ear transfer functions could be measured. In guinea pigs, OME was created by injecting lipopolysaccharide (LPS) into the middle ear. Evidence of OME was assessed by otoscopy, tympanometry, histology, and by measuring the volume of fluid in the middle ear. Vibrations of the umbo and round window membrane were measured with a laser Doppler vibrometer at frequency range of 200-40 kHz in three groups of 3, 7, and 14 days after injection of LPS. Changes in displacement of the umbo and round window membrane in response to 80 dB SPL sound in the ear canal were measured across the frequency range. Displacement of both the umbo and round window membrane was reduced at all time points following LPS injections. Further, the change of the displacement transmission ratio (DTR) from the tympanic membrane to the round window occurred mainly in chronic (e.g. 14 days post-LPS injection) OME ears. This study provides useful data for analyzing the change of middle ear transfer function in OME ears.
Collapse
|