Comparison of auditory responses determined by acoustic stimulation and by mechanical round window stimulation at equivalent stapes velocities

Using Stapes Velocity to Estimate the Efficacy of Mechanical Stimulation of the Round Window With an Active Middle Ear Implant

OBJECTIVE

To test a method to measure the efficacy of active middle ear implants when coupled to the round window.

METHODS

Data previously published in Koka et al. ( Hear Res 2010;263:128-137) were used in this study. Simultaneous measurements of cochlear microphonics (CM) and stapes velocity in response to both acoustic stimulation (forward direction) and round window (RW) stimulation (reverse direction) with an active middle ear implant (AMEI) were made in seven ears in five chinchillas. For each stimulus frequency, the amplitude of the CM was measured separately as a function of intensity (dB SPL or dB mV). Equivalent vibrational input to the cochlea was determined by equating the acoustic and AMEI-generated CM amplitudes for a given intensity. In the condition of equivalent CM amplitude between acoustic and RW stimulation-generated output, we assume that the same vibrational input to the cochlea was present regardless of the route of stimulation.

RESULTS

The measured stapes velocities for equivalent CM output from the two types of input were not significantly different for low and medium frequencies (0.25-4 kHz); however, the velocities for AMEI-RW drive were significantly lower for higher frequencies (4-14 kHz). Thus, for RM stimulation with an AMEI, stapes velocities can underestimate the mechanical input to the cochlea by ~20 dB for frequencies greater than ~4 kHz.

CONCLUSIONS

This study confirms that stapes velocity (with the assumption of equivalent stapes velocity for forward and reverse stimulation) cannot be used as a proxy for effective input to the cochlea when it is stimulated in the reverse direction. Future research on application of intraoperative electrophysiological measurements during surgery (CM, compound action potential, or auditory brainstem response) for estimating efficacy and optimizing device coupling and performance is warranted.

Round Window Stimulation of the Cochlea

Mixed hearing loss associated with a sensorineural component and an impaired conductive mechanism for sound from the external ear canal to the cochlea represents a challenge for rehabilitation using either surgery or traditional hearing amplification. Direct stimulations of the ossicular chain and the round window (RW) membrane have allowed an improved hearing in this population. The authors review the developments in basic and clinical research that have allowed the exploration of new routes for inner ear stimulation. Similar changes occur in the electrophysiological measures in response to auditory stimulation through the traditional route and direct mechanical stimulation of the RW. The latter has proven to be very effective as a means of hearing rehabilitation in a group of patients with significant difficulties with hearing and communication.

The design of a lumped parameter model considering the stimulus path of round window

BACKGROUND:

Sound normally enters the ear canal, passes through the middle ear, and stimulates the cochlea through the oval window. Alternatively, the cochlea can be stimulated in a reverse manner, namely round window stimulation. The reverse stimulation is not well understood, partly because in classic lumped-parameter models the path of reverse drive during the round window stimulation is usually not considered.

OBJECTIVE:

The study goal is to gain a better understanding of the hearing mechanism during round window stimulation.

METHODS:

A piezo actuator was coupled to the oval and round window of the guinea pigs. The auditory brainstem response produced by the forward and reverse stimulation at four frequencies was recorded.

RESULTS:

The results show that the input voltage of the actuator required at the hearing threshold in the round window drive was higher than that in the oval window drive. In order to understand the data, we designed a lumped-parameter cochlear model that can simulate both forward and reverse drive. The model-predicted results were consistent with the experimental results.

CONCLUSIONS:

The response of the auditory system to stimulus of oval window and round window was quantified through animal experimentation, and guinea pigs were used as experimental animals. When the same stimulus was applied to the oval window and round window of the cochlea, the ABR signals were compared. A lumped parameter model was designed to incorporate the sound transmission paths in both oval and round window stimulation. The simulated results are consistent with those of animal experiments. This model will be useful in understanding the inner-ear response in round window.

The Influence of Piezoelectric Transducer Stimulating Sites on the Performance of Implantable Middle Ear Hearing Devices: A Numerical Analysis

To overcome the inherent deficiencies of hearing aids, implantable middle ear hearing devices (IMEHDs) have emerged as a new treatment for hearing loss. However, clinical results show that the IMEHD performance varies with its transducer’s stimulating site. To numerically analyze the influence of the piezoelectric transducer’s stimulating sites on its hearing compensation performance, we constructed a human ear finite element model and confirmed its validity. Based on this finite element model, the displacement stimulation, which simulates the piezoelectric transducer’s stimulation, was applied to the umbo, the incus long process, the incus body, the stapes, and the round window membrane, respectively. Then, the stimulating site’s effect of the piezoelectric transducer was analyzed by comparing the corresponding displacements of the basilar membrane. Besides, the stimulating site’s sensitivity to the direction of excitation was also studied. The result of the finite element analysis shows that stimulating the incus body is least efficient for the piezoelectric transducer. Meanwhile, stimulating the round window membrane or the stapes generates a higher basilar membrane displacement than stimulating the eardrum or the incus long process. However, the performance of these two ideal sites’ stimulation is sensitive to the changes in the excitation’s direction. Thus, the round window membrane and the stapes is the ideal stimulating sites for the piezoelectric transducer regarding the driving efficiency. The direction of the excitation should be guaranteed for these ideal sites.

Development of the head, pinnae, and acoustical cues to sound location in a precocial species, the guinea pig (Cavia porcellus)

The morphology of the head and pinna shape the spatial and frequency dependence of sound propagation that give rise to the acoustic cues to sound source location. During early development, the physical dimensions of the head and pinna increase rapidly. Thus, the binaural (interaural time and level differences, ITD and ILD) and monaural (spectral shape) cues are also hypothesized to change rapidly. Complex interactions between the size and shape of the head and pinna limit the accuracy of simple acoustical models (e.g. spherical) and necessitate empirical measurements. Here, we measured the cues to location in the developing guinea pig, a precocial species commonly used for studies of the auditory system. We measured directional transfer functions (DTFs) and the dimensions of the head and pinna in guinea pigs from birth (P0) through adulthood. Dimensions of the head and pinna increased by 87% and 48%, respectively, reaching adult values by ∼8 weeks (P56). The monaural acoustic gain produced by the head and pinna increased with frequency and age, with maximum gains at higher frequencies (>8 kHz) reaching values of 10-21 dB for all ages. The center frequency of monaural spectral notches also decreased with age, from higher frequencies (∼17 kHz) at P0 to lower frequencies (∼12 kHz) in adults. In all animals, ILDs and ITDs were dependent on both frequency and spatial location. Over development, the maximum ILD magnitude increased from ∼15 dB at P0 to ∼30 dB in adults (at frequencies >8 kHz), while the maximum low frequency ITDs increased from ∼185 μs at P0 to ∼300 μs in adults. These results demonstrate that the changes in the acoustical cues are directly related to changes in head and pinna morphology.

Difference of auditory brainstem responses by stimulating to round and oval window in animal experiments

ABSTACT To ensure the safety and efficacy of implantable hearing aids, animal experiments are an essential developmental procedure, in particular, auditory brainstem responses (ABRs) can be used to verify the objective effectiveness of implantable hearing aids. This study measured and compared the ABRs generated when applying the same vibration stimuli to an oval window and round window. The ABRs were measured using a TDT system 3 (TDT, USA), while the vibration stimuli were applied to a round window and oval window in 4 guinea pigs using a piezo-electric transducer with a proper contact tip. A paired t-test was used to determine any differences between the ABR amplitudes when applying the stimulation to an oval window and round window. The paired t-test revealed a significant difference between the ABR amplitudes generated by the round and oval window stimulation (t = 10.079, α < .0001). Therefore, the results confirmed that the biological response to round window stimulation was not the same as that to oval window stimulation.

Direct Intracochlear Acoustic Stimulation Using a PZT Microactuator

Combined electric and acoustic stimulation has proven to be an effective strategy to improve hearing in some cochlear implant users. We describe an acoustic microactuator to directly deliver stimuli to the perilymph in the scala tympani. The 800 µm by 800 µm actuator has a silicon diaphragm driven by a piezoelectric thin film (e.g., lead-zirconium-titanium oxide or PZT). This device could also be used as a component of a bimodal acoustic-electric electrode array. In the current study, we established a guinea pig model to test the actuator for its ability to deliver auditory signals to the cochlea in vivo. The actuator was placed through the round window of the cochlea. Auditory brainstem response (ABR) thresholds, peak latencies, and amplitude growth were calculated for an ear canal speaker versus the intracochlear actuator for tone burst stimuli at 4, 8, 16, and 24 kHz. An ABR was obtained after removal of the probe to assess loss of hearing related to the procedure. In some animals, the temporal bone was harvested for histologic analysis of cochlear damage. We show that the device is capable of stimulating ABRs in vivo with latencies and growth functions comparable to stimulation in the ear canal. Further experiments will be necessary to evaluate the efficiency and safety of this modality in long-term auditory stimulation and its ability to be integrated with conventional cochlear implant arrays.

The Codacs™ direct acoustic cochlear implant actuator: exploring alternative stimulation sites and their stimulation efficiency

This work assesses the efficiency of the Codacs system actuator (Cochlear Ltd., Sydney Australia) in different inner ear stimulation modalities. Originally the actuator was intended for direct perilymph stimulation after stapedotomy using a piston prosthesis. A possible alternative application is the stimulation of middle ear structures or the round window (RW). Here the perilymph stimulation with a K-piston through a stapes footplate (SFP) fenestration (N = 10) as well as stimulation of the stapes head (SH) with a Bell prosthesis (N = 9), SFP stimulation with an Omega/Aerial prosthesis (N = 8) and reverse RW stimulation (N = 10) were performed in cadaveric human temporal bones (TBs). Codacs actuator output is expressed as equivalent sound pressure level (eq. SPL) using RW and SFP displacement responses, measured by Laser Doppler velocimetry as reference. The axial actuator coupling force in stimulation of stapes and RW was adjusted to ~ 5 mN. The Bell prosthesis and Omega/Aerial prosthesis stimulation generated similar mean eq. SPLs (Bell: 127.5–141.8 eq. dB SPL; Omega/Aerial: 123.6–143.9 eq. dB SPL), being significantly more efficient than K-piston perilymph stimulation (108.6–131.6 eq. dB SPL) and RW stimulation (108.3–128.2 eq. dB SPL). Our results demonstrate that SH, SFP and RW are adequate alternative stimulation sites for the Codacs actuator using coupling prostheses and an axial coupling force of ~ 5 mN. Based on the eq. SPLs, all investigated methods were adequate for in vivo hearing aid applications, provided that experimental conditions including constant coupling force will be implemented.