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Lobato LC, Paul S, Cordioli JA. Stochastic modeling of the human middle ear dynamics under pathological conditions. Comput Biol Med 2024; 179:108802. [PMID: 38959526 DOI: 10.1016/j.compbiomed.2024.108802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Although the dynamics of the middle ear (ME) have been modeled since the mid-twentieth century, only recently stochastic approaches started to be applied. In this study, a stochastic model of the ME was utilized to predict the ME dynamics under both healthy and pathological conditions. METHODS The deterministic ME model is based on a lumped-parameter representation, while the stochastic model was developed using a probabilistic non-parametric approach that randomizes the deterministic model. Subsequently, the ME model was modified to represent the ME under pathological conditions. Furthermore, the simulated data was used to develop a classifier model of the ME condition based on a machine learning algorithm. RESULTS The ME model under healthy conditions exhibited good agreement with statistical experimental results. The ranges of probabilities from models under pathological conditions were qualitatively compared to individual experimental data, revealing similarities. Moreover, the classifier model presented promising results. DISCUSSION The results aimed to elucidate how the ME dynamics, under different conditions, can overlap across various frequency ranges. Despite the promising results, improvements in the stochastic and classifier models are necessary. Nevertheless, this study serves as a starting point that can yield valuable tools for researchers and clinicians.
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Affiliation(s)
- Lucas C Lobato
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianopolis, 88040-900, Brazil.
| | - Stephan Paul
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianopolis, 88040-900, Brazil
| | - Júlio A Cordioli
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianopolis, 88040-900, Brazil
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2
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Eberhard KE, Merchant GR, Nakajima HH, Neely ST. Toward Automating Diagnosis of Middle- and Inner-ear Mechanical Pathologies With a Wideband Absorbance Regression Model. Ear Hear 2024; 45:1241-1251. [PMID: 38797886 PMCID: PMC11333182 DOI: 10.1097/aud.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES During an initial diagnostic assessment of an ear with normal otoscopic exam, it can be difficult to determine the specific pathology if there is a mechanical lesion. The audiogram can inform of a conductive hearing loss but not the underlying cause. For example, audiograms can be similar between the inner-ear condition superior canal dehiscence (SCD) and the middle-ear lesion stapes fixation (SF), despite differences in pathologies and sites of lesion. To gain mechanical information, wideband tympanometry (WBT) can be easily performed noninvasively. Absorbance , the most common WBT metric, is related to the absorbed sound energy and can provide information about specific mechanical pathologies. However, absorbance measurements are challenging to analyze and interpret. This study develops a prototype classification method to automate diagnostic estimates. Three predictive models are considered: one to identify ears with SCD versus SF, another to identify SCD versus normal, and finally, a three-way classification model to differentiate among SCD, SF, and normal ears. DESIGN Absorbance was measured in ears with SCD and SF as well as normal ears at both tympanometric peak pressure (TPP) and 0 daPa. Characteristic impedance was estimated by two methods: the conventional method (based on a constant ear-canal area) and the surge method, which estimates ear-canal area acoustically.Classification models using multivariate logistic regression predicted the probability of each condition. To quantify expected performance, the condition with the highest probability was selected as the likely diagnosis. Model features included: absorbance-only, air-bone gap (ABG)-only, and absorbance+ABG. Absorbance was transformed into principal components of absorbance to reduce the dimensionality of the data and avoid collinearity. To minimize overfitting, regularization, controlled by a parameter lambda, was introduced into the regression. Average ABG across multiple frequencies was a single feature.Model performance was optimized by adjusting the number of principal components, the magnitude of lambda, and the frequencies included in the ABG average. Finally, model performances using absorbance at TPP versus 0 daPa, and using the surge method versus constant ear-canal area were compared. To estimate model performance on a population unknown by the model, the regression model was repeatedly trained on 70% of the data and validated on the remaining 30%. Cross-validation with randomized training/validation splits was repeated 1000 times. RESULTS The model differentiating between SCD and SF based on absorbance-only feature resulted in sensitivities of 77% for SCD and 82% for SF. Combining absorbance+ABG improved sensitivities to 96% and 97%. Differentiating between SCD and normal using absorbance-only provided SCD sensitivity of 40%, which improved to 89% by absorbance+ABG. A three-way model using absorbance-only correctly classified 31% of SCD, 20% of SF and 81% of normal ears. Absorbance+ABG improved sensitivities to 82% for SCD, 97% for SF and 98% for normal. In general, classification performance was better using absorbance at TPP than at 0 daPa. CONCLUSION The combination of wideband absorbance and ABG as features for a multivariate logistic regression model can provide good diagnostic estimates for mechanical ear pathologies at initial assessment. Such diagnostic automation can enable faster workup and increase efficiency of resources.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology—Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Copenhagen Hearing and Balance Centre, Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | | | - Hideko Heidi Nakajima
- Department of Otolaryngology—Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Lauxmann M, Viehl F, Priwitzer B, Sackmann B. Preliminary results of classifying otosclerosis and disarticulation using a convolutional neural network trained with simulated wideband acoustic immittance data. Heliyon 2024; 10:e32733. [PMID: 38975150 PMCID: PMC11226844 DOI: 10.1016/j.heliyon.2024.e32733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Current noninvasive methods of clinical practice often do not identify the causes of conductive hearing loss due to pathologic changes in the middle ear with sufficient certainty. Wideband acoustic immittance (WAI) measurement is noninvasive, inexpensive and objective. It is very sensitive to pathologic changes in the middle ear and therefore promising for diagnosis. However, evaluation of the data is difficult because of large interindividual variations. Machine learning methods like Convolutional neural networks (CNN) which might be able to deal with this overlaying pattern require a large amount of labeled measurement data for training and validation. This is difficult to provide given the low prevalence of many middle-ear pathologies. Therefore, this study proposes an approach in which the WAI training data of the CNN are simulated with a finite-element ear model and the Monte-Carlo method. With this approach, virtual populations of normal, otosclerotic, and disarticulated ears were generated, consistent with the averaged data of measured populations and well representing the qualitative characteristics of individuals. The CNN trained with the virtual data achieved for otosclerosis an AUC of 91.1 %, a sensitivity of 85.7 %, and a specificity of 85.2 %. For disarticulation, an AUC of 99.5 %, sensitivity of 100 %, and specificity of 93.1 % was achieved. Furthermore, it was estimated that specificity could potentially be increased to about 99 % in both pathological cases if stapes reflex threshold measurements were used to confirm the diagnosis. Thus, the procedures' performance is comparable to classifiers from other studies trained with real measurement data, and therefore the procedure offers great potential for the diagnosis of rare pathologies or early-stages pathologies. The clinical potential of these preliminary results remains to be evaluated on more measurement data and additional pathologies.
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Affiliation(s)
- Michael Lauxmann
- Doctor of Engineering, Faculty of Engineering, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Felix Viehl
- Master of Science, Reutlingen Research Institute, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Barbara Priwitzer
- Doctor of Natural Sciences, Faculty of Engineering, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Benjamin Sackmann
- Master of Science, Reutlingen Research Institute, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
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Remenschneider A, Cheng JT. Contemporary Mechanics of Conductive Hearing Loss. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY--HEAD AND NECK SURGERY 2024; 35:2-10. [PMID: 38680732 PMCID: PMC11052546 DOI: 10.1016/j.otot.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The middle ear plays a critical role for the conversion of acoustic energy to mechanical vibrations that subsequently enter the cochlea. It is middle ear impedance matching through ossicular coupling that has enabled land-dwelling vertebrates to hear soft airborne sounds. Conductive hearing loss may result from damage to the delicate middle ear structures following infection, trauma or rapid pressure changes. An understanding of the mechanics of the middle ear significantly improves the oto-surgeon's ability to effectively diagnose conductive hearing loss, localize the responsible lesion and then effectively correct the conduction abnormality. This article reviews some of the basic knowledge of middle ear mechanics for sound transmission, highlights recent advances in developing new techniques to assist in diagnosis of middle ear disease, and finally sheds light on future research aimed at improving the diagnosis and management of middle ear pathology.
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Affiliation(s)
- Aaron Remenschneider
- Department of otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
- Department of otolaryngology, head and neck surgery, Harvard Medical School, Boston, MA
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA
| | - Jeffrey Tao Cheng
- Department of otolaryngology, head and neck surgery, Harvard Medical School, Boston, MA
- Eaton Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA
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Sugimoto H, Toya T, Watanabe Y, Takei W, Nagai R, Donjo Y, Motoo R, Inaba M, Yoshizaki T, Murakoshi M. Wideband frequency impedance for diagnosis of ossicular chain abnormality. Acta Otolaryngol 2023; 143:958-964. [PMID: 38134217 DOI: 10.1080/00016489.2023.2292168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The accurate estimation of the ossicular chain abnormalities using existing functional examinations has been difficult. AIMS/OBJECTIVES This study aimed to verify the accuracy of preoperative diagnosis of ossicular chain abnormalities using a wideband frequency impedance (WFI) meter, which can measure the dynamic characteristics of the middle ear. MATERIAL AND METHODS Retrospective cohort study. Fourteen ears of patients with ossicular chain abnormalities that were definitively diagnosed surgically were included in this study. The following data were collected for each participant: sound pressure level (SPL) curve measured using the WFI meter and a sweep frequency impedance (SFI) meter, WFI measurements plotted on the resonance frequency (RF)-ΔSPL plane, distribution map of the dynamic characteristics of the middle ear, preoperative audiometry results, and the definitive surgical diagnosis. RESULTS The SPL curve obtained using the WFI meter had lesser noise than that obtained using the SFI meter. The distribution map revealed that the ossicular chain separation range and ossicular chain fixation range were completely separated. The hearing data tended to be poor in cases with small ΔSPL. CONCLUSIONS AND SIGNIFICANCE WFI can potentially enhance the accuracy of SFI. In addition, it can also be used for the classification of ossicular chain separation and fixation as well as the quantification of fixation in cases of ossicular chain anomalies that cannot be diagnosed using conventional tests.
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Affiliation(s)
- Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Teruki Toya
- Faculty of Engineering, University of Yamanashi, Kofu, Japan
| | - Yoshihiro Watanabe
- Innovative Clinical Research Center, Kanazawa University Hospital, Japan
| | - Wataru Takei
- Faculty of Education, Institute of Human and Social Sciences, Kanazawa University, Japan
| | - Risa Nagai
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yasunori Donjo
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Ryosei Motoo
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Manabu Inaba
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Michio Murakoshi
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Japan
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Ebrahimian A, Mohammadi H, Maftoon N. Relative importance and interactions of parameters of finite-element models of human middle ear. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:619-634. [PMID: 37535428 DOI: 10.1121/10.0020273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023]
Abstract
In the last decades, finite-element models of the middle ear have been widely used to predict the middle-ear vibration outputs. Even with the simplest linear assumption for material properties of the structures in the middle ear, these models need tens of parameters. Due to the complexities of measurements of material properties of these structures, accurate estimations of the values of most of these parameters are not possible. In this study, we benefited from the stochastic finite-element model of the middle ear we had developed in the past, to perform global sensitivity analysis. For this aim, we implemented Sobol' sensitivity analysis which ranks the importance of all uncertain parameters and interactions among them at different frequencies. To decrease the computational costs, we found Sobol' indices from surrogate models that we created using stochastic finite-element results and the polynomial chaos expansion method. Based on the results, the Young's modulus and thickness of the tympanic membrane, Young's modulus and damping of the stapedial annular ligaments, and the Young's modulus of ossicles are among the parameters with the greatest impacts on vibrations of the umbo and stapes footplate. Furthermore, the most significant interactions happen between the Young's modulus and thickness of the tympanic membrane.
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Affiliation(s)
- Arash Ebrahimian
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Hossein Mohammadi
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Lucas M, Folkeard P, Levy S, Dundas D, Scollie S, Agrawal S. Effects of earlens lens placement on sound field thresholds, tympanometric measurements and wideband acoustic immittance. Int J Audiol 2023; 62:12-20. [PMID: 35015963 DOI: 10.1080/14992027.2021.1978566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The Earlens is a direct-drive hearing device consisting of a lens which physically displaces the umbo to achieve appropriate gain. The objective is to determine the clinical acceptability of clinical immittance measurements in Earlens wearers. DESIGN Controlled before-after within-subjects repeated measures study. STUDY SAMPLE Data is reported for measurements obtained on 15 subjects (average age of 72.2 years) with data from 30 ears. RESULTS There was a small effect of lens placement on sound field thresholds in most subjects. The largest damping effect of 4 dB was observed at 1000 Hz. An average reduction of 0.17 mL was identified in compliance following lens placement (p < 0.05). An effect of the lens on power absorbance obtained at ambient and peak pressure was found. The lens resulted in an increase in power absorbance at low frequencies (below 500 Hz) and a decrease in the mid to high-frequency range of approximately 500-3500 Hz (p < 0.05). CONCLUSIONS Lens wear had a small effect on audiometric thresholds and tympanometry for most patients. Clinicians who use compliance and power absorbance should take into consideration lens effects on these measurements. Additional work is required to develop clinical normative ranges of these measures for wearers of the Earlens.
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Affiliation(s)
- Matthew Lucas
- National Centre for Audiology, Western University, London, Canada
| | - Paula Folkeard
- National Centre for Audiology, Western University, London, Canada
| | | | | | - Susan Scollie
- National Centre for Audiology, Western University, London, Canada.,School of Communication Sciences & Disorders, Western University, London, Canada
| | - Sumit Agrawal
- National Centre for Audiology, Western University, London, Canada.,Department of Otolaryngology-Head and Neck Surgery, London, Canada.,Department of Medical Biophysics, London, Canada.,Department of Electrical and Computer Engineering, Western University, London, Canada
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Li C, Xiong Z, Zhou L, Huang W, He Y, Li L, Shi H, Lu J, Wang J, Li D, Yin S. Interfacing Perforated Eardrums with Graphene-Based Membranes for Broadband Hearing Recovery. Adv Healthc Mater 2022; 11:e2201471. [PMID: 35899802 DOI: 10.1002/adhm.202201471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Indexed: 01/28/2023]
Abstract
Eardrum perforation and associated hearing loss is a global health problem. Grafting perforated eardrum with autologous tissues in clinic can restore low-frequency hearing but often leaves poor recovery of high-frequency hearing. In this study, the potential of incorporating a thin multilayered graphene membrane (MGM) into the eardrum for broadband hearing recovery in rats is examined. The MGM shows good biocompatibility and biostability to promote the growth of eardrum cells in a regulated manner with little sign of tissue rejection and inflammatory response. After three weeks of implantation, the MGM is found to be encapsulated by a thin layer of newly grown tissue on both sides without a significant folded overgrowth that is often seen in natural healing. The perforation is well sealed, and broadband hearing recovery (1-32 kHz) is enabled and maintained for at least 2 months. Mechanical simulations show that the high elastic modulus of MGM and thin thickness of the reconstructed eardrum play a critical role in the recovery of high-frequency hearing. This work demonstrates the promise of the use of MGM as a functional graft for perforated eardrum to recover hearing in the broadband frequency region and suggests a new acoustics-related medical application for graphene-related 2D materials.
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Affiliation(s)
- Chunyan Li
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Zhiyuan Xiong
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Lei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongshan Hospital affiliated to Fudan University, Shanghai, 200032, China
| | | | - Yushi He
- Shanghai Electrochemical Energy Devices Research Center, School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Linpeng Li
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Haibo Shi
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jiayu Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, B3J 1Y6, Canada
| | - Dan Li
- Department of Chemical Engineering, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Shankai Yin
- Department of Otorhinolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
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Pieterse H, Biagio-De Jager L, Hofmeyr LM, Vinck BHME. Wideband acoustic immittance in superior semicircular canal dehiscence. Auris Nasus Larynx 2022; 49:921-927. [PMID: 35351349 DOI: 10.1016/j.anl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The apparent effect of superior semicircular canal dehiscence (SSCD) on middle ear- and cochlear impedance has led researchers to investigate the use of wideband acoustic immittance as a screening tool when SSCD is suspected. The purpose of the study was to describe the absorbance characteristics and tympanometric values of ears with confirmed SSCD measured at tympanometric peak pressure (TPP) and at ambient pressure. METHODS Wideband Acoustic Immittance was performed at ambient pressure and at TPP on ten participants (12 ears) with confirmed SSCD, as well as on an age- and gender matched control group (12 ears). Inferential statistics were used to determine whether statistical differences existed for the absorbance values at each of the averaged frequencies, the resonance frequency (RF) and tympanometric data between the SSCD and control groups. RESULTS The mean absorbance of the SSCD group reached a maximum at 890.9 Hz and a minimum at 6349.6 Hz. When testing absorbance at TPP, a statistically significant increase/peak in the absorbance values of the SSCD group (compared to those of the control group) was found from 630 to 890.9 Hz and a decrease from 4489.8 to 6349.6 Hz. Similar patterns were observed for absorbance at ambient pressure. A lower mean RF for ears with SSCD as well as an increased mean admittance magnitude (AM) value at RF was found compared to those of the control group. CONCLUSION The use of SSCD as a screening tool when SSCD is suspected was strengthened by results similar to those of previous studies. As a result of the significant difference in RF of SSCD ears compared to the RF of the control group, the potential value of measuring the RF of the middle ear to differentiate between mass-and stiffness dominated pathologies, was also illustrated.
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Affiliation(s)
- Hendriena Pieterse
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Leigh Biagio-De Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
| | - Louis M Hofmeyr
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Bart H M E Vinck
- Department of Rehabilitation Sciences, Ghent University, Belgium
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Lobato LC, Paul S, Cordioli JA. Statistical analysis of the human middle ear mechanical properties. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:2043. [PMID: 35364966 DOI: 10.1121/10.0009890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/07/2022] [Indexed: 05/23/2023]
Abstract
Many experimental data on the human middle ear (ME) mechanics and dynamics can be found in the literature. Nevertheless, discussions about the uncertainties of these data are scarce. The present study compiles experimental data on the mechanical properties of the human ME. The summary statistics of mean and standard deviation of the data were collected and the coefficients of variation were computed and pooled. Moreover, the linear correlation and distribution were assessed for the ossicles' mass. Results show that, generally, the uncertainties of the stiffness properties of the tympanic membrane, ligaments, and tendons are larger than the uncertainties of the ossicles' mass. In addition, the uncertainties of the ME response vary across frequency. The vibration measures, such as the stapes' velocity normalized by the sound pressure at the tympanic membrane, are more uncertain than ME input impedance and reflectance. It is expected that the results presented in this study will provide the basis for the development of probabilistic models of the human ME.
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Affiliation(s)
- Lucas C Lobato
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Stephan Paul
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Júlio A Cordioli
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
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Sackmann B, Eberhard P, Lauxmann M. Parameter Identification From Normal and Pathological Middle Ears Using a Tailored Parameter Identification Algorithm. J Biomech Eng 2022; 144:1119456. [PMID: 34505125 DOI: 10.1115/1.4052371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/08/2022]
Abstract
Current clinical practice is often unable to identify the causes of conductive hearing loss in the middle ear with sufficient certainty without exploratory surgery. Besides the large uncertainties due to interindividual variances, only partially understood cause-effect principles are a major reason for the hesitant use of objective methods such as wideband tympanometry in diagnosis, despite their high sensitivity to pathological changes. For a better understanding of objective metrics of the middle ear, this study presents a model that can be used to reproduce characteristic changes in metrics of the middle ear by altering local physical model parameters linked to the anatomical causes of a pathology. A finite-element model is, therefore, fitted with an adaptive parameter identification algorithm to results of a temporal bone study with stepwise and systematically prepared pathologies. The fitted model is able to reproduce well the measured quantities reflectance, impedance, umbo and stapes transfer function for normal ears and ears with otosclerosis, malleus fixation, and disarticulation. In addition to a good representation of the characteristic influences of the pathologies in the measured quantities, a clear assignment of identified model parameters and pathologies consistent with previous studies is achieved. The identification results highlight the importance of the local stiffness and damping values in the middle ear for correct mapping of pathological characteristics and address the challenges of limited measurement data and wide parameter ranges from the literature. The great sensitivity of the model with respect to pathologies indicates a high potential for application in model-based diagnosis.
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Affiliation(s)
- Benjamin Sackmann
- Reutlingen Research Institute, Reutlingen University, Reutlingen 72762, Germany
| | - Peter Eberhard
- Institute of Engineering and Computational Mechanics, University of Stuttgart, Stuttgart 70569, Germany
| | - Michael Lauxmann
- School of Engineering, Reutlingen University, Reutlingen 72762, Germany
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Lobato LC, Paul S, Cordioli JA, Ritto TG. Stochastic model of the human middle ear using a nonparametric probabilistic approach. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:2055. [PMID: 35364916 DOI: 10.1121/10.0009763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Several mathematical models of the human middle ear dynamics have been studied since the mid-twentieth century. Despite different methods applied, all of these models are based on deterministic approaches. Experimental data have shown that the middle ear behaves as an uncertain system due to the variability among individuals. In this context, stochastic models are useful because they can represent a population of middle ears with its intrinsic uncertainties. In this work, a nonparametric probabilistic approach is used to model the human middle ear dynamics. The lumped-element method is adopted to develop deterministic baseline models, and three different optimization processes are proposed and applied to the adjustment of the stochastic models. Results show that the stochastic models proposed can reproduce the experimental data in terms of mean and coefficient of variation. In addition, this study shows the importance of properly defining the acceptable range of each input parameter in order to obtain a reliable stochastic model.
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Affiliation(s)
- Lucas C Lobato
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Stephan Paul
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Júlio A Cordioli
- Acoustic and Vibration Laboratory, Federal University of Santa Catarina, Florianópolis, 88040-900, Brazil
| | - Thiago G Ritto
- Federal University of Rio de Janeiro, Rio de Janeiro, 21941-901, Brazil
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Preserving Wideband Tympanometry Information With Artifact Mitigation. Ear Hear 2022; 43:563-576. [PMID: 34387582 PMCID: PMC8855961 DOI: 10.1097/aud.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Absorbance measured using wideband tympanometry (WBT) has been shown to be sensitive to changes in middle and inner ear mechanics, with potential to diagnose various mechanical ear pathologies. However, artifacts in absorbance due to measurement noise can obscure information related to pathologies and increase intermeasurement variability. Published reports frequently present absorbance that has undergone smoothing to minimize artifact; however, smoothing changes the true absorbance and can destroy important narrow-band characteristics such as peaks and notches at different frequencies. Because these characteristics can be unique to specific pathologies, preserving them is important for diagnostic purposes. Here, we identify the cause of artifacts in absorbance and develop a technique to mitigate artifacts while preserving the underlying WBT information. DESIGN A newly developed Research Platform for the Interacoustics Titan device allowed us to study raw microphone recordings and corresponding absorbances obtained by WBT measurements. We investigated WBT measurements from normal hearing ears and ears with middle and inner ear pathologies for the presence of artifact and noise. Furthermore, it was used to develop an artifact mitigation procedure and to evaluate its effectiveness in mitigating artifacts without distorting the true WBT information. RESULTS We observed various types of noise that can plague WBT measurements and that contribute to artifacts in computed absorbances, particularly intermittent low-frequency noise. We developed an artifact mitigation procedure that incorporates a high-pass filter and a Tukey window. This artifact mitigation resolved the artifacts from low-frequency noise while preserving characteristics in absorbance in both normal hearing ears and ears with pathology. Furthermore, the artifact mitigation reduced intermeasurement variability. CONCLUSIONS Unlike smoothing algorithms used in the past, our artifact mitigation specifically removes artifacts caused by noise. It does not change frequency response characteristics, such as narrow-band peaks and notches in absorbance at different frequencies that can be important for diagnosis. Also, by reducing intermeasurement variability, the artifact mitigation can improve the test-retest reliability of these measurements.
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Velikoselskii A, Papatziamos G, Smeds H, Verrecchia L. Wideband tympanometry in ears with superior canal dehiscence before and after surgical correction. Int J Audiol 2021; 61:692-697. [PMID: 34420430 DOI: 10.1080/14992027.2021.1964041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Wideband tympanometry (WBT) has been shown to be sensitive to mechanical changes in the ear. This study investigated the effect of surgical correction of superior canal dehiscence (SCD) on WBT (i.e. absorbance and middle ear resonance frequency) compared to those on common surgical outcomes such as symptom resolution, vestibular evoked myogenic potentials (VEMP), and hearing thresholds. STUDY SAMPLE AND STUDY DESIGN Seven patients (eight ears with SCD) who underwent surgical correction of SCD underwent WBT in addition to pure-tone audiometry and VEMP assessment. RESULTS Postoperatively, all ears showed normalised/decreased absorbance at low frequencies and slightly enhanced absorbance in the middle frequency range (7/8 ears). The middle ear resonance frequency, which was initially lower than normal in most patients, increased in 6/8 operated ears, and decreased in two ears with no/partial symptom relief. In comparison, complete symptom control was observed in 6/8 operated ears, VEMP amplitudes reduced or normalised in all ears, and hearing thresholds remained stable or improved in 6/8 ears and worsened in two ears. CONCLUSIONS Surgery seems to change the response to WBT in patients with SCD. The results of WBT may represent mechanical changes induced by SCD, and should be considered when evaluating surgical outcomes.
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Affiliation(s)
- Aleksandr Velikoselskii
- Division of Ear, Nose and Throat Diseases, Audiology and Neurotology Section, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Papatziamos
- Division of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
| | - Henrik Smeds
- Division of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
| | - Luca Verrecchia
- Division of Ear, Nose and Throat Diseases, Audiology and Neurotology Section, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
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Attias J, Rabinovics N, Nageris B, Hilly O. The Impact of Superior Canal Dehiscence on Power Absorbance, Otoacoustic Emissions, and Hearing in Fat Sand Rats. Otol Neurotol 2021; 42:1104-1111. [PMID: 34191786 DOI: 10.1097/mao.0000000000003147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Superior Semicircular Canal Dehiscence (SSCD) may lead to vestibular and auditory impairments. OBJECTIVE To study the effects of power absorbance (PA), Distortion Product Otoacoustic emissions (DPOAE), and hearing thresholds in normal ears of fat sand rats, after a bullotomy, creation and patching. METHODS SSCD was performed unilaterally in eight normal hearing animals while the contra-lateral un-operated ear was used as a control. Measures included auditory brain stem responses thresholds for air and bone conduction stimuli, DPOAEs and PA at peak pressure. RESULTS The normal PA pattern of the animals grossly resembled that of human ears. A bullotomy generated specific, large and significant (p < 0.0001) changes in PA without altering hearing thresholds. SSCD significantly decreased PA at low (p < 0.02) and increased at high frequencies (p < 0.03), but on a smaller scale than the bullotomy. SSCD, induced a mean air-bone gaps of 24.3 for clicks, and 31.2 dB for 1 kHz TB. SSCD also increased the DPOAEs levels by mean of 10.1 dB SPL (p < 0.03). Patching the dehiscence, reversed partially the PA changes, the auditory threshold shifts, and the DPOAEs levels to pre-SSCD values. CONCLUSIONS SSCD affects both incoming and emitting sounds from the ear, probably due to its effect on cochlear impedance and stiffness of the middle and inner ear. The presence of DPOAEs and ABGs indicated a "third window" disease, i.e., SSCD. Due to similar PA patterns after bullotomy and SCCD, PA alone has limited diagnostic yield for patients with SCCD.
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Affiliation(s)
- Joseph Attias
- Department of Communication Sciences & Disorders, University of Haifa, Haifa
- The Institute for Audiology & Clinical Neurophysiology, Schneider Children's Medical Center of Israel
| | - Naomi Rabinovics
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva
- Department of Otorhinolaryngology-Head and Neck Surgery, Samson Assuta Ashdod Hospital, Ashdod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv to Ohad Hilly
| | - Benny Nageris
- Department of Otorhinolaryngology-Head and Neck Surgery, Samson Assuta Ashdod Hospital, Ashdod
- Department of Otorhinolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel
| | - Ohad Hilly
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva
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Merchant GR, Neely ST. The influence of otitis media with effusion on middle-ear impedance estimated from wideband acoustic immittance measurements. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:969. [PMID: 34470321 PMCID: PMC8349246 DOI: 10.1121/10.0005822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
The goal of this work was to estimate the middle-ear input impedance ( Zme) from wideband acoustic immittance (WAI) measures and determine whether Zme improves the clinical utility of WAI. The data used in this study were from a previously reported set of WAI measurements in ears with otitis media with effusion [OME; Merchant, Al-Salim, Tempero, Fitzpatrick, and Neely (2021). Ear Hear., published online]. Ears with OME were grouped based on effusion volume, which was confirmed during tube surgery. Zme was estimated from the measured ear-canal impedance. An electrical-analog model of ear-canal acoustics and middle-ear mechanics was used to model the ear canal and Zme. The model results fit the measured responses well for all conditions. A regression approach was used to classify the responses of different variable types to effusion volume groups and determine the specificity and sensitivity of the binary classifications. The Zme magnitude increased with increasing effusion volume. The area under the receiver operating characteristic curve (AUC) was compared for binary decisions of the OME categories. The Zme estimate resulted in a clinically meaningful improvement in the AUC for distinguishing healthy ears from ears with OME. Overall, these results suggest that Zme estimation may provide useful information of potential clinical value to improve the diagnostic utility of WAI measurements for OME.
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Affiliation(s)
- Gabrielle R Merchant
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
| | - Stephen T Neely
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
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Torrecilla SG, Avan P. Wideband tympanometry patterns in relation to intracranial pressure. Hear Res 2021; 408:108312. [PMID: 34298416 DOI: 10.1016/j.heares.2021.108312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/19/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Wideband tympanometry performs a more thorough analysis of middle-ear mechanics than the conventional single-frequency method with a 226-Hz probe tone. The present work examines the sensitivity of wideband tympanometry to the stiffness of the stapes-annular ligament system in relation to intracranial pressure (ICP) and labyrinthine fluid pressure. Here, body tilt allowed ICP to be set at different values. Sixty-eight ears of volunteers were tested sequentially in upright, supine, head-down (-30°) and upright postures. Energy absorbance of the ear was measured in these postures with a commercially available wideband-tympanometry device between 0.25 and 3 kHz, at ear-canal pressures between -600 and 300 daPa. In each posture, it was possible to find a single (posture-dependent) pressure in the ear canal at which a tympanometric peak occurred at all frequencies below about 1.1 kHz. The average across ears of tympanometric-peak pressure (TPP), close to 0 in upright posture, got increasingly positive, +19 daPa in supine and +27 daPa in head-down positions. The three-dimensional plot of energy absorbance against frequency and pressure displayed an invariant shape, merely shifting with TPP along the pressure axis. Thus, a properly adjusted ear-canal pressure neutralized the effects of ICP on the ear's energy absorbance. Comparisons to published invasive assessments of ICP in the different tested body positions led to the proposed relationship ICP ≈ 15 TPP, likely describing the transformer effect between tympanic membrane and stapes-annular ligament system at quasi-static pressures. With wideband tympanometry, the middle ear may serve as a precision scales for noninvasive ICP measurements.
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Affiliation(s)
| | - Paul Avan
- Neurosensory Biophysics Laboratory, University Clermont Auvergne, France; Institut de l'Audition, Paris, France; Centre Jean Perrin, Clermont-Ferrand, France.
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Merchant GR, Schulz KM, Patterson JN, Fitzpatrick D, Janky KL. Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance. Ear Hear 2021; 41:1111-1124. [PMID: 32032225 PMCID: PMC7392788 DOI: 10.1097/aud.0000000000000831] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. DESIGN Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. RESULTS All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. CONCLUSIONS Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.
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Affiliation(s)
| | - Kyli M. Schulz
- Boys Town National Research Hospital, Omaha, NE 68131
- The University of Texas at Austin, TX 78712
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Liu H, Xue L, Yang J, Cheng G, Zhou L, Huang X. Effect of ossicular chain deformity on reverse stimulation considering the overflow characteristics of third windows. Comput Methods Biomech Biomed Engin 2021; 25:257-272. [PMID: 34229548 DOI: 10.1080/10255842.2021.1948023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stimulating the round window membrane via an active actuator of the middle ear implant, named the reverse stimulation, has become an option to help patients with ossicular chain deformity (OCD) to restore hearing. However, there is still no concise description of how OCD affects reverse stimulation considering the overflow characteristics of third windows. In the present study, an impedance model considering the vestibular and cochlear aqueducts was used to investigate the dynamic response of the cochlea to reverse stimulation under OCD. First, a finite-element (FE) model of the middle ear and the ear canal was used to estimate the changes in reverse middle-ear impedance caused by ossicular chain fixation and ossicular chain interruption. Then, the impedance model was used to predict the reverse transfer function, which characterizes the effect of OCD on the dynamic response of the cochlea. The results show that ossicular chain fixation reduces the reverse stimulation's performance. Moreover, the existence of the third windows complicates the effect of ossicular chain fixation on the reverse stimulation and boosts obviously the reverse stimulation's performance at low frequencies. In contrast, regardless of the existence of third windows, ossicular chain interruption enhances the effect of reverse stimulation.
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Affiliation(s)
- Houguang Liu
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Lin Xue
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Jianhua Yang
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Gang Cheng
- School of Mechatronic Engineering, China University of Mining and Technology, Xuzhou, China
| | - Lei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, China
| | - Xinsheng Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Zhongshan Hospital affiliated to Fudan University, Shanghai, China
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Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance. Ear Hear 2021; 42:1183-1194. [PMID: 33928915 DOI: 10.1097/aud.0000000000001037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this work is to determine whether there is a systematic effect of middle ear effusion volume on wideband acoustic immittance in children with surgically confirmed otitis media with effusion. DESIGN Wideband acoustic immittance was measured in 49 ears from children (9 months to 11 years) who had a diagnosis of otitis media with effusion and compared to 14 ears from children (10 months to 10 years) without a recent history of otitis media. For children with otitis media with effusion, wideband acoustic immittance testing took place in the child's preoperative waiting room before surgical placement of tympanostomy tubes. Testing was completed in a pressurized condition (wideband tympanometry) for all ears as well as in an ambient condition in a subset of ears. Intraoperative findings regarding effusion volume were reported by the surgeons immediately before tube placement and confirmed following myringotomy. This classified the volume of effusion as compared to middle ear volume categorically as either full, partial, or clear of effusion. The type of wideband acoustic immittance explored in this work was absorbance. Absorbance responses were grouped based on effusion volume into one of four groups: full effusions, partial effusions, ears clear of effusion at the time of surgery, and normal control ears. Standard tympanometry was also completed on all ears. RESULTS Absorbance is systematically reduced as the volume of the middle ear effusion increases. This reduction is present at most frequencies but is greatest in the frequency range from 1 to 5 kHz. A multivariate logistic regression approach was utilized to classify ears based on effusion volume. The regression approach classified ears as effusion present (full and partial ears) or absent (clear ears and normal control ears) with 100% accuracy, ears with effusion present as either partial or full with 100% accuracy, and ears without effusion as either normal control ears or ears clear of effusion with 75% accuracy. Regression performance was also explored when the dataset was split into a training set (70% of the data) and a validation test set (30% of the data) to simulate how this approach would perform on unseen data in a clinical setting. Accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve are reported. Overall, this approach demonstrates high sensitivity and specificity for classifying ears as effusion being present or absent and as present effusions being full or partial with areas under the curve ranging from 1 to 0.944. Despite the lack of effusion present in both clear ears and normal control ears, this approach was able to distinguish between these ears, but with a more moderate sensitivity and specificity. No systematic effect of effusion volume was found on standard tympanometry. CONCLUSIONS Wideband acoustic immittance, and more specifically, absorbance, is a strong and sensitive indicator of the volume of a middle ear effusion in children with otitis media with effusion.
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Evaluation of Artificial Fixation of the Incus and Malleus With Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) in a Temporal Bone Model. Otol Neurotol 2020; 41:45-51. [PMID: 31664003 DOI: 10.1097/mao.0000000000002444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A significant number of adults suffer from conductive hearing loss due to chronic otitis media, otosclerosis, or other pathologies. An objective measurement of ossicular mobility is needed to avoid unnecessarily invasive middle ear surgery and to improve hearing outcomes. METHODS Minimally invasive intraoperative laser vibrometry provides a method that is compatible with middle ear surgery, where the tympanic membrane is elevated. The ossicles were driven by a floating mass transducer and their mobility was measured using a laser Doppler vibrometer. Utilising this method, we assessed both the absolute velocities of the umbo and incus long process as well as the incus-to-umbo velocity ratio during artificial fixation of the incus alone or incus and malleus together. RESULTS The reduction of absolute velocities was 8 dB greater at the umbo and 17 dB at the incus long process for incus-malleus fixations when compared with incus fixation alone. Incus fixation alone resulted in no change to the incus-to-umbo velocity ratio where incus-malleus fixations reduced this ratio (-11 dB). The change in incus velocity was shown to be the most suitable parameter to distinguish between incus fixation and incus-malleus fixation. When the whole frequency range was analyzed, one could also differentiate these two fixations from previously published stapes fixation, where the higher frequencies were less affected. CONCLUSION Minimally invasive intraoperative laser vibrometry provides a promising objective analysis of ossicular mobility that would be useful intraoperatively.
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Abstract
Third window syndrome describes a set of vestibular and auditory symptoms that arise when a pathological third mobile window is present in the bony labyrinth of the inner ear. The pathological mobile window (or windows) adds to the oval and round windows, disrupting normal auditory and vestibular function by altering biomechanics of the inner ear. The most commonly occurring third window syndrome arises from superior semicircular canal dehiscence (SSCD), where a section of bone overlying the superior semicircular canal is absent or thinned (near-dehiscence). The presentation of SSCD syndrome is well characterized by clinical audiological and vestibular tests. In this review, we describe how the third compliant window introduced by a SSCD alters the biomechanics of the inner ear and thereby leads to vestibular and auditory symptoms. Understanding the biomechanical origins of SSCD further provides insight into other third window syndromes and the potential of restoring function or reducing symptoms through surgical repair.
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Affiliation(s)
- Marta M. Iversen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Richard D. Rabbitt
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Department of Otolaryngology, University of Utah, Salt Lake City, UT, United States
- Neuroscience Program, University of Utah, Salt Lake City, UT, United States
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Merchant GR, Siegel JH, Neely ST, Rosowski JJ, Nakajima HH. Effect of Middle-Ear Pathology on High-Frequency Ear Canal Reflectance Measurements in the Frequency and Time Domains. J Assoc Res Otolaryngol 2019; 20:529-552. [PMID: 31673928 PMCID: PMC6889121 DOI: 10.1007/s10162-019-00735-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/20/2019] [Indexed: 10/25/2022] Open
Abstract
The effects of middle-ear pathology on wideband acoustic immittance and reflectance at frequencies above 6-8 kHz have not been documented, nor has the effect of such pathologies on the time-domain reflectance. We describe an approach that utilizes sound frequencies as high as 20 kHz and quantifies reflectance in both the frequency and time domains. Experiments were performed with fresh normal human temporal bones before and after simulating various middle-ear pathologies, including malleus fixation, stapes fixation, and disarticulation. In addition to experimental data, computational modeling was used to obtain fitted parameter values of middle-ear elements that vary systematically due to the simulated pathologies and thus may have diagnostic implications. Our results demonstrate that the time-domain reflectance, which requires acoustic measurements at high frequencies, varies with middle-ear condition. Furthermore, the extended bandwidth frequency-domain reflectance data was used to estimate parameters in a simple model of the ear canal and middle ear that separates three major conductive pathologies from each other and from the normal state.
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Affiliation(s)
- Gabrielle R. Merchant
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Boys Town National Research Hospital, Omaha, NE USA
| | | | | | - John J. Rosowski
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
| | - Hideko H. Nakajima
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
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A Study of Wideband Energy Reflectance in Patients with Otosclerosis: Data from a Chinese Population. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2070548. [PMID: 31485439 PMCID: PMC6710738 DOI: 10.1155/2019/2070548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/17/2019] [Accepted: 07/14/2019] [Indexed: 11/25/2022]
Abstract
Objective(s) The purpose of this study was to explore the effectiveness of wideband acoustic immittance (WAI) in the diagnosis of otosclerosis by comparing the differences in the energy reflectance (ER) of WAI between patients with otosclerosis and age- and gender-matched normal hearing controls in the Chinese population. Methods Twenty surgically confirmed otosclerotic ears were included in the otosclerotic group. The ER of WAI at ambient and peak pressures, resonance frequency, and 226-Hz tympanogram were collected prior to surgery using a Titan hearing test platform (Interacoustics A/S, Middelfart, Denmark). All diagnoses of otosclerosis in the tested ear were confirmed by surgery after the measurements. Thirteen normal adults (26 ears) who were age- and gender-matched with the otosclerotic patients were included as the control group. Results At peak pressure, the ERs of otosclerotic patients were higher than those of the control group for frequencies less than 4,000Hz and were lower for frequencies greater than 4,000Hz. In addition, within the analyzed frequencies, the differences observed at 2,520Hz was statistically significant (p<0.05/16=0.003, Bonferroni corrected). At ambient pressure, the differences observed at 1,260 and 6,350Hz were statistically significant (p<0.05/16=0.003, Bonferroni corrected). Although the differences between the otosclerotic and control groups exhibited similar trends to those in studies implemented in Caucasian populations, the norms in the present study in the control group were different from those in the Caucasian populations, suggesting racial differences in WAI test results. Regarding the middle ear resonance frequency, no significant difference was observed between the two groups (P>0.05). Conclusion WAI can provide valuable information for the diagnosis of otosclerosis in the Chinese population. Norms and diagnostic criteria corresponding to the patient's racial group are necessary to improve the efficiency of WAI in the diagnosis of otosclerosis.
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Stieger C, Guan X, Farahmand RB, Page BF, Merchant JP, Abur D, Nakajima HH. Intracochlear Sound Pressure Measurements in Normal Human Temporal Bones During Bone Conduction Stimulation. J Assoc Res Otolaryngol 2018; 19:523-539. [PMID: 30171386 DOI: 10.1007/s10162-018-00684-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/12/2018] [Indexed: 01/18/2023] Open
Abstract
Bone conduction (BC) is heavily relied upon in the diagnosis and treatment of hearing loss, but is poorly understood. For example, the relative importance and frequency dependence of various identified BC sound transmission mechanisms that contribute to activate the cochlear partition remain unknown. Recently, we have developed techniques in fresh human cadaveric specimens to directly measure scalae pressures with micro-fiberoptic sensors, enabling us to monitor the input pressure drive across the cochlear partition that triggers the cochlear traveling wave during air conduction (AC) and round-window stimulation. However, BC stimulation poses challenges that can result in inaccurate intracochlear pressure measurements. Therefore, we have developed a new technique described here that allows for precise measurements during BC. Using this new technique, we found that BC stimulation resulted in pressure in scala vestibuli that was significantly higher in magnitude than in scala tympani for most frequencies, such that the differential pressure across the partition-the input pressure drive-was similar to scala vestibuli pressure. BC (stimulated by a Bone Anchored Hearing Aid [Baha]) showed that the mechanisms of sound transmission in BC differ from AC, and also showed the limitations of the Baha bandwidth. Certain kinematic measurements were generally proportional to the cochlear pressure input drive: for AC, velocity of the stapes, and for BC, low-frequency acceleration and high-frequency velocity of the cochlear promontory. Therefore, our data show that to estimate cochlear input drive in normal ears during AC, stapes velocity is a good measure. During BC, cochlear input drive can be estimated for low frequencies by promontory acceleration (though variable across ears), and for high frequencies by promontory velocity.
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Affiliation(s)
- Christof Stieger
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA. .,Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA. .,University Bern, Bern, Switzerland. .,Department of ENT, University of Basel Hospital, Hebelstr. 10, 4031, Basel, Switzerland.
| | - Xiying Guan
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA
| | | | - Brent F Page
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA
| | - Julie P Merchant
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA
| | - Defne Abur
- Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA.,Smith College, Northampton, MA, USA
| | - Hideko Heidi Nakajima
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Massachusetts Eye & Ear, Boston, MA, USA
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Keefe DH, Archer KL, Schmid KK, Fitzpatrick DF, Feeney MP, Hunter LL. Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions. J Am Acad Audiol 2018; 28:838-860. [PMID: 28972472 DOI: 10.3766/jaaa.16172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. PURPOSE To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. RESEARCH DESIGN A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. STUDY SAMPLE The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). DATA COLLECTION AND ANALYSIS Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. RESULTS Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic. CONCLUSIONS Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.
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Affiliation(s)
| | - Kelly L Archer
- Boys Town National Research Hospital, Omaha, NE.,University of Nebraska Lincoln, Lincoln, NE
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | | | - M Patrick Feeney
- National Center for Rehabilitative Auditory Research, Veterans Administration and Oregon Health & Science University, Portland, OR
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Kim SY, Han JJ, Oh SH, Lee JH, Suh MW, Kim MH, Park MK. Differentiating among conductive hearing loss conditions with wideband tympanometry. Auris Nasus Larynx 2018; 46:43-49. [PMID: 29885747 DOI: 10.1016/j.anl.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information. METHODS We recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups. RESULTS The normal subjects showed an average peak pressure of -19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (-124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P<0.022). Mastoid problems subjects showed decreased absorbance at all frequencies. CONCLUSION WBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Seoul, South Korea
| | - Jae Joon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Me Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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28
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Charaziak KK, Shera CA. Compensating for ear-canal acoustics when measuring otoacoustic emissions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 141:515. [PMID: 28147590 PMCID: PMC5848844 DOI: 10.1121/1.4973618] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Otoacoustic emissions (OAEs) provide an acoustic fingerprint of the inner ear, and changes in this fingerprint may indicate changes in cochlear function arising from efferent modulation, aging, noise trauma, and/or exposure to harmful agents. However, the reproducibility and diagnostic power of OAE measurements is compromised by the variable acoustics of the ear canal, in particular, by multiple reflections and the emergence of standing waves at relevant frequencies. Even when stimulus levels are controlled using methods that circumvent standing-wave problems (e.g., forward-pressure-level calibration), distortion-product otoacoustic emission (DPOAE) levels vary with probe location by 10-15 dB near half-wave resonant frequencies. The method presented here estimates the initial outgoing OAE pressure wave at the eardrum from measurements of the conventional OAE, allowing one to separate the emitted OAE from the many reflections trapped in the ear canal. The emitted pressure level (EPL) represents the OAE level that would be recorded were the ear canal replaced by an infinite tube with no reflections. When DPOAEs are expressed using EPL, their variation with probe location decreases to the test-retest repeatability of measurements obtained at similar probe positions. EPL provides a powerful way to reduce the variability of OAE measurements and improve their ability to detect cochlear changes.
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Affiliation(s)
- Karolina K Charaziak
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA
| | - Christopher A Shera
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA
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