Measurements of human middle ear forward and reverse acoustics: implications for otoacoustic emissions

Effectiveness of active middle ear implant placement methods in pathological conditions: basilar membrane vibration simulation

Active middle ear implants (AMEI) amplify mechanical vibrations in the middle ear and transmit them to the cochlea. The AMEI includes a floating mass transducer (FMT) that can be placed using two different surgical approaches: "oval window (OW) vibroplasty" and "round window (RW) vibroplasty." The OW and RW are windows located on the cochlea. Normally, sound stimulus is transmitted from the middle ear to cochlea via the OW. RW vibroplasty has been suggested as an alternative method due to the difficulty of applying OW vibroplasty in patients with ossicle dysfunction. Several reports compare the advantages of each approach through pre and postoperative hearing tests. However, quantitatively assessing the treatment effect is challenging due to individual differences in pathologies. This study investigates the vibration transmission efficiency of each surgical approach using a finite-element model of the human cochlea. Vibration of the basilar membrane (BM) of the cochlea is simulated by applying the stimulus through the OW or RW. Pathological conditions, such as impaired stapes mobility, are simulated by increasing the stiffness of the stapedial annular ligament. RW closure due to chronic middle ear diseases is a common clinical occurrence and is simulated by increasing the stiffness of the RW membrane in the model. The results show that the vibration amplitude of the BM is larger when the stimulus is applied to the RW compared to the OW, except for cases of RW membrane ossification. The difference in these amplitudes is particularly significant when stapedial mobility is limited. These results suggest that RW vibroplasty would be advantageous, especially in cases of accompanying stapedial mobility impairment. Additionally, it is suggested that transitioning to OW vibroplasty could still ensure a sufficient level of vibratory transmission efficiency when placing the FMT on the RW membrane is difficult due to anatomical problems in the tympanic cavity or confirmed severe pathological conditions around the RW.

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.

Cochlear Theta Activity Oscillates in Phase Opposition during Interaural Attention

It is widely established that sensory perception is a rhythmic process as opposed to a continuous one. In the context of auditory perception, this effect is only established on a cortical and behavioral level. Yet, the unique architecture of the auditory sensory system allows its primary sensory cortex to modulate the processes of its sensory receptors at the cochlear level. Previously, we could demonstrate the existence of a genuine cochlear theta (∼6-Hz) rhythm that is modulated in amplitude by intermodal selective attention. As the study's paradigm was not suited to assess attentional effects on the oscillatory phase of cochlear activity, the question of whether attention can also affect the temporal organization of the cochlea's ongoing activity remained open. The present study utilizes an interaural attention paradigm to investigate ongoing otoacoustic activity during a stimulus-free cue-target interval and an omission period of the auditory target in humans. We were able to replicate the existence of the cochlear theta rhythm. Importantly, we found significant phase opposition between the two ears and attention conditions of anticipatory as well as cochlear oscillatory activity during target presentation. Yet, the amplitude was unaffected by interaural attention. These results are the first to demonstrate that intermodal and interaural attention deploy different aspects of excitation and inhibition at the first level of auditory processing. Whereas intermodal attention modulates the level of cochlear activity, interaural attention modulates the timing.

Stimulus-frequency otoacoustic emissions and middle-ear pressure gains in a finite-element mouse model

For evoked otoacoustic emissions (OAEs), the stimulus and emission signals traverse the middle ear (ME) in forward and reverse directions, respectively. In this study, a fully coupled three-dimensional finite-element model of the mouse ear canal (EC), ME, and cochlea was used to calculate ME pressure gains, impedances, and reflectances at the EC-entrance and stapes-footplate-cochlear-fluid interfaces. The cochlear model incorporates a series of interdigitated Y-shaped structures sandwiched between the basilar membrane and reticular lamina, each comprised of a Deiters' cell, its phalangeal-process extension, and an outer hair cell (OHC). By introducing random perturbations to the OHC gains, stimulation-frequency otoacoustic emissions (SFOAEs) were generated. Raising the perturbation magnitude from 10% to 80% increased the SFOAE magnitude by up to 24 dB in the 10-30 kHz frequency range. Increasing or decreasing the stiffness of the stapes annular ligament and eardrum by a factor of 8 changed the SFOAEs by up to 30 dB, but the round-trip ME gain as measured could not account for this. A modified round-trip ME gain, with reflections removed at the EC-entrance and stapes-cochlea boundaries, eliminated a ±10 dB discrepancy and allowed ME changes to be quantitatively associated with changes in measured OAEs.

External and middle ear influence on envelope following responses

Considerable between-subject variability in envelope following response (EFR) amplitude limits its clinical translation. Based on a pattern of lower amplitude and larger variability in the low (<1.2 kHz) and high (>8 kHz), relative to mid (1-3 kHz) frequency carriers, we hypothesized that the between-subject variability in external and middle ear (EM) contribute to between-subject variability in EFR amplitude. It is predicted that equalizing the stimulus reaching the cochlea by accounting for EM differences using forward pressure level (FPL) calibration would at least partially improve response amplitude and reduce between-subject variability. In 21 young normal hearing adults, EFRs of four modulation rates (91, 96, 101, and 106 Hz) were measured concurrently from four frequency bands [low (0.091-1.2 kHz), mid (1-3 kHz), high (4-5.4 kHz), and very high (vHigh; 8-9.4 kHz)], respectively, with 12 harmonics each. The results indicate that FPL calibration in-ear and in a coupler leads to larger EFR amplitudes in the low and vHigh frequency bands relative to conventional coupler root-mean-square calibration. However, improvement in variability was modest with FPL calibration. This lack of a statistically significant improvement in variability suggests that the dominant source of variability in EFR amplitude may arise from cochlear and/or neural processing.

An additional source of distortion-product otoacoustic emissions from perturbation of nonlinear force by reflection from inhomogeneities

The basilar membrane in the cochlea can be modeled as an array of fluid coupled segments driven by stapes vibration and by the undamping nonlinear force simulating cochlear amplification. If stimulated with two tones, the model generates additional tones due to nonlinear distortion. These distortion products (DPs) can be transmitted into the ear canal and produce distortion-product otoacoustic emissions (DPOAEs) known to be generated in the healthy ear of various vertebrates. This study presents a solution for DPs in a two-dimensional nonlinear cochlear model with cochlear roughness-small irregularities in the impedance along the basilar membrane, which may produce additional DPs due to coherent reflection. The solution allows for decomposition of various sources of DPs in the model. In addition to the already described nonlinear-distortion and coherent-reflection mechanisms of DP generation, this study identifies a long-latency DPOAE component due to perturbation of nonlinear force. DP wavelets that are coherently reflected due to impedance irregularities travel toward the stapes across the primary generation region of DPs and there evoke perturbation of the nonlinear undamping force. The ensuing DP wavelets have opposite phase to the wavelets arising from coherent reflection, which results in partial cancellation of the coherent-reflection DP wavelets.

A numerical approach to investigating the mechanisms behind tonotopy in the bush-cricket inner-ear

Bush-crickets (or katydids) have sophisticated and ultrasonic ears located in the tibia of their forelegs, with a working mechanism analogous to the mammalian auditory system. Their inner-ears are endowed with an easily accessible hearing organ, the crista acustica (CA), possessing a spatial organisation that allows for different frequencies to be processed at specific graded locations within the structure. Similar to the basilar membrane in the mammalian ear, the CA contains mechanosensory receptors which are activated through the frequency dependent displacement of the CA. While this tonotopical arrangement is generally attributed to the gradual stiffness and mass changes along the hearing organ, the mechanisms behind it have not been analysed in detail. In this study, we take a numerical approach to investigate this mechanism in the Copiphora gorgonensis ear. In addition, we propose and test the effect of the different vibration transmission mechanisms on the displacement of the CA. The investigation was carried out by conducting finite-element analysis on a three-dimensional, idealised geometry of the C. gorgonensis inner-ear, which was based on precise measurements. The numerical results suggested that (i) even the mildest assumptions about stiffness and mass gradients allow for tonotopy to emerge, and (ii) the loading area and location for the transmission of the acoustic vibrations play a major role in the formation of tonotopy.

A Modelling Study on the Comparison of Predicted Auditory Nerve Firing Rates for the Personalized Indication of Cochlear Implantation

The decision of whether to perform cochlear implantation is crucial because implantation cannot be reversed without harm. The aim of the study was to compare model-predicted time–place representations of auditory nerve (AN) firing rates for normal hearing and impaired hearing with a view towards personalized indication of cochlear implantation. AN firing rates of 1024 virtual subjects with a wide variety of different types and degrees of hearing impairment were predicted. A normal hearing reference was compared to four hearing prosthesis options, which were unaided hearing, sole acoustic amplification, sole electrical stimulation, and a combination of the latter two. The comparisons and the fitting of the prostheses were based on a ‘loss of action potentials’ (LAP) score. Single-parameter threshold analysis suggested that cochlear implantation is indicated when more than approximately two-thirds of the inner hair cells (IHCs) are damaged. Second, cochlear implantation is also indicated when more than an average of approximately 12 synapses per IHC are damaged due to cochlear synaptopathy (CS). Cochlear gain loss (CGL) appeared to shift these thresholds only slightly. Finally, a support vector machine predicted the indication of a cochlear implantation from hearing loss parameters with a 10-fold cross-validated accuracy of 99.2%.

A comparative study of eight human auditory models of monaural processing

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

Whistling While it Works: Spontaneous Otoacoustic Emissions and the Cochlear Amplifier

Perhaps the most striking evidence for active processes operating within the inner ears of mammals and non-mammals alike is their ability to spontaneously produce sound. Predicted by Thomas Gold in 1948, some 30 years prior to their discovery, the narrow-band sounds now known as spontaneous otoacoustic emissions (SOAEs) remain incompletely understood, their origins controversial. Without a single equation in the main text, we review the essential concepts underlying the "local-" and "global-oscillator" frameworks for understanding SOAE generation. Comparing their key assumptions and predictions, we relate the two frameworks to unresolved questions about the biophysical mechanisms of cochlear amplification.

On the hearing effects of a cholesteatoma growing: A biomechanical study

Chronic otitis media enables the appearance of a benign middle ear tumor, known as a cholesteatoma, that may compromise hearing. To evaluate the influence of a cholesteatoma growth on the hearing function, a computational middle ear model based on the finite element method was used and three different size of cholesteatoma were modeled. The cholesteatoma solidification and the consequent degradation of the ossicles were also simulated as two condition that commonly occurs during cholesteatoma evolution. A sound pressure level of 80 dB SPL was applied in the tympanic membrane and a steady state analysis was performed for frequencies from 100 Hz to 10 kHz. The displacements of both the tympanic membrane and the stapes footplate were measured. The results were compared with a healthy case and it was shown that the cholesteatoma development leads to a decrease in the umbo and stapes displacements. The ossicles degradation simulation showed the higher difference comparing with the cholesteatoma in an initial stage, with lower displacements in the stapes footplate mainly for high frequencies. The observed displacement differences are directly connected to hearing loss, being possible to conclude that cholesteatoma evolution in the middle ear will lead to hearing problems, mainly in an advanced stage.

A Comparison of Intracochlear Pressures During Ipsilateral and Contralateral Stimulation With a Bone Conduction Implant

OBJECTIVES

To compare contralateral to ipsilateral stimulation with percutaneous and transcutaneous bone conduction implants.

BACKGROUND

Bone conduction implants (BCIs) effectively treat conductive and mixed hearing losses. In some cases, such as in single-sided deafness, the BCI is implanted contralateral to the remaining healthy ear in an attempt to restore some of the benefits provided by binaural hearing. While the benefit of contralateral stimulation has been shown in at least some patients, it is not clear what cues or mechanisms contribute to this function. Previous studies have investigated the motion of the ossicular chain, skull, and round window in response to bone vibration. Here, we extend those reports by reporting simultaneous measurements of cochlear promontory velocity and intracochlear pressures during bone conduction stimulation with two common BCI attachments, and directly compare ipsilateral to contralateral stimulation.

METHODS

Fresh-frozen whole human heads were prepared bilaterally with mastoidectomies. Intracochlear pressure (PIC) in the scala vestibuli (PSV) and tympani (PST) was measured with fiber optic pressure probes concurrently with cochlear promontory velocity (VProm) via laser Doppler vibrometry during stimulation provided with a closed-field loudspeaker or a BCI. Stimuli were pure tones between 120 and 10,240 Hz, and response magnitudes and phases for PIC and VProm were measured for air and bone conducted sound presentation.

RESULTS

Contralateral stimulation produced lower response magnitudes and longer delays than ipsilateral in all measures, particularly for high-frequency stimulation. Contralateral response magnitudes were lower than ipsilateral response magnitudes by up to 10 to 15 dB above ~2 kHz for a skin-penetrating abutment, which increased to 25 to 30 dB and extended to lower frequencies when applied with a transcutaneous (skin drive) attachment.

CONCLUSIONS

Transcranial attenuation and delay suggest that ipsilateral stimulation will be dominant for frequencies over ~1 kHz, and that complex phase interactions will occur during bilateral or bimodal stimulation. These effects indicate a mechanism by which bilateral users could gain some bilateral advantage.

Effect of ossicular chain deformity on reverse stimulation considering the overflow characteristics of third windows

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.

Conductive hearing loss in large vestibular aqueduct syndrome -clinical observations and proof-of-concept predictive modeling by a biomechanical approach

OBJECTIVE

The purpose of this study was to investigate the effect of a dilated vestibular aqueduct on conductive hearing loss (CHL). A biomechanical method was proposed for modeling the patterns of CHL in patients with large vestibular aqueduct syndrome (LVAS).

STUDY DESIGN

High resolution computed tomography (CT) scans and pure tone audiometry (PTA) were retrospectively collected from 16 patients who were diagnosed with LVAS. Seventeen ears with measurable air-bone gaps (ABGs) on PTA were applied for model development. The sizes of midpoint, operculum and distal segment were measured from CT to calculate the biomechanical parameters of each vestibular aqueduct. The mechanical effect of the dilated vestibular aqueduct on sound conduction was simulated using a lumped-parameter model. The CHL levels predicted by the model were compared with the observed ABGs at 250, 500 and 1000 Hz respectively.

RESULTS

The model was able to predict the trend that greater ABGs occurred at lower frequencies, which were consistent with clinical observations. However, deviations between the predicted and the observed ABGs became larger as the frequency increased. None of the correlation coefficients between the radiologic measures and the observed ABG levels were significant.

CONCLUSION

These findings lend support to the feasibility of this approach in modeling CHL in LVAS. The presence of a dilated vestibular aqueduct leads to altered impedance and sound pressure, suggesting the impact of a pathological third window. High individual variability of the observed ABGs implies additional factors may also be involved, especially at 500 Hz and 1000 Hz.

Toward an Individual Binaural Loudness Model for Hearing Aid Fitting and Development

The individual loudness perception of a patient plays an important role in hearing aid satisfaction and use in daily life. Hearing aid fitting and development might benefit from individualized loudness models (ILMs), enabling better adaptation of the processing to individual needs. The central question is whether additional parameters are required for ILMs beyond non-linear cochlear gain loss and linear attenuation common to existing loudness models for the hearing impaired (HI). Here, loudness perception in eight normal hearing (NH) and eight HI listeners was measured in conditions ranging from monaural narrowband to binaural broadband, to systematically assess spectral and binaural loudness summation and their interdependence. A binaural summation stage was devised with empirical monaural loudness judgments serving as input. While NH showed binaural inhibition in line with the literature, binaural summation and its inter-subject variability were increased in HI, indicating the necessity for individualized binaural summation. Toward ILMs, a recent monaural loudness model was extended with the suggested binaural stage, and the number and type of additional parameters required to describe and to predict individual loudness were assessed. In addition to one parameter for the individual amount of binaural summation, a bandwidth-dependent monaural parameter was required to successfully account for individual spectral summation.

Mouse middle-ear forward and reverse acoustics

The mouse is an important animal model for hearing science. However, our knowledge of the relationship between mouse middle-ear (ME) anatomy and function is limited. The ME not only transmits sound to the cochlea in the forward direction, it also transmits otoacoustic emissions generated in the cochlea to the ear canal (EC) in the reverse direction. Due to experimental limitations, a complete characterization of the mouse ME has not been possible. A fully coupled finite-element model of the mouse EC, ME, and cochlea was developed and calibrated against experimental measurements. Impedances of the EC, ME, and cochlea were calculated, alongside pressure transfer functions for the forward, reverse, and round-trip directions. The effects on sound transmission of anatomical changes such as removing the ME cavity, pars flaccida, and mallear orbicular apophysis were also calculated. Surprisingly, below 10 kHz, the ME cavity, eardrum, and stapes annular ligament were found to significantly affect the cochlear input impedance, which is a result of acoustic coupling through the round window. The orbicular apophysis increases the delay of the transmission line formed by the flexible malleus, incus, and stapes, and improves the forward sound-transmission characteristics in the frequency region of 7-30 kHz.

Finite element simulation of cochlear traveling wave under air and bone conduction hearing

Besides the normal hearing pathway known as air conduction (AC), sound can also transmit to the cochlea through the skull, known as bone conduction (BC). During BC stimulation, the cochlear walls demonstrate rigid body motion (RBM) and compressional motion (CPM), both inducing the basilar membrane traveling wave (TW). Despite numerous measuring and modeling efforts for the TW phenomenon, the mechanism remains unclear, especially in the case of BC. This paper proposes a 3D finite element cochlea model mimicking the TW under BC. The model uses a traditional "box model" form, but in a spiral shape, with two fluid chambers separated by the long and flexible BM. The cochlear fluid was enclosed by bony walls, the oval and round window membranes. Contingent boundary conditions and stimulations are introduced according to the physical basis of AC and BC. Particularly for BC, both RBM and CPM of the cochlea walls are simulated. Harmonic numerical solutions are obtained at multiple frequencies among the hearing range. The BM vibration amplitude ([Formula: see text]) and its relation with volume displacement difference between the oval and round windows [Formula: see text], as well as the pressure difference at the base of the cochlea ([Formula: see text]), are analyzed. The simulated BM response at 12 mm from the base is peaked at about 3 k Hz, which is consistent with published experimental data. The TW properties under AC and BC are the same and have a common mechanism. (1) [Formula: see text] is proportional to [Formula: see text] at low frequencies. (2) [Formula: see text] is also proportional to [Formula: see text], within 5 dB error at high frequencies such as 16 k Hz. This study partly reveals the common quantitative relations between the TW and related factors under AC and BC hearing.

Transient otoacoustic emissions and audiogram fine structure in the extended high-frequency region

OBJECTIVE

Previous studies at conventional audiometric frequencies found associations between the ripple depth seen in audiogram fine structure (AFS) and amplitudes of both transient evoked otoacoustic emissions (TEOAEs) and overall hearing threshold levels (HTLs). These associations are explained by the cochlear mechanical theory of multiple coherent reflections of the travelling wave apically by reflections sites on the basilar membrane and basally by the stapes.

DESIGN

The aim was to investigate whether a similar relationship is seen in the extended high-frequency (EHF) range from 8-16 kHz. Measurements from 8-16 kHz were obtained in normal-hearing subjects comprising EHF HTLs, EHF TEOAEs using a double evoked paradigm, and Bekesy audiometry to assess AFS ripple depth and spectral periodicity.

STUDY SAMPLE

Twenty eight normal-hearing subjects participated.

RESULTS

Results showed no significant correlation between AFS ripple depth and either frequency-averaged EHF HTLs or EHF TEOAE amplitudes. The amplitude of AFS ripple depth was also lower than that seen in the conventional frequency region and spectral periodicity in the ripple more difficult to discern.

CONCLUSION

The results suggest a weaker interference pattern between forward and reverse cochlear travelling waves in the most basal region compared to more apical regions, or a difference in cochlear mechanical properties.

Cochlear activity in silent cue-target intervals shows a theta-rhythmic pattern and is correlated to attentional alpha and theta modulations

BACKGROUND

A long-standing debate concerns where in the processing hierarchy of the central nervous system (CNS) selective attention takes effect. In the auditory system, cochlear processes can be influenced via direct and mediated (by the inferior colliculus) projections from the auditory cortex to the superior olivary complex (SOC). Studies illustrating attentional modulations of cochlear responses have so far been limited to sound-evoked responses. The aim of the present study is to investigate intermodal (audiovisual) selective attention in humans simultaneously at the cortical and cochlear level during a stimulus-free cue-target interval.

RESULTS

We found that cochlear activity in the silent cue-target intervals was modulated by a theta-rhythmic pattern (~ 6 Hz). While this pattern was present independently of attentional focus, cochlear theta activity was clearly enhanced when attending to the upcoming auditory input. On a cortical level, classical posterior alpha and beta power enhancements were found during auditory selective attention. Interestingly, participants with a stronger release of inhibition in auditory brain regions show a stronger attentional modulation of cochlear theta activity.

CONCLUSIONS

These results hint at a putative theta-rhythmic sampling of auditory input at the cochlear level. Furthermore, our results point to an interindividual variable engagement of efferent pathways in an attentional context that are linked to processes within and beyond processes in auditory cortical regions.

Forward and Reverse Middle Ear Transmission in Gerbil with a Normal or Spontaneously Healed Tympanic Membrane

Tympanic membranes (TM) that have healed spontaneously after perforation present abnormalities in their structural and mechanical properties; i.e., they are thickened and abnormally dense. These changes result in a deterioration of middle ear (ME) sound transmission, which is clinically presented as a conductive hearing loss (CHL). To fully understand the ME sound transmission under TM pathological conditions, we created a gerbil model with a controlled 50% pars tensa perforation, which was left to heal spontaneously for up to 4 weeks (TM perforations had fully sealed after 2 weeks). After the recovery period, the ME sound transmission, both in the forward and reverse directions, was directly measured with two-tone stimulation. Measurements were performed at the input, the ossicular chain, and output of the ME system, i.e., at the TM, umbo, and scala vestibuli (SV) next to the stapes. We found that variations in ME transmission in forward and reverse directions were not symmetric. In the forward direction, the ME pressure gain decreased in a frequency-dependent manner, with smaller loss (within 10 dB) at low frequencies and more dramatic loss at high frequency regions. The loss pattern was mainly from the less efficient acoustical to mechanical coupling between the TM and umbo, with little changes along the ossicular chain. In the reverse direction, the variations in these ears are relatively smaller. Our results provide detailed functional observations that explain CHL seen in clinical patients with abnormal TM, e.g., caused by otitis media, that have healed spontaneously after perforation or post-tympanoplasty, especially at high frequencies. In addition, our data demonstrate that changes in distortion product otoacoustic emissions (DPOAEs) result from altered ME transmission in both the forward and reverse direction by a reduction of the effective stimulus levels and less efficient transfer of DPs from the ME into the ear canal. This confirms that DPOAEs can be used to assess both the health of the cochlea and the middle ear.

Low-passed outer hair cell response and apical-basal transition in a nonlinear transmission-line cochlear model

The low-pass characteristic of the outer hair cell (OHC) voltage response to mechanical stimulation could be considered a serious problem for cochlear models aiming at explaining high-frequency active amplification by introducing instantaneous nonlinear terms because active gain would dramatically decrease at high frequency. Evidence from experimental studies by Nam and Fettiplace [(2012). PloS One 7, e50572] suggests that the local cutoff frequency significantly increases approaching the cochlear base, somehow mitigating this problem. In this study, low-pass filtering of an internal force term, derived from a physiologically plausible OHC schematization by Lu, Zhak, Dallos, and Sarpeshkar [(2006). Hear. Res. 214, 45-67] is included in a simple one-dimensional (1-D) two-degrees-of-freedom transmission-line model by Sisto, Shera, Altoè, and Moleti [(2019). J. Acoust. Soc. Am. 146, 1685-1695] The frequency dependence of the low-pass filter phase-shift naturally yields a transition from sharp tuning and wide dynamical gain range in the basal cochlea to low tuning and poor dynamical range in the apical region. On the other hand, the frequency-dependent attenuation of low-pass filtering makes it more difficult to obtain the high gain (40-50 dB) of the basal basilar membrane response that is experimentally measured in mammals at low stimulus levels. Pressure focusing in the short-wave resonant region, which is not accounted for in this 1-D model, may help in acquiring the additional gain necessary to match the experimental data.

Research on coupling effects of actuator and round window membrane on reverse stimulation of human cochlea

An active actuator of a middle-ear implant coupled to the round window membrane (RWM), which transmits vibration to the cochlea, has been used to compensate for hearing loss in patients. However, various factors affect the coupling condition between the actuator and the RWM, resulting in coupling leakage. In this study, a coupling impedance model of the human ear and the actuator was used to investigate the effect of inefficient coupling during reverse stimulation. First, the three-port circuit network model of the actuator was coupled with the acoustic impedance model of human ear reverse sound transmission. Meanwhile, the inefficient coupling impedance was estimated. Then, the effect of the actuator's coupling on reverse stimulation was studied by comparing the reverse pressure transfer function. Furthermore, the inefficient coupling's influence in the ear with middle-ear disorder was also investigated by simulating two typical forms of middle-ear disorder: otosclerosis and ossicular chain disarticulation. The results show that the change of the inefficient coupling impedance plays a significant role during reverse stimulation. Inefficient coupling of the actuator and the RWM deteriorates the cochlear response of reverse stimulation over the entire frequency range. Additionally, the coupling effect of the actuator does not change the influence tendency of middle-ear disorder on reverse stimulation's performance, but changes the response amplitude of the reverse stimulation.

Comparing spontaneous and stimulus frequency otoacoustic emissions in mice with tectorial membrane defects

The global standing-wave model for generation of spontaneous otoacoustic emissions (SOAEs) suggests that they are amplitude-stabilized standing waves and that the spacing between SOAEs corresponds to the interval over which the phase changes by one cycle as determined from the phase-gradient delays of stimulus frequency otoacoustic emissions (SFOAEs). Because data characterizing the relationship between spontaneous and evoked emissions in nonhuman mammals are limited, we examined SOAEs and SFOAEs in tectorial membrane (TM) mutants and their controls. Computations indicate that the spacing between adjacent SOAEs is predicted by the SFOAE phase-gradient delays for TM mutants lacking Ceacam16, where SOAE frequencies are greater than ~20 kHz and the mutants retain near-normal hearing when young. Mice with a missense mutation in Tecta (Tecta^Y1870C/+), as well as mice lacking Otoancorin (Otoa^-/-), were also examined. Although these mutants exhibit hearing loss, they generate SOAEs with average frequencies of 11 kHz in Tecta^Y1870C/+ and 6 kHz in Otoa^-/-. In these animals, the spacing between adjacent SOAEs is larger than predicted by the SFOAE phase delays. It is also demonstrated that mice do not exhibit the strong frequency-dependence in signal coding that characterizes species with good low-frequency hearing. In fact, a transition occurs near the apical end of the mouse cochlea rather than at the mid-point along the cochlear partition. Hence, disagreements with the standing-wave model are not easily explained by a transition in tuning ratios between apical and basal regions of the cochlea, especially for SOAEs generated in Tecta^Y1870C/+mice.

Investigation of Mechanisms in Bone Conduction Hyperacusis With Third Window Pathologies Based on Model Predictions

A lumped element impedance model of the inner ear with sources based on wave propagation in the skull bone was used to investigate the mechanisms of hearing sensitivity changes with semi-circular canal dehiscence (SSCD) and alterations of the size of the vestibular aqueduct. The model was able to replicate clinical and experimental findings reported in the literature. For air conduction, the reduction in cochlear impedance due to a SSCD reduces the intra-cochlear pressure at low frequencies resulting in a reduced hearing sensation. For bone conduction, the reduced impedance in the vestibular side due to the SSCD facilitates volume velocity caused by inner ear fluid inertia, and this effect dominates BC hearing with a third window opening on the vestibular side. The SSCD effect is generally greater for BC than for AC. Moreover, the effect increases with increased area of the dehiscence, but areas more than the cross section area of the semi-circular canal itself leads to small alterations. The model-predicted air-bone gap for a SSCD of 1 mm² is 30 dB at 100 Hz that decreases with frequency and become non-existent at frequencies above 1 kHz. According to the model, this air-bone gap is similar to the air-bone gap of an early stage otosclerosis. The normal variation of the size of the vestibular aqueduct do not affect air conduction hearing, but can vary bone conduction sensitivity by up to 15 dB at low frequencies. Reinforcement of the OW to mitigate hyperacusis with SSCD is inefficient while a RW reinforcement can reset the bone conduction sensitivity to near normal.

A cochlea with three parts? Evidence from otoacoustic emission phase in humans

The apical and basal regions of the cochlea appear functionally distinct. In humans, compelling evidence for an apical-basal transition derives from the phase of otoacoustic emissions (OAEs), whose frequency dependence differs at low and high frequencies. Although OAEs arising from the two major source mechanisms (distortion and reflection) both support the existence of an apical-basal transition-as identified via a prominent bend (or "break") in OAE phase slope-the two OAE types disagree about its precise location along the cochlea. Whereas distortion OAEs at frequency 2f₁-f₂ suggest that the apical-basal transition occurs near the 2.5 kHz place, reflection OAEs locate the transition closer to 1 kHz. To address this discrepancy, distortion and reflection OAEs were measured and analyzed in 20 young human adults from 0.25-8 kHz and at eight primary-frequency ratios f₂/f₁ in the range 1-1.5. Break frequencies and OAE phase-gradient delays were estimated by fitting segmented linear models to the unwrapped phase. When distortion- and reflection-OAE phase are considered as functions of ln f₂-that is, as linear functions of the location of their putative site of generation within the cochlea-the analysis identifies not just two but three main cochlear segments, meeting at transition frequencies of approximately 0.9 and 2.6 kHz, whose locations are largely independent both of primary-frequency ratio and emission type. A simple model incorporating an abrupt transition from wave- to place-fixed behavior near the middle of the cochlea accounts for key features of distortion-OAE phase.

Nonlinear reflection as a cause of the short-latency component in stimulus-frequency otoacoustic emissions simulated by the methods of compression and suppression

Stimulus-frequency otoacoustic emissions (SFOAEs) are generated by coherent reflection of forward traveling waves by perturbations along the basilar membrane. The strongest wavelets are backscattered near the place where the traveling wave reaches its maximal amplitude (tonotopic place). Therefore, the SFOAE group delay might be expected to be twice the group delay estimated in the cochlear filters. However, experimental data have yielded steady-state SFOAE components with near-zero latency. A cochlear model is used to show that short-latency SFOAE components can be generated due to nonlinear reflection of the compressor or suppressor tones used in SFOAE measurements. The simulations indicate that suppressors produce more pronounced short-latency components than compressors. The existence of nonlinear reflection components due to suppressors can also explain why SFOAEs can still be detected when suppressors are presented more than half an octave above the probe-tone frequency. Simulations of the SFOAE suppression tuning curves showed that phase changes in the SFOAE residual as the suppressor frequency increases are mostly determined by phase changes of the nonlinear reflection component.

The role of third windows on human sound transmission of forward and reverse stimulations: A lumped-parameter approach

The vestibular and cochlear aqueducts serve as additional sound transmission paths and produce different degrees of volume velocity shunt flow in cochlear sound transmission. To investigate its effect on forward and reverse stimulations, a lumped-parameter model of the human ear, which incorporates the third windows, was developed. The model combines a transmission-line ear-canal model, a middle-ear model, and an inner-ear model, which were developed previously by different investigators. The model is verified by comparison with experiments. The intracochlear differential-pressure transfer functions, which reflect the input force to the organ of Corti, were calculated. The results show that middle-ear gain for forward sound transmission is greater than the gain for reverse sound transmission. Changes in the cochlear aqueduct impedance have little effect on forward and reverse stimulations. The vestibular aqueduct has little effect on forward stimulation, but increasing its impedance causes deterioration on reverse stimulation below 300 Hz. Decreasing its impedance increases the excitation effect during reverse stimulation over the entire frequency, especially below 1000 Hz. Moreover, compared with the case without the third windows, the presence of the third windows has little effect on forward stimulation. Whereas, it boosts the reverse stimulation's performance below 300 Hz.

Achieved Gain and Subjective Outcomes for a Wide-Bandwidth Contact Hearing Aid Fitted Using CAM2

Supplemental Digital Content is available in the text.

Objectives:

The objective of this study was to test the ability to achieve, maintain, and subjectively benefit from extended high-frequency amplification in a real-world use scenario, with a device that restores audibility for frequencies up to 10 kHz.

Design:

A total of 78 participants (149 ears) with mild to moderately-severe sensorineural hearing loss completed one of two studies conducted across eight clinical sites. Participants were fitted with a light-driven contact hearing aid (the Earlens system) that directly drives the tympanic membrane, allowing extended high-frequency output and amplification with minimal acoustic feedback. Cambridge Method for Loudness Equalization 2 - High Frequency (CAM2)-prescribed gains for experienced users were used for initial fitting, and adjustments were made when required according to participant preferences for loudness and comfort or when measures of functional gain (FG) indicated that more or less gain was needed. Participants wore the devices for an extended period. Prescribed versus adjusted output and gain, frequency-specific FG, and self-perceived benefit assessed with the Abbreviated Profile of Hearing Aid Benefit, and a custom questionnaire were documented. Self-perceived benefit results were compared with those for unaided listening and to ratings with participants’ own acoustic hearing aids.

Results:

The prescribed low-level insertion gain from 6 to 10 kHz averaged 53 dB across all ears, with a range from 26 to 86 dB. After adjustment, the gain from 6 to 10 kHz decreased to an average of 45 dB with a range from 16 to 86 dB. Measured FG averaged 39 dB from 6 to 10 kHz with a range from 11 to 62 dB. Abbreviated Profile of Hearing Aid Benefit results revealed a significant improvement in communication relative to unaided listening, averaging 28 to 32 percentage points for the background noise, reverberation, and ease of communication subscales. Relative to participants’ own hearing aids, the subscales ease of communication and aversiveness showed small but significant improvements for Earlens ranging from 6 to 7 percentage points. For the custom satisfaction questionnaire, most participants rated the Earlens system as better than their own hearing aids in most situations.

Conclusions:

Participants used and reported subjective benefit from the Earlens system. Most participants preferred slightly less gain at 6 to 10 kHz than prescribed for experienced users by CAM2, preferring similar gains to those prescribed for inexperienced users, but gains over the extended high frequencies were high relative to those that are currently available with acoustic hearing aids.

Effect of Middle-Ear Pathology on High-Frequency Ear Canal Reflectance Measurements in the Frequency and Time Domains

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.

Finite element analysis of round-window stimulation of the cochlea in patients with stapedial otosclerosis

An active actuator coupled to the round window (RW) can transmit mechanical vibrations into the cochlea and has become a therapeutic option of hearing rehabilitation for patients with stapedial otosclerosis. A finite-element model of the human ear that includes sound transmission effects of the vestibular and cochlear aqueducts of the inner ear is adopted in this study for investigating the cochlear response to RW stimulation under stapes fixation. There are two effects due to otosclerosis of the stapes: the fixation of the stapedial annular ligament (SAL) and the increase of the stapes mass. The frequency responses of the middle ear and cochlea with normal and otosclerotic stapes are calculated under sound and RW stimulations. The results show that changes in the material property of the stapes have different effects on the cochlear responses under sound and RW stimulations. Because of the vestibuli aqueduct, the reduction in the low-frequency magnitude of the pressure difference across the cochlear partition due to SAL fixation is much smaller under RW stimulation than under sound stimulation. The results of this study help understand sound transmission during RW stimulation in patients with stapedial otosclerosis.

The influence of distributed source regions in the formation of the nonlinear distortion component of cubic distortion-product otoacoustic emissions

Distortion product otoacoustic emissions (DPOAEs) are evoked by two stimulus tones with frequency f₁ and f₂ of ratio f₂/f₁  in the range between approximately 1.05 and 1.4. This study theoretically and experimentally analyzes the cubic 2f₁-f₂ DPOAE for different stimulus levels of one of the tones while the other is constant. Simulations for f₂/f₁ of 1.2 and moderate stimulus levels (30-70 dB sound pressure level) indicate that cubic distortion products are generated along a relatively large length of the basilar membrane, the extent of which increases with stimulus level. However, apical from the place of maximum nonlinear force, the wavelets generated by these distributed sources mutually cancel. Therefore, although the spatial extent of the primary DPOAE sources broadens with increasing stimulus level (up to 1.5 oct), the basilar-membrane region contributing to the DPOAE signal is relatively narrow (0.6 oct) and level independent. The observed dependence of DPOAE amplitude on stimulus level can be well-approximated by a point source at the basilar-membrane place where the largest distortion product (maximum of the nonlinear force) is generated. Onset and offset of the DPOAE signal may contain amplitude overshoots (complexities), which are in most cases asymmetrical. Two-tone suppression was identified as the main cause of these onset and offset complexities. DPOAE measurements in two normal-hearing subjects support the level dependence of the steady-state DPOAE amplitude and the asymmetry in the onset and offset responses predicted by the theoretical analysis.

Contrasting Effects of Pressure Compensation on TEOAE and DPOAE in Children With Negative Middle Ear Pressure

In children with normal cochlear acuity, middle ear fluid often abolishes otoacoustic emissions (OAEs), and negative middle ear pressure (NMEP) reduces them. No convincing evidence of beneficial pressure compensation on distortion product OAE (DPOAE) has yet been presented. Two studies aimed to document effects of NMEP on transient OAE (TEOAE) and DPOAE. In Study 1, TEOAE and DPOAE pass/fail responses were analyzed before and after pressure compensation in 50 consecutive qualifying referrals having NMEP from -100 to -299 daPa. Study 2 concentrated on DPOAE, recording both amplitude (distortion product amplitude) and signal-to-noise ratio (SNR) before and after pressure compensation. Of the 20 participants, 5 had both ears qualifying. An effect of compensation on meeting a pass criterion was present in TEOAE for both left and right ear data in Study 1 but not demonstrable in DPOAE. In Study 2, the distortion product amplitude compensation effect was marginal overall, and depended on recording frequency band. SNR values improved moderately after pressure compensation in the two (overlapping) sets of single-ear data. In the five cases with both ears qualifying, a stronger compensation effect size, over 3 dB, was seen. The absolute dependence of SNR on frequency was also strongly replicated, but in no analysis, the frequency × compensation interaction was significant. Independent of particular frequency range, the data support a limited SNR improvement in 2 to 3 dB for compensation in DPOAE, with slightly larger effects in ears giving SNRs between 0 dB and +6 dB, where pass/fail cutoffs would generally be located.

Power Dissipation in the Cochlea Can Enhance Frequency Selectivity

The cochlear cavity is filled with viscous fluids, and it is partitioned by a viscoelastic structure called the organ of Corti complex. Acoustic energy propagates toward the apex of the cochlea through vibrations of the organ of Corti complex. The dimensions of the vibrating structures range from a few hundred (e.g., the basilar membrane) to a few micrometers (e.g., the stereocilia bundle). Vibrations of microstructures in viscous fluid are subjected to energy dissipation. Because the viscous dissipation is considered to be detrimental to the function of hearing-sound amplification and frequency tuning-the cochlea uses cellular actuators to overcome the dissipation. Compared to extensive investigations on the cellular actuators, the dissipating mechanisms have not been given appropriate attention, and there is little consensus on damping models. For example, many theoretical studies use an inviscid fluid approximation and lump the viscous effect to viscous damping components. Others neglect viscous dissipation in the organ of Corti but consider fluid viscosity. We have developed a computational model of the cochlea that incorporates viscous fluid dynamics, organ of Corti microstructural mechanics, and electrophysiology of the outer hair cells. The model is validated by comparing with existing measurements, such as the viscoelastic response of the tectorial membrane, and the cochlear input impedance. Using the model, we investigated how dissipation components in the cochlea affect its function. We found that the majority of acoustic energy dissipation of the cochlea occurs within the organ of Corti complex, not in the scalar fluids. Our model suggests that an appropriate dissipation can enhance the tuning quality by reducing the spread of energy provided by the outer hair cells' somatic motility.

Forward and Reverse Waves: Modeling Distortion Products in the Intracochlear Fluid Pressure

Distortion product otoacoustic emissions are sounds that are emitted by the cochlea due to the nonlinearity of the outer hair cells. These emissions play an important role both in clinical settings and research laboratories. However, how distortion products propagate from their generation location to the middle ear remains unclear; whether distortion products propagate as a slow reverse traveling wave, or as a fast compression wave, through the cochlear fluid has been debated. In this article, we evaluate the contributions of the slow reverse wave and fast compression wave to the propagation of intracochlear distortion products using a physiologically based nonlinear model of the gerbil cochlea. This model includes a 3D two-duct model of the intracochlear fluid and a realistic model of outer hair cell biophysics. Simulations of the distortion products in the cochlear fluid pressure in response to a two-tone stimulus are compared with published in vivo experimental results. Whereas experiments have characterized distortion products at a limited number of locations, this model provides a complete description of the fluid pressure at all locations in the cochlear ducts. As in experiments, the spatial variations of the distortion products in the fluid pressure have some similarities with what is observed in response to a pure tone. Analysis of the fluid pressure demonstrates that although a fast wave component is generated, the slow wave component dominates the response. Decomposition of the model simulations into forward and reverse wave components shows that a slow forward propagating wave is generated due to the reflection of the slow reverse wave at the stapes. Wave interference between the reverse and forward components sometimes complicates the analysis of distortion products propagation using measurements at a few locations.

Distortion product otoacoustic emissions: Sensitive measures of tympanic -membrane perforation and healing processes in a gerbil model

Distortion product otoacoustic emissions (DPOAEs) evoked by two pure tones carry information about the mechanisms that generate and shape them. Thus, DPOAEs hold promise for providing powerful noninvasive diagnostic details of cochlear operations, middle ear (ME) transmission, and impairments. DPOAEs are sensitive to ME function because they are influenced by ME transmission twice, i.e., by the inward-going primary tones in the forward direction and the outward traveling DPOAEs in the reverse direction. However, the effects of ME injuries on DPOAEs have not been systematically characterized. The current study focused on exploring the utility of DPOAEs for examining ME function by methodically characterizing DPOAEs and ME transmission under pathological ME conditions, specifically under conditions of tympanic-membrane (TM) perforation and spontaneous healing. Results indicated that DPOAEs were measurable with TM perforations up to ∼50%, and DPOAE reductions increased with increasing size of the TM perforation. DPOAE reductions were approximately flat across test frequencies when the TM was perforated about 10% (<1/8 of pars tensa) or less. However, with perforations greater than 10%, DPOAEs decreased further with a low-pass filter shape, with ∼30 dB loss at frequencies below 10 kHz and a quick downward sloping pattern at higher frequencies. The reduction pattern of DPOAEs across frequencies was similar to but much greater than, the directly measured ME pressure gain in the forward direction, which suggested that reduction in the DPOAE was a summation of losses of ME ear transmission in both the forward and reverse directions. Following 50% TM perforations, DPOAEs recovered over a 4-week spontaneously healing interval, and these recoveries were confirmed by improvements in auditory brainstem response (ABR) thresholds. However, up to 4-week post-perforation, DPOAEs never fully recovered to the levels obtained with normal intact TM, consistent with the incomplete recovery of ABR thresholds and ME transmission, especially at high-frequency regions, which could be explained by an irregularly dense and thickened healed TM. Since TM perforations in patients are commonly caused by either trauma or infection, the present results contribute towards providing insight into understanding ME transmission under pathological conditions as well as promoting the application of DPOAEs in the evaluation and diagnosis of deficits in the ME-transmission system.

Tympanic membrane surface motions in forward and reverse middle ear transmissions

Characterization of Tympanic Membrane (TM) surface motions with forward and reverse stimulation is important to understanding how the TM transduces acoustical and mechanical energy in both directions. In this paper, stroboscopic opto-electronic holography is used to quantify motions of the entire TM surface induced by forward sound and reverse mechanical stimulation in human cadaveric ears from 0.25 to 18.4 kHz. The forward sound stimulus was coupled to an anatomically realistic artificial ear canal that allowed optical access to the entire TM surface, and the reverse mechanical stimulus was applied to the body of the incus by a piezo-electric stimulator. The results show clear differences in TM surface motions evoked by the two stimuli. In the forward case, TM motion is dominated by standing-wave-like modal motions that are consistent with a relatively uniform sound-pressure load over the entire TM surface. With reverse mechanical stimulation, the TM surface shows more traveling waves, consistent with a localized mechanical drive applied to the manubrium embedded in the TM. With both stimuli, the manubrium moves less than the rest of the TM, consistent with the TM acting like a compliant membrane rather than a stiff diaphragm, and also consistent with catenary behavior due to the TM's curved shape.

Effects of tympanic membrane perforation on middle ear transmission in gerbil

Perforations of the tympanic membrane (TM) alter its structural and mechanical properties, thus resulting in a deterioration of sound transmission through the middle ear (ME), which presents itself clinically as a conductive hearing loss (CHL). The resulting CHL is proposed to be due to the loss of the pressure difference across the TM between the outer ear canal space and the ME cavity, a hypothesis which has been tested with both theoretical and experimental approaches. In the past, direct experimental observations had been either from the ME input (umbo) or the output of the stapes, and were focused mainly on the low frequency region. However, there was little documentation providing a thorough picture of the influence of systematically increasing sizes of TM perforations on ME sound transmission from the input (i.e., pressure at the TM or motion of the umbo) to the output (pressure produced by the motion of the stapes). Our study explored ME transmission in gerbil under conditions of a normal, intact TM followed by the placement of mechanically-induced TM perforations ranging from miniscule to complete removal of the pars tensa, leaving the other parts of ME intact. Testing up to 50 kHz, variations of ME transmission were characterized in simultaneously measured tone induced pressure responses at the TM (P_TM), pressure responses in the scala vestibuli next to the stapes (P_SV), and velocity measurements of the umbo (V_umbo), as well as by detailed descriptions of sound transmission from the TM to the stapes, i.e., the umbo transfer function (TF), the transfer of the sound stimulus along the ossicular chain as found from the ratio of cochlear pressure to umbo motion, and ME pressure gain (MEPG). Our results suggested that increasing the size of TM perforations led to a reduction in MEPG, which appeared to be primarily due to the reduction in the effective/initial mechanical drive to the umbo, with a relatively smaller decrease of sound transfer along the ossicular chain. Expansion of the perforation more than 25% appeared to drastically reduce sound transmission through the ME, especially for the higher frequencies.

High frequency transient-evoked otoacoustic emission measurements using chirp and click stimuli

Transient-evoked otoacoustic emissions (TEOAEs) at high frequencies are a non-invasive physiological test of basilar membrane mechanics at the basal end, and have clinical potential to detect risk of hearing loss related to outer-hair-cell dysfunction. Using stimuli with constant incident pressure across frequency, TEOAEs were measured in experiment 1 at low frequencies (0.7-8 kHz) and high frequencies (7.1-14.7 kHz) in adults with normal hearing up to 8 kHz and varying hearing levels from 9 to 16 kHz. In combination with click stimuli, chirp stimuli were used with slow, medium and fast sweep rates for which the local frequency increased or decreased with time. Chirp TEOAEs were transformed into equivalent click TEOAEs by inverse filtering out chirp stimulus phase, and analyzed similarly to click TEOAEs. To improve detection above 8 kHz, TEOAEs were measured in experiment 2 with higher-level stimuli and longer averaging times. These changes increased the TEOAE signal-to-noise ratio (SNR) by 10 dB. Slower sweep rates were investigated but the elicited TEOAEs were detected in fewer ears compared to faster rates. Data were acquired in adults and children (age 11-17 y), including children with cystic fibrosis (CF) treated with ototoxic antibiotics. Test-retest measurements revealed satisfactory repeatability of high-frequency TEOAE SNR (median of 1.3 dB) and coherence synchrony measure, despite small test-retest differences related to changes in forward and reverse transmission in the ear canal. The results suggest the potential use of such tests to screen for sensorineural hearing loss, including ototoxic loss. Experiment 2 was a feasibility study to explore TEOAE test parameters that might be used in a full-scale study to screen CF patients for risk of ototoxic hearing loss.

Intracochlear Sound Pressure Measurements in Normal Human Temporal Bones During Bone Conduction Stimulation

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.

Physiologically motivated individual loudness model for normal hearing and hearing impaired listeners

A loudness model with a central gain is suggested to improve individualized predictions of loudness scaling data from normal hearing and hearing impaired listeners. The current approach is based on the loudness model of Pieper et al. [(2016). J. Acoust. Soc. Am. 139, 2896], which simulated the nonlinear inner ear mechanics as transmission-line model in a physical and physiological plausible way. Individual hearing thresholds were simulated by a cochlear gain reduction in the transmission-line model and linear attenuation (damage of inner hair cells) prior to an internal threshold. This and similar approaches of current loudness models that characterize the individual hearing loss were shown to be insufficient to account for individual loudness perception, in particular at high stimulus levels close to the uncomfortable level. An additional parameter, termed "post gain," was introduced to improve upon the previous models. The post gain parameter amplifies the signal parts above the internal threshold and can better account for individual variations in the overall steepness of loudness functions and for variations in the uncomfortable level which are independent of the hearing loss. The post gain can be interpreted as a central gain occurring at higher stages as a result of peripheral deafferentation.

Impedances of the inner and middle ear estimated from intracochlear sound pressures in normal human temporal bones

For almost a decade, we have measured intracochlear sound pressures evoked by air conducted (AC) sound presented to the ear canal in many fresh human cadaveric specimens. Similar measurements were also obtained during round window (RW) mechanical stimulation in multiple specimens. In the present study, we use our accumulated data of intracochlear pressures and simultaneous velocity measurements of the stapes or RW to determine acoustic impedances of the cochlear partition, RW, and the leakage paths from scala vestibuli and scala tympani, as well as the reverse middle ear impedance. With these impedances, we develop a computational lumped-element model of the normal ear that illuminates fundamental mechanisms of sound transmission. To calculate the impedances for our model, we use data that passes strict inclusion criteria of: (a) normal middle-ear transfer function defined as the ratio of stapes velocity to ear-canal sound pressure, (b) no evidence of air within the inner ear, and (c) tight control of the pressure sensor sensitivity. After this strict screening, updated normal means, as well as individual representative data, of ossicular velocities and intracochlear pressures for AC and RW stimulation are used to calculate impedances. This work demonstrates the existence and the value of physiological acoustic leak impedances that can sometimes contribute significantly to sound transmission for some stimulation modalities. This model allows understanding of human sound transmission mechanisms for various sound stimulation methods such as AC, RW, and bone conduction, as well as sound transmission related to otoacoustic emissions.

The eardrums move when the eyes move: A multisensory effect on the mechanics of hearing

The peripheral hearing system contains several motor mechanisms that allow the brain to modify the auditory transduction process. Movements or tensioning of either the middle ear muscles or the outer hair cells modifies eardrum motion, producing sounds that can be detected by a microphone placed in the ear canal (e.g., as otoacoustic emissions). Here, we report a form of eardrum motion produced by the brain via these systems: oscillations synchronized with and covarying with the direction and amplitude of saccades. These observations suggest that a vision-related process modulates the first stage of hearing. In particular, these eye movement-related eardrum oscillations may help the brain connect sights and sounds despite changes in the spatial relationship between the eyes and the ears.

Interactions between sensory pathways such as the visual and auditory systems are known to occur in the brain, but where they first occur is uncertain. Here, we show a multimodal interaction evident at the eardrum. Ear canal microphone measurements in humans (n = 19 ears in 16 subjects) and monkeys (n = 5 ears in three subjects) performing a saccadic eye movement task to visual targets indicated that the eardrum moves in conjunction with the eye movement. The eardrum motion was oscillatory and began as early as 10 ms before saccade onset in humans or with saccade onset in monkeys. These eardrum movements, which we dub eye movement-related eardrum oscillations (EMREOs), occurred in the absence of a sound stimulus. The amplitude and phase of the EMREOs depended on the direction and horizontal amplitude of the saccade. They lasted throughout the saccade and well into subsequent periods of steady fixation. We discuss the possibility that the mechanisms underlying EMREOs create eye movement-related binaural cues that may aid the brain in evaluating the relationship between visual and auditory stimulus locations as the eyes move.

A common microstructure in behavioral hearing thresholds and stimulus-frequency otoacoustic emissions

Behavioral hearing thresholds and otoacoustic emission (OAE) spectra often exhibit quasiperiodic fluctuations with frequency. For behavioral and OAE responses to single tones-the latter referred to as stimulus-frequency otoacoustic emissions (SFOAEs)-this microstructure has been attributed to intracochlear reflections of SFOAE energy between its region of generation and the middle ear boundary. However, the relationship between behavioral and SFOAE microstructures, as well as their presumed dependence on the properties of the SFOAE-generation mechanism, have yet to be adequately examined. To address this, behavioral thresholds and SFOAEs evoked by near-threshold tones were compared in 12 normal-hearing female subjects. The microstructures observed in thresholds and both SFOAE amplitudes and delays were found to be strikingly similar. SFOAE phase accumulated an integer number of cycles between the frequencies of microstructure maxima, consistent with a dependence of microstructure periodicity on SFOAE propagation delays. Additionally, microstructure depth was correlated with SFOAE magnitude in a manner resembling that predicted by the intracochlear reflection framework, after assuming reasonable values of parameters related to middle ear transmission. Further exploration of this framework may yield more precise estimates of such parameters and provide insight into their frequency dependence.

An elemental approach to modelling the mechanics of the cochlea

The motion along the basilar membrane in the cochlea is due to the interaction between the micromechanical behaviour of the organ of Corti and the fluid movement in the scalae. By dividing the length of the cochlea into a finite number of elements and assuming a given radial distribution of the basilar membrane motion for each element, a set of equations can be separately derived for the micromechanics and for the fluid coupling. These equations can then be combined, using matrix methods, to give the fully coupled response. This elemental approach reduces to the classical transmission line model if the micromechanics are assumed to be locally-reacting and the fluid coupling is assumed to be entirely one-dimensional, but is also valid without these assumptions. The elemental model is most easily formulated in the frequency domain, assuming quasi-linear behaviour, but a time domain formulation, using state space method, can readily incorporate local nonlinearities in the micromechanics. Examples of programs are included for the elemental model of a human cochlea that can be readily modified for other species.

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General formulation of an elemental model for cochlear mechanics.

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Reduce to the transmission line model for locally-reacting micromechanical and 1D fluid coupling.

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Incorporation of non-uniform areas, 3D fluid coupling and non locally-reacting micromechanics.

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MATLAB programs for the elemental model in the frequency domain and time domain.

Light-Driven Contact Hearing Aid for Broad-Spectrum Amplification: Safety and Effectiveness Pivotal Study

Objective:

Demonstrate safety and effectiveness of the light-driven contact hearing aid to support FDA clearance.

Study Design:

A single-arm, open-label investigational-device clinical trial.

Setting:

Two private-practice and one hospital-based ENT clinics.

Patients:

Forty-three subjects (86 ears) with mild-to-severe bilateral sensorineural hearing impairment.

Intervention:

Bilateral amplification delivered via a light-driven contact hearing aid comprising a Tympanic Lens (Lens) with a customized platform to directly drive the umbo and a behind-the-ear sound processor (Processor) that encodes sound into light pulses to wirelessly deliver signal and power to the Lens.

Main Outcome Measures:

The primary safety endpoint was a determination of “no change” (PTA4 < 10 dB) in residual unaided hearing at the 120-day measurement interval. The primary efficacy endpoint was improvement in word recognition using NU-6 at the 30-day measurement interval over the baseline unaided case. Secondary efficacy endpoints included functional gain from 2 to 10 kHz and speech-in-noise improvement over the baseline unaided case using both omnidirectional and directional microphones.

Results:

The results for the 86 ears in the study determined a mean change of −0.40 dB in PTA4, indicating no change in residual hearing (p < 0.0001). There were no serious device- or procedure-related adverse events, or unanticipated adverse events. Word recognition aided with the Earlens improved significantly (p < 0.0001) over the unaided performance, by 35% rationalized arcsine units on average. Mean functional gain was 31 dB across 2 to 10 kHz. The average speech-recognition threshold improvement over the unaided case for the Hearing in Noise Test was 0.75 dB (p = 0.028) and 3.14 dB (p < 0.0001) for the omnidirectional and directional microphone modes, respectively.

Conclusion:

The safety and effectiveness data supported a de novo 510(k) submission that received clearance from the FDA.

Functional Outcomes of Heparin-Binding Epidermal Growth Factor-Like Growth Factor for Regeneration of Chronic Tympanic Membrane Perforations in Mice

We aim to demonstrate that regeneration of chronic tympanic perforations with heparin-binding epidermal growth factor-like growth factor (HB-EGF) delivered by an injectable hydrogel restored hearing to levels similar to that of nonperforated tympanic membranes. Chronic tympanic membrane perforation is currently managed as an outpatient surgery with tympanoplasty. Due to the costs of this procedure in the developed world and a lack of accessibility and resources in developing countries, there is a great need for a new treatment that does not require surgery. In this study, we show in a mouse model through measurement of auditory brainstem response and distortion product otoacoustic emissions that tympanic perforations lead to hearing loss and this can be predominantly recovered with HB-EGF treatment (5 μg/mL). Our animal model suggests a return to function between 2 and 6 months after treatment. Auditory brainstem response thresholds had returned to the control levels at 2 months, but the distortion product otoacoustic emissions returned between 2 and 6 months. We also show how the vibration characteristics of the regenerated tympanic membrane, as measured by laser Doppler vibrometry, can be similar to that of an unperforated tympanic membrane. Using the best available methods for preclinical evaluation in animal models, it is likely that HB-EGF-like growth factor treatment leads to regeneration of chronic tympanic membrane perforations and restoration of the tympanic membrane to normal function, suggesting a potential route for nonsurgical treatment.