External and middle ear sound pressure distribution and acoustic coupling to the tympanic membrane

The influence of tympanic-membrane orientation on acoustic ear-canal quantities: A finite-element analysis

Assuming plane waves, ear-canal acoustic quantities, collectively known as wideband acoustic immittance (WAI), are frequently used in research and in the clinic to assess the conductive status of the middle ear. Secondary applications include compensating for the ear-canal acoustics when delivering stimuli to the ear and measuring otoacoustic emissions. However, the ear canal is inherently non-uniform and terminated at an oblique angle by the conical-shaped tympanic membrane (TM), thus potentially confounding the ability of WAI quantities in characterizing the middle-ear status. This paper studies the isolated possible confounding effects of TM orientation and shape on characterizing the middle ear using WAI in human ears. That is, the non-uniform geometry of the ear canal is not considered except for that resulting from the TM orientation and shape. This is achieved using finite-element models of uniform ear canals terminated by both lumped-element and finite-element middle-ear models. In addition, the effects on stimulation and reverse-transmission quantities are investigated, including the physical significance of quantities seeking to approximate the sound pressure at the TM. The results show a relatively small effect of the TM orientation on WAI quantities, except for a distinct delay above 10 kHz, further affecting some stimulation and reverse-transmission quantities.

Inaccuracies of deterministic finite-element models of human middle ear revealed by stochastic modelling

For over 40 years, finite-element models of the mechanics of the middle ear have been mostly deterministic in nature. Deterministic models do not take into account the effects of inter-individual variabilities on middle-ear parameters. We present a stochastic finite-element model of the human middle ear that uses variability in the model parameters to investigate the uncertainty in the model outputs (umbo, stapes, and tympanic-membrane displacements). We demonstrate: (1) uncertainties in the model parameters can be magnified by more than three times in the umbo and stapes footplate responses at frequencies above 2 kHz; (2) middle-ear models are biased and they distort the output distributions; and (3) with increased frequency, the highly-uncertain regions spatially spread out on the tympanic membrane surface. Our results assert that we should be mindful when using deterministic finite-element middle-ear models for critical tasks such as novel device developments and diagnosis.

Numerical model characterization of the sound transmission mechanism in the tympanic membrane from a high-speed digital holographic experiment in transient regime

A methodology for the development of a finite element numerical model of the tympanic membrane (TM) based on experiments carried out in the time domain on a cadaveric human temporal bone is presented. Using a high-speed digital holographic (HDH) system, acoustically-induced transient displacements of the TM surface are obtained. The procedure is capable to generate and validate the finite element model of the TM by numerical and experimental data correlation. Reverse engineering approach is used to identify key material parameters that define the mechanical response of the TM. Finally, modal numerical simulations of the specimen are performed. Results show the feasibility of the methodology to obtain an accurate model of a specific specimen and to help interpret its behaviour with additional numerical simulations. STATEMENT OF SIGNIFICANCE: Improving knowledge of the dynamic behavior of the tympanic membrane is key to understanding the sound transmission system in human hearing and advance in the treatment of its pathologies. Recently we acquired a new tool to carry out experiments in transient regime by means of digital laser holography, capable of providing a large amount of information in a controlled transient test. In this work, these data are used to develop a methodology that generates a numerical model of the tympanic membrane based on numerical-experimental correlations. It is important to be able to develop models that fit specific patients. In this work, additional modal simulations are also presented that, in addition to validating the results, provide more information on the specimen.

Comments on forward pressure and other reflectance-based quantities for delivering stimuli to the ear

The forward pressure has been proposed as an "optimal" reflectance-based quantity for delivering stimuli to the ear during evoked otoacoustic-emission measurements and audiometry. It is motivated by and avoids detrimental stimulus-level errors near standing-wave antiresonance frequencies when levels are adjusted in situ. While enjoying widespread popularity within research, the forward pressure possesses certain undesirable properties, some of which complicate its implementation into commercial otoacoustic-emission instruments conforming to existing international standards. These properties include its inability to approximate the total sound pressure anywhere in the ear canal and its discrepancy from the sound pressure at the tympanic membrane, which depends directly on the reflectance. This paper summarizes and comments on such properties of the forward pressure. Further, based on previous published data, alternative reflectance-based quantities that do not share these properties are investigated. A complex integrated pressure, with magnitude identical to the previously proposed scalar integrated pressure, is suggested as a suitable quantity for avoiding standing-wave errors when delivering stimuli to the ear. This complex integrated pressure approximates the magnitude and phase of the sound pressure at the tympanic membrane and can immediately be implemented into standardized commercial instruments to take advantage of improved stimulus-level accuracy and reproducibility in the clinic.

Morphology of human ear canal and its effect on sound transmission

The ear canal (EC) is essential for sound transfer and crucial for hearing. Some pathological conditions may modify its morphology, leading to EC sound pressure redistribution, and stapes footplate displacement (FPD) gain alteration. However, no consensus regarding pathological EC and its impact on sound transfer has yet been achieved. To address the effect of morphology of EC on sound pressure redistribution and FPD gain. Varied pathological EC finite element (FE) models were constructed and analyzed based on FE analysis. The results indicated that canal wall down mastoidectomy decreases the second resonance frequency of the EC. The canal wall down mastoidectomy, with conchaplasty increased the first resonance frequency, but decreased the second along with the interval sound pressure gain increased, following which the FPD gain was altered. Stenosis of the EC at the internal portion decreased the second resonance frequency with minimal effect to the first part. When the stenosis moved to the outer portion of the EC, the first resonance frequency decreased, and the second one increased, along with the interval sound pressure gain decreased and FPD gain. Finally, the simplified EC model exerted a minimal effect on sound transfer. The minimal change in EC, such as simplification, straightening, canal wall down mastoidectomy, or enlargement, moderately affects the sound transfer; however, the EC stenosis deteriorates the sound transfer remarkably.

The impact of tympanic membrane perforations on middle ear transfer function

Purpose

Injury or inflammation of the middle ear often results in the persistent tympanic membrane (TM) perforations, leading to conductive hearing loss (HL). However, in some cases the magnitude of HL exceeds that attributable by the TM perforation alone. The aim of the study is to better understand the effects of location and size of TM perforations on the sound transmission properties of the middle ear.

Methods

The middle ear transfer functions (METF) of six human temporal bones (TB) were compared before and after perforating the TM at different locations (anterior or posterior lower quadrant) and to different degrees (1 mm, ¼ of the TM, ½ of the TM, and full ablation). The sound-induced velocity of the stapes footplate was measured using single-point laser-Doppler-vibrometry (LDV). The METF were correlated with a Finite Element (FE) model of the middle ear, in which similar alterations were simulated.

Results

The measured and calculated METF showed frequency and perforation size dependent losses at all perforation locations. Starting at low frequencies, the loss expanded to higher frequencies with increased perforation size. In direct comparison, posterior TM perforations affected the transmission properties to a larger degree than anterior perforations. The asymmetry of the TM causes the malleus-incus complex to rotate and results in larger deflections in the posterior TM quadrants than in the anterior TM quadrants. Simulations in the FE model with a sealed cavity show that small perforations lead to a decrease in TM rigidity and thus to an increase in oscillation amplitude of the TM mainly above 1 kHz.

Conclusion

Size and location of TM perforations have a characteristic influence on the METF. The correlation of the experimental LDV measurements with an FE model contributes to a better understanding of the pathologic mechanisms of middle-ear diseases. If small perforations with significant HL are observed in daily clinical practice, additional middle ear pathologies should be considered. Further investigations on the loss of TM pretension due to perforations may be informative.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00405-021-07078-9.

Necessities, opportunities, and challenges for tympanic membrane perforation scaffolding-based bioengineering

Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation.

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.

Structural stiffening in the human middle ear due to static pressure: Finite-element analysis of combined static and dynamic middle-ear behavior

The vibration response of the middle ear (ME) to sound changes when static pressure gradients are applied across the tympanic membrane (TM). To date, it has not been well understood which mechanisms lead to these changes in ME vibration response. In this study, a 3D finite-element model of the human ME was developed that simulates the sound-induced ME vibration response when positive and negative static pressures of up to 4 kPa are applied to the TM. Hyperelasticity of the soft-tissue components was considered to simulate large deformations under static pressure. Some ME components were treated as viscoelastic materials to capture the difference between their static and dynamic stiffness, which was needed to replicate both static and dynamic ME behavior. The change in dynamic stiffness with static preload was simulated by linearization of the hyperelastic constitutive model around the predeformed state. For the preloaded harmonic response, we found that the statically deformed ME geometry introduced asymmetry in the vibration loss between positive and negative pressure, which was due to the TM cone shape. As opposed to previous assumptions, the prestress in the ME due to static pressure had a substantial impact on the vibration response. We also found that material nonlinearity led to a higher stiffening at the umbo but a less pronounced stiffening at the footplate compared to the linear elastic condition. The results suggest that flexibility of the incudomalleolar joint (IMJ) enhances the decoupling of static umbo and footplate displacements, and that viscosity and viscoelasticity of the IMJ could play a role in the transfer of sound-induced vibrations from the umbo to the footplate. The components of the incudostapedial joint had minimal effect on ME mechanical behavior.

Influence of transient pressure changes on speech intelligibility: Implications for next-generation train travel

High-speed trains are operated in increasingly complex railway networks and continual improvement of driver assistance systems is necessary to maintain safety. Speech offers the opportunity to provide information to the driver without disrupting visual attention. However, it is not known whether the transient pressure changes inside trains passing through tunnels interfere with speech intelligibility. Our primary goal was to test whether the most severe pressure variations occurring in high-speed trains (25 hPa in 2 s) affect speech intelligibility in individuals with normal hearing ability and secondly whether a potential effect would depend on the direction of the pressure change. A cross-over design was used to compare speech intelligibility, measured with the monosyllable word test by Wallenberg and Kollmeier, in steady ambient pressure versus subsequent to pressure events, both realised in a pressure chamber. Since data for a power calculation did not exist, we conducted a pilot study with 20 participants to estimate variance of intra-individual differences. The upper 80% confidence limit guided sample size of the main campaign, which was performed with 72 participants to identify a 10% difference while limiting alpha (5%) and beta error (10%). On average, a participant understood 0.7 fewer words following a pressure change event compared to listening in steady ambient pressure. However, this intra-individual differences varied strongly between participants, standard deviation (SD) ± 4.5 words, resulting in a negligible effect size of 0.1 and the Wilcoxon signed rank test (Z = -1.26; p = 0.21) did not distinguish it from chance. When comparing decreasing and increasing pressure events an average of 0.2 fewer words were understood (± 3.9 SD). The most severe pressure changes expected to occur in high-speed trains passing through tunnels do not interfere with speech intelligibility and are in itself not a risk factor for loss of verbal information transmission.

Tympanic Resonance Hypothesis

Seemingly unrelated symptoms in the head and neck region are eliminated when a patch is applied on specific locations on the Tympanic Membrane. Clinically, two distinct patient populations can be distinguished; cervical and masticatory muscle tensions are involved, and mental moods of anxiety or need. Clinical observations lead to the hypothesis of a “Tympanic Resonance Regulating System.” Its controller, the Trigeminocervical complex, integrates external auditory, somatosensory, and central impulses. It modulates auditory attention, and directs it toward unpredictable external or expected domestic and internal sounds: peripherally by shifting the resonance frequencies of the Tympanic Membrane; centrally by influencing the throughput of auditory information to the neural attention networks that toggle between scanning and focusing; and thus altering the perception of auditory information. The hypothesis leads to the assumption that the Trigeminocervical complex is composed of a dorsal component, and a ventral one which may overlap with the concept of “Trigeminovagal complex.” “Tympanic Dissonance” results in a host of local and distant symptoms, most of which can be attributed to activation of the Trigeminocervical complex. Diagnostic and therapeutic measures for this “Tympanic Dissonance Syndrome” are suggested.

How flexibility and eardrum cone shape affect sound conduction in single-ossicle ears: a dynamic model study of the chicken middle ear

It is believed that non-mammals have poor hearing at high frequencies because the sound-conduction performance of their single-ossicle middle ears declines above a certain frequency. To better understand this behavior, a dynamic three-dimensional finite-element model of the chicken middle ear was constructed. The effect of changing the flexibility of the cartilaginous extracolumella on middle-ear sound conduction was simulated from 0.125 to 8 kHz, and the influence of the outward-bulging cone shape of the eardrum was studied by altering the depth and orientation of the eardrum cone in the model. It was found that extracolumella flexibility increases the middle-ear pressure gain at low frequencies due to an enhancement of eardrum motion, but it decreases the pressure gain at high frequencies as the bony columella becomes more resistant to extracolumella movement. Similar to the inward-pointing cone shape of the mammalian eardrum, it was shown that the outward-pointing cone shape of the chicken eardrum enhances the middle-ear pressure gain compared to a flat eardrum shape. When the outward-pointing eardrum was replaced by an inward-pointing eardrum, the pressure gain decreased slightly over the entire frequency range. This decrease was assigned to an increase in bending behavior of the extracolumella and a reduction in piston-like columella motion in the model with an inward-pointing eardrum. Possibly, the single-ossicle middle ear of birds favors an outward-pointing eardrum over an inward-pointing one as it preserves a straight angle between the columella and extrastapedius and a right angle between the columella and suprastapedius, which provides the optimal transmission.

Fluid-Structure Finite-Element Modelling and Clinical Measurement of the Wideband Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear

The anatomical differences between the newborn ear and the adult one result in different input admittance responses in newborns than those in adults. Taking into account fluid-structure interactions, we have developed a finite-element model to investigate the wideband admittance responses of the ear canal and middle ear in newborns for frequencies up to 10 kHz. We have also performed admittance measurements on a group of 23 infants with ages between 14 and 28 days, for frequencies from 250 to 8000 Hz with 1/12-octave resolution. Sensitivity analyses of the model were performed to investigate the contributions of the ear canal and middle ear to the overall admittance responses, as well as the effects of the material parameters, measurement location and geometrical variability. The model was validated by comparison with our new data and with data from the literature. The model provides a quantitative understanding of the canal and middle-ear resonances around 500 and 1800 Hz, respectively, and also predicts the effects of the first resonance mode of the middle-ear cavity (around 6 kHz) as well as the first and second standing-wave modes in the ear canal (around 7.2 and 9.6 kHz, respectively), which may explain features seen in our high-frequency-resolution clinical measurements.

The path of a click stimulus from ear canal to umbo

The tympanic membrane (TM) has a key role in transmitting sounds to the inner ear, but a concise description of how the TM performs this function remains elusive. This paper probes TM operation by applying a free field click stimulus to the gerbil ear and exploring the consequent motions of the TM and umbo. Motions of the TM were measured both on radial tracks starting close to the umbo and on a grid distal and adjacent to the umbo. The experimental results confirmed the high fidelity of sound transmission from the ear canal to the umbo. A delay of 5-15 μs was seen in the onset of TM motion between points just adjacent to the umbo and mid-radial points. The TM responded with a ringing motion, with different locations possessing different primary ringing frequencies. A simple analytic model from the literature, treating the TM as a string, was used to explore the experimental results. The click-based experiments and analysis led to the following description of TM operation: A transient sound pressure on the TM causes a transient initial TM motion that is maximal ∼ at the TM's radial midpoints. Mechanical forces generated by this initial prominent TM distortion then pull the umbo inward, leading to a delayed umbo response. The initial TM deformation also gives rise to prolonged mechanical ringing on the TM that does not result in significant umbo motion, likely due to destructive interference from the range of ringing frequencies. Thus, the umbo's response is a high-fidelity representation of the transient stimulus. Because any sound can be considered as a consecutive series of clicks, this description is applicable to any sound stimulus.

Technical note for post-auricular route surgery in Mongolian gerbil

The Mongolian gerbil (Meriones unguiculatus) is commonly used in hearing research because the hearing frequency spectrum of the gerbil is rather similar to that of the human being. However, a precise description of the surgical post-auricular route has not been reported. The aim of this technical note is to provide details on the procedure and the surgical anatomy of the post-auricular route in the Mongolian gerbil. Surgery was performed under general anesthesia on eight (2 males and 6 females) adult Mongolian gerbils. All steps of the post-auricular route were detailed. This surgery provided an access to the following structures: the semi-circular posterior and lateral canals, the external auditory meatus, the tympanic membrane, the round window, the stapes, the stapedial artery and the reliefs of the cochlea. No anatomic variation was noticed among the 8 animals. This post-auricular route in the Mongolian gerbil defines a brief and simple surgery, overall standardized as a consequence of the absence of common anatomic variation, with painless and uncomplicated post-operative stage.

3D finite element model of the chinchilla ear for characterizing middle ear functions

Chinchilla is a commonly used animal model for research of sound transmission through the ear. Experimental measurements of the middle ear transfer function in chinchillas have shown that the middle ear cavity greatly affects the tympanic membrane (TM) and stapes footplate (FP) displacements. However, there is no finite element (FE) model of the chinchilla ear available in the literature to characterize the middle ear functions with the anatomical features of the chinchilla ear. This paper reports a recently completed 3D FE model of the chinchilla ear based on X-ray micro-computed tomography images of a chinchilla bulla. The model consisted of the ear canal, TM, middle ear ossicles and suspensory ligaments, and the middle ear cavity. Two boundary conditions of the middle ear cavity wall were simulated in the model as the rigid structure and the partially flexible surface, and the acoustic-mechanical coupled analysis was conducted with these two conditions to characterize the middle ear function. The model results were compared with experimental measurements reported in the literature including the TM and FP displacements and the middle ear input admittance in chinchilla ear. An application of this model was presented to identify the acoustic role of the middle ear septa-a unique feature of chinchilla middle ear cavity. This study provides the first 3D FE model of the chinchilla ear for characterizing the middle ear functions through the acoustic-mechanical coupled FE analysis.

A study of sound transmission in an abstract middle ear using physical and finite element models

The classical picture of middle ear (ME) transmission has the tympanic membrane (TM) as a piston and the ME cavity as a vacuum. In reality, the TM moves in a complex multiphasic pattern and substantial pressure is radiated into the ME cavity by the motion of the TM. This study explores ME transmission with a simple model, using a tube terminated with a plastic membrane. Membrane motion was measured with a laser interferometer and pressure on both sides of the membrane with micro-sensors that could be positioned close to the membrane without disturbance. A finite element model of the system explored the experimental results. Both experimental and theoretical results show resonances that are in some cases primarily acoustical or mechanical and sometimes produced by coupled acousto-mechanics. The largest membrane motions were a result of the membrane's mechanical resonances. At these resonant frequencies, sound transmission through the system was larger with the membrane in place than it was when the membrane was absent.

Finite-Element Modelling of the Response of the Gerbil Middle Ear to Sound

We present a finite-element model of the gerbil middle ear that, using a set of baseline parameters based primarily on a priori estimates from the literature, generates responses that are comparable with responses we measured in vivo using multi-point vibrometry and with those measured by other groups. We investigated the similarity of numerous features (umbo, pars-flaccida and pars-tensa displacement magnitudes, the resonance frequency and break-up frequency, etc.) in the experimental responses with corresponding ones in the model responses, as opposed to simply computing frequency-by-frequency differences between experimental and model responses. The umbo response of the model is within the range of variability seen in the experimental data in terms of the low-frequency (i.e., well below the middle-ear resonance) magnitude and phase, the main resonance frequency and magnitude, and the roll-off slope and irregularities in the response above the resonance frequency, but is somewhat high for frequencies above the resonance frequency. At low frequencies, the ossicular axis of rotation of the model appears to correspond to the anatomical axis but the behaviour is more complex at high frequencies (i.e., above the pars-tensa break-up). The behaviour of the pars tensa in the model is similar to what is observed experimentally in terms of magnitudes, phases, the break-up frequency of the spatial vibration pattern, and the bandwidths of the high-frequency response features. A sensitivity analysis showed that the parameters that have the strongest effects on the model results are the Young's modulus, thickness and density of the pars tensa; the Young's modulus of the stapedial annular ligament; and the Young's modulus and density of the malleus. Displacements of the tympanic membrane and manubrium and the low-frequency displacement of the stapes did not show large changes when the material properties of the incus, stapes, incudomallear joint, incudostapedial joint, and posterior incudal ligament were changed by ±10 % from their values in the baseline parameter set.

Sound pressure distribution within natural and artificial human ear canals: forward stimulation

This work is part of a study of the interaction of sound pressure in the ear canal (EC) with tympanic membrane (TM) surface displacement. Sound pressures were measured with 0.5-2 mm spacing at three locations within the shortened natural EC or an artificial EC in human temporal bones: near the TM surface, within the tympanic ring plane, and in a plane transverse to the long axis of the EC. Sound pressure was also measured at 2-mm intervals along the long EC axis. The sound field is described well by the size and direction of planar sound pressure gradients, the location and orientation of standing-wave nodal lines, and the location of longitudinal standing waves along the EC axis. Standing-wave nodal lines perpendicular to the long EC axis are present on the TM surface >11-16 kHz in the natural or artificial EC. The range of sound pressures was larger in the tympanic ring plane than at the TM surface or in the transverse EC plane. Longitudinal standing-wave patterns were stretched. The tympanic-ring sound field is a useful approximation of the TM sound field, and the artificial EC approximates the natural EC.