Reproducing ear-canal reflectance using two measurement techniques in adult ears

Preliminary results of classifying otosclerosis and disarticulation using a convolutional neural network trained with simulated wideband acoustic immittance data

Current noninvasive methods of clinical practice often do not identify the causes of conductive hearing loss due to pathologic changes in the middle ear with sufficient certainty. Wideband acoustic immittance (WAI) measurement is noninvasive, inexpensive and objective. It is very sensitive to pathologic changes in the middle ear and therefore promising for diagnosis. However, evaluation of the data is difficult because of large interindividual variations. Machine learning methods like Convolutional neural networks (CNN) which might be able to deal with this overlaying pattern require a large amount of labeled measurement data for training and validation. This is difficult to provide given the low prevalence of many middle-ear pathologies. Therefore, this study proposes an approach in which the WAI training data of the CNN are simulated with a finite-element ear model and the Monte-Carlo method. With this approach, virtual populations of normal, otosclerotic, and disarticulated ears were generated, consistent with the averaged data of measured populations and well representing the qualitative characteristics of individuals. The CNN trained with the virtual data achieved for otosclerosis an AUC of 91.1 %, a sensitivity of 85.7 %, and a specificity of 85.2 %. For disarticulation, an AUC of 99.5 %, sensitivity of 100 %, and specificity of 93.1 % was achieved. Furthermore, it was estimated that specificity could potentially be increased to about 99 % in both pathological cases if stapes reflex threshold measurements were used to confirm the diagnosis. Thus, the procedures' performance is comparable to classifiers from other studies trained with real measurement data, and therefore the procedure offers great potential for the diagnosis of rare pathologies or early-stages pathologies. The clinical potential of these preliminary results remains to be evaluated on more measurement data and additional pathologies.

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.

A reference for ear-canal absorbance based on semi-anechoic waveguides

Wideband acoustic immittance (WAI), in particular, ear-canal absorbance, is a useful clinical tool for assessing the middle-ear status and diagnosing conductive hearing disorders. However, little evidence documents the measurement accuracy of WAI in human ears, and, because its clinical adoption is still in its infancy, no international standards exist to define appropriate requirements for commercial instrumentation. A challenge from a standardization point of view is the lack of an absorbance reference, i.e., an acoustic load similar to the adult ear canal with a known absorbance. This paper explores various approaches to providing such an acoustic load to quantify WAI measurement accuracy. The approaches considered here include standardized and inexpensive occluded-ear simulators, and a family of semi-anechoic waveguides with different step discontinuities in cross-sectional area. These semi-anechoic waveguides could be included in a future WAI standard. In addition, a means of monitoring the stability of WAI calibrations over time is proposed, utilizing a single inexpensive occluded-ear simulator.

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.

A reciprocity method for validating acoustic ear-probe source calibrations

Measurements of wideband acoustic immittance (WAI) rely on the calibration of an ear probe to obtain its acoustic source parameters. The clinical use of WAI and instruments offering the functionality are steadily growing, however, no international standard exists to ensure a certain reliability of the hardware and methods underlying such measurements. This paper describes a reciprocity method that can evaluate the accuracy of and identify errors in ear-probe source calibrations. By placing the ear probes of two calibrated WAI instruments face-to-face at opposite ends of a short waveguide, the source parameters of each ear probe can be measured using the opposite calibrated ear probe. The calibrated and measured source parameters of each ear probe can then be compared directly, and the influence of possible calibration errors on WAI measurements may be approximated. In various exemplary ear-probe calibrations presented here, the reciprocity method accurately identifies errors that would otherwise remain undetected and result in measurement errors in real ears. The method is likely unsuitable for routine calibration of WAI instruments but may be considered for conformance testing as part of a potential future WAI standard.

A systematic study on effects of calibration-waveguide geometry and least-squares formulation on ear-probe source calibrations

Measuring ear-canal absorbance and compensating for effects of the ear-canal acoustics on otoacoustic-emission measurements using an ear probe rely on accurately determining its acoustic source parameters. Using pressure measurements made in several rigid waveguides and models of their input impedances, a conventional calibration method estimates the ear-probe Thévenin-equivalent source parameters via a least-squares fit to an over-determined system of equations. Such a calibration procedure involves critical considerations on the geometry and number of utilized calibration waveguides. This paper studies the effects of calibration-waveguide geometry on achieving accurate ear-probe calibrations and measurements by systematically varying the lengths, length ratios, radii, and number of waveguides. For calibration-waveguide lengths in the range of 10-60 mm, accurate calibrations were generally obtained with absorbance measurement errors of approximately 0.02. Longer waveguides resulted in calibration errors, mainly due to coincident resonance frequencies among waveguides in the presence of mismatches between their assumed and actual geometries. The accuracy of calibrations was independent of the calibration-waveguide radius, except for an increased sensitivity of wider waveguides to noise. Finally, it is demonstrated how reformulating the over-determined system of equations to return the least-squares reflectance source parameters substantially reduces calibration and measurement errors.

Preserving Wideband Tympanometry Information With Artifact Mitigation

OBJECTIVE

Absorbance measured using wideband tympanometry (WBT) has been shown to be sensitive to changes in middle and inner ear mechanics, with potential to diagnose various mechanical ear pathologies. However, artifacts in absorbance due to measurement noise can obscure information related to pathologies and increase intermeasurement variability. Published reports frequently present absorbance that has undergone smoothing to minimize artifact; however, smoothing changes the true absorbance and can destroy important narrow-band characteristics such as peaks and notches at different frequencies. Because these characteristics can be unique to specific pathologies, preserving them is important for diagnostic purposes. Here, we identify the cause of artifacts in absorbance and develop a technique to mitigate artifacts while preserving the underlying WBT information.

DESIGN

A newly developed Research Platform for the Interacoustics Titan device allowed us to study raw microphone recordings and corresponding absorbances obtained by WBT measurements. We investigated WBT measurements from normal hearing ears and ears with middle and inner ear pathologies for the presence of artifact and noise. Furthermore, it was used to develop an artifact mitigation procedure and to evaluate its effectiveness in mitigating artifacts without distorting the true WBT information.

RESULTS

We observed various types of noise that can plague WBT measurements and that contribute to artifacts in computed absorbances, particularly intermittent low-frequency noise. We developed an artifact mitigation procedure that incorporates a high-pass filter and a Tukey window. This artifact mitigation resolved the artifacts from low-frequency noise while preserving characteristics in absorbance in both normal hearing ears and ears with pathology. Furthermore, the artifact mitigation reduced intermeasurement variability.

CONCLUSIONS

Unlike smoothing algorithms used in the past, our artifact mitigation specifically removes artifacts caused by noise. It does not change frequency response characteristics, such as narrow-band peaks and notches in absorbance at different frequencies that can be important for diagnosis. Also, by reducing intermeasurement variability, the artifact mitigation can improve the test-retest reliability of these measurements.