The role of pars flaccida in human middle ear sound transmission

Evaluation of acoustic changes in and the healing outcomes of rat eardrums with pars tensa and pars flaccida perforations

Objectives

To systematically explore the differences in acoustic changes and healing outcomes of tympanic membranes (TMs) with pars flaccida perforation (PFP) and pars tensa perforation (PTP).

Methods

We created PFPs and PTPs of various sizes in Sprague-Dawley rats, and evaluated TM umbo velocity and hearing function using laser Doppler vibrometry and auditory brainstem response (ABR) measurement before and immediately after perforation. Two weeks later, hearing was reevaluated and TMs were investigated by immunohistochemical staining.

Results

Small PFPs and PTPs did not significantly affect umbo velocity and hearing function. Large PFPs increased umbo velocity loss at low frequency (1.5 kHz) and elevated ABR thresholds within 1-2 kHz. Large PTP caused significant velocity loss at low frequencies from 1.5 to 3.5 kHz and threshold elevations at full frequencies (1-2 kHz). Two weeks after the perforation, the hearing function of rats with healed PFPs recovered completely. However, high-frequency hearing loss (16-32 kHz) persisted in rats with healed PTPs. Morphological staining revealed that no increase in the thickness and obvious increase in collagen I level of regenerated par flaccida; regenerated pars tensa exhibited obvious increase in thickness and increased collagen I, while the collagen II regeneration was limited with discontinuous and disordered structure in regenerated pars tensa.

Conclusion

The hearing loss caused by large PFP limits at low frequencies while large PTP can lead to hearing loss at wide range frequencies. PFP and PTP have different functional outcomes after spontaneous healing, which is determined by the discrepant structure reconstruction and collagen regeneration.

Applicability of vital staining and tissue clearing to vascular anatomy and melanocytes' evaluation of temporal bone in six laboratory species

The purpose of the present study was to define the applicability of tissue clearing to the field of otology. We combined tissue clearing with vital staining perfusion via a pumping system to examine the vascular anatomy of temporal bones in laboratory animals. We used six different types of species including Korean wild mouse, mouse, Mongolian gerbil, hamsters and Guinea pigs. A mixture of Alcian blue reagent and 4% paraformaldehyde was circulated throughout the entire circulatory system of the animal via a perfusion pump system. Transparency images were obtained from the temporal bones according to the protocol of the SunHyun 3D Imaging Kit. In examining the inner surface of the tympanic membrane, flaccid part (pars flaccida) was positioned along the entire marginal area in Guinea pig. In the Guinea pig, unlike the other species, the cortical bone of the mastoid (bullae) was easily removed using cold instruments, allowing a direct approach to the enclosed structures. The distribution and pattern of cochlea melanocytes were compared among the species. "Mobius strip"-like accumulated melanocytes in vestibules were shown in both the Korean wild mouse and mouse. The collateral blood supply to the cochlea in six different species was checked in various pattern. Combining dye infusion with tissue-clearing techniques, we documented the middle ear and transparent inner ear structures in six different species. The information and associated images will help other researchers to develop hypotheses and design experimental investigations.

The effects of varying tympanic-membrane material properties on human middle-ear sound transmission in a three-dimensional finite-element model

An anatomically based three-dimensional finite-element human middle-ear (ME) model is used to test the sensitivity of ME sound transmission to tympanic-membrane (TM) material properties. The baseline properties produce responses comparable to published measurements of ear-canal input impedance and power reflectance, stapes velocity normalized by ear-canal pressure (P_EC), and middle-ear pressure gain (MEG), i.e., cochlear-vestibule pressure (P_V) normalized by P_EC. The mass, Young's modulus (E_TM), and shear modulus (G_TM) of the TM are varied, independently and in combination, over a wide range of values, with soft and bony TM-annulus boundary conditions. MEG is recomputed and plotted for each case, along with summaries of the magnitude and group-delay deviations from the baseline over low (below 0.75 kHz), mid (0.75-5 kHz), and high (above 5 kHz) frequencies. The MEG magnitude varies inversely with increasing TM mass at high frequencies. Increasing E_TM boosts high frequencies and attenuates low and mid frequencies, especially with a bony TM annulus and when G_TM varies in proportion to E_TM, as for an isotropic material. Increasing G_TM on its own attenuates low and mid frequencies and boosts high frequencies. The sensitivity of MEG to TM material properties has implications for model development and the interpretation of experimental observations.

Anatomical boundary of the tympanic membrane pars flaccida of the Meriones unguiculatus (Mongolian gerbil)

The pars flaccida of the Meriones unguiculatus (Mongolian gerbil) was in previous studies shown to bulge almost spherically when pressurized, a behavior suggesting that it is suspended by a fixed circular boundary. The question arises whether this "functional" boundary is based on an underlying circular anatomical boundary, an important issue for modeling the middle-ear mechanics. In this article, the boundaries of the Mongolian gerbil pars flaccida were visualized in situ with otomicroscopy and in slides with light microscopy and by micro-CT radiology. For the major part of its circumference, the pars flaccida was found to be suspended by rigid bone, that is, the tympanic legs. The remaining boundary is made up of the terminal portion of the handle of the malleus and the soft tissue of the terminal arches. The attachment to these structures is simple and uncomplicated, and the geometry is regular and symmetric: deviating by only 3.5% from a perfect circular shape. The findings justify the use of a fixed circular boundary as a good approximation for the modeling of pars flaccida deformation in the Mongolian gerbil.

Displacement pattern of the normal pars flaccida in the gerbil

OBJECTIVE

The aim of the current study was to assess the mechanical stiffness properties of the normal pars flaccida and to compare the results with those obtained in earlier studies on the pars tensa.

BACKGROUND

Postinflammatory changes such as retraction pockets and cholesteatoma develop in the pars flaccida as well as in the pars tensa of the tympanic membrane. In these authors' previous experimental studies, stiffness changes are shown to develop early in the pars tensa in response to purulent otitis media and otitis media with effusion. These changes are suggested to be precursors to a later development of retraction pockets and cholesteatoma. In the clinical situation, retraction pockets are often found in the pars flaccida only. This study will establish the stiffness properties of the normal pars flaccida and form a base for forthcoming studies of the pars flaccida in response to otitis media with effusion and purulent otitis media, as well as retraction pocket formation and cholesteatoma.

METHODS

A measure for the mechanical stiffness properties of the normal pars flaccida in the gerbil was assessed as its displacement for a given transtympanic pressure. The method used was moiré interferometry, which is a noncontacting optical technique to measure the shape of the surface of an object.

RESULTS

The displacement of the pars flaccida was a nonlinear and asymmetric function of pressure. The displacement per pressure unit rose steeply at low middle ear pressures to level out and reach a steady state at higher pressures. The displacement versus pressure characteristics for the pars flaccida strongly differed from those of the pars tensa. The pars tensa seemed more elastic.

CONCLUSION

Reference values for displacement versus pressure characteristics of the normal gerbil pars flaccida were obtained using a moiré interferometry method. The mechanical stiffness properties of the normal pars flaccida were strongly different from those of the pars tensa.

Effects of middle-ear static pressure on pars tensa and pars flaccida of gerbil ears

It has long been known that static pressure affects middle-ear function and conventional tympanometry uses variations in static pressure for clinical assessment of the middle ear. However, conventional tympanometry treats the entire tympanic membrane as a uniform interface between the external and middle ear and does not differentiate the behavior of the two components of the tympanic membrane, pars tensa and pars flaccida. To analyze separately the different acoustic behavior of these two tympanic membrane components, laser Doppler velocimetry is used to determine the motion of each of these two structures. The velocities of points near the center of p. tensa and p. flaccida in response to the external-ear sound pressure at different middle-ear static pressures were measured in nine gerbil ears. The effect of middle-ear static pressure on the acoustic response of both structures is similar in that non-zero middle-ear static pressures generally reduce the velocity magnitude of the two membrane components in response to sound stimuli. Middle-ear under-pressures tend to reduce the velocity magnitude more than do middle-ear over-pressures. The acoustic stiffness and inertance of both p. tensa and p. flaccida are altered by static pressure, as shown in our results as changes of transfer-function phase angle. Compared to p. tensa, p. flaccida showed larger reductions in the velocity magnitude to small over- and under-pressures near the ambient middle-ear pressure. This higher pressure sensitivity of p. flaccida has been found in all ears and may link the previously proposed middle-ear pressure regulating and the acoustic shunting functions of p. flaccida. We also describe, in both p. tensa and p. flaccida, a frequency dependence of the velocity measurements, hysteresis of velocity magnitude between different directions of pressure sweep and asymmetrical effects of over- and under-pressure on the point velocity.

Volume displacement of the gerbil eardrum pars flaccida as a function of middle ear pressure

The pars flaccida (PF) is a small region of the eardrum, with elasticity and histology completely different from the rest of the membrane, which has often been attributed a pressure regulating function for the middle ear (ME). In this paper, the volume displacement of the PF as a function of ME pressure is discussed. The deformation of the PF was measured in vitro in five Mongolian gerbil ears, by means of an opto-electronic moiré interferometer. Volume displacement was determined at small intervals in three sequential pressure cycles, in the range of +/- 0.4 kPa, +/- 2 kPa, and again +/- 0.4 kPa. The displacement was found to be a highly non-linear function of pressure, with a strong increase up to 0.4 kPa ME over- or underpressure and remaining nearly unchanged for pressures beyond 0.4 kPa. In all animals, maximal volume displacement was less than 0.5 microl, or 0.2% of total ME air volume. Clear hysteresis was found between the deformations at the same pressure level in the increasing and decreasing parts of the pressure cycles. Membrane behavior in the first 0.4 kPa pressure cycle was significantly different from that in the second 0.4 kPa cycle, which followed the 2 kPa pressure cycle. The results indicate that the ME pressure change regulation function of the PF is limited to very small pressure changes of a few hundred Pa around ambient pressure, and that larger ME pressures cause at least short-term changes in the membrane's behavior.

Measurement and modeling of boundary shape and surface deformation of the Mongolian gerbil pars flaccida

The shape of the pars flaccida (PF) boundary and its pressure induced deformation was measured in five Mongolian gerbil ears, using an opto-electronic moiré interferometer. To determine the PF boundary, membranes were deformed by middle ear (ME) pressures of -2 kPa and +2 kPa. The boundary of the PF was defined as the locus of points where the pressure induced deformation begins. To a very high precision, this boundary was found to be a circle with the same radius for both over- and underpressure deformations. Between animals the radius varied from 0.760 mm to 0.778 mm. We show that the shape of the PF, while being deformed by static pressure in the ME, can be modeled as part of a sphere. Volume displacement can then be calculated as the volume enclosed by the sphere cap, delimited by the circular PF boundary plane. Volume displacement was calculated for membranes deformed by 400 Pa ME overpressure and -400 Pa ME underpressure. The agreement of the experimental data with the sphere cap model is shown to be very good, and results in a volume displacement measuring accuracy which is better than 10%.

Effects of pars flaccida on sound conduction in ears of Mongolian gerbil: acoustic and anatomical measurements

This paper presents evidence on how the pars flaccida of the tympanic membrane affects the acoustic input to the middle and inner ear. Measurements of middle-ear acoustic input admittance and sound-pressure levels in both the ear canal and the middle-ear cavity were made in ears of eight gerbils before and after manipulations of the middle ear and tympanic membrane. The results are interpreted in terms of a model proposed by Kohllöffel [Hear, Res. 13(1984) 83-88]. The input-admittance measurements show that the pars flaccida of gerbil acts as a resonator with a resonance frequency of approx. 500 Hz. The admittance of this resonator appears in parallel with the input admittance of the pars tensa and its ossicular and cochlear load. At frequencies below the resonance, the pars flaccida admittance is compliance-like and its magnitude is comparable to that of the pars tensa and its load; consequently, the presence of pars flaccida increases the overall middle-ear input admittance and decreases the pressure difference across the tympanic membrane. At higher frequencies, the admittance of pars flaccida is mass-like and small in magnitude, and it has negligible influence on the overall middle-ear input admittance and the pressure difference across the tympanic membrane. These results suggest that the presence of pars flaccida reduces low-frequency acoustic input to the middle- and inner-ear and consequently decreases hearing sensitivity in this frequency range. Our measurements suggest that with a constant sound pressure stimulus, stiffening the gerbil pars flaccida would increase the motion of the pars tensa by 3-10 dB at frequencies below the normal flaccida resonance.

Treatment of tympanic membrane retraction with the holmium laser

Politzerization, the Valsalva maneuver, and ventilation tube insertion are available treatments for tympanic membrane retraction. Ventilation of the middle ear cavity can correct tympanic membrane retraction in many cases, but not in all. Retraction may be localized or diffuse. This article describes experiments performed to evaluate a new method to "tighten" retracted or flaccid tympanic membranes with a holmium laser in a human temporal bone model. Ten temporal bones with mild-to-moderate retraction of the posterior superior quadrant or pars flaccida were treated with a series of laser pulses around and to the area of retraction. Umbo displacement before and after laser treatment was performed with a laser Doppler vibrometer to evaluate the effect on the acoustic function of the tympanic membrane. In all ears, the posterior superior quadrant retraction appeared to be completely corrected. Laser treatment of the posterior superior quadrant retraction produced improvement in umbo displacement below 1.0 kHz. After treatment of pars flaccida retraction, the configuration was improved a small amount; however, no increase in umbo displacement was found.

The middle ear as a baroreceptor

Under pressure in the middle ear is thought to be important in the pathogenesis of chronic otitis media with effusion and its sequelae, but the cause of the under pressure and the mechanisms responsible for regulation of the normal middle ear pressure are a matter of debate. Numerous studies have examined the effect of large pressure changes on the ear; however, the ear's sensitivity to smaller pressure changes has received little attention. This study examines the sensitivity of the ear to atmospheric air pressure changes induced in the external ear canal. It is concluded that the normal ear is a very sensitive pressure receptor, and that the sensation is probably registered by stretch receptors in the tympanic membrane. Pathological changes in the tympanic membrane are associated with impaired baroreceptor function. The implications of these findings in the physiology of the ear and the regulation of middle ear pressure are discussed.