Effect of middle ear pressure change on middle ear mechanics

Performance of personalised prosthesis under static pressure: Numerical analysis and experimental validation

This study investigates the performance of personalised middle ear prostheses under static pressure through a combined approach of numerical analysis and experimental validation. The sound transmission performances of both normal and reconstructed middle ears undergo changes under high positive or negative pressure within the middle ear cavity. This pressure fluctuation has the potential to result in prosthesis displacement/extrusion in patients. To optimise the design of middle ear prostheses, it is crucial to consider various factors, including the condition of the middle ear cavity in which the prosthesis is placed. The integration of computational modelling techniques with non-invasive imaging modalities has demonstrated significant promise and distinct prospects in middle ear surgery. In this study, we assessed the efficacy of Finite Element (FE) analysis in modelling the responses of both normal and reconstructed middle ears to elevated static pressure within the ear canal. The FE model underwent validation using experimental data derived from human cadaveric temporal bones before progressing to subsequent investigations. Afterwards, we assessed stapes and umbo displacements in the reconstructed middle ear under static pressure, with either a columella-type prosthesis or a prosthetic incus, closely resembling a healthy incus. Results indicated the superior performance of the prosthetic incus in terms of both sound transmission to the inner ear and stress distribution patterns on the TM, potentially lowering the risk of prosthesis displacement/extrusion. This study underscores the potential of computational analysis in middle ear surgery, encompassing aspects such as prosthesis design, predicting outcomes in ossicular chain reconstruction (OCR), and mitigating experimental costs.

Effects of preloads on middle-ear transfer function and acoustic reflex in ossiculoplasty with PORP

INTRODUCTION

Surgical outcomes in ossiculoplasty with partial ossicular replacement prostheses (PORPs) are greatly influenced by the amount of preload imposed on the PORP. In this study, the attenuation of the middle-ear transfer function (METF) was experimentally investigated for prosthesis-related preloads in different directions, with and without concurrent application of stapedial muscle tension. Different PORP designs were assessed to determine functional benefits of specific design features under preload conditions.

METHODS

The experiments were performed on fresh-frozen human cadaveric temporal bones. The effect of preloads along different directions were experimentally assessed by simulating anatomical variance and postoperative position changes in a controlled setup. The assessments were performed for three different PORP designs featuring either a fixed shaft or ball joint and a Bell-type or Clip-interface. Further, the combined effect of the preloads towards the medial direction with tensional forces of the stapedial muscle was assessed. The METF was obtained via laser-Doppler vibrometry for each measurement condition.

RESULTS

The preloads as well as the stapedial muscle tension primarily attenuated the METF between 0.5 and 4 kHz. The largest attenuations resulted from the preload towards the medial direction. The attenuation of the METF with stapedial muscle tension was reduced with concurrent PORP preloads. PORPs with a ball joint resulted in reduced attenuation only for preloads along the long axis of the stapes footplate. In contrast to the clip interface, the Bell-type interface was prone to lose coupling with the stapes head for preloads in the medial direction.

CONCLUSIONS

The experimental study of the preload effects indicates a direction-dependent attenuation of the METF, with the most pronounced effects resulting from preloads towards the medial direction. Based on the obtained results, the ball joint offers tolerance for angular positioning while the clip interface prevents PORP dislocations for preloads in lateral direction. At high preloads, the attenuation of the METF with stapedial muscle tension is reduced, which should be considered for the interpretation of postoperative acoustic reflex tests.

ESPRESS.0: Eustachian Tube-Inspired Tactile Sensor Exploiting Pneumatics for Range Extension and SenSitivity Tuning

Optimising the sensitivity of a tactile sensor to a specific range of stimuli magnitude usually compromises the sensor's widespread usage. This paper presents a novel soft tactile sensor capable of dynamically tuning its stiffness for enhanced sensitivity across a range of applied forces, taking inspiration from the Eustachian tube in the mammalian ear. The sensor exploits an adjustable pneumatic back pressure to control the effective stiffness of its 20 mm diameter elastomer interface. An internally translocated fluid is coupled to the membrane and optically tracked to measure physical interactions at the interface. The sensor can be actuated by pneumatic pressure to dynamically adjust its stiffness. It is demonstrated to detect forces as small as 0.012 N, and to be sensitive to a difference of 0.006 N in the force range of 35 to 40 N. The sensor is demonstrated to be capable of detecting tactile cues on the surface of objects in the sub-millimetre scale. It is able to adapt its compliance to increase its ability for distinguishing between stimuli with similar stiffnesses (0.181 N/mm difference) over a large range (0.1 to 1.1 N/mm) from only a 0.6 mm deep palpation. The sensor is intended to interact comfortably with skin, and the feasibility of its use in palpating tissue in search of hard inclusions is demonstrated by locating and estimating the size of a synthetic hard node embedded 20 mm deep in a soft silicone sample. The results suggest that the sensor is a good candidate for tactile tasks involving unpredictable or unknown stimuli.

Three-dimensional quasi-static displacement of human middle-ear ossicles under static pressure loads: Measurement using a stereo camera system

The time delay and/or malfunctioning of the Eustachian tube may cause pressure differences across the tympanic membrane, resulting in quasi-static movements of the middle-ear ossicles. While quasi-static displacements of the human middle-ear ossicles have been measured one- or two-dimensionally in previous studies, this study presents an approach to trace three-dimensional movements of the human middle-ear ossicles under static pressure loads in the ear canal (EC). The three-dimensional quasi-static movements of the middle-ear ossicles were measured using a custom-made stereo camera system. Two cameras were assembled with a relative angle of 7° and then mounted onto a robot arm. Red fluorescent beads of a 106-125 µm diameter were placed on the middle-ear ossicles, and quasi-static position changes of the fluorescent beads under static pressure loads were traced by the stereo camera system. All the position changes of the ossicles were registered to the anatomical intrinsic frame based on the stapes footplate, which was obtained from µ-CT imaging. Under negative ear-canal pressures, a rotational movement around the anterior-posterior axis was dominant for the malleus-incus complex, with small relative movements between the two ossicles. The stapes showed translation toward the lateral direction and rotation around the long axis of the stapes footplate. Under positive EC pressures, relative motion between the malleus and the incus at the IMJ became larger, reducing movements of the incus and stapes considerably and thus performing a protection function for the inner-ear structures. Three-dimensional tracing of the middle-ear ossicular chain provides a better understanding of the protection function of the human middle ear under static pressured loads as immediate responses without time delay.

Vibration Measurements of the Gerbil Eardrum Under Quasi-static Pressure Sweeps

Tympanometry provides an objective measurement of the status of the middle ear. During tympanometry, the ear-canal pressure is varied, while the response of the ear to sound pressure is measured. The effects of the pressure on the mechanics of the middle ear are not well understood. This study is a continuation of our previous work in which the vibration response of the gerbil eardrum was measured in vivo under quasi-static pressure steps. In this study, we delivered a continuous pressure sweep to the middle ear and measured the vibration response at four locations for six gerbils. Vibrations were recorded using a single-point laser Doppler vibrometer and glass-coated reflective beads (diameter ~ 40 µm) at the umbo and on the mid-manubrium, posterior pars tensa and anterior pars tensa.The vibration magnitudes were similar to those in the previous step-wise pressurization experiments. Most gerbils showed repeatability within less than 10 dB for consecutive cycles. As described in the previous study, as the frequency was increased at ambient pressure, the vibration magnitude on the manubrium increased slightly to a broad peak (referred to as R1) and then decreased until a small peak appeared (referred to as R2), followed by multiple peaks and troughs as the magnitude decreased further. The low-frequency vibration magnitude (at 1 kHz) decreased monotonically as the pressure became more negative except for a dip (about 500 Pa wide) that occurred between - 700 and - 1800 Pa. The lowest overall magnitude was recorded in the dip at mid-manubrium. The vibration magnitudes also decreased as the middle-ear pressure was made more positive and were larger than those at negative pressures. R1 was only visible at negative and small positive middle-ear pressures, while R2 was visible for both positive and negative pressures. R2 split into multiple branches after the middle-ear pressure became slightly positive. No magnitude dip was visible for positive middle-ear pressures.The low-frequency vibration magnitudes at negative middle-ear pressures on the pars tensa were higher than those on the manubrium. R1 was not visible for large negative middle-ear pressures on the pars tensa. R2 appeared as a multi-peak feature on the pars tensa as well, and a higher-frequency branch on the posterior pars tensa appeared as a trough on the anterior pars tensa. The magnitude dip was not present on the pars tensa. The largest overall magnitude was recorded at the R2 peak on the posterior pars tensa.The results of this study expand on the findings of the step-wise pressurization experiments and provide further insight into the evolution of the vibration response of the eardrum under quasi-static pressures.

Prevalence of and Factors Associated With Eustachian Tube Dysfunction Among the Public in Taif, Saudi Arabia

Background

The eustachian tube is a tubular structure connecting the middle ear cavity with the nasopharynx, providing ventilation and pressure equalization in the middle ear, mucociliary clearance, and preventing the reflux of sound and fluid from the nasopharynx. Therefore, any kind of deficiency in this tube will lead to eustachian tube dysfunction (ETD).

Aim

This study aims to evaluate the prevalence and associated factors of ETD in the Taif public.

Materials and methods

A descriptive cross-sectional survey was conducted among the public in Taif, Saudi Arabia and it was done during the period between September 7 and September 28, 2021. A predesigned online questionnaire in the Arabic language was used to collect the data. The questionnaire contained three main parts. The first one included demographic questions, the second risk factors, and the third manifestations of ETD. The questionnaire was initiated after a literature review of similar articles and after experts' consultation for validity and reliability.

Results

A total of 693 participants completed the study questionnaire. The exact 546 (78.8%) participants were females and 671 (96.8%) were Saudi. The exact 122 (61%) participants among those who had ETD or hearing loss reported improvement in their symptoms after moving to another city below sea level. The exact 146 (21.1%) participants had ETD while 547 (78.9%) had reported normal function. ETD was detected among 69.2% of those who were previously diagnosed with ETD versus 20.1% of others (P=0.001). Participants with a family history of hearing loss showed a nearly doubled risk for having ETD (OR=1.98; 95% CI: 1.33-2.94) and smokers had nearly the same doubled likelihood(OR=1.83; 95% CI: 1.01-3.48).

Conclusion

In conclusion, our study revealed a slightly high prevalence of ETD and hearing loss among the public in Taif, Saudi Arabia, and the factors associated with ETD.

Contribution of the flexible incudo-malleal joint to middle-ear sound transmission under static pressure loads

The incudo-malleal joint (IMJ) in the human middle ear is a true diarthrodial joint and it has been known that the flexibility of this joint does not contribute to better middle-ear sound transmission. Previous studies have proposed that a gliding motion between the malleus and the incus at this joint prevents the transmission of large displacements of the malleus to the incus and stapes and thus contributes to the protection of the inner ear as an immediate response against large static pressure changes. However, dynamic behavior of this joint under static pressure changes has not been fully revealed. In this study, effects of the flexibility of the IMJ on middle-ear sound transmission under static pressure difference between the middle-ear cavity and the environment were investigated. Experiments were performed in human cadaveric temporal bones with static pressures in the range of +/- 2 kPa being applied to the ear canal (relative to middle-ear cavity). Vibrational motions of the umbo and the stapes footplate center in response to acoustic stimulation (0.2-8 kHz) were measured using a 3D-Laser Doppler vibrometer for (1) the natural IMJ and (2) the IMJ with experimentally-reduced flexibility. With the natural condition of the IMJ, vibrations of the umbo and the stapes footplate center under static pressure loads were attenuated at low frequencies below the middle-ear resonance frequency as observed in previous studies. After the flexibility of the IMJ was reduced, additional attenuations of vibrational motion were observed for the umbo under positive static pressures in the ear canal (EC) and the stapes footplate center under both positive and negative static EC pressures. The additional attenuation of vibration reached 4~7 dB for the umbo under positive static EC pressures and the stapes footplate center under negative EC pressures, and 7~11 dB for the stapes footplate center under positive EC pressures. The results of this study indicate an adaptive mechanism of the flexible IMJ in the human middle ear to changes of static EC pressure by reducing the attenuation of the middle-ear sound transmission. Such results are expected to be used for diagnosis of the IMJ stiffening and to be applied to design of middle-ear prostheses.

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.

Inner ear pressure evaluation using wideband tympanometry in children with Large Vestibular Aqueduct Syndrome (LVAS): A pilot study

OBJECTIVE

To investigate middle ear function in children with Large Vestibular Aqueduct Syndrome (LVAS) to explore the feasibility of measuring inner ear pressure using Wideband tympanometry (WBT).

METHODS

13 young children with LVAS were recruited. WBT and other audiological measurements i.e., Auditory Steady State Response (ASSR), Auditory Brain Stem Response (ABR), and Distorted Product Otoacoustic Emissions (DPOAE) were performed. Absorbance under ambient and peak pressure were compared with normative data, and analyzed using a one sample t-test.

RESULTS

Average absorbance in children with LVAS was significantly lower than normative data under ambient pressure at 1000, 1189, 1296, 2000 Hz and 4000 Hz. Absorbance under peak pressure was also significantly lower at 707, 794, 917, 1000, 1189, 1297, 1498 and 2000 Hz. However, absorbance was higher than standard values above 4000 Hz under ambient and peak pressure. It was also higher under ambient pressure at frequencies below 500 Hz.

CONCLUSION

The special characteristics of middle ear function found in children with Large Vestibular Aqueduct Syndrome (LVAS) indicate that WBT offers a sensitive and non-invasive method to evaluate inner ear pressure indirectly.

Effect of Negative Middle Ear Pressure and Compensated Pressure on Wideband Absorbance and Otoacoustic Emissions in Children

Objective This study investigated pressurized transient evoked otoacoustic emission (TEOAE) responses and wideband absorbance (WBA) in healthy ears and ears with negative middle ear pressure (NMEP). Method In this cross-sectional study, TEOAE amplitude, signal-to-noise ratio, and WBA were measured at ambient and tympanometric peak pressure (TPP) in 36 ears from 25 subjects with healthy ears (age range: 3.1-13.0 years) and 88 ears from 76 patients with NMEP (age range: 2.0-13.1 years), divided into 3 groups based on NMEP (Group 1 with TPP between -101 and -200 daPa, Group 2 with TPP between -201 and -300 daPa, and Group 3 with TPP between -301 and -400 daPa). Results Mean TEOAE amplitude, signal-to-noise ratio, and WBA were increased at TPP relative to that measured at ambient pressure between 0.8 and 1.5 kHz. Further decrease in TPP beyond -300 daPa did not result in further increases in the mean TEOAE or WBA at TPP. The correlation between TEOAE and WBA was dependent on the frequency, pressure conditions, and subject group. There was no difference in pass rates between the 2 pressure conditions for the control group, while the 3 NMEP groups demonstrated an improvement in pass rates at TPP. With pressurization, the false alarm rate for TEOAE due to NMEP was reduced by 17.8% for NMEP Group 1, 29.2% for NMEP Group 2, and 15.8% for NMEP Group 3. Conclusion Results demonstrated the feasibility and clinical benefits of measuring TEOAE and WBA under pressurized conditions. Pressurized TEOAE and WBA should be used for assessment of ears with NMEP in hearing screening programs to reduce false alarm rates.

Vibroplasty combined with tympanic membrane reconstruction in middle ear ventilation disorders

Although the Vibrant Soundbridge is one of the most frequently used active middle ear implants, data regarding how middle ear ventilation disorders may affect the transmission behavior of its floating mass transducer are still insufficient. Studies involving coupling the floating mass transducer to the stapes head are particularly lacking. This temporal bone study evaluated the influence of simulated middle ear ventilation disorders on the middle ear transfer function in the reconstructed middle ear. The middle ear transfer function was measured using Laser Doppler Vibrometry after vibroplasty onto the stapes head, with or without tympanic membrane reconstruction. Middle ear ventilation disorders were simulated through changes in static pressure via the external ear channel with a maximum pressure of +3 kPa. Slice thickness of tympanic membrane reconstruction material was measured using micro-CT. When the reconstructed ossicular chain and the reconstructed tympanic membrane were mechanically excited by the floating mass transducer under conditions of ambient static pressure, the transmission behavior was found to be independent of the type of tissue used. Increase in static pressure up to +3 kPa caused maximum low frequency transmission loss of 15 dB when elastic grafts were used and 5 dB when stiff tissue was inserted. At high frequencies, measured loss of up to 5 dB was relatively independent of the tissue stiffness. Increase in static pressure led to displacement of the tissues towards the vestibulum and caused stiffening, especially of the annular ligament. Stiffening-induced transmission losses were mainly found at low frequencies and could not be compensated by the floating mass transducer in this range. Above 1300 Hz, the continuous force spectrum of the actuator sufficiently protected against loss of amplitude. To minimize postoperative transmission loss due to persisting ventilation disorders, choosing a very stiff tympanic membrane reconstruction material seems to be appropriate.

Effects of Negative Middle Ear Pressure on Wideband Acoustic Immittance in Normal-Hearing Adults

OBJECTIVES

Wideband acoustic immittance (WAI) measurements are capable of quantifying middle ear performance over a wide range of frequencies relevant to human hearing. Static pressure in the middle ear cavity affects sound transmission to the cochlea, but few datasets exist to quantify the relationship between middle ear transmission and the static pressure. In this study, WAI measurements of normal ears are analyzed in both negative middle ear pressure (NMEP) and ambient middle ear pressure (AMEP) conditions, with a focus on the effects of NMEP in individual ears.

DESIGN

Eight subjects with normal middle ear function were trained to induce consistent NMEPs, quantified by the tympanic peak pressure (TPP) and WAI. The effects of NMEP on the wideband power absorbance level are analyzed for individual ears. Complex (magnitude and phase) WAI quantities at the tympanic membrane (TM) are studied by removing the delay due to the residual ear canal (REC) volume between the probe tip and the TM. WAI results are then analyzed using a simplified classical model of the middle ear.

RESULTS

For the 8 ears presented here, NMEP has the largest and most significant effect across ears from 0.8 to 1.9 kHz, resulting in reduced power absorbance by the middle ear and cochlea. On average, NMEP causes a decrease in the power absorbance level for low- to mid-frequencies, and a small increase above about 4 kHz. The effects of NMEP on WAI quantities, including the absorbance level and TM impedance, vary considerably across ears. The complex WAI at the TM and fitted model parameters show that NMEP causes a decrease in the aggregate compliance at the TM. Estimated REC delays show little to no dependence on NMEP.

CONCLUSIONS

In agreement with previous results, these data show that the power absorbance level is most sensitive to NMEP around 1 kHz. The REC effect is removed from WAI measurements, allowing for direct estimation of complex WAI at the TM. These estimates show NMEP effects consistent with an increased stiffness in the middle ear, which could originate from the TM, tensor tympani, annular ligament, or other middle ear structures. Model results quantify this nonlinear, stiffness-related change in a systematic way, that is not dependent on averaging WAI results in frequency bands. Given the variability of pressure effects, likely related to intersubject variability at AMEP, TPP is not a strong predictor of change in WAI at the TM. More data and modeling will be needed to better quantify the relationship between NMEP, WAI, and middle ear transmission.

Quantitative Pneumatic Otoscopy Using a Light-Based Ranging Technique

Otitis media is the leading cause of hearing loss in children. It is commonly associated with fluid in the ear, which can result in up to 45 dB of hearing loss for extended periods of time during a child's most important developmental years. Accurate assessment of middle ear effusions is an important part of understanding otitis media. Current technologies used to diagnose otitis media with effusion are pneumatic otoscopy, tympanometry, and acoustic reflectometry. While all of these techniques can reasonably diagnose the presence of an effusion, they provide limited information about the infection present behind the tympanic membrane.We have developed a technique based on low-coherence interferometry-a non-invasive optical ranging technique capable of sensing depth-resolved microscopic scattering features through the eardrum-to quantify eardrum thickness and integrity, as well as detect any effusion, purulence, or biofilm behind the tympanic membrane. In this manuscript, the technique is coupled with a pneumatic otoscope to measure minute deflections of the tympanic membrane from insufflation pressure stimuli. This results in quantitative measurements of tympanic membrane mobility, which may be used to gain a better understanding of the impact of infection on the membrane dynamics. A small pilot study of 15 subjects demonstrates the ability of pneumatic low-coherence interferometry to quantitatively differentiate normal ears from ears with effusions present. Analysis of the strengths and weaknesses of the technique, as well as focus areas of future research, is also discussed.

Restoration of middle-ear input in fluid-filled middle ears by controlled introduction of air or a novel air-filled implant

The effect of small amounts of air on sound-induced umbo velocity in an otherwise saline-filled middle ear (ME) was investigated to examine the efficacy of a novel balloon-like air-filled ME implant suitable for patients with chronically non-aerated MEs. In this study, air bubbles or air-filled implants were introduced into saline-filled human cadaveric MEs. Umbo velocity, a convenient measure of ME response, served as an indicator of hearing sensitivity. Filling the ME with saline reduced umbo velocity by 25-30 dB at low frequencies and more at high frequencies, consistent with earlier work (Ravicz et al., Hear. Res. 195: 103-130 (2004)). Small amounts of air (∼30 μl) in the otherwise saline-filled ME increased umbo velocity substantially, to levels only 10-15 dB lower than in the dry ME, in a frequency- and location-dependent manner: air in contact with the tympanic membrane (TM) increased umbo velocity at all frequencies, while air located away from the TM increased umbo velocity only below about 500 Hz. The air-filled implant also affected umbo velocity in a manner similar to an air bubble of equivalent compliance. Inserting additional implants into the ME had the same effect as increasing air volume. These results suggest these middle-ear implants would significantly reduce conductive hearing loss in patients with chronically fluid-filled MEs.

Wideband energy reflectance measurements: effects of negative middle ear pressure and application of a pressure compensation procedure

The wideband energy reflectance (ER) technique has become popular as a tool for evaluating middle ear function. Negative middle ear pressure (MEP) is a prevalent form of middle ear dysfunction, which may impact application of ER measurements in differential diagnosis. A negative MEP may be countervailed by application of an equivalent negative ear canal pressure. The present study examined ER in the same ears under normal and experimentally induced negative MEP conditions. Thirty-five subjects produced at least one negative MEP each (-40 to -225 daPa). Negative MEP significantly altered ER in a frequency-specific manner that varied with MEP magnitude. ER increased for low- to mid-frequencies with the largest change (~0.20 to 0.40) occurring between 1 and 1.5 kHz. ER decreased for frequencies above 3 kHz with the largest change (~-0.10 to -0.25) observed between 4.5 and 5.5 kHz. Magnitude of changes increased as MEP became more negative, as did the frequencies at which maximum changes occurred, and the frequency at which enhancement transitioned to reduction. Ear canal pressure compensation restored ER to near baseline values. This suggests that the compensation procedure adequately mitigates the effects of negative MEP on ER. Theoretical issues and clinical implications are discussed.

Mechanisms of tympanic membrane and incus mobility loss in acute otitis media model of guinea pig

Acute otitis media (AOM) is a rapid infection of middle ear due to bacterial or viral invasion. The infection commonly leads to negative pressure and purulent effusion in the middle ear. To identify how these changes affect tympanic membrane (TM) mobility or sound transmission through the middle ear, we hypothesize that pressure, effusion, and structural changes of the middle ear are the main mechanisms of conductive hearing loss in AOM. To test the hypothesis, a guinea pig AOM model was created by injection of Streptococcus pneumoniae. Three days post inoculation, vibration of the TM at umbo in response to input sound in the ear canal was measured at three experimental stages: intact, pressure-released, and effusion-drained AOM ears. The vibration of the incus tip was also measured after the effusion was removed. Results demonstrate that displacement of the TM increased mainly at low frequencies when pressure was released. As the effusion was removed, the TM mobility increased further but did not reach the level of the normal ear at low frequencies. This was caused by middle ear structural changes or adhesions on ossicles in AOM. The structural changes also affected movement of the incus at low and high frequencies. The results provide new evidence for understanding the mechanism of conductive hearing loss in AOM.

Flexibility within the middle ears of vertebrates

INTRODUCTION AND AIMS

Tympanic middle ears have evolved multiple times independently among vertebrates, and share common features. We review flexibility within tympanic middle ears and consider its physiological and clinical implications.

COMPARATIVE ANATOMY

The chain of conducting elements is flexible: even the 'single ossicle' ears of most non-mammalian tetrapods are functionally 'double ossicle' ears due to mobile articulations between the stapes and extrastapes; there may also be bending within individual elements.

SIMPLE MODELS

Simple models suggest that flexibility will generally reduce the transmission of sound energy through the middle ear, although in certain theoretical situations flexibility within or between conducting elements might improve transmission. The most obvious role of middle-ear flexibility is to protect the inner ear from high-amplitude displacements.

CLINICAL IMPLICATIONS

Inter-ossicular joint dysfunction is associated with a number of pathologies in humans. We examine attempts to improve prosthesis design by incorporating flexible components.

Effects of middle-ear disorders on power reflectance measured in cadaveric ear canals

OBJECTIVE

Reflectance measured in the ear canal offers a noninvasive method to monitor the acoustic properties of the middle ear, and few systematic measurements exist on the effects of various middle-ear disorders on the reflectance. This work uses a human cadaver-ear preparation and a mathematical middle-ear model to both measure and predict how power reflectance R is affected by the middle-ear disorders of static middle-ear pressures, middle-ear fluid, fixed stapes, disarticulated incudostapedial joint, and tympanic-membrane perforations.

DESIGN

R was calculated from ear-canal pressure measurements made on human-cadaver ears in the normal condition and five states: (1) positive and negative pressure in the middle-ear cavity, (2) fluid-filled middle ear, (3) stapes fixed with dental cement, (4) incudostapedial joint disarticulated, and (5) tympanic-membrane perforations. The middle-ear model of Kringlebotn (1988) was modified to represent the middle-ear disorders. Model predictions are compared with measurements.

RESULTS

For a given disorder, the general trends of the measurements and model were similar. The changes from normal in R, induced by the simulated disorder, generally depend on frequency and the extent of the disorder (except for the disarticulation). Systematic changes in middle-ear static pressure (up to 6300 daPa) resulted in systematic increases in R. These affects were most pronounced for frequencies up to 1000 to 2000 Hz. Above about 2000 Hz there were some asymmetries in behavior between negative and positive pressures. Results with fluid in the middle-ear air space were highly dependent on the percentage of the air space that was filled. Changes in R were minimal when a smaller fraction of the air space was filled with fluid, and as the air space was filled with more saline, R increased at most frequencies. Fixation of the stapes generally resulted in a relatively small low-frequency increase in R. Disarticulation of the incus with the stapes led to a consistent low-frequency decrease in R with a distinctive minimum below 1000 Hz. Perforations of the tympanic membrane resulted in a decrease in R for frequencies up to about 2000 Hz; at these lower frequencies, smaller perforations led to larger changes from normal when compared with larger perforations.

CONCLUSIONS

These preliminary measurements help assess the utility of power reflectance as a diagnostic tool for middle-ear disorders. In particular, the measurements document (1) the frequency ranges for which the changes are largest and (2) the extent of the changes from normal for a spectrum of middle-ear disorders.

Mechanical properties of stapedial annular ligament

Stapedial annular ligament (SAL) provides a sealed but mobile boundary between the stapes footplate and oval window bony wall. Mechanical properties of the SAL affect the transmission of ossicular movement into the cochlea in sound conduction. However, the mechanical properties of this tissue have never been investigated due to its complexity. In this paper, we report measurement of the viscoelastic properties of SAL on human cadaver temporal bones using a micro-material testing system with digital image correlation analysis. The measured load-deformation relations of SAL samples were converted into shear stress-shear strain relationship, stress relaxation function, and ultimate shear stress and shear strain of the SAL. The hyperelastic Ogden model was used to describe constitutive behavior of the SAL and a 3D finite element model of the experimental setup with SAL was created for assessing the effects of loading variation and measurement errors on results. The study demonstrates that the human SAL is a typical viscoelastic material with hysteresis, nonlinear stress-strain relationship and stress relaxation function. The shear modulus changes from 3.6 to 220 kPa when the shear stress increases from 2 to 140 kPa. These results provide useful information on quasi-static behavior of the SAL.

Efficacy of transnasal nebulized surfactant on experimental otitis media with effusion in guinea pig

OBJECTIVE

Recently experimental trials have demonstrated that nebulized natural surfactant is effective in the treatment of experimental otitis media with effusion (OME). Two methodologically incomplete studies using animal models of induced OME have reported that nebulized surfactant can improve Eustachian tube function. There have been no reports that investigated the efficacy of the nebulized surfactant for OME using analysis of tympanic membrane vibration. In this study, we evaluated the therapeutic effect of nebulized natural surfactant by investigation of tympanic membrane vibration.

MATERIALS AND METHODS

The guinea pigs (n=20) were divided into three groups. Four normal guinea pigs without any treatment were used as normal controls. Sixteen pigs were given experimental OME in both ear and then divided into two groups. The OME model of guinea pig was created by transbullar injection 10 microl of lipopolysaccharide in saline. Experimental group 1 (n=8) was nebulized phosphate buffered saline (PBS). Experimental group 2 (n=8) was nebulized natural bovine surfactant. The transnasal nebulization was repeated for 7 days in both experimental groups. On the 8th day, both experimental groups and normal control group were measured the tympanic membrane vibration by laser Doppler vibrometer (LDV), and additionally histopathologic observation was performed by scanning electron microscope (SEM).

RESULTS

The TM vibration velocity in nebulized PBS group showed significantly reduced mainly at low frequencies. However, nebulized natural surfactant group recovered the reduction of tympanic membrane vibration. In nebulized PBS group, SEM showed severe thickened subepithelial layer and hyperplasia of gland structure. However, in nebulized natural surfactant group, SEM showed the reduced the thickness of subepithelial layer and the loss of glandular hyperplasia.

CONCLUSION

From our results, the nebulized natural surfactant is postulated to be effective in the treatment of intractable OME in animal model. The measurement of tympanic membrane vibration for analysis of middle ear mechanics was significantly corresponding to the middle ear mucosal changes. LDV is a useful tool for investigate the therapeutic effect of nebulized surfactant in experimental OME. With supporting clinical studies, nebulization of natural surfactant may become noninvasive treatment of OME in future.

Effects of ear-canal pressurization on middle-ear bone- and air-conduction responses

In extremely loud noise environments, it is important to not only protect one's hearing against noise transmitted through the air-conduction (AC) pathway, but also through the bone-conduction (BC) pathways. Much of the energy transmitted through the BC pathways is concentrated in the mid-frequency range around 1.5-2 kHz, which is likely due to the structural resonance of the middle ear. One potential approach for mitigating this mid-frequency BC noise transmission is to introduce a positive or negative static pressure in the ear canal, which is known to reduce BC as well as AC hearing sensitivity. In the present study, middle-ear ossicular velocities at the umbo and stapes were measured using human cadaver temporal bones in response to both BC and AC excitations, while static air pressures of +/-400 mm H(2)O were applied in the ear canal. For the maximum negative pressure of -400 mm H(2)O, mean BC stapes-velocity reductions of about 5-8 dB were observed in the frequency range from 0.8 to 2.5 kHz, with a peak reduction of 8.6(+/-4.7)dB at 1.6 kHz. Finite-element analysis indicates that the peak BC-response reduction tends to be in the mid-frequency range because the middle-ear BC resonance, which is typically around 1.5-2 kHz, is suppressed by the pressure-induced stiffening of the middle-ear structure. The measured data also show that the BC responses are reduced more for negative static pressures than for positive static pressures. This may be attributable to a difference in the distribution of the stiffening among the middle-ear components depending on the polarity of the static pressure. The characteristics of the BC-response reductions are found to be largely consistent with the available psychoacoustic data, and are therefore indicative of the relative importance of the middle-ear mechanism in BC hearing.

Change of middle ear transfer function in otitis media with effusion model of guinea pigs

Otitis media with effusion (OME) is an inflammatory disease of the middle ear that causes most cases of conductive hearing loss observed in the pediatric population. With the long term goal of evaluating middle ear function with OME, the aim of the current study was to create an animal model of OME in which middle ear transfer functions could be measured. In guinea pigs, OME was created by injecting lipopolysaccharide (LPS) into the middle ear. Evidence of OME was assessed by otoscopy, tympanometry, histology, and by measuring the volume of fluid in the middle ear. Vibrations of the umbo and round window membrane were measured with a laser Doppler vibrometer at frequency range of 200-40 kHz in three groups of 3, 7, and 14 days after injection of LPS. Changes in displacement of the umbo and round window membrane in response to 80 dB SPL sound in the ear canal were measured across the frequency range. Displacement of both the umbo and round window membrane was reduced at all time points following LPS injections. Further, the change of the displacement transmission ratio (DTR) from the tympanic membrane to the round window occurred mainly in chronic (e.g. 14 days post-LPS injection) OME ears. This study provides useful data for analyzing the change of middle ear transfer function in OME ears.

Combined effect of fluid and pressure on middle ear function

In our previous studies, the effects of effusion and pressure on sound transmission were investigated separately. The aim of this study is to investigate the combined effect of fluid and pressure on middle ear function. An otitis media with effusion model was created by injecting saline solution and air pressure simultaneously into the middle ear of human temporal bones. Tympanic membrane displacement in response to 90 dB SPL sound input was measured by a laser vibrometer and the compliance of the middle ear was measured by a tympanometer. The movement of the tympanic membrane at the umbo was reduced up to 17 dB by the combination of fluid and pressure in the middle ear over the auditory frequency range. The fluid and pressure effects on the umbo movement in the fluid-pressure combination are not additive. The combined effect of fluid and pressure on the umbo movement is different compared with that of only fluid or pressure change in the middle ear. Negative pressure in fluid-pressure combination had more effect on middle ear function than positive pressure. Tympanometry can detect the middle ear pressure of the fluid-pressure combination. This study provides quantitative information for analysis of the combined effect of fluid and pressure on tympanic membrane movement.

Finite-element analysis of middle-ear pressure effects on static and dynamic behavior of human ear

A finite-element analysis for static behavior of middle ear under variation of the middle-ear pressure was conducted in a 3D model of human ear by combining the hyperelastic Mooney-Rivlin material model and geometry nonlinearity. An empirical formula was then developed to calculate material parameters of the middle-ear soft tissues as the stress-dependent elastic modulus relative to the middle-ear pressure. Dynamic behavior of the middle ear in response to sound pressure in the ear canal was predicted under various positive and negative middle-ear pressures. The results from static analysis indicate that a positive middle ear pressure produces the static displacements of the tympanic membrane (TM) and footplate more than a negative pressure. The dynamic analysis shows that the reductions of the TM and footplate vibration magnitudes under positive middle-ear pressure are mainly determined by stress dependence of elastic modulus. The reduction of the TM and footplate vibrations under negative pressure was caused by both the geometry changes of middle-ear structures and the stress dependence of elastic modulus.

Testing a method for quantifying the output of implantable middle ear hearing devices

This report describes tests of a standard practice for quantifying the performance of implantable middle ear hearing devices (also known as implantable hearing aids). The standard and these tests were initiated by the Food and Drug Administration of the United States Government. The tests involved measurements on two hearing devices, one commercially available and the other home built, that were implanted into ears removed from human cadavers. The tests were conducted to investigate the utility of the practice and its outcome measures: the equivalent ear canal sound pressure transfer function that relates electrically driven middle ear velocities to the equivalent sound pressure needed to produce those velocities, and the maximum effective ear canal sound pressure. The practice calls for measurements in cadaveric ears in order to account for the varied anatomy and function of different human middle ears.

Laser interferometry measurements of middle ear fluid and pressure effects on sound transmission

An otitis media with effusion model in human temporal bones with two laser vibrometers was created in this study. By measuring the displacement of the stapes from the medial side of the footplate, the transfer function of the middle ear, which is defined as the displacement transmission ratio (DTR) of the tympanic membrane to footplate, was derived under different middle ear pressure and fluid in the cavity with a correction factor for cochlear load. The results suggest that the DTR increases with increasing frequency up to 4k Hz when the middle ear pressure was changing from 0 to 20 or -20 cm H20 (e.g., +/-196 daPa) and fluid level was increasing from 0 to a full middle ear cavity. The positive and negative pressures show different effects on the DTR. The effect of fluid on DTR varies between three frequency ranges: f < 1k, between 1k and 4k, and f > 4k Hz. These findings show how the efficiency of the middle ear system for sound transmission changes during the presence of fluid in the cavity and variations of middle ear pressure.

Mechanisms of hearing loss resulting from middle-ear fluid

Fluid in the middle ear, a defining feature of otitis media with effusion (OME), is commonly associated with a 20- to 30-dB conductive hearing loss. The effects and relative importance of various mechanisms leading to conductive hearing loss were investigated in a human temporal bone preparation. Umbo velocity in response to ear-canal sound was measured with a laser vibrometer while saline and silicone fluids of viscosity 5-12,000 cSt were introduced into the middle ear to contact part or all of the tympanic membrane (TM) and fill part or all of the middle ear. At low frequencies, reductions in umbo velocity (deltaVU) of up to 25 dB depended on the percentage of the original middle-ear air space that remained air-filled, which suggests that the primary mechanism in hearing loss at low frequencies is a reduction of the admittance of the middle-ear air space due to displacement of air with fluid. At higher frequencies, deltaVU (of up to 35 dB) depended on the percentage of the TM contacted by fluid, which suggests that the primary mechanism at high frequencies is an increase in tympanic membrane mass by entrained fluid. The viscosity of the fluid had no significant effect on umbo velocity. deltaVU for the fluid-filled middle ear matched hearing losses reported in patients whose middle ear was believed to be completely filled with fluid. The difference between deltaVU for a partly-filled middle ear and hearing losses reported in patients whose middle ear was believed to be incompletely fluid-filled is consistent with the reported effect of middle-ear underpressure (commonly seen in OME) on umbo velocity. Small amounts of air in the middle ear are sufficient to facilitate umbo motion at low frequencies.

A normative study of tympanic membrane motion in humans using a laser Doppler vibrometer (LDV)

Laser Doppler vibrometry was used to measure the sound-induced tympanic membrane (TM) velocity, assessed near the umbo, in 56 normal hearing human subjects at nine sound frequencies. A second series of measurements was made in 47 subjects with sensorineural hearing loss (SNHL). Each set of measurements has features in common with previously published results. The measured velocity magnitude (normalized by the stimulus sound pressure) at any one frequency ranged among subjects by factors of 3-0.3 (+/-10 dB) from the mean and the phase angle of the normalized velocity ranged from +/-15 degrees around the mean at low frequencies to more than +/-200 degrees around the mean at 6 kHz. Measurements repeated after intervals of minutes to months were generally within 40% in magnitude (+/-3 dB) and 20 degrees in phase. Sources of variability included the effect of small differences in the location of the measurement on the TM and small static middle-ear pressures. No effects of stimulus level, ear sidedness (right or left), gender, age or the presence or absence of SNHL were found. These results provide a baseline normal response for studies of TM velocity with conductive hearing losses of different etiologies.

Middle ear mechanics of Type III tympanoplasty (stapes columella): II. Clinical studies

OBJECTIVES

To determine the structural features that are responsible for the large variation in postoperative hearing results after Type III stapes columella tympanoplasty, to compare the clinical results after Type III tympanoplasty with predictions based on experimental investigations using a temporal bone model, and to investigate the effectiveness of a modification in surgical technique for Type III reconstruction.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary referral center.

INCLUSION CRITERIA

The ear was healed with an intact tympanic membrane graft; the status of the stapes was known, whether mobile or fixed; and the postoperative status of aeration of the middle ear was known, whether aerated or not.

MAIN OUTCOME MEASURE

Air-bone gap at frequencies 250, 500, 1,000, 2,000 and 4,000 Hz.

RESULTS

In ears with temporalis fascia graft onto stapes head: mobile stapes and aerated middle ear (n = 34), mean air-bone gaps at audiometric frequencies were 15 to 30 dB, consistent with predictions of the experimental model; mobile stapes and nonaerated middle ear (n = 16), large air-bone gaps of 35 to 55 dB; fixed stapes and aerated middle ear (n = 4), large air-bone gaps of 30 to 50 dB; fixed stapes and nonaerated middle ear (n = 2), large air-bone gaps of 30 to 70 dB. In ears with a fascia-cartilage graft onto stapes head, where a thin disc of meatal cartilage, 0.3 to 0.5 mm thick and 4 to 6 mm in diameter was interposed between the fascia graft and the stapes head: mobile stapes and aerated middle ear (n = 9), mean air-bone gaps at audiometric frequencies were 10 to 25 dB, about 5 dB better at 250, 500, and 2,000 Hz than in ears with only a fascia graft ( <0.05), improvement consistent with that observed experimentally when a thin cartilage disc was used in the temporal bone model, hypothesis that the cartilage increased the effective vibrating area of the graft; mobile stapes and nonaerated middle ear (n = 2), air-bone gaps were 40 to 50 dB.

CONCLUSIONS

Large air-bone gaps of 30 to 70 dB occurred as a result of stapes fixation, nonaeration of the middle ear, or both. When the stapes was mobile and the middle ear was aerated, a fascia graft resulted in air-bone gaps of 15 to 30 dB. Interposing a thin disc of cartilage between the fascia graft and stapes head to improve the effective vibrating graft area gave better hearing, with air-bone gaps of 10 to 25 dB. The clinical Type III results were consistent with predictions based on experimental investigations of mechanics of the Type III procedure in a temporal bone model.

Measurement of sound emission by endoscopic lithotripters: an in vitro study and theoretical estimation of risk of hearing loss in a fetus

BACKGROUND

There is concern about applying intraureteral lithotripsy in pregnant patients, as the sound created by the equipment may damage fetal hearing.

MATERIALS AND METHODS

The sound intensities produced by electrokinetic, pneumomechanic, holmium laser, ultrasound, and electrohydraulic intraluminal lithotripters were measured in an in vitro model.

RESULTS

The purely mechanical modalities (electrokinetic and pneumomechanic) generated lower peak pressures than the other devices. Theoretical calculations were performed based on the fact that in vivo, the sound path and the fetal middle ear cavities are filled with fluid. Calculated pressure levels that give displacement amplitudes of the tympanic membrane, the ossicles, and the basilar membrane comparable to hearing loss risk criteria for airborne impulsive noise are greater than measured for all of the lithotripters. The fluid-filled middle ear thus seems to give the fetus protection against sound. The fluid also improves the symmetry of the cochlea structure, reducing the influence of direct bone transmission.

CONCLUSIONS

The peak pressure of the sound emitted by lithotripsy in the ureter during pregnancy is unlikely to be harmful to fetal hearing. Other risk factors, such as the form of the sound waves and the pulse duration were not evaluated. The theoretical assessments are simplified, and one should be careful about drawing conclusions from theoretical considerations and calculations alone.

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.

Frequency characteristics of sound transmission in middle ears from Norwegian cattle, and the effect of static pressure differences across the tympanic membrane and the footplate

For 23 cadaver ears from Norwegian cattle, frequency characteristics for the round-window volume displacement relative to the sound pressure at the eardrum have been measured, and are compared to earlier results for human ears [M. Kringlebotn and T. Gundersen, J. Acoust. Soc. Am. 77(1), 159-164 (1985)]. For human as well as for cattle ears, mean amplitude curves have peaks at about 0.7 kHz. At lower frequencies, the mean amplitude for cattle ears is about 5 dB smaller than for human ears. The amplitude curves cross at about 2 kHz, and toward higher frequencies the amplitude for cattle ears becomes increasingly larger. If amplitude curves are roughly approximated by straight lines above 1 kHz, the slope for cattle ears is about -5 dB/octave as compared to about -15 dB/octave for human ears. The phase of the round-window volume displacement lags behind the phase of the sound pressure at the tympanic membrane. The phase lag is close to zero below 0.2 kHz, but increases to about 3.5 pi at 20 kHz for cattle ears, as compared to less than 2 pi for human ears. Further investigations are needed in order to explain the observed differences. Sound transmission in the ear decreases with an increasing static pressure difference across the tympanic membrane, especially at frequencies below 1 kHz, where pressure differences of 10 and 60 cm water cause mean transmission losses of about 10 and 26 dB, respectively, the losses being somewhat larger for overpressures than for underpressures in the ear canal. At higher frequencies, the transmission losses are smaller. For small overpressures, and in a limited frequency range near 3 kHz, even some transmission enhancement may occur. Static pressure variations in the inner ear have only a minor influence on sound transmission. Static pressures relative to the middle ear in the range 0-60 cm water cause mean sound transmission losses less than 5 dB below 1 kHz, and negligible losses at higher frequencies.

Middle ear influence on otoacoustic emissions. I: noninvasive investigation of the human transmission apparatus and comparison with model results

Evoked otoacoustic emissions (EOAEs) are generated within the cochlea in response to external sounds, and they can be acoustically detected in the external auditory meatus after backward propagation through the middle ear. In addition to being used to probe the cochlear mechanisms, they are expected to be sensitive to minute changes in middle ear impedance. Systematic measurements of the changes in the vectorial components of EOAEs were carried out after various manipulations of the human middle ear in order to characterize the influence of stiffness and inertia of the stapes and tympanic-membrane systems. For this purpose, stapedius muscle contractions were elicited by high-level contralateral sound, controlled changes in middle ear pressure (range +/-100 daPa) were produced and the tympanic membrane was loaded with water droplets. A computer model of the middle ear network was implemented using a standard lumped-element electric analog of the middle ear (Zwislocki's model). Forward and backward transmission changes were simulated and model predictions were compared to experimental data. Apart from the case of positive middle ear pressures, a close qualitative correspondence was found between model and real-ear results. Each of the effects was characterized by a unique pattern of phase and magnitude changes as a function of frequency, in relation to the mechanical characteristics of the involved subsystem (i.e. stapes stiffness, tympanic-membrane stiffness or mass) and its resonance properties. Owing to their high sensitivity, EOAEs could be helpful for an accurate individual multifrequency analysis of middle ear impedance by comparisons under rest and test conditions.

Tympanic pressure gradients and otoacoustic emissions

OBJECTIVE

The purpose of this study was to investigate the immediate effects of tympanic over- and under-pressure, induced by variations in ambient pressure on click-evoked otoacoustic emissions (CEOAEs) in healthy individuals. It was of particular interest to elucidate whether changes in the CEOAE response in both spectral and time domains could be attributed not only to tympanic, but also to cochlear influence.

DESIGN

Nine healthy subjects with normal hearing and middle ear pressure were exposed to ambient pressure changes in a pressure chamber. The pressure was progressively changed in 100 daPa steps to accomplish an increase and a decrease in tympanic pressure. Pressure equilibration of the middle ear was avoided. The relative tympanic over- and under-pressure (+/- 320daPa) was monitored by tympanometry and the CEOAEs recorded at every step of tympanic pressure change.

RESULTS

There was a statistically significant reduction of the otoacoustic emission (OAE) response levels and reproducibility already at 100 daPa of ambient pressure change. The OAE response was progressively reduced by increased pressure gradients. The CEOAEs recorded during progressive tympanic over- and under-pressure also had increasingly shorter latencies. These changes of the OAE response characteristics were most pronounced in the 750 to 3000 Hz frequency bands.

CONCLUSIONS

The progressive attenuation of the OAE response and the concomitant shortening of the OAE response latencies were observed during a combination of altered middle and inner ear pressure. Although the middle and inner ear influence cannot be separated we suggest, based on our findings, that the shortening of latencies may partly be caused by inner ear pressure changes and stiffening of the labyrinthine membranes. Further studies are needed to more specifically clarify the relative contribution of the tympanic and labyrinthine influence, respectively, for the various aspects of pressure influence on the OAE response.

Toynbee Memorial Lecture 1997. Middle ear mechanics in normal, diseased and reconstructed ears

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following: (1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears. (2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation. (3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed post-operative hearing results and suggest surgical guidelines in order to optimize the post-operative results. (4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.