[Audiological outcome of bimodal CI users over time and depending on different influencing factors]. / Audiologisches Ergebnis bimodal versorgter CI-Träger:innen im zeitlichen Verlauf und in Abhängigkeit unterschiedlicher Einflussfaktoren.

BACKGROUND: Hearing-impaired persons with asymmetric hearing loss and a unilateral indication for a cochlear implant (CI) generally benefit from a bimodal hearing solution. The influence of bimodal fitting on speech comprehension (SC) over time has not yet been sufficiently investigated. The present study examines the influence of bimodal fitting on SC in bimodally fitted CI users with postlingual deafness at least 36 months after implantation and analyzes possible influencing factors. METHODS: Included in this retrospective longitudinal study were 54 bimodally fitted speech-competent CI users with at least 36 months of CI experience. Audiometric data of these CI users at predefined timepoints were compared. RESULTS: The change in the results of the Freiburg monosyllabic test (FT) over 36 months was significant (p < 5%) for the deafness group at <10 years for both the 65 dB sound pressure level (SPL) and at 80 dB SPL and also significant for the deafness group ≥10 years for 65 dB SPL. In the Oldenburg sentence test (OlSa) there was a highly significant change (p < 0.1%) for S0, S0N0, and S0NCI configurations and a very significant change (p < 1%) for S0NHA (HA: hearing aid). Age at implantation as a possible influencing factor could not be confirmed in the FT. In contrast, the duration of deafness was a negative influencing factor for SC with CI in the FT, whereas a longer duration of deafness was associated with worse results in the FT. The degree of hearing loss in the ear fitted with an HA did not influence SC. The median bimodal benefit (here: difference in SC with bimodal fitting compared to unilateral HA fitting for FT at 65 dB SPL) was 10% over the total study period. For a median of 79% of the test subjects, the bimodal benefit was found over the entire period of 36 months. CONCLUSION: Over time, SC improves significantly with a CI for the bimodal test subjects. The investigated influencing factors (age, duration of deafness, and degree of hearing loss in the contralateral ear) support the indication for bimodal provision in accordance with the guideline in Germany for cochlear implantation-regardless of age, duration of deafness, and hearing ability of the contralateral ear.

Finite Element Model of a Piezo-Electric Actuator Coupled to the Middle Ear.

The hearing contact lens® (HCL) is a new type of hearing aid devices. One of its main components is a piezo-electric actuator. In order to evaluate and maximize the HCL's performance, a model of the HCL coupled to a middle-ear model was developed using finite element approach. The model was validated step by step starting with the HCL only. To validate the HCL model, vibrational measurements on the HCL were performed using a laser-doppler-vibrometer (LDV). Then, a silicone cap was placed onto the HCL to provide an interface between the HCL and the tympanic membrane of the middle-ear model, and additional LDV measurements on temporal bones were performed to validate the coupled model that was used to evaluate the equivalent sound pressure of the HCL. Moreover, a de-eper insight was gained into the contact between the HCL and tympanic membrane and its effects on the HCL performance. The model can be used to investigate the sensitivity of geometrical and material parameters with respect to performance measures of the HCL and evaluate the feedback behavior.

[Laser Doppler vibrometric measurements on human temporal bones]. / Laser-Doppler-vibrometrische Messungen an humanen Felsenbeinen.

Laser Doppler vibrometric (LDV) measurements on human temporal bones represent the standard method for predicting the performance of active middle ear implants (AMEI) and are used as preclinical tests in the development, approval process, and indication expansion of AMEI. The quality of the coupling of the floating mass transducer to the mobile structures of the middle ear is decisive for the performance of the implant and patients' hearing perception. The cochlea can be stimulated via the oval window (forward stimulation) or the round window (reverse stimulation). For forward stimulation, the ASTM standard F2504-05 defines a method to ensure physiologically normal properties of the temporal bones used in the experiments. For reverse stimulation, which depends even more critically on the quality of the temporal bone, a comparable standard method is lacking. Appropriate preparation and storage of the human petrous bone as well as suitable LDV test setups with respect to calibration and reproducibility of measuring positions and angles provide results that allow a comparison of different types of coupling and also correlate well with clinical data.

Objective audiometry with DPOAEs : New findings for generation mechanisms and clinical applications.

BACKGROUND: Distortion product otoacoustic emissions (DPOAEs) and transient-evoked otoacoustic emissions (TEOAEs) are sound waves generated as byproducts of the cochlear amplifier. These are measurable in the auditory canal and represent an objective method for diagnosing functional disorders of the inner ear. Conventional DPOAE and TEOAE methods permit detection of hearing impairment, but with less than desirable accuracy. OBJECTIVE: By accounting for DPOAE generation mechanisms, the aim is to improve the accuracy of inner-ear diagnosis. METHODS: DPOAEs consist of two components, which emerge at different positions along the cochlea and which may cause artifacts due to mutual interference. Here, the two components are separated in the time domain using short stimulus pulses. Optimized stimulus levels facilitate the acquisition of DPOAEs with maximum amplitudes. DPOAE and Békésy audiograms were recorded from 41 subjects in a clinically relevant frequency range of 1.5-6 kHz. RESULTS: The short stimulus pulses allowed artifact-free measurement of DPOAEs. Semilogarithmic input-output functions yielded estimated distortion product thresholds, which were significantly correlated with the subjectively acquired Békésy thresholds. In addition, they allowed detection of hearing impairment from 20 dB HL, with 95% sensitivity and only a 5% false-positive rate. This accuracy was achieved with a measurement time of about 1-2 min per frequency. CONCLUSION: Compared to conventional DPOAE and TEOAE methods, separation of DPOAE components using short-pulse DPOAEs in combination with optimized stimulus parameters considerably enhances the accuracy of DPOAEs for diagnosing impairment of the cochlear amplifier.

[Objective audiometry with DPOAEs : New findings for generation mechanisms and clinical applications. German version]. / Objektive Hördiagnostik mit DPOAE : Neue Erkenntnisse zur Generierung und klinischen Anwendung.

BACKGROUND: Distortion product otoacoustic emissions (DPOAEs) and transient evoked otoacoustic emissions (TEOAEs) are sound waves generated as byproducts of the cochlear amplifier. These are measurable in the auditory canal and represent an objective method for diagnosing functional disorders of the inner ear. Conventional DPOAE and TEOAE methods permit detection of hearing impairment, but with less than desirable accuracy. OBJECTIVE: By accounting for DPOAE generation mechanisms, the aim is to improve the accuracy of inner-ear diagnosis. MATERIALS AND METHODS: DPOAEs consist of two components, which emerge at different positions along the cochlea and which may cause artifacts due to mutual interference. Here, the two components are separated in the time domain using short stimulus pulses. Optimized stimulus levels facilitate the acquisition of DPOAEs with maximum amplitudes. DPOAE and Békésy audiograms were recorded from 41 subjects in a clinically relevant frequency range of 1.5 to 6 kHz. RESULTS: The short stimulus pulses allowed artifact-free measurement of DPOAEs. Semilogarithmic input-output functions yielded estimated distortion product thresholds, which were significantly correlated with the subjectively acquired Békésy thresholds. In addition, they allowed detection of hearing impairment from 20 dB HL, with 95 % sensitivity and only a 5 % false-positive rate. This accuracy was achieved with a measurement time of about 1-2 min per frequency. CONCLUSIONS: Compared to conventional DPOAE and TEOAE methods, separation of DPOAE components using short-pulse DPOAEs in combination with optimized stimulus parameters considerably enhances the accuracy of DPOAEs for diagnosing impairment of the cochlear amplifier.

Design study of a miniaturized displacement transducer (MDT) for an active middle ear implant system.

People suffering from moderate to severe hearing loss can be treated with active middle ear implants. A new approach in this field is to implant an electromechanical transducer onto the round window membrane in order to improve coupling and be able to treat patients with middle-ear problems. In this paper the design study for a miniaturized displacement transducer (MDT) for the round window is presented. Based on a requirement analysis, the basic principle and analytical modeling of the actuator is shown. A parameter variation study results in an optimized actuator configuration that is able to generate an amplification of 110 dB SPL theoretically. As a next step this actuator has to be manufactured and tested.

[Sound and velocity DPOAEs : Technology, methodology and perspectives]. / Schall- und Geschwindigkeits-DPOAE : Technologie, Methodik und Perspektiven.

Recent publications show that DPOAE measurements can generate a more accurate diagnosis, if (1) their fine structure is suppressed, and (2) if the calibration of the sound field is improved. Reduction of the fine structure is particularly important in the frequency range below 4 kHz in subjects with intact cochlear amplifier and can reduce the standard deviation of threshold estimations based on DPOAE-input/output functions from 11 dB to 6 dB. Improving the sound-field calibration has most impact in the frequency range above 4 kHz. Threshold estimations based on laserinterferometrically measured DPOAE input-output functions where the sound field was calibrated close to the tympanic membrane have been shown to reduce the standard deviation down to 8.6 dB in humans and 6.5 dB in guinea pigs. Compared with conventional DPOAE measures, such as amplitude or signal-to-noise ratio, threshold estimation based on DPOAE-I/O functions has the advantage that its slope provides additional information about the middle-ear; however, its specificity is limited. In the future, combined methods such as acoustic reflectance or laser vibrometry on the umbo promise a reliable assessment of the middle-ear contribution to DPOAE.

[Laser Doppler vibrometric measurements of DPOAE in humans. Eardrum vibrations reflect middle- and inner-ear characteristics]. / Laser-Doppler-vibrometrische Messungen von DPOAE an Menschen. Trommelfellschwingungen spiegeln Mittel- und Innenohrcharakteristika wider.

BACKGROUND: Up to now, laser interferometric vibration measurements of the human eardrum have not provided any information about cochlear function, because the measurement devices have not been sufficiently sensitive. METHODS: After designing a new type of laser Doppler vibrometer (LDV) that allows detection of displacement amplitudes down to about 1 pm, we used this device in 20 subjects to measure growth functions of the distortion products of otoacoustic emissions (DPOAE) as vibrations of the umbo. For comparison, DPOAE growth functions were also measured conventionally with an acoustic probe in the closed external auditory meatus. Hearing thresholds were estimated from both sets of measurements and compared with Békésy thresholds. RESULTS: The standard deviation of the threshold estimate obtained from the vibration DPOAEs was 8.6 dB, which is significantly smaller than that of the threshold estimate (16.7 dB) obtained from the acoustic DPOAEs. We attribute the smaller standard deviation for the LDV data to the fact that these measurements are made in an open sound field and are therefore less susceptible to pressure calibration errors. CONCLUSIONS: Being relatively free of sound-field measurement artefacts, the LDV method allows precise estimation of the hearing threshold. Vibration measurements of the umbo have, therefore, considerable potential for the differential diagnosis of mechanical dysfunction of the middle and inner ear.

Distortion product otoacoustic emissions measured as vibration on the eardrum of human subjects.

It has previously not been possible to measure eardrum vibration of human subjects in the region of auditory threshold. It is proposed that such measurements should provide information about the status of the mechanical amplifier in the cochlea. It is this amplifier that is responsible for our extraordinary hearing sensitivity. Here, we present results from a laser Doppler vibrometer that we designed to noninvasively probe cochlear mechanics near auditory threshold. This device enables picometer-sized vibration measurements of the human eardrum in vivo. With this sensitivity, we found the eardrum frequency response to be linear down to at least a 20-dB sound pressure level (SPL). Nonlinear cochlear amplification was evaluated with the cubic distortion product of the otoacoustic emissions (DPOAEs) in response to sound stimulation with two tones. DPOAEs originate from mechanical nonlinearity in the cochlea. For stimulus frequencies, f1 and f2, with f2/f1 = 1.2 and f2 = 4-9.5 kHz, and intensities L1 and L2, with L1 = 0.4L(2) + 39 dB and L2 = 20-65 dB SPL, the DPOAE displacement amplitudes were no more than 8 pm across subjects (n = 20), with hearing loss up to 16 dB. DPOAE vibration was nonlinearly dependent on vibration at f2. The dependence allowed the hearing threshold to be estimated objectively with high accuracy; the standard deviation of the threshold estimate was only 8.6 dB SPL. This device promises to be a powerful tool for differentially characterizing the mechanical condition of the cochlea and middle ear with high accuracy.

[Laser Doppler vibrometry: a new tool for diagnosing hearing loss with an intact eardrum]. / Laser Doppler vibrometria: un nou instrument pentru diagnosticarea Hipoacuziei cu timpan închis.

The diagnosis of hearing loss with an intact eardrum frequently requires an entire battery of hearing tests, without the guarantee of an exact diagnosis. The techniques frequently provide only orientation for it, without establishing the site of the lesion and the etiology of the hearing loss. Laser Doppler vibrometry is a new technique, which has recently proved capable, of partially resolving this problem. The method is based on the study of the sound-induced vibration of the eardrum in humans in vivo, using a laser Doppler vibrometer. The method proved to be useful in the diagnosis of the pathology of the middle ear sound transmission system, avoiding the need for exploratory tympanotomy. Called "laser-audiometry", the method promises to become a new diagnostic tool for hearing impairment.

Absolute interferometric distance measurement using a FM-demodulation technique.

We propose an interferometric method for measuring absolute distances larger than the wavelength. A laser diode is used as a light source. The principle of operation is based on multiple-wavelength interferometry that uses a modulated light source. This method uses the fact that the wavelength of light emitted by the laser diode can be varied by means of the injection current. The modulation of the injection current in combination with the optical heterodyne technique causes a high-frequency phase-modulated detector signal. The phase deviation of the signal is a measure of the optical path difference in the interferometer. By FM demodulation of the detector output with a phase-locked loop demodulator, the optical path difference can be determined directly without the classical ambiguity problem of interferometry. The measuring range in the experiments was limited to 50 mm by the maximum travel range of the used specimen translation stage. Because of the inherent light sensitivity of the method described, the rangefinder can be used for three-dimensional profile measurements on a wide variety of objects, even on diffuse scattering surfaces.