Contemporary Mechanics of Conductive Hearing Loss.

The middle ear plays a critical role for the conversion of acoustic energy to mechanical vibrations that subsequently enter the cochlea. It is middle ear impedance matching through ossicular coupling that has enabled land-dwelling vertebrates to hear soft airborne sounds. Conductive hearing loss may result from damage to the delicate middle ear structures following infection, trauma or rapid pressure changes. An understanding of the mechanics of the middle ear significantly improves the oto-surgeon's ability to effectively diagnose conductive hearing loss, localize the responsible lesion and then effectively correct the conduction abnormality. This article reviews some of the basic knowledge of middle ear mechanics for sound transmission, highlights recent advances in developing new techniques to assist in diagnosis of middle ear disease, and finally sheds light on future research aimed at improving the diagnosis and management of middle ear pathology.

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

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

Characterization and Clinical Use of Bone Conduction Transducers at Extended High Frequencies.

Measurement of bone conduction (BC) hearing thresholds at extended high frequencies (EHF; above 8 kHz) is of clinical interest but is technically complicated by limitations in standard BC transducer output, a lack of calibration standards and sparse clinical data from human subjects. A recently described calibration scheme using an artificial mastoid and interposed accelerometer is applied in this study to characterize and compare acceleration and computed force outputs over the 4-20 kHz range of two standard BC transducers: the RadioEar® B71 and B81, as well as two non-standard, commercially available BC transducers: the Tascam® HP-F200 and the Aftershokz® AS400. Measures of linear output growth, harmonic distortion and acoustic radiation are assessed and compared across devices. A maximum linear input voltage is established for each BC transducer using measurements of linear output growth and total harmonic distortion. At maximum linear input level, the Tascam shows superior force output by 25 to 40 dB above 8 kHz and the widest dynamic EHF range. Acoustic radiation per output force was lowest for the Tascam, whereas the AS400 behaved more like an air conduction earphone than a force generator. In a cohort of 15 normal hearing volunteers, BC thresholds, measured with the Tascam and reported in dB re 1 rms µN, were consistent with historical measures of EHF BC thresholds in similar subjects using an alternative BC transducer.

Methods for the calibration of bone conduction transducers at frequencies from 5 to 20 kHz.

Techniques for standardizing the output of bone conduction transducers over the 5-20 kHz range are presented. The techniques include definitions of the standard artificial mastoid (AM) impedance and force sensitivity in that high-frequency range using an impedance head coupled to a vibration source. The AM impedance is shown to vary with the contact area of the vibration source. The AM force sensitivity does not vary with the contact area but does exhibit sharp frequency dependences over the 14-20 kHz range. The sharp frequency dependence complicates the use of the AM force sensor as a stand-alone calibration device at these high frequencies. An alternative calibration scheme that uses an accelerometer interposed between the vibrator and the AM impedance is described. Comparisons of the two schemes demonstrate that the accelerometer method produces more consistent results. Comparisons of the force and acceleration output of one bone conduction vibrator at high frequencies suggest those outputs depend on the driven load. The loads used in the two calibration schemes are compared to what is known of the impedance of the skin-covered head.

Material characterization of thin planar structures using full-field harmonic vibration response measured with stroboscopic holography.

We propose a novel material characterization method to estimate the Young's modulus of thin 2-D structures using non-modal noisy single frequency harmonic vibration data measured with holography. The method uses finite-difference discretization to apply the plate equation to all measured pixels inside the boundary of the vibrating structure and then treats the problem as a Bayesian optimization process to find the value of the Young's modulus by minimizing the Euclidian distance between the measured displacement field and repeatedly calculated displacement field using the plate equation. In order to assess the accuracy of the method, ground truth harmonic displacement magnitude fields of different plates were obtained using analytical solutions and the finite-element method and were used to estimate the Young's moduli. We applied Gaussian and non-Gaussian noise with different intensities to assess the robustness and accuracy of the proposed material characterization method in the presence of noise. We demonstrated that for multiple benchmarks for signal to noise ratio of down to 0 dB, our proposed method had errors of less than 5%. We also quantified the effects of uncertainties in the geometrical and material parameters as well as boundary conditions on the estimated Young's modulus. Furthermore, we studied the effects of the mesh size on the runtime and applied the method to experimental holography vibration measurement data of a copper plate.

The onset of nonlinear growth of middle-ear responses to high intensity sounds.

The human tympanic membrane (TM) and ossicles are generally considered to act as a linear system as they conduct low and moderate level environmental sounds to the cochlea. At intense stimulus levels (> 120 dB SPL) there is evidence that the TM and ossicles no longer act linearly. The anatomical structures that contribute to the nonlinear responses and their level and frequency dependences are not well defined. We used cadaveric human ears to characterize middle-ear responses to continuous tones between 200 and 20,000 Hz with levels between 60 and 150 dB SPL. The responses of the TM and ossicles are essentially sinusoidal, even at the highest stimulus level, but grow nonlinearly with increased stimulus level. The umbo and the stapes show different nonlinear behaviors: The umbo displacement grows faster than the stimulus level (expansive growth) at frequencies below 2000 Hz, while the stapes exhibits mostly compressive growth (grows slower than the stimulus level) over a wide frequency range. The sound pressure level where the nonlinearity first becomes obvious and the displacement at that level are lower at the stapes than at the umbo. These observations suggest the presence of multiple nonlinear processes within the middle ear. The existence of an expansive growth of umbo displacement that has limited effect on the stapes compressive growth suggests that the ossicular joints reduce the coupling between multiple nonlinear mechanisms within the middle ear. This study provides new data to test and refine middle-ear nonlinear models.

Optical coherence tomographic measurements of the sound-induced motion of the ossicular chain in chinchillas: Additional modes of ossicular motion enhance the mechanical response of the chinchilla middle ear at higher frequencies.

Wavelength-swept optical coherence tomography (OCT) was used to scan the structure of cadaveric chinchilla ears in three dimensions with high spatial resolution and measure the sound-induced displacements of the entire OCT-visible lateral surfaces of the ossicles in the lateral-to-medial direction. The simultaneous measurement of structure and displacement allowed a precise match between the observed motion and its structural origin. The structure and measured displacements are consistent with previously published data. The coincident detailed structural and motion measurements demonstrate the presence of several frequency-dependent modes of ossicular motion, including: (i) rotation about an anteriorly-to-posteriorly directed axis positioned near the commonly defined anatomical axis of rotation that dominates at frequencies below 8 kHz, (ii) a lateral-to-medial translational component that is visible at frequencies from 2 to greater than 10 kHz, and (iii) a newly described rotational mode around an inferiorly-to-superiorly directed axis that parallels the manubrium of the malleus and dominates ossicular motion between 10 and 16 kHz. This new axis of rotation is located near the posterior edge of the manubrium. The onset of the second rotational mode leads to a boost in the magnitude of sound-induced stapes displacement near 14 kHz, and adds a half-cycle to the accumulating phase in middle-ear sound transmission. Similar measurements in one ear after interruption of the incudostapedial joint suggest the load of the cochlea and stapes annular ligament is important to the presence of the second rotational mode, and acts to limit simple ossicular translation.

Sound pressure distribution within human ear canals: II. Reverse mechanical stimulation.

This work is part of a study of the interactions of ear canal (EC) sound with tympanic membrane (TM) surface displacements. In human temporal bones, the ossicles were stimulated mechanically "in reverse" to mimic otoacoustic emissions (OAEs), and the sound field within the ear canal was sampled with 0.5-2 mm spacing near the TM surface and at more distal locations within the EC, including along the longitudinal EC axis. Sound fields were measured with the EC open or occluded. The reverse-driven sound field near the TM had larger and more irregular spatial variations below 10 kHz than with forward sound stimulation, consistent with a significant contribution of nonuniform sound modes. These variations generally did not propagate more than ∼4 mm laterally from the TM. Longitudinal sound field variations with the EC open or blocked were consistent with standing-wave patterns in tubes with open or closed ends. Relative contributions of the nonuniform components to the total sound pressure near the TM were largest at EC natural frequencies where the longitudinal component was small. Transverse variations in EC sound pressure can be reduced by reducing longitudinal EC sound pressure variations, e.g., via reducing reflections from occluding earplugs.

Tympanic membrane surface motions in forward and reverse middle ear transmissions.

Characterization of Tympanic Membrane (TM) surface motions with forward and reverse stimulation is important to understanding how the TM transduces acoustical and mechanical energy in both directions. In this paper, stroboscopic opto-electronic holography is used to quantify motions of the entire TM surface induced by forward sound and reverse mechanical stimulation in human cadaveric ears from 0.25 to 18.4 kHz. The forward sound stimulus was coupled to an anatomically realistic artificial ear canal that allowed optical access to the entire TM surface, and the reverse mechanical stimulus was applied to the body of the incus by a piezo-electric stimulator. The results show clear differences in TM surface motions evoked by the two stimuli. In the forward case, TM motion is dominated by standing-wave-like modal motions that are consistent with a relatively uniform sound-pressure load over the entire TM surface. With reverse mechanical stimulation, the TM surface shows more traveling waves, consistent with a localized mechanical drive applied to the manubrium embedded in the TM. With both stimuli, the manubrium moves less than the rest of the TM, consistent with the TM acting like a compliant membrane rather than a stiff diaphragm, and also consistent with catenary behavior due to the TM's curved shape.

Mapping the phase and amplitude of ossicular chain motion using sound-synchronous optical coherence vibrography.

The sound-driven vibration of the tympanic membrane and ossicular chain of middle-ear bones is fundamental to hearing. Here we show that optical coherence tomography in phase synchrony with a sound stimulus is well suited for volumetric, vibrational imaging of the ossicles and tympanic membrane. This imaging tool - OCT vibrography - provides intuitive motion pictures of the ossicular chain and how they vary with frequency. Using the chinchilla ear as a model, we investigated the vibrational snapshots and phase delays of the manubrium, incus, and stapes over 100 Hz to 15 kHz. The vibrography images reveal a previously undescribed mode of motion of the chinchilla ossicles at high frequencies.

Otopathologic evaluation of temporalis fascia grafts following successful tympanoplasty in humans.

OBJECTIVE: Temporalis fascia is a commonly used graft material in tympanoplasty; however, little is known about how the histological structure of fascia remodels postimplantation. Herein, we aim to quantify the pre- and postoperative microstructure of temporalis fascia and compare histological findings to the native tympanic membrane (TM). METHODS: Temporal bone specimens having undergone successful subtotal or total drum replacement using temporalis fascia were identified (n = 3). Surgically prepared preimplantation temporalis fascia (PreTF, n = 4) and normal TMs (n = 5) were used as controls. Multiple measurements of thickness of PreTF and of normal and fascia reconstructed TMs at the mesotympanum and hypotympanum were obtained. Collagen fiber patterns of normal and reconstructed TMs were histologically described. RESULTS: In cases of fascia tympanoplasty, the mean time of surgery to death was 16 years (range 8-28 years). All cases contained an aerated middle ear without residual perforation. There was no significant difference between the thickness of PreTF and fascia of reconstructed TMs (234.9 ± 144.9 µm vs. 162.9 ± 71.9 µm, P = 0.1). The lamina propria and total thicknesses of controls (59.8 ± 39.3 µm and 83.7 ± 42.4 µm, respectively) were thinner than the PreTF and fascia-reconstructed TMs, respectively, in all cases (P ≤ 0.001, P ≤ 0.001). Reconstructed TMs contained a thick, longitudinal fiber structure that was qualitatively similar to PreTF. CONCLUSION: Based on human temporal bone specimens, temporalis fascia does not significantly remodel, change thickness, or change fibrous structure following successful tympanoplasty. Results have implications for selection and surgical preparation of graft materials in TM reconstruction. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:E351-E358, 2018.

In-plane and out-of-plane motions of the human tympanic membrane.

Computer-controlled digital holographic techniques are developed and used to measure shape and four-dimensional nano-scale displacements of the surface of the tympanic membrane (TM) in cadaveric human ears in response to tonal sounds. The combination of these measurements (shape and sound-induced motions) allows the calculation of the out-of-plane (perpendicular to the surface) and in-plane (tangential) motion components at over 1,000,000 points on the TM surface with a high-degree of accuracy and sensitivity. A general conclusion is that the in-plane motion components are 10-20 dB smaller than the out-of-plane motions. These conditions are most often compromised with higher-frequency sound stimuli where the overall displacements are smaller, or the spatial density of holographic fringes is higher, both of which increase the uncertainty of the measurements. The results are consistent with the TM acting as a Kirchhoff-Love's thin shell dominated by out-of-plane motion with little in-plane motion, at least with stimulus frequencies up to 8 kHz.

Response of the human tympanic membrane to transient acoustic and mechanical stimuli: Preliminary results.

The response of the tympanic membrane (TM) to transient environmental sounds and the contributions of different parts of the TM to middle-ear sound transmission were investigated by measuring the TM response to global transients (acoustic clicks) and to local transients (mechanical impulses) applied to the umbo and various locations on the TM. A lightly-fixed human temporal bone was prepared by removing the ear canal, inner ear, and stapes, leaving the incus, malleus, and TM intact. Motion of nearly the entire TM was measured by a digital holography system with a high speed camera at a rate of 42 000 frames per second, giving a temporal resolution of <24 µs for the duration of the TM response. The entire TM responded nearly instantaneously to acoustic transient stimuli, though the peak displacement and decay time constant varied with location. With local mechanical transients, the TM responded first locally at the site of stimulation, and the response spread approximately symmetrically and circumferentially around the umbo and manubrium. Acoustic and mechanical transients provide distinct and complementary stimuli for the study of TM response. Spatial variations in decay and rate of spread of response imply local variations in TM stiffness, mass, and damping.

The Effect of Ear Canal Orientation on Tympanic Membrane Motion and the Sound Field Near the Tympanic Membrane.

The contribution of human ear canal orientation to tympanic membrane (TM) surface motion and sound pressure distribution near the TM surface is investigated by using an artificial ear canal (aEC) similar in dimensions to the natural human ear canal. The aEC replaced the bony ear canal of cadaveric human temporal bones. The radial orientation of the aEC relative to the manubrium of the TM was varied. Tones of 0.2 to 18.4 kHz delivered through the aEC induced surface motions of the TM that were quantified using stroboscopic holography; the distribution of sound in the plane of the tympanic ring P TR was measured with a probe tube microphone. The results suggest that the ear canal orientation has no substantial effect on TM surface motions, but P TR at frequencies above 10 kHz is influenced by the ear canal orientation. The complex TM surface motion patterns observed at frequencies above a few kilohertz are not correlated with simpler variations in P TR distribution at the same frequencies, suggesting that the complex sound-induced TM motions are more related to the TM mechanical properties, shape, and boundary conditions rather than to spatial variations in the acoustic stimulus.

Three-dimensional vibrometry of the human eardrum with stroboscopic lensless digital holography.

The eardrum or tympanic membrane (TM) transforms acoustic energy at the ear canal into mechanical motions of the ossicles. The acousto-mechanical transformer behavior of the TM is determined by its shape, three-dimensional (3-D) motion, and mechanical properties. We have developed an optoelectronic holographic system to measure the shape and 3-D sound-induced displacements of the TM. The shape of the TM is measured with dual-wavelength holographic contouring using a tunable near IR laser source with a central wavelength of 780 nm. 3-D components of sound-induced displacements of the TM are measured with the method of multiple sensitivity vectors using stroboscopic holographic interferometry. To accurately obtain sensitivity vectors, a new technique is developed and used in which the sensitivity vectors are obtained from the images of a specular sphere that is being illuminated from different directions. Shape and 3-D acoustically induced displacement components of cadaveric human TMs at several excitation frequencies are measured at more than one million points on its surface. A numerical rotation matrix is used to rotate the original Euclidean coordinate of the measuring system in order to obtain in-plane and out-of-plane motion components. Results show that in-plane components of motion are much smaller (<20%) than the out-of-plane motions' components.

Comparisons of the mechanics of partial and total ossicular replacement prostheses with cartilage in a cadaveric temporal bone preparation.

CONCLUSIONS: Reconstruction of the ossicular chain differentially affects the motion of the tympanic membrane (TM) and the stapes. OBJECTIVES: To determine the effect of different ossicular replacement procedures on the sound-induced motion of the TM and stapes. METHODS: A combination of digital stroboscopic holography and laser Doppler vibrometry was used to determine the sound-induced motion of the TM and stapes in cadaveric temporal bones in which the ossicular chain was reconstructed using 12 varied standard techniques. The variations included the use of total or partial ossicular prosthesis, size of cartilage interposed between the TM and the prosthesis, and the length or fit of the prosthesis between the TM and stapes. The measurements were carried out in repeated measures format, so that each manipulation was performed in each temporal bone. RESULTS: The volume displacement of the TM was in general reduced by reconstruction, with the largest reductions occurring with high-frequency stimulation in the reconstructions with a 'large' cartilage oval interposed between the TM and the prosthesis. Larger stapes motions in response to low-frequency sound were observed with either 'loose' or 'best' fit TORP with a 'small' cartilage plate between the TM and the prosthesis.

Viscoelastic properties of the human tympanic membrane studied with stroboscopic holography and finite element modeling.

A new anatomically-accurate Finite Element (FE) model of the tympanic membrane (TM) and malleus was combined with measurements of the sound-induced motion of the TM surface and the bony manubrium, in an isolated TM-malleus preparation. Using the results, we were able to address two issues related to how sound is coupled to the ossicular chain: (i) Estimate the viscous damping within the tympanic membrane itself, the presence of which may help smooth the broadband response of a potentially highly resonant TM, and (ii) Investigate the function of a peculiar feature of human middle-ear anatomy, the thin mucosal epithelial fold that couples the mid part of the human manubrium to the TM. Sound induced motions of the surface of ex vivo human eardrums and mallei were measured with stroboscopic holography, which yields maps of the amplitude and phase of the displacement of the entire membrane surface at selected frequencies. The results of these measurements were similar, but not identical to measurements made in intact ears. The holography measurements were complemented by laser-Doppler vibrometer measurements of sound-induced umbo velocity, which were made with fine-frequency resolution. Comparisons of these measurements to predictions from a new anatomically accurate FE model with varied membrane characteristics suggest the TM contains viscous elements, which provide relatively low damping, and that the epithelial fold that connects the central section of the human manubrium to the TM only loosely couples the TM to the manubrium. The laser-Doppler measurements in two preparations also suggested the presence of significant variation in the complex modulus of the TM between specimens. Some animations illustrating the model results are available at our website (www.uantwerp.be/en/rg/bimef/downloads/tympanic-membrane-motion).

Wave motion on the surface of the human tympanic membrane: holographic measurement and modeling analysis.

Sound-induced motions of the surface of the tympanic membrane (TM) were measured using stroboscopic holography in cadaveric human temporal bones at frequencies between 0.2 and 18 kHz. The results are consistent with the combination of standing-wave-like modal motions and traveling-wave-like motions on the TM surface. The holographic techniques also quantified sound-induced displacements of the umbo of the malleus, as well as volume velocity of the TM. These measurements were combined with sound-pressure measurements near the TM to compute middle-ear input impedance and power reflectance at the TM. The results are generally consistent with other published data. A phenomenological model that behaved qualitatively like the data was used to quantify the relative magnitude and spatial frequencies of the modal and traveling-wave-like displacement components on the TM surface. This model suggests the modal magnitudes are generally larger than those of the putative traveling waves, and the computed wave speeds are much slower than wave speeds predicted by estimates of middle-ear delay. While the data are inconsistent with simple modal displacements of the TM, an alternate model based on the combination of modal motions in a lossy membrane can also explain these measurements without invoking traveling waves.

Measurements of three-dimensional shape and sound-induced motion of the chinchilla tympanic membrane.

UNLABELLED: Opto-electronic computer holographic measurements were made of the tympanic membrane (TM) in cadaveric chinchillas. Measurements with two laser wavelengths were used to compute the 3D-shape of the TM. Single laser wavelength measurements locked to eight distinct phases of a tonal stimulus were used to determine the magnitude and the relative phase of the surface displacements. These measurements were made at over 250,000 points on the TM surface. The measured motions contained spatial phase variations consistent with relatively low-order (large spatial frequency) modal motions and smaller magnitude higher-order (smaller spatial frequency) motions that appear to travel, but may also be explained by losses within the membrane. The measurement of shape and thin shell theory allowed us to separate the measured motions into those components orthogonal to the plane of the tympanic ring, and those components within the plane of the tympanic ring based on the 3D-shape. The predicted in-plane motion components are generally smaller than the out-of-plane perpendicular component of motion. Since the derivation of in-plane and out-of plane depended primarily on the membrane shape, the relative sizes of the predicted motion components did not vary with frequency. SUMMARY: A new method for simultaneously measuring the shape and sound-induced motion of the tympanic membrane is utilized to estimate the 3D motion on the membrane surface. This article is part of a special issue entitled "MEMRO 2012".

Digital holographic measurements of shape and 3D sound-induced displacements of Tympanic Membrane.

Acoustically-induced vibrations of the Tympanic Membrane (TM) play a primary role in the hearing process, in that these motions are the initial mechanical response of the ear to airborne sound. Characterization of the shape and 3D displacement patterns of the TM is a crucial step to a better understanding of the complicated mechanics of sound reception by the ear. In this paper, shape and sound-induced 3D displacements of the TM in cadaveric chinchillas are measured by a lensless Dual-Wavelength Digital Holography system (DWDHS). The DWDHS consists of Laser Delivery (LD), Optical Head (OH), and Computing Platform (CP) subsystems. Shape measurements are performed in double-exposure mode and with the use of two wavelengths of a tunable laser while nanometer-scale displacements are measured along a single sensitivity direction and with a constant wavelength. In order to extract the three principal components of displacement in full-field-of-view, and taking into consideration the anatomical dimensions of the TM, we combine principles of thin-shell theory together with both, displacement measurements along the single sensitivity vector and TM surface shape. To computationally test this approach, Finite Element Methods (FEM) are applied to the study of artificial geometries.