The curvature quantification of wave I in auditory brainstem responses detects cochlear synaptopathy in human beings.

PURPOSE: Patients with age-related hearing loss complain often about reduced speech perception in adverse listening environment. Studies on animals have suggested that cochlear synaptopathy may be one of the primary mechanisms responsible for this phenomenon. A decreased wave I amplitude in supra-threshold auditory brainstem response (ABR) can diagnose this pathology non-invasively. However, the interpretation of the wave I amplitude in humans remains controversial. Recent studies in mice have established a robust and reliable mathematic algorithm, i.e., curve curvature quantification, for detecting cochlear synaptopathy. This study aimed to determine whether the curve curvature has sufficient test-retest reliability to detect cochlear synaptopathy in aging humans. METHODS: Healthy participants were recruited into this prospective study. All subjects underwent an audiogram examination with standard and extended high frequencies ranging from 0.125 to 16 kHz and an ABR with a stimulus of 80 dB nHL click. The peak amplitude, peak latency, curvature at the peak, and the area under the curve of wave I were calculated and analyzed. RESULTS: A total of 80 individuals with normal hearing, aged 18 to 61 years, participated in this study, with a mean age of 26.4 years. Pearson correlation analysis showed a significant negative correlation between curvature and age, as well as between curvature and extended high frequency (EHF) threshold (10-16 kHz). Additionally, the same correlation was observed between age and area as well as age and EHF threshold. The model comparison demonstrated that the curvature at the peak of wave I is the best metric to correlate with EHF threshold. CONCLUSION: The curvature at the peak of wave I is the most sensitive metric for detecting cochlear synaptopathy in humans  and may be applied in routine diagnostics to detect early degenerations of the auditory nerve.

Transimpedance Matrix Can Be Used to Estimate Electrode Positions Intraoperatively and to Monitor Their Positional Changes Postoperatively in Cochlear Implant Patients.

OBJECTIVE: Accurate positioning of the electrode array during cochlear implant (CI) surgery is crucial for achieving optimal hearing outcomes. Traditionally, postoperative radiological imaging has been used to assess electrode position. Transimpedance matrix (TIM) measurements have also emerged as a promising method for assessing electrode position. This involves utilizing electric field imaging to create an electric distance matrix by analyzing voltage variations among adjacent electrodes. This study aimed to investigate the feasibility of using intraoperative TIM measurements to estimate electrode position and monitor postoperative changes. STUDY DESIGN: Retrospective cohort study. SETTING: University Medical center, tertiary academic referral center. PATIENTS: Patients undergoing CI (CI622) surgery between January 2019 and June 2022. INTERVENTION: CI electrode positions and maximal angular insertion depths (maxAID) were determined using X-ray imaging according to Stenvers' projection. The mean gradient phase (MGP) was extracted from the TIM, and a correlation between the MGP and maxAID was examined. A model was then built to estimate the maxAID using the MGP, and changes in electrode location over time were assessed using this model. MAIN OUTCOME MEASURES: Twenty-four patients were included in this study. A positive correlation between the maxAID and the MGP ( R = 0.7, p = 0.0001) was found. The established model was able to predict the maxAID with an accuracy of 27.7 ± 4.4°. Comparing intraoperative and postoperative TIM measurements, a decrease of 24.1° ± 10.7° in maxAID over time was observed. CONCLUSION: TIM measurements are useful for estimating the insertion depth of the electrode and monitoring changes in the electrode's position over time.

Automated detection of electrically evoked stapedius reflexes (eSR) during cochlear implantation.

INTRODUCTION: In cochlear implantation, objective fitting methods are needed to optimize audiological results in small children or patients with poor compliance. Intraoperatively measured electrically evoked stapedius reflexes (eSR) can be used as a marker for the patient's discomfort level. The aim of this study was to develop and evaluate an automated detection method for eSR and to compare it to the detection rate of the surgeon and independent observers. METHODS: Cochlear implantation using a fully digital surgical microscope was performed. Movements of the stapedius tendon were recorded and analyzed by means of computer vision technique. Differences in eSR elicited by stimulating electrodes at different cochlear locations (basal, middle and apical) were analyzed. The eSR detection rate of the image processing algorithm was compared to the surgeon's detection rate and to those of two less experienced observers. RESULTS: A total of 387 electrically impulses were applied. The stimulation of middle turn electrodes showed significantly higher detection rates (50.4%) compared to the basal (40.0%; p = 0.001) and apical (43.6%; p = 0.03) turn. The software identified significantly more of the applied stimuli (58.4%) compared to the surgeon (46.3%; p = 0.0007), the intermediate observer (37.7%; p < 0.0001) and the unexperienced observer (41.3%; p < 0.0001). CONCLUSION: The feasibility of an automated intraoperative software-based detection of eSR is demonstrated. By improving the eSR detection methods and their clinical applicability, their utility in objective cochlear implant fitting may be substantially increased.

Three-dimensional force analysis of surgical manipulations at the long process of the incus.

PURPOSE: Surgical manipulation with application of inappropriate force may damage middle ear structures leading to hearing loss. This work analyzes the forces applied in simulated otosurgical exercises in a laboratory set-up by measuring the spatial components of applied forces with objective assessment criteria. With these criteria, the individual force characteristics applied by the surgeon can be quantified and an objective feedback can be given about their surgical maneuvers. METHODS: A natural size model of the human incus was mounted on a load cell to measure the spatial forces in all three directions during different manipulation tasks performed under the microscope by ten surgeons from our department having different levels of experience in otosurgery. The motions of the incus model and the instrument tip were recorded simultaneously with a video camera. RESULTS: Independent of surgical experience, a three-dimensional force pattern could be detected with components transverse to the desired force directions. The measured forces applied by trainees showed larger variations in magnitude, in spatial distribution and in temporal course than those applied by experienced surgeons. A better repeatability of identical tasks, constancy of force patterns and low peak force values could be seen in the group of experienced surgeons. CONCLUSIONS: The laboratory system presented in this study using simultaneous video and 3-D force registration allows the objective assessment of surgical manipulations, e.g., at the long process of the incus. Training with video and force feedback provides information about surgical techniques and skill development of surgeons and has the potential to shorten the learning curve and to diminish intra-operative risks to patients.

On the origin of ear clicks during deglutition or pressure equalization.

To explore the origin of clicking sounds in the ear during deglutition or other pharyngeal movements, which are interpreted differently in the literature. Experimental study at a tertiary referral centre. Acoustic phenomena during a forced opening test of the Eustachian tube (ET) were studied in a temporal bone model. Additionally, in vivo experiments were carried out in healthy volunteers for ruling out movements of the ossicular chain or the drumhead as potential causes of clicks. Thus, acoustic recordings were performed parallel to stapedius or tensor reflex measurements or pneumatic video endoscopies of the tympanic membrane. Obviously the acoustic signals (clicks) appear when the tube opens, which could be visualized and acoustically recorded during forced opening tests in temporal bone experiments. Middle ear muscle contractions with movements of the tympanic membrane did not cause any click events. Together with the results of a previous paper (9) we interpret the clicks as disruptions of fluid or mucus films covering the mucosa during the ET opening. The final goal of our studies is to use such clicks as indicators of ET openings in a new tube function test, which has to be elaborated.

"Physiological" Ear Clicking: Its Origin and Potential Usability as a Test Tool for the Eustachian Tube Function.

OBJECTIVE: To explore the origin of "physiological" ear clicks during deglutition or other pharyngeal movements, which, in contrast to disturbing frequent clicks under pathologic conditions, mostly remain unnoticed by the patient. STUDY DESIGN: Clinical experimental study at a tertiary referral center. METHODS: Ear clicks were recorded by a microphone sealing the external ear canal parallel to endoscopic or manometric evaluations of the Eustachian tube function. RESULTS: Obviously, the acoustic signals (clicks) appear when the tube opens. The clicks might be explained by a disruption of fluid or mucus films covering the mucosa. As in our tests clicks could be recorded regularly, they might potentially be used as indicators in a new tube function test, which has to be elaborated.

Can nasal decongestants improve eustachian tube function?

OBJECTIVE: To evaluate the effect of nasal decongestants on eustachian tube (ET) opening. STUDY DESIGN: A prospective nonrandomized study. SETTING: A tertiary referral center. PATIENTS: Twenty-four patients (44 ears) with intact eardrums, 39 patients (43 ears) having a noninfected eardrum defect, and six patients with an upper airway infection. INTERVENTIONS: Nasal or intratympanal (in perforated ears) application of a nasal decongestant (xylometazoline 0.1%). MAIN OUTCOME MEASURES: Change of tube opening quality (yes or no; better or worse) measuring tube opening parameters (pressure, latency) using the Estève method and pressure equalization tests (swallowing at negative and positive external ear canal pressures). RESULTS: In most cases, nasal decongestion or intratympanal use of decongestants have no effect on ET opening. Improvement in tube opening is rather an exception and, in a minority of patients, a reduced ET function was evident. CONCLUSION: Our acute studies revealed no improvement in eustachian ventilatory tube function with the administration of nasal decongestants.

Would an endosteal CI-electrode make sense? Comparison of the auditory nerve excitability from different stimulation sites using ESRT measurements and mathematical models.

UNLABELLED: Regarding potential endosteal cochlear implant electrodes, the primary goal of this paper is to compare different intra- and extra-cochlear stimulation sites in terms of current strengths needed for stimulating the auditory nerve. Our study was performed during routine cochlear implantation using needle electrodes for electric stimulation and by visually recording electrically elicited stapedius reflexes (ESRT) as a measure for the stimulus transfer. Of course this rather simple setup only allows rough estimations, which, however, may provide further arguments whether or not to proceed with the concept of an endosteal electrode. In addition, a mathematical model is being developed. In a pilot study, intra-operative electric stimuli were applied via a needle electrode commonly used for the promontory stimulation test. Thus, stapedius reflex thresholds (ESRTs), electrically elicited via the needle from different points inside and outside the cochlea served as indicators for the suitability of different electrode positions towards the modiolus. Tests were performed on 11 CI-recipients. In addition, the extension of electrical fields from different stimulation sites is simulated in a mathematical cochlea model. In most patients ESRT measurements could be performed and evaluated. Thus an "endosteal" stimulation seems possible, although the current intensities must be higher than at intraluminal stimulation sites. Moreover, our model calculations confirm that the extension of electric fields is less favourable with increasing distance from the electrode to the ganglion nerve cells. In terms of hearing, the concept of an endosteal electrode should only be promoted, if its superiority for hearing preservation can be proven, e.g. in animal experiments. However, for other indications like the electric suppression of tinnitus, further research seems advisable. LEVELS OF EVIDENCE: N/A.

Experiments on the mechanism of underwater hearing.

CONCLUSION: The findings suggest that underwater sound perception is realized by the middle ear rather than by bone conduction, at least in shallow water conditions. OBJECTIVE: To prove whether underwater sound perception is effected by bone conduction or by conduction via the middle ear. METHODS: Five divers, breathing through snorkels, were tested in a swimming pool, to determine whether a sound was louder when the acoustic source placed was in front of the head in comparison with a lateral application facing the ear region. The second experiment investigated whether sound perception is influenced by ear protection plugs in underwater conditions. Also, the effect of a 5 mm thick neoprene hood was determined, with and without an additional perforation in the ear region. RESULTS: Sounds were louder when applied from a position laterally facing the ear, louder without than with a protection plug, louder without than with a neoprene hood on, and louder when the neoprene hood had a perforation in the region of the ear than with an intact hood.