[New clinical applications for laser Doppler vibrometry in otology]. / Neue klinische Anwendungen der Laser-Doppler-Vibrometrie in der Otologie.

BACKGROUND: An instrument to measure vibration in the middle ear needs to be sensitive enough to detect displacement on a nanometer scale, yet not affect the vibration itself. Numerous techniques have been described in the literature, but laser Doppler vibrometry (LDV) has nowadays become established as the standard method in hearing research. OBJECTIVE: This article aims to present possible clinical applications of an LDV system in otology. MATERIALS AND METHODS: A commercially available single-point vibrometer was used. Measurements were carried out both with the sensor head mounted on an operating microscope and as a handheld device with the sensor head manually inserted in the ear canal. For the latter, a custom-made unit containing an electrically tunable lens was attached to the sensor head. Middle ear vibrations were measured in a temporal bone model as well as in patients during and after implantation of a Vibrant Soundbridge (VSB; MED-EL Corp., Durham/NC, USA). RESULTS: Different types of middle ear pathologies can be distinguished by the frequency response of the umbo. The LDV technique can be used for intraoperative quantification of the coupling quality of the VSB's Floating Mass Transducer (FMT; MED-EL) to the ossicle chain during VSB implantation. Postoperatively, the method serves as a follow-up testing tool if a deterioration in aided hearing threshold occurs. The measurement can reveal changes in the umbo transfer function, e. g., due to middle ear scarring or dislocation of the FMT. CONCLUSION: Many clinical questions in otology can be addressed by LDV. However, due to the high acquisition costs of an LDV system, the relatively large instrumental setup, and the large inter-ear variability of middle-ear function, the technique has not (yet) become established in clinical routine.

Middle and inner ear modelling: from microCT images to 3D reconstruction and coupling of models.

We present finite element (FE) modeling approaches of ear mechanics including 3-dimensional (3D) reconstruction of the human middle and inner ear. Specifically, we demonstrate a semi-automatic methodology for the 3D reconstruction of the inner ear structures, a FE harmonic response model of the middle ear to predict the stapes footplate frequency response, a 2D FE slice model of the cochlea for the coupled response at the micromechanical level for either acoustic or electrical excitation and a coupled FE middle ear model with a simplified cochlea box model to simulate the basilar membrane velocity in response to acoustic excitation. The proposed methodologies are validated against experimental and literature data and the results are in good agreement.

Finite element model of the stapes-inner ear interface.

Since 1958, stapedotomy has been the method of choice for middle ear surgeons who operate on patients suffering from otosclerosis, especially stiffening of the interface between the stapes footplate of the middle ear and the oval window, which is a part of the cochlea of the inner ear. Later, many surgeons started to use the Schuknecht prosthesis, which consists of cartilage and is inserted into the complete opened oval window during stapedectomy. Our study shows that basilar membrane (BM) displacement is increased with an increasing stapes footplate area by a numerical simulation including the different geometries. An increase in the footplate area leads to an increase in BM displacement equivalent to 13 dB. Therefore, we recommend prostheses with areas as big as the normal stapes footplate area.

3D-finite element model of the human cochlea including fluid-structure couplings.

The propagation of acoustic waves in the inner ear in vivo could not be quantified completely yet. This is in particular true in conjunction with the micromechanical structures of the organ of Corti, though these data are important for the explanation and discussion of clinical measurements like otoacoustic emissions and auditory brainstem responses. To access these problems a three-dimensional mechanical model of the cochlea including the fluid-structure couplings is developed and evaluated numerically by finite elements. Although the complex cochlear partition is covered by passive mechanical elements, the results fit early experiments (1928), which studied the wave propagation in the cochlea with fresh human cadavers [G. von Békésy: Experiments in Hearing. New York, McGraw-Hill, 1960]. Additionally it is now easy to calculate the mechanical input impedance of the cochlea. These results agree with recent experiments [S.N. Merchant et al.: Hear Res 1996;97:30-45].

Active nonlinear mechanics of the organ of Corti including the stereocilia-tectorial membrane complex.

There is a large amount of knowledge about the different components of the organ of Corti (OC), but little is known about how these components act together in vivo. To clarify the complex mechanical behavior of the OC, anatomic results are carefully analyzed and used to develop a finite element model of a short section of OC, which includes 8 outer hair cells (OHC) and their supporting structures. The modal analysis shows the frequency-dependent phase reversal of the radial stereocilia displacement. The transient computation confirms the amplification of OC displacements when the ability of the OHC to contract and elongate is considered. The inclusion of a nonlinear function describing the mechanoelectrical transduction in OHC amplifies and distorts the displacement of the OC when it is stimulated by a sinusoidal input pressure function. These results are in agreement with other psychoacoustic, electrophysiologic and otoacoustic measurements.

Nonlinear mechanics of the organ of Corti caused by Deiters cells.

Though the organ of Corti (OC) has been an object of experimental and theoretical hearing research, open questions remain concerning the processing of acoustic signals by the cochlea where the OC is located. Today there is extensive knowledge about single parts of the organ but a lack of understanding as to how these elements act together. One of the reasons for this is the missing analysis of the mechanics of the OC in three dimensions. In order to fill this gap, we have analyzed a short section (0.06 mm) of the basilar membrane including the OC and evaluated its nonlinear finite element model numerically. The Deiters cells are idealized as thin elastic beams with a comparably low modulus of elasticity of actin. Therefore, they show nonlinear mechanical behavior generating additional frequency components with two-tone stimulation.

[Correlation of the latency shift and brain stem potentials in basocochlear hearing loss and the time course of the click stimulus-induced evoked wave in the cochlea]. / Zusammenhang zwischen der Latenzverschiebung der Hirnstammpotentiale bei basokochleärer Schwerhörigkeit und dem Zeitverlauf der durch den Klick-Reiz ausgelösten Erregungswelle in der Kochlea.

Frequency-specific information on high tone loss in the inner ear can, and if so only indirectly, be obtained from changes in latency of the click-evoked brain stem potential (ABR). The relationship between latency increases of the Jewett-wave-V in basocochlear hearing loss and the time course of the travelling wave on the basilar membrane will be presented. The latency increases of basocochlear hearing loss at 2 kHz, 1 kHz and 500 Hz correspond to both the computer-simulated time course of the travelling wave and to those of the derived responses. From a pathophysiological standpoint, receptor cells in basocochlear hearing loss are not functional, beginning at the oval window, so that, dependent on the degree of inactivity, a delay corresponding to that of the time course of the travelling wave passes until active hair cells are reached and action potentials released that produce, when summed up a potential of delayed latency.

[Effect of cochlear processes in generating Jewett IV and V brain stem potential components]. / Einfluss kochleärer Prozesse bei der Generierung der Hirnstammpotentialkomponenten Jewett IV and V.

Polarity of the stimulus influences latency, amplitude and waveform of the human auditory brainstem response (ABR). One clear feature is the splitting of the wave complex JIV and JV in separate peaks following rarefaction stimulation. ABR was recorded using high-pass filtering to mask the basilar membrane partially to establish whether and to what extent basal hair cells contribute to waves IV and V. Wave IV disappeared in response to rarefaction stimuli with masking of the basal region. In contrast, wave V appeared with reduced amplitude and delayed latency in response to condensation stimuli. A model was developed to determine the motion of the basilar membrane and the distribution over time of the action potential on the auditory nerve fibers following rarefaction and condensation stimuli. The rarefaction stimulus produces a bifid and the condensation stimulus only a single-peaked contribution. It is suggested that the splitting of the wave complex IV and V may be traced to mechanical processing in the cochlea.

[Response latency characteristics for ENT medical assessment of auditory brain stem evoked response]. / Pegel-Latenz-Kennlinienfelder zur HNO-ärztlichen Befundhilfe bei der BERA.

A schematic description of the correlation between the various types of hearing disorders and the behaviour of auditory brain stem responses (ABR) is presented. Conductive pathology and high-frequency cochlear hearing loss prolong wave component latency due to energy loss and hair cell dysfunction. Latency is not affected in flat cochlear hearing loss. Prolonged interwave latencies between wave I and wave V indicate eighth nerve and brain stem disorders. An algorithm in the form of a flow chart was developed for location of the malfunction. Families of characteristics of wave V intensity-latency functions were designed for faster detection and more precise evaluation of conductive and cochlear hearing losses.

Click ABR intensity-latency characteristics in diagnosing conductive and cochlear hearing losses.

A schematic description of the correlation between various pathologies of hearing impairments and the behavior of auditory brainstem responses (ABR) is presented. Conductive pathology and high-frequency cochlear hearing losses prolong wave component latency due to energy loss and hair cell dysfunction. In cases of flat cochlear hearing loss latency is not affected. Prolonged interwave latencies between wave I and wave V indicate eight nerve and brainstem disorders. An algorithm was developed in the form of a flow chart for locating various malfunctions. Fields of wave V intensity-latency functions were designed for the faster detection and more precise evaluation of conductive and cochlear hearing losses.

[Spatial representation of basilar membrane movement with 3D computer graphics]. / Räumliche Darstellung der Basilarmembranbewegung mit 3D-Computergraphik.

A mathematical model of the cochlea was implemented on a computer. The basilar membrane motion was computed for single, two, and multi-tone stimuli as well as for musical sounds and vowels. The pattern of the travelling waves were presented in three-dimensional color computer graphics. The high performance 3D graphics system performs local hidden surface removal, 3D geometric transformations and supports local lighting models to generate truly realistic shading for complex 3D objects. An addressable 1280 by 1024 pixel matrix assures crisp, precise resolution of the finest detail in the graphic images. The spatial pattern of basilar membrane motion conveys an impression of the image of acoustic stimuli on the basilar membrane. Firstly, the motion pattern of the travelling wave to a single tone is presented. The superposition of several tones (two-tone, multi-tone) causes a superposition of the travelling waves along the basilar membrane whereby the place principle in the cochlear partition becomes more clearly recognizable. Sounds (flute and violin) and vowels (German "u" and "i") evoke a complex motion pattern on the basilar membrane. The realization of the chronological order of movements on the basilar membrane can be made by computer animation. This enables the analysis of the space-time patterns of complex acoustic stimuli.