A New, Promising Experimental Ossicular Prosthesis: A Human Temporal Bone Study With Laser Doppler Vibrometry.

OBJECTIVE: We compared the sound transmission using different types of total ossicular replacement prostheses (TORP); we then studied the performance of a new TORP that we designed inspired by the columella, the single ossicle found in birds. METHODS: Stapedial vibrations were measured on nine freshly frozen human temporal bones with laser Doppler vibrometry. We then compared the performances of eight common TORP positions or designs as well as the new silver prototype of bird-type prosthesis, designed also according to our digital holography patterns of the human tympanic membrane (TM). RESULTS: The TORPs placed in lateral contact with both the TM and the malleus handle outperformed, at most frequencies, those placed only in contact with the TM.The new bird-type prosthesis performed equally well or better than all other prostheses. CONCLUSION: If the malleus handle can be retained when placing a TORP, the best sound transmission can be achieved by placing the TORP in contact with both the distal part of the malleus handle and the TM. The good performance of our bird-type prosthesis suggests that there is still room for future improvement of prosthesis design to further optimize hearing outcomes after surgery.

Eardrum displacement and strain in the Tokay gecko (Gekko gecko) under quasi-static pressure loads.

The eardrum is the primary component of the middle ear and has been extensively investigated in humans. Measuring the displacement and deformation of the eardrum under different quasi-static loading conditions gives insight in its mechanical behavior and is fundamental in determining the material properties of the eardrum. Currently, little is known about the behavior and material properties of eardrums in non-mammals. To explore the mechanical properties of the eardrum in non-mammalian ears, we investigated the quasi-static response of the eardrum of a common lizard: the Tokay gecko (Gekko gecko). The middle ear cavity was pressurized using repetitive linear pressure cycles ranging from -1.5 to 1.5 kPa with pressure change rates of 0.05, 0.1 and 0.2 kPa/s. The resulting shape, displacement and in-plane strain of the eardrum surface were measured using 3D digital image correlation. When middle-ear pressure is negative, the medial displacement of the eardrum is much larger than the displacement observed in mammals; when middle-ear pressure is positive, the lateral displacement is much larger than in mammals, which is not observed in bird single-ossicle ears. Peak-to-peak displacements are about 2.8 mm, which is larger than in any other species measured up to date. The peak-to-peak displacements are at least five times larger than observed in mammals. The pressure-displacement curves show hysteresis, and the energy loss within one pressure cycle increases with increasing pressure rate, contrary to what is observed in rabbit eardrums. The energy lost during a pressure cycle is not constant over the eardrum. Most energy is lost at the region where the eardrum connects to the hearing ossicle. Around this eardrum-ossicle region, a 5% increase in energy loss was observed when pressure change rate was increased from 0.05 kPa/s to 0.2 kPa/s. Other parts of the eardrum showed little increase in the energy loss. The orientation of the in-plane strain on the eardrum was mainly circumferential with strain amplitudes of about +1.5%. The periphery of the measured eardrum surface showed compression instead of stretching and had a different strain orientation. The TM of Gekko gecko shows the highest displacements of all species measured up till now. Our data show the first shape, displacement and deformation measurements on the surface of the eardrum of the gecko and indicate that there could exist a different hysteresis behavior in different species.

Evaluation of Artificial Fixation of the Incus and Malleus With Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) in a Temporal Bone Model.

BACKGROUND: A significant number of adults suffer from conductive hearing loss due to chronic otitis media, otosclerosis, or other pathologies. An objective measurement of ossicular mobility is needed to avoid unnecessarily invasive middle ear surgery and to improve hearing outcomes. METHODS: Minimally invasive intraoperative laser vibrometry provides a method that is compatible with middle ear surgery, where the tympanic membrane is elevated. The ossicles were driven by a floating mass transducer and their mobility was measured using a laser Doppler vibrometer. Utilising this method, we assessed both the absolute velocities of the umbo and incus long process as well as the incus-to-umbo velocity ratio during artificial fixation of the incus alone or incus and malleus together. RESULTS: The reduction of absolute velocities was 8 dB greater at the umbo and 17 dB at the incus long process for incus-malleus fixations when compared with incus fixation alone. Incus fixation alone resulted in no change to the incus-to-umbo velocity ratio where incus-malleus fixations reduced this ratio (-11 dB). The change in incus velocity was shown to be the most suitable parameter to distinguish between incus fixation and incus-malleus fixation. When the whole frequency range was analyzed, one could also differentiate these two fixations from previously published stapes fixation, where the higher frequencies were less affected. CONCLUSION: Minimally invasive intraoperative laser vibrometry provides a promising objective analysis of ossicular mobility that would be useful intraoperatively.

Strain distribution in rabbit eardrums under static pressure.

Full-field strain maps of intact rabbit eardrums subjected to static pressures are presented. A stochastic intensity pattern was applied to 12 eardrums, and strain maps were measured at the medial site using a stereoscopic digital image correlation setup for pressures between -2 and 2 kPa. Ear canal overpressures induced circumferential orientated positive strains between manubrium and the eardrum border that increased almost linearly with pressure. Radially orientated negative strains were found at the border and manubrium. Ear canal underpressures caused negative circumferential strains between manubrium and the tympanic annulus but radially orientated positive strains at the borders. The magnitudes of these negative strains at underpressures were larger than those of positive strains at overpressures and were nonlinearly proportional to pressure. In three ears, strains were calculated with intact and removed cochlea. The effect of cochlea removal on the peak-to-peak strain was found to be no more than 3%.

Average middle ear frequency response curves with preservation of curve morphology characteristics.

For the validation of modelling results or the comparison of middle ear interventions, such as prostheses placement, average responses of middle ear vibrations are needed. One such response is the amplitude and phase of the vibration of the stapes footplate as a function of frequency. Average responses and their standard deviation are commonly obtained by calculating the mean of a number of measured responses at each frequency. A typical middle ear magnitude response curve shows a number of distinct peaks, and the location of these peaks varies between ears. By simply taking an average along the magnitude or phase response axis, the typical fine structure of the response curve is flattened out, delivering an average curve which no longer has the typical morphology of an individual response curve. This paper introduces methods to avoid this problem by first aligning the typical curve features along the frequency axis prior to calculating the average along the magnitude or phase axis, resulting in average magnitude and phase curves which maintain the typical morphology of the curve obtained for an individual ear. In the method, landmark points on the response magnitude curves are defined and the frequencies at which these points occur are averaged. Next, these average frequencies are used to align the landmark points between curves, prior to averaging values along the magnitude or phase axes. Methods for semi-automatic and manual assignment of landmark points and curve alignment are presented. After alignment, the correspondence between the original landmark frequencies and aligned frequencies is obtained together with the warping function which maps each original magnitude curve to its aligned version. The phase curves are aligned using the warping functions determined from the corresponding magnitude curves. Finally, a method is proposed to compare the data set of an individual measurement or model result to an aligned average curve in terms of magnitude and frequency by applying the alignment procedure to the individual curve.

An Optimal Partial Ossicular Prosthesis Should Connect Both to the Tympanic Membrane and Malleus: A Temporal Bone Study Using Laser Doppler Vibrometry.

OBJECTIVE: To compare stapes vibrations in different partial ossicular replacement prosthesis (PORP) applications. METHODS: Stapedial vibrations were measured on fresh frozen human temporal bones with laser Doppler vibrometry. Eight different types of common ossiculoplasty methods were compared regarding recovery of stapes vibrations in relation with the normal ossicular chain. The PORPs were divided into three groups: 1) PORPs with the lateral contact only with the tympanic membrane, 2) PORPs with lateral contact only to the malleus handle, and 3) PORPs with lateral contact with both the malleus handle and the tympanic membrane. RESULTS: The PORPs with lateral contact only to the malleus handle performed better than the PORPs with lateral contact to the tympanic membrane only at 2 kHZ, but the best recovery was found in the group with contact both to the malleus handle and the tympanic membrane. CONCLUSION: The best sound transmission might be achieved by placing a PORP in contact with both the tympanic membrane and the handle of the malleus.

Minimally invasive laser vibrometry (MIVIB) with a floating mass transducer - A new method for objective evaluation of the middle ear demonstrated on stapes fixation.

Ossicular fixation through otosclerosis, chronic otitis media and other pathologies, especially tympanosclerosis, are treated by surgery if hearing aids fail as an alternative. However, the best hearing outcome is often based on knowledge of the degree and location of the fixation. Objective methods to quantify the degree and position of the fixation are largely lacking. Laser vibrometry is a known method to detect ossicular fixation but clinical applicability remains limited. A new method, minimally invasive laser vibrometry (MIVIB), is presented to quantify ossicle mobility using laser vibrometry measurement through the ear canal after elevating the tympanic membrane, thus making the method feasible in minimally invasive explorative surgery. A floating mass transducer provides a clinically relevant transducer to drive ossicular vibration. This device was attached to the manubrium and drove vibrations at the same angle as the longitudinal axis of the stapes and was therefore used to assess ossicular chain mobility in a fresh-frozen temporal bone model with and without stapes fixation. The ratio between the umbo and incus long process was shown to be useful in assessing stapes fixation. The incus-to-umbo velocity ratio decreased by 15 dB when comparing the unfixated situation to stapes fixation up to 2.5 kHz. Such quantification of ossicular fixation using the incus-to-umbo velocity ratio would allow quick and objective analysis of ossicular chain fixations which will assist the surgeon in surgical planning and optimize hearing outcomes.