Comparison of sheep and human middle-ear ossicles: anatomy and inertial properties.

The sheep middle ear has been used in training to prepare physicians to perform surgeries and to test new ways of surgical access. This study aimed to (1) collect anatomical data and inertial properties of the sheep middle-ear ossicles and (2) explore effects of these features on sound transmission, in comparison to those of the human. Characteristic dimensions and inertial properties of the middle-ear ossicles of White-Alpine sheep (n = 11) were measured from high-resolution micro-CT data, and were assessed in comparison with the corresponding values of the human middle ear. The sheep middle-ear ossicles differed from those of human in several ways: anteroinferior orientation of the malleus handle, relatively small size of the incus with a relatively short distance to the lenticular process, a large area of the articular surfaces at the incudostapedial joint, and a relatively small moment of inertia along the anterior-posterior axis. Analysis in this study suggests that structure and orientation of the middle-ear ossicles in the sheep are conducive to an increase in the hinge-like ossicular-lever-action around the anterior-posterior axis. Considering the substantial anatomical differences, outcomes of middle-ear surgeries would presumably be difficult to assess from experiments using the sheep middle ear.

Fully implantable hearing aid in the incudostapedial joint gap.

A fully implantable hearing aid is introduced which is a combined sensor-actuator-transducer designed for insertion into the incudostapedial joint gap (ISJ). The active elements each consist of a thin titanium membrane with an applied piezoelectric single crystal. The effectiveness of the operating principle is verified in a temporal bone study. We also take a closer look at the influence of an implantation-induced increase in middle ear stiffness on the transducer's output. An assembly of the transducer with 1 mm thickness is built and inserted into six temporal bones. At this thickness, the stiffness of the annular ligament is considerably increased, which leads to a loss in functional gain for the transducer. It is assumed that a thinner transducer would reduce this effect. In order to examine the performance for a prospective reduced pretension, we increased the gap size at the ISJ by 0.5 mm by removing the capitulum of the stapes in four temporal bones. The TM is stimulated with a broadband multisine sound signal in the audiological frequency range. The movement of the stapes footplate is measured with a laser Doppler vibrometer. The sensor signal is digitally processed and the amplified signal drives the actuator. The resulting feedback is minimized by an active noise control least mean square (LMS) algorithm which is implemented on a field programmable gate array. The dynamic range and the functional gain of the transducer in the temporal bones are determined. The results are compared to measurements from temporal bones without ISJ extension and to the results of Finite Elements Model (FE model) simulations. In the frequency range above 2 kHz a functional gain of 30 dB and more is achieved. This proposes the transducer as a potential treatment for high frequency hearing loss, e.g. for patients with noise-induced hearing loss. The transducer offers sufficient results for a comprehensive application. Adaptations in the transducer design or surgical approach are necessary to cope with ligament stiffening issues. These cause insufficient performance for low frequencies under 1 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.

On the connection between the tympanic membrane and the malleus.

BACKGROUND: The tympano-mallear connection (TMC) is the soft-tissue connection between the tympanic membrane (TM) and the manubrium of the malleus. Some studies suggest that its mechanical properties may have a substantial influence on the mechanics and transfer function of the middle ear. However, relatively little is known about the dimensions of the TMC and its variability among individuals. METHOD: Thirteen samples were collected from human temporal bones, consisting of only the malleus and the TM. They were imaged using µCT without contrast enhancing agent. From the µCT images, the TMC dimensions were measured in both anterior-posterior direction (TMC width) and medial-lateral direction (TMC thickness). Three selected samples were examined using histological microscopy. RESULTS: Both TMC width and thickness featured a large variability among individuals. The minimal TMC width along the manubrium for different individuals covered a range between 83 and 840 µm. The minimal thickness ranged from 48 to 249 µm and the maximal thickness from 236 to 691 µm. Histological sections showed that the TMC consists of a narrow core of dense regular connective tissue, surrounded by loose connective tissue. In some samples, either of these two components was absent in the TMC at some manubrium locations. The configuration of these components varied among the samples as well. CONCLUSION: Our data confirm that a large inter-individual variability exists in the properties of the TM-malleus connection in humans in terms of its dimensions, tissue composition and configuration. Average data and their variability margins will be useful input for testing the importance of the TMC in finite element models.

A method to measure sound transmission via the malleus-incus complex.

BACKGROUND: The malleus-incus complex (MIC) plays a crucial role in the hearing process as it transforms and transmits acoustically-induced motion of the tympanic membrane, through the stapes, into the inner-ear. However, the transfer function of the MIC under physiologically-relevant acoustic stimulation is still under debate, especially due to insufficient quantitative data of the vibrational behavior of the MIC. This study focuses on the investigation of the sound transformation through the MIC, based on measurements of three-dimensional motions of the malleus and incus with a full six degrees of freedom (6 DOF). METHODS: The motion of the MIC was measured in two cadaveric human temporal bones with intact middle-ear structures excited via a loudspeaker embedded in an artificial ear canal, in the frequency range of 0.5-5 kHz. Three-dimensional (3D) shapes of the middle-ear ossicles were obtained by sequent micro-CT imaging, and an intrinsic frame based on the middle-ear anatomy was defined. All data were registered into the intrinsic frame, and rigid body motions of the malleus and incus were calculated with full six degrees of freedom. Then, the transfer function of the MIC, defined as velocity of the incus lenticular process relative to velocity of the malleus umbo, was obtained and analyzed. RESULTS: Based on the transfer function of the MIC, the motion of the lenticularis relative to the umbo reduces with frequency, particularly in the 2-5 kHz range. Analysis of the individual motion components of the transfer function indicates a predominant medial-lateral component at frequencies below 1 kHz, with low but considerable anterior-posterior and superior-inferior components that become prominent in the 2-5 kHz range. CONCLUSION: The transfer function of the human MIC, based on motion of the umbo and lenticularis, has been visualized and analyzed. While the magnitude of the transfer function decreases with frequency, its spatio-temporal complexity increases significantly.

Biomechanics of the incudo-malleolar-joint - Experimental investigations for quasi-static loads.

Under large quasi-static loads, the incudo-malleolar joint (IMJ), connecting the malleus and the incus, is highly mobile. It can be classified as a mechanical filter decoupling large quasi-static motions while transferring small dynamic excitations. This is presumed to be due to the complex geometry of the joint inducing a spatial decoupling between the malleus and incus under large quasi-static loads. Spatial Laser Doppler Vibrometer (LDV) displacement measurements on isolated malleus-incus-complexes (MICs) were performed. With the malleus firmly attached to a probe holder, the incus was excited by applying quasi-static forces at different points. For each force application point the resulting displacement was measured subsequently at different points on the incus. The location of the force application point and the LDV measurement points were calculated in a post-processing step combining the position of the LDV points with geometric data of the MIC. The rigid body motion of the incus was then calculated from the multiple displacement measurements for each force application point. The contact regions of the articular surfaces for different load configurations were calculated by applying the reconstructed motion to the geometry model of the MIC and calculate the minimal distance of the articular surfaces. The reconstructed motion has a complex spatial characteristic and varies for different force application points. The motion changed with increasing load caused by the kinematic guidance of the articular surfaces of the joint. The IMJ permits a relative large rotation around the anterior-posterior axis through the joint when a force is applied at the lenticularis in lateral direction before impeding the motion. This is part of the decoupling of the malleus motion from the incus motion in case of large quasi-static loads.

Contribution of the incudo-malleolar joint to middle-ear sound transmission.

The malleus and incus in the human middle ear are linked by the incudo-malleolar joint (IMJ). The mobility of the human IMJ under physiologically relevant acoustic stimulation and its functional role in middle-ear sound transmission are still debated. In this study, spatial stapes motions were measured during acoustic stimulation (0.25-8 kHz) in six fresh human temporal bones for two conditions of the IMJ: (1) normal IMJ and (2) IMJ with experimentally-reduced mobility. Stapes velocity was measured at multiple points on the footplate using a scanning laser Doppler vibrometry (SLDV) system, and the 3D motion components were calculated under both conditions of the IMJ. The artificial reduction of the IMJ mobility was confirmed by measuring the relative motion between the malleus and the incus. The magnitudes of the piston-like motion of the stapes increased with the reduced IMJ mobility above 2 kHz. The increase was frequency dependent and was prominent from 2 to 4 kHz and at 5.5 kHz. The magnitude ratios of the rocking-like motions to the piston-like motion were similar for both IMJ conditions. The frequency-dependent change of the piston-like motion after the reduction of the IMJ mobility suggests that the IMJ is mobile under physiologically relevant levels of acoustic stimulation, especially at frequencies above 2 kHz.

Three-dimensional vibration of the malleus and incus in the living gerbil.

In previous studies, 3D motion of the middle-ear ossicles in cat and human was explored, but models for hearing research have shifted in the last few decades to smaller mammals, and gerbil, in particular, has become a popular hearing model. In the present study, we have measured with an optical interferometer the 3D motion of the malleus and incus in anesthetized gerbil for sound of moderate intensity (90-dB sound pressure level) over a broad frequency range. To access the ossicles, the pars flaccida was removed exposing the neck and head of the malleus and the incus from the malleus-incus joint to the plate of the lenticular process. Vibration measurements were done at six to eight points per ossicle while the angle of observation was varied over approximately 30 ° to enable calculation of the 3D rigid-body velocity components. These components were expressed in an intrinsic reference frame, with one axis along the anatomical suspension axis of the malleus-incus block and a second axis along the stapes piston direction. Another way of describing the motion that does not assume an a priori rotation axis is to calculate the instantaneous rotation axis (screw axis) of the malleus/incus motion. Only at frequencies below a few kilohertz did the screw axis have a maximum rotation in a direction close to that of the ligament axis. A slight slippage in the malleus-incus joint developed with increasing frequency. Our findings are useful in determining the sound transfer characteristics through the middle ear and serve as a reference for validation of mathematical middle-ear models. Last but not least, comparing our present results in gerbil with those of previously measured species (human and cat) exposes similarities and dissimilarities among them.

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).

Optimal ossicular site for maximal vibration transmissions to coupled transducers.

Totally implantable middle-ear prosthetic devices, such as the Esteem system (Envoy Medical Corporation), detect vibrational motion of the middle-ear ossicles rather than acoustic stimulation to the eardrum. This eliminates the need for a subcutaneous microphone, which is susceptible to interference by ambient noises. Study of the vibrational characteristics of the human ossicles provides valuable information for determining the site of maximum ossicular motion that would be optimal for attachment of the sensor portion of the prosthesis. In this study, vibrational responses at seven locations on the middle-ear ossicles (i.e., the malleus head, 4 different points on the incus body, middle of the incus long process, tip of the incus long process) in human temporal bones (n = 6) were measured using a laser Doppler vibrometer. The measurements were repeated after separating the incudostapedial joint (ISJ). Measured displacement at each location was normalized with the sound pressure level near the tympanic membrane (TM) for representation in the form of a displacement transfer function (DTF). The normalized squared sum of the DTFs (NSSDTF) was then calculated as a measure of vibration motion through a specific frequency range at the considered sites. The relatively large NSSDTF was observed at the sites on the superior part of the malleus head (MH), on the lateral part of the incus body (IBL), and on the superior part of the incus body near the incudomalleal joint (IBS1) for the frequency ranges of 1-4 kHz and 1-9 kHz, regardless of the condition of the ISJ. This indicates that maximum vibrational motion of the middle-ear is deliverable to the piezoelectric transducer of totally implantable devices through these sites. This article is part of a special issue entitled "MEMRO 2012".

Sound transmission along the ossicular chain in common wild-type laboratory mice.

The use of genetically modified mice can accelerate progress in auditory research. However, the fundamental profile of mouse hearing has not been thoroughly documented. In the current study, we explored mouse middle ear transmission by measuring sound-evoked vibrations at several key points along the ossicular chain using a laser-Doppler vibrometer. Observations were made through an opening in pars flaccida. Simultaneously, the pressure at the tympanic membrane close to the umbo was monitored using a micro-pressure-sensor. Measurements were performed in C57BL mice, which are widely used in hearing research. Our results show that the ossicular local transfer function, defined as the ratio of velocity to the pressure at the tympanic membrane, was like a high-pass filter, almost flat at frequencies above ∼15 kHz, decreasing rapidly at lower frequencies. There was little phase accumulation along the ossicles. Our results suggested that the mouse ossicles moved almost as a rigid body. Based on these 1-dimensional measurements, the malleus-incus-complex primarily rotated around the anatomical axis passing through the gonial termination of the anterior malleus and the short process of the incus, but secondary motions were also present. This article is part of a special issue entitled "MEMRO 2012".

Experimental study on admissible forces at the incudomalleolar joint.

HYPOTHESIS: The forces that cause rupture of the incudomalleolar joint during the fixation of stapedial prostheses can be determined by means of load-deflection measurements at the long process of the incus. As in other tissues, 3 ranges of forces can be defined: micro rupture, rupture, and short-term maximum. BACKGROUND: A crucial step in stapes surgery is the attachment of the stapedial prosthesis to the long process of the incus. It is unknown which forces occur during the crimping process that increase the risk of damage to the incudomalleolar joint or incus luxation. The goal of this study was to assess the admissible range of forces at the long process of the incus that would be tolerable before damaging the structures and to compare them with the forces occurring during surgery. METHODS: Load-deflection curves in the lateral-medial and anterior-posterior direction were measured in 9 freshly frozen or fresh temporal bones. The force was measured with a load cell, and displacement was taken from the encoder information of the electrically driven translation stage on which the load cell was mounted. The long process of the incus was coupled to the load cell via a customized needle. We also monitored with video recordings for visual confirmation of findings. RESULTS: The rupture force at which the middle ear was found to be severely injured was 894 (724-1018) mN in the anterior-posterior direction and 695 (574-771) mN in the lateral-medial direction. Micro-ruptures occurred at forces around 568 (469-686) mN in the anterior-posterior direction and in the lateral-medial direction at 406 (254-514) mN. Short-term maximum forces of 1,321 (1,051-1,533) mN were measured in the anterior-posterior direction and 939 (726-1,132) mN in the lateral-medial direction. CONCLUSION: Rupture forces of the incudomalleolar joint could be defined with high accuracy. These results were used to calculate risks of incus luxation or subluxation during stapes surgery. Compared with the use of clip and SMA prostheses, the risk of damage from a crimping procedure is significantly higher.

Reverse transmission along the ossicular chain in gerbil.

In a healthy cochlea stimulated with two tones f (1) and f (2), combination tones are generated by the cochlea's active process and its associated nonlinearity. These distortion tones travel "in reverse" through the middle ear. They can be detected with a sensitive microphone in the ear canal (EC) and are known as distortion product otoacoustic emissions. Comparisons of ossicular velocity and EC pressure responses at distortion product frequencies allowed us to evaluate the middle ear transmission in the reverse direction along the ossicular chain. In the current study, the gerbil ear was stimulated with two equal-intensity tones with fixed f (2)/f (1) ratio of 1.05 or 1.25. The middle ear ossicles were accessed through an opening of the pars flaccida, and their motion was measured in the direction in line with the stapes piston-like motion using a laser interferometer. When referencing the ossicular motion to EC pressure, an additional amplitude loss was found in reverse transmission compared to the gain in forward transmission, similar to previous findings relating intracochlear and EC pressure. In contrast, sound transmission along the ossicular chain was quite similar in forward and reverse directions. The difference in middle ear transmission in forward and reverse directions is most likely due to the different load impedances-the cochlea in forward transmission and the EC in reverse transmission.

Tensores del velo del paladar y del martillo: vínculos anatómicos, funcionales y sintomáticos / Tensor veli palatini and tensor tympani muscles: Anatomical, functional and symptomatic links

Introducción y objetivos: Los desórdenes temporomandibulares están asociados con síntomas como tinnitus, vértigo, sensación de pérdida auditiva, plenitud ótica y otalgia. La conexión y disfunción de los músculos tensor del martillo (TM) y tensor del velo del paladar (TVP) parece estar asociada a esta sintomatología referida. Se busca demostrar y explicar esta conexión a través de la morfometría de las estructuras. Métodos: Se estudiaron 22 bloques pareados y 1 izquierdo de hueso temporal humanos. Se realizaron medidas digitales correspondientes al TM y el músculo del estribo. Resultados: La longitud promedio del músculo del estribo fue de 5,8mm (DE: 0,61) y la del TM fue de 19,69mm (DE: 1,07). En la totalidad de las muestras se halló conexión anatómica de los músculos TVP y TM a través de un tendón común. Conclusiones: Se matiza la necesidad de un manejo interdisciplinario entre el médico y el odontólogo especialista en dolor craneofacial (AU)

Introduction and objectives: Temporomandibular disorders are associated with symptoms such as tinnitus, vertigo, sensation of hearing loss, ear fullness and otalgia. The connection and dysfunction of the tensor tympani and tensor veli palatini muscles seems to be associated with the aforementioned symptoms. We seek to demonstrate and explain this connection through the morphometry of these structures. Methods: We studied 22 paired blocks and 1 left side of human temporal bone. Digital measurements were made of the tensor tympani muscles and stapes. Results: The average length of the stapedial muscle was 5.8mm SD 0.61, and that of the tensor tympani was 19.69mm SD 1.07. Anatomical connections were found in all the samples between the tensor veli palatini muscles through a common tendon. Conclusions: There is a need for an interdisciplinary management between physician and specialized dentist in cases of craniofacial pain (AU)

A sum of simple and complex motions on the eardrum and manubrium in gerbil.

Based on comparisons of ear canal and scala vestibuli pressures the gerbil middle ear transmits sound with a gain of approximately 25 dB that is almost flat from 2 to 40 kHz, and with a delay-like phase corresponding to a 25-30 micros delay. How the middle ear is able to transmit sound with such high temporal and amplitude fidelity is not known, and is particularly mysterious given the complex motion the ossicles and tympanic membrane (TM) are known to undergo. To explore this question, we looked at the velocities of the manubrium and along a line on the TM. The TM motion was complex, and could be approximated as the combination of a wave-like motion and an in-and-out piston-like motion. The manubrium underwent bending at some stimulus frequencies and therefore its motion was not like a rigid body. It had a complex motion with frequency fine structure that seemed likely to be derived from resonances on the drum-like TM.

Tympanic-membrane and malleus-incus-complex co-adaptations for high-frequency hearing in mammals.

The development of the unique capacity for high-frequency hearing in many mammals was due in part to changes in the middle ear, such as the evolution of three distinct middle-ear bones and distinct radial and circumferential collagen fiber layers in the eardrum. Ossicular moment(s) of inertia (MOI) and principal rotational axes, as well as eardrum surface areas, were calculated from micro-CT-based 3-D reconstructions of human, cat, chinchilla, and guinea pig temporal bones. For guinea pig and chinchilla, the fused malleus-incus complex rotates about an anterior-posterior axis, due to the relatively lightweight ossicles and bilateral symmetry of the eardrum. For human and cat, however, the MOI calculated for the unfused malleus are 5-6 times smaller for rotations about an inferior-superior axis than for rotations about the other two orthogonal axes. It is argued that these preferred motions, along with the presence of a mobile malleus-incus joint and asymmetric eardrum, enable efficient high-frequency sound transmission in spite of the relatively large ossicular masses of these species. This work argues that the upper-frequency hearing limit of a given mammalian species can in part be understood in terms of morphological co-adaptations of the eardrum and ossicular chain.

Tympanic membrane boundary deformations derived from static displacements observed with computerized tomography in human and gerbil.

The middle ear is too complex a system for its function to be fully understood with simple descriptive models. Realistic mathematical models must be used in which structural elements are represented by geometrically correct three-dimensional (3D) models with correct physical parameters and boundary conditions. In the past, the choice of boundary conditions could not be based on experimental evidence as no clear-cut data were available. We have, therefore, studied the deformation of the tympanic membrane (TM) at its boundaries using X-ray microscopic computed tomography in human and gerbil while static pressure was applied to the ear canal. The 3D models of the TM and its bony attachments were carefully made and used to measure the deformation of the TM with focus on the periphery and the manubrium attachment. For the pars flaccida of the gerbil, the boundary condition can, for the most part, be described as simply supported. For the human pars flaccida, the situation is more complicated: superiorly, the membrane contacts the underlying bone more and more when pushed further inward, and it gradually detaches from the wall when sucked outward. In gerbil, the attachment of the TM to the manubrium can be described as simply supported. In human, the manubrium is attached underneath the TM via the plica mallearis and the contact of the TM with the bone is indirect. For both human and gerbil, a simple boundary condition for the peripheral edge of the pars tensa is not appropriate due to the intricate structure at the edge: the TM thickens rapidly before continuing into the annulus fibrosis which finally makes contact with the bone.

Topography of the chorda tympani nerve and the tensor tympani muscle in carnivores provides a new synapomorphy for Herpestidae (Carnivora, Mammalia).

The topographical relationship of the chorda tympani nerve (chorda tympani) to the tensor tympani muscle in the middle ear of carnivores provides new phylogenetic information. The examination of histological serial sections of 16 carnivore species representing most families revealed two distinct character states concerning the course of the chorda tympani: a hypotensoric state with the nerve running below the insertion tendon of the tensor tympani muscle, and an epitensoric state with the nerve running above the tendon. The shift from the plesiomorphic hypotensoric chorda tympani to the apomorphic epitensoric condition occurred once in carnivore phylogeny: Only in the herpestid species under study does the chorda tympani cross above the tensor tympani muscle. Therefore, we introduce the epitensoric pattern as a new synapomorphy for herpestids. Within the herpestids we find the following structural distinctions: Herpestes javanicus and Galerella sanguinea have a chorda tympani running in a sulcus directly above the insertion of the tensor tympani muscle, whereas in the eusocial herpestid species Suricata suricatta and Mungos mungo the chorda tympani lies far above the insertion of the muscle.

Ossicular resonance modes of the human middle ear for bone and air conduction.

The mean resonance frequency of the human middle ear under air conduction (AC) excitation is known to be around 0.8-1.2 kHz. However, studies suggest that the mean resonance frequency under bone conduction (BC) excitation is at a higher frequency around 1.5-2 kHz. To identify the cause for this difference, middle-ear responses to both AC and BC excitations were measured at the umbo and lateral process of the malleus using five human cadaver temporal bones. The resonance modes identified from these measurements, along with finite element analysis results, indicate the presence of two ossicular modes below 2 kHz. The dominant mode under AC excitation is the first mode, which typically occurs around 1.2 kHz and is characterized by a "hinging" ossicular motion, whereas the dominant mode under BC excitation is the second mode, which typically occurs around 1.7 kHz and is characterized by a "pivoting" ossicular motion. The results indicate that this second mode is responsible for the translational component in the malleus handle motion. The finding is also consistent with the hypothesis that a middle-ear structural resonance is responsible for the prominent peak seen at 1.5-2 kHz in BC limit data.