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Middle ear mechanics in normal, diseased and reconstructed ears

Published online by Cambridge University Press:  29 June 2007

Saumil N. Merchant ,
Michael E. Ravicz ,
Susan E. Voss ,
William T. Peake  and
John J. Rosowski
Saumil N. Merchant*
Affiliation:
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Eaton-Peabody Laboratory of Auditory Physiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA. Speech and Hearing Sciences Program, Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA.
Michael E. Ravicz
Affiliation:
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Eaton-Peabody Laboratory of Auditory Physiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
Susan E. Voss
Affiliation:
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Eaton-Peabody Laboratory of Auditory Physiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Speech and Hearing Sciences Program, Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA.
William T. Peake
Affiliation:
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Eaton-Peabody Laboratory of Auditory Physiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Speech and Hearing Sciences Program, Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA. Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
John J. Rosowski
Affiliation:
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Eaton-Peabody Laboratory of Auditory Physiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA. Speech and Hearing Sciences Program, Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA. Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
*
Address for correspondence: Saumil N. Merchant, M.D., Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. Fax: (617) 573-3914
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Abstract

A review of the structure-function relationships in normal, diseased and reconstructed middle ears is presented. Variables used to describe the system are sound pressure, volume velocity and acoustic impedance. We discuss the following

(1) Sound can be transmitted from the ear canal to the cochlea via two mechanisms: the tympanoossicular system (ossicular coupling) and direct acoustic stimulation of the oval and round windows (acoustic coupling). In the normal ear, middle-ear pressure gain, which is the result of ossicular coupling, is frequency-dependent and smaller than generally believed. Acoustic coupling is negligibly small in normal ears, but can play a significant role in some diseased and reconstructed ears.

(2) The severity of conductive hearing loss due to middle-ear disease or after tympanoplasty surgery can be predicted by the degree to which ossicular coupling, acoustic coupling, and stapes-cochlear input impedance are compromised. Such analyses are used to explain the air-bone gaps associated with lesions such as ossicular interruption, ossicular fixation and tympanic membrane perforation.

(3) With type IV and V tympanoplasty, hearing is determined solely by acoustic coupling. A quantitative analysis of structure-function relationships can both explain the wide range of observed postoperative hearing results and suggest surgical guidelines in order to optimize the post-operative results.

(4) In tympanoplasty types I, II and III, the hearing result depends on the efficacy of the reconstructed tympanic membrane, the efficacy of the reconstructed ossicular chain and adequacy of middle-ear aeration. Currently, our knowledge of the mechanics of these three factors is incomplete. The mechanics of mastoidectomy and stapedectomy are also discussed.

Keywords

EarmiddleHearing lossconductiveTympanoplasty
Type
Toynbee Memorial Lecture 1997
Information
The Journal of Laryngology & Otology , Volume 112 , Issue 8 , August 1998 , pp. 715 - 731
Copyright
Copyright © JLO (1984) Limited 1998

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Footnotes

Presented at the Royal Society of Medicine, London, November 7, 1997.

References

Anthony, W. P., Harrison, C. W. (1972) Tympanic membrane perforation – effect on audiogram. Archives of Otolaryngology 95: 506–510.CrossRefGoogle ScholarPubMed
Austin, D. F. (1990) Mechanics of Hearing. In Surgery of the Ear. 4th Edition. (Glasscock, M. E., Shambaugh, G. E., eds), W. B. Saunders, Philadelphia, pp 297–320.Google Scholar
Brackmann, D. E., Sheehy, J. L., Luxford, W. M. (1984) TORPS and PORPS in tympanoplasty: A review of 1042 operations. Otolaryngology – Head and Neck Surgery 92: 32–37.CrossRefGoogle ScholarPubMed
Colletti, V., Fiorino, F. G., Sittoni, V. (1987) Minisculptured ossicle grafts versus implants: long term results. American Journal of Otology 8: 553–559.Google ScholarPubMed
Gacek, R. R. (1973) Symposium on tympanoplasty. Results of modified type V tympanoplasty. Laryngoscope 83: 437–447.Google Scholar
Goldenberg, R. A. (1992) Hydroxylapapite ossicular replacement prostheses: a four year experience. Otolaryngology – Head and Neck Surgery 106: 261–269.Google Scholar
Goode, R. L., Ball, G., Nishihara, S., Nakamura, K. (1996) Laser doppler vibrometer (LDV) – a new clinical tool for the otologist. American Journal of Otology 17: 813–822.Google ScholarPubMed
Goode, R. L., Friedrichs, R., Falk, S. (1977) Effect on hearing thresholds of surgical modification of the external ear. Annals of Otology, Rhinology and Laryngology 86: 441–451.Google Scholar
Goode, R. L., Nishihara, S. (1994) Experimental models of ossiculoplasty. Otolaryngologic Clinics of North America 27: 663–675.Google Scholar
Goodhill, V. (1979) Ear Diseases, Deafness and Dizziness. Harper and Row, Hagerstown.Google Scholar
Gotay-Rodriguez, V. M., Schuknecht, H. F. (1977) Experiences with type IV tympanomastoidectomy. Laryngoscope 87: 522–528.CrossRefGoogle ScholarPubMed
Hüttenbrink, K. (1988) The mechanics of the middle ear at static pressures. Acta Otolaryngologica (Stock) Suppl 451: 1–35.Google Scholar
Jackson, C. G., Glasscock, M. E., Schwaber, M. K., Nissen, A. J., Christiansen, S. G. (1983) Ossicular chain reconstruction: The TORP and PROP in chronic ear disease. Laryngoscope 93: 981–988.Google Scholar
Kurokawa, H., Goode, R. L. (1995) Sound pressure gain produced by the human middle ear. Otolaryngology – Head and Neck Surgery 113: 349–355.CrossRefGoogle ScholarPubMed
Lau, T., Tos, M. (1986) Long term results of surgery for granulating otitis. American Journal of Otolaryngology 7: 341–345.CrossRefGoogle ScholarPubMed
Lee, K., Schuknecht, H. F. (1971) Results of tympanoplasty and mastoidectomy at the Massachusetts Eye and Ear Infirmary. Laryngoscope 81: 529–543.Google Scholar
Liston, S. L., Levine, S. C., Margolis, R. H., Yanz, J. L. (1991) Use of intraoperative auditory brainstem responses to guide prosthesis positioning. Laryngoscope 101: 1009–1012.Google Scholar
Lynch, T. J., Nedzelnitsky, V., Peake, W. T. (1982) Input impedance of the cochlea in cat. Journal of the Acoustical Society of America 72: 108–130.CrossRefGoogle ScholarPubMed
Merchant, S. N., Ravicz, M. E., Puria, S., Voss, S. E., Whittemore, K. R., Peake, W. T., Rosowski, J. J. (1997b) Analysis of middle ear mechanics and application to diseased and reconstructed ears. American Journal of Otology 18: 139–154.Google Scholar
Merchant, S. N., Ravicz, M. E., Rosowski, J. J. (1996) Acoustic input impedance of the stapes and cochlea in human temporal bones. Hearing Research 97: 30–45.Google Scholar
Merchant, S. N., Ravicz, M. E., Rosowski, J. J. (1997a) Experimental investigation of the mechanics of type IV tympanoplasty. Annals of Otology, Rhinology and Laryngology 106: 49–60.CrossRefGoogle Scholar
Merchant, S. N., Rosowski, J. J., Ravicz, M. E. (1995) Middle ear mechanics of type IV and type V tympanoplasty: II. Clinical analysis and surgical implications. American Journal of Otology 16: 565–575.Google ScholarPubMed
Molvaer, O., Vallersnes, F. M., Kringlebotn, M. (1978) The size of the middle ear and the mastoid air cell. Acta Otolaryngologica (Stockh) 85: 24–32.Google Scholar
Montandon, P., Chatelain, C. (1991) Restoration of hearing with type V tympanoplasty. Oto-rhino-laryngology 53: 342–345.Google Scholar
Murakami, S., Gyo, K., Goode, R. L. (1997) Effect of middle ear pressure change on middle ear mechanics. Acta Otolaryngologica (Stock) 117: 390–395.CrossRefGoogle ScholarPubMed
Nadol, J. B., Schuknecht, H. F. (1993) Surgery of the Ear and Temporal Bone. Raven Press, New York.Google Scholar
Nishihara, S., Aritomo, H., Goode, R. L. (1993) Effect of changes in mass on middle ear function. Otolaryngology – Head and Neck Surgery 109: 899–910.Google Scholar
Nishihara, S., Goode, R. L. (1994) Experimental study of the acoustic properties of incus replacement prostheses in a human temporal bone model. American Journal of Otology 15: 485–494.Google Scholar
Peake, W. T., Rosowski, J. J., Lynch, T. J. (1992) Middle-ear transmission: Acoustic versus ossicular coupling in cat and human. Hearing and Research 57: 245–268.Google Scholar
Pennington, C. L. (1973) Incus interposition techniques. Annals of Otology 82: 518–531.Google Scholar
Proctor, B. (1964) Type 4 Tympanoplasty: a critical review of 122 cases. Archives of Otolaryngology 79: 176–181.Google Scholar
Puria, S., Peake, W. T., Rosowski, J. J. (1997) Sound pressure measurements in the cochlear vestibule of human cadaver ears. Journal of the Acoustical Society of America 101: 2754–2770.CrossRefGoogle ScholarPubMed
Ragheb, S. M., Gantz, B. J., McCabe, B. F. (1987) Hearing results after cholesteatoma surgery: the Iowa experience. Laryngoscope 97: 1254–1263.CrossRefGoogle ScholarPubMed
Rosowski, J. J., Davis, P. J., Merchant, S. N., Donahue, K. M., Coltrera, M. D. (1990) Cadaver middle ears as models for living ears: Comparisons of middle ear input immittance. Annals of Otology, Rhinology and Laryngology 99: 403–412.CrossRefGoogle ScholarPubMed
Rosowski, J. J., Merchant, S. N. (1995) Mechanical and acoustical analysis of middle ear reconstruction. American Journal of Otology 16: 486–497.Google Scholar
Rosowski, J. J., Merchant, S. N., Ravicz, M. E. (1995) Middle ear mechanics of type IV and type V tympanoplasty: I. Model analysis and predictions. American Journal of Otology 16: 555–564.Google ScholarPubMed
Schuknecht, H. F. (1974) Pathology of the Ear, 1st Edition, Harvard University Press, Cambridge.Google Scholar
Schuknecht, H. F. (1993) Pathology of the Ear, 2nd Edition, Lea and Febiger, Philadelphia.Google Scholar
Shambaugh, G. E. (1967) Surgery of the Ear, 1st Edition, W. B. Saunders Co., Philadelphia.Google Scholar
Toynbee, J. (1860) The Diseases of the Ear, their Nature, Diagnosis and Treatment. Churchill, London, pp 422.Google Scholar
Vlaming, M. S. M. G., Feenstra, L. (1986) Studies on the mechanics of the reconstructed human middle ear. Clinical Otolaryngology 11: 411–422.CrossRefGoogle ScholarPubMed
Voss, S. E. (1998) Effects of tympanic membrane perforations on middle-ear sound transmission: measurements, mechanisms and models. PhD Thesis, Massachusetts Institute of Technology, Cambridge, MA.Google Scholar
Voss, S. E., Rosowski, J. J., Merchant, S. N., Peake, W. T. (1997) How do tympanic membrane perforations affect human middle-ear sound transmission? Abstracts of the 20th Midwinter Meeting of the Association for Research in Otolaryngology (ARO),ARO,Des Moines, p 49.Google Scholar
Voss, S. E., Rosowski, J. J., Peake, W. T. (1996) Is the pressure difference between the oval and round windows the effective acoustic stimulus for the cochlea? Journal of the Acoustical Society of America 100: 1602–1616.CrossRefGoogle ScholarPubMed
Whittemore, K. R., Merchant, S. N., Rosowski, J. J. (1998) Acoustic mechanisms: canal wall up versus canal wall down mastoidectomy. Otolaryngology – Head and Neck Surgery 118: 751–761.Google Scholar
Wullstein, H. (1956) The restoration of the function of the middle ear, in chronic otitis media. Annals of Otology, Rhinology and Laryngology 65: 1020–1041.Google Scholar
Wullstein, H. (1960) Results of tympanoplasty. Archives of Otolaryngology 71: 478–485.Google Scholar