Middle-ear Mechanics in Normal and Pathological Ears

描述(申请人提供)：我们的工作目标是了解正常中耳、病变中耳和再造中耳的声音传播，以便为中耳疾病患者开发更好的诊断测试和手术方法。中耳疾病，如慢性中耳炎(COM)，在美国影响着1000多万人，是严重的传导性听力损失的常见原因，严重程度高达60分贝。听力损失30-60分贝会严重影响患者的生活和沟通能力。耳科医生公认，鼓室成形术后的听力效果往往不能令人满意。导致手术失败的因素包括对重建耳的结构-功能关系缺乏清楚的了解，以及目前的诊断测试(耳镜、测听、鼓室导纳)未能确定这种关系。在过去的五年里，我们利用独特而强大的方法组合来研究中耳力学，包括使用激光多普勒测振仪的在体测量，在身体人类颞骨中的在体LTRO测量，以及基于物理的定量建模。我们的工作包括a)使用激光测振仪进行新的测试，以改进鼓膜完整患者的听骨病变的术前鉴别诊断；b)为某些类型的中耳外科手术(例如：III型鼓室成形术、腓骨切除术)提供具体的手术建议，以优化术后听力结果。在接下来的五年里，我们的目标是在a)正常耳，b)鼓膜穿孔和上鼓管裂开的病变耳，以及c)接受听骨膜或鼓膜重建术的COM患者中进一步开发和利用这些方法。我们还将对一种新的手持式探头进行体外评估，以客观、术中诊断听小骨固定。我们预计，我们的工作将导致更好地了解正常和病理性中耳的结构-功能关系，改进传导性听力损失的鉴别诊断，更好地术前患者咨询和手术计划，减少手术失败的数量，优化手术技术和听力结果。

DESCRIPTION (provided by applicant): The goal of our work is to understand sound transmission in normal, diseased and reconstructed middle ears so as to develop better diagnostic tests and surgical procedures for patients with middle-ear disease. Middle ear diseases, such as chronic otitis media (COM), which affect over 10 million people in the U.S., are common causes of significant conductive hearing loss that range in severity up to 60 dB. Hearing losses of 30-60 dB have significant adverse effects on patients' lives and their ability to communicate. It is acknowledged by otologic surgeons that postoperative hearing results after tympanoplasty procedures for COM are often unsatisfactory. Factors contributing to failures after surgical procedures include lack of clear understanding of structure-function relationships in the reconstructed ear and failure of current diagnostic tests (otoscopy,audiometry, tympanometry) to identify such relationships. Over the past five years, we have utilized a unique and powerful combination of methods to study middle-ear mechanics including in-vlvo measurements using laser Doppler vibrometry, In-vltro measurements in cadaveric human temporal bones, and physics-based, quantitative modeling. Our work has a) resulted in new tests employing laser vibrometry for improved preoperative differential diagnosis of ossicular lesions in patients with an intact tympanic membrane, and b) provided specific surgical recommendations to optimize postoperative hearing results in certain types of middle-ear surgical procedures (examples: type III tympanoplasty, stapedectomy). Over the next five years, we aim to develop and exploit these methods further in a) normal ears, b) diseased ears with tympanic membrane perforations and superior canal dehiscence, and c) ears that have undergone ossicular or tympanic membrane reconstructions for COM. We will also perform in-vitro evaluation of a novel, hand-held probe for objective, intra-operative diagnosis of ossicular fixation. We anticipate that our work will lead to better understanding of structure-function relationships in normal and pathological middle ears, improved differential diagnosis of conductive hearing loss, better preoperative patient counseling and surgical planning, reduction in the number of failed surgeries and optimization of surgical techniques and hearing results.