Mechanics of Human Middle & Inner Ear: Basic Science & Clinical Application

人体中部力学

• 批准号: 8650511
• 负责人: Hideko Heidi Nakajima
• 金额: $ 40.5万
• 依托单位: MASSACHUSETTS EYE AND EAR INFIRMARY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-17 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8650511
• 关键词: Acoustics; Address; Affect; Air; Anatomy; Anterior semicircular canal (body structure); Area; Audiometry; Basic Science; Bone Conduction; Characteristics; Chronic; Clinical; Cochlea; Conductive hearing loss; Controlled Environment; Coupled; Coupling; Devices; Diagnosis; Diagnostic; Diagnostic tests; Disease; Ear; Ear Diseases; Environment; External auditory canal; Hearing; Hearing Aids; Hearing problem; Human; Knowledge; Laboratories; Labyrinth; Lesion; Life; Liquid substance; Measurement; Measures; Mechanical Stimulation; Mechanics; Membrane; Methods; Middle Ear Implant; Mixed Conductive-Sensorineural Hearing Loss; Monitor; Morphologic artifacts; Motion; Operative Surgical Procedures; Otitis Media; Outcome; Oval Window; Pathology; Pathway interactions; Patients; Performance; Preparation; Property; Reconstructive Surgical Procedures; Recording of previous events; Relative (related person); Reporting; Research Personnel; Respiratory Diaphragm; Response to stimulus physiology; Safety; Semicircular canal structure; Sensorineural Hearing Loss; Sensory; Simulate; Stapes; Stimulus; Symptoms; System; Techniques; Testing; Time; Translating; Ultrasonography; Use of New Techniques; bone; clinical application; design; electric impedance; hearing impairment; improved; middle ear; operation; pressure; public health relevance; relating to nervous system; research study; response; round window; sensor; sound; success; tool; transmission process; vibration

Project Summary/Abstract Many patients suffer from conductive hearing loss (CHL) that is intractable to treatment, although their neurosensory system is intact. Round-window (RW) and bone-conduction (BC) stimulation have been proven to provide improved hearing for CHL that have failed various treatments. However these alternative stimulation methods have limited success. Their application is hindered both by a lack of knowledge of the unique mechanisms by which sound is transmitted to the cochlear partition by these stimulus methods, and limitations in the manner in which they are applied. Fresh human cadaveric preparations allow for controlled invasive experiments to elucidate these mechanisms, simulate various conductive diseases and evaluate and improve devices and treatments. With our new technique of intracochlear pressure measurement, we can better understand the mechanisms of these alternative sound stimulus pathways that differ substantially from normal air-conducted sound stimulation. Furthermore, the determination of the differential pressure stimulus, DP, allows monitoring of the input to the cochlea during normal and alternative stimulation and in disease conditions where the inner-ear impedances are changed, such as superior semicircular canal dehiscence (SCD). We employ this technique to answer questions that could not be previously addressed: Aim 1) Evaluate and improve methods for stimulating the RW. RW stimulation with crudely-modified middle-ear implants has aided numerous patients with CHL that were not helped by other means. However, hearing results have varied. We will develop a "coupling system" for RW stimulation that is specific for the unique anatomy and mechanical properties of the RW. This system will provide safer, more efficient and consistent RW stimulation. By measuring DP in the controlled environment of human cadaveric preparations, the performance of our coupling system will be compared quantitatively to other RW stimulation coupling methods, and critical features for safety, efficiency, consistency and ease of surgical implementation will be ascertained. Furthermore, the mechanical specifications required to optimize performance of a RW actuator will be determined. Aim 2) Elucidate the mechanisms involved in BC stimulation of the ear and determine how BC is affected by different pathologies. BC stimulation is used to diagnose sensory-neural hearing loss and to treat conductive and mixed hearing loss, yet the mechanisms of BC stimulation are not well understood. We will advance the understanding of BC and its effects by measuring intracochlear differential pressure, DP, evoked by BC stimulation in human cadaveric preparations. The study will: 1) Determine the contributions to BC of the inertial effects of ossicular motion and cochlear fluids and the compression effect of surrounding bone; 2) Determine the effects of the direction of BC stimulation; and 3) Determine the effect of SCD on BC. The measurements of BC-evoked DP will elucidate BC mechanisms and improve applications of BC for diagnosis and treatment.

项目概要/摘要 许多患者患有难以治疗的传导性听力损失 (CHL)，尽管他们 神经感觉系统完好无损。圆窗 (RW) 和骨传导 (BC) 刺激已得到证实 为各种治疗失败的 CHL 提供改善的听力。然而这些替代方案 刺激方法的成功有限。它们的应用因缺乏相关知识而受到阻碍 通过这些刺激方法将声音传输到耳蜗分区的独特机制，以及 它们的应用方式受到限制。新鲜的人体尸体制剂可以控制 侵入性实验来阐明这些机制，模拟各种传导性疾病并评估和 改进设备和治疗方法。利用我们的耳蜗内压力测量新技术，我们可以 更好地理解这些替代声音刺激途径的机制，这些途径与 正常的空气传导声音刺激。此外，压差刺激的确定， DP，允许在正常和替代刺激以及疾病期间监测耳蜗的输入 内耳阻抗发生变化的情况，例如上半规管裂开 (SCD)。 我们采用这种技术来回答以前无法解决的问题：目标 1) 评估和 改进刺激RW的方法。使用粗略修改的中耳植入物进行 RW 刺激 帮助了许多无法通过其他方式得到帮助的 CHL 患者。然而，听证会的结果却各不相同。 我们将开发一种用于 RW 刺激的“耦合系统”，该系统专门针对独特的解剖结构和 RW 的机械性能。该系统将提供更安全、更高效和一致的 RW 刺激。 通过在人体尸体制剂的受控环境中测量 DP，我们的性能 耦合系统将与其他 RW 刺激耦合方法进行定量比较，并且关键 将确定手术实施的安全性、效率、一致性和易用性的特点。 此外，优化 RW 执行器性能所需的机械规格将是 决定。目标 2) 阐明 BC 刺激耳朵的机制并确定 BC 的作用机制 受不同病理的影响。 BC 刺激用于诊断感觉神经性听力损失并治疗 传导性和混合性听力损失，但 BC 刺激的机制尚不清楚。我们将 通过测量耳蜗内压差、DP、诱发值，加深对 BC 及其影响的理解 通过BC刺激人类尸体制剂。该研究将： 1) 确定对 BC 的贡献 听骨运动和耳蜗液的惯性效应以及周围骨骼的压缩效应； 2） 确定BC刺激方向的效果； 3) 确定 SCD 对 BC 的影响。这 BC 诱发的 DP 测量将阐明 BC 机制并改进 BC 在诊断中的应用 和治疗。