Tympanometric laser Doppler vibrometry measurements of middle ear function

鼓室导抗激光多普勒振动测量中耳功能

• 批准号: 10424361
• 负责人: Martin Patrick Feeney
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10424361
• 关键词: 3D Print; Acoustics; Air Pressure; Area; Audiology; Clinic; Clinical; Clinical Trials; Computers; Control Groups; Custom; Data; Data Collection; Diagnosis; Diagnostic; Diagnostic Sensitivity; Disease; Ear; Emerging Technologies; Enrollment; Evaluation; External auditory canal; Frequencies; Gaussian model; Goals; Grant Review; Healthcare Systems; Hearing; Hearing Tests; Hour; Individual; Lasers; Malleus; Masks; Measurement; Measures; Modeling; Movement; Otolaryngologist; Otosclerosis; Outcome Study; Pathology; Patients; Physiological; Positioning Attribute; Process; Publishing; Pump; Rehabilitation Centers; Research; Sampling; Sensorineural Hearing Loss; Speculums; Stapes; Stimulus; System; Tail; Techniques; Technology; Testing; Tympanic membrane; Tympanometry; United States National Institutes of Health; Veterans; Visit; Work; auditory rehabilitation; base; bone; data acquisition; data repository; hearing impairment; improved; middle ear; middle ear disorder; normal hearing; pressure; recruit; sample fixation; sound; tool; vibration

Laser Doppler vibrometry (LDV) is an emerging technology for assessing middle ear (ME) function that detects the sound-induced velocity (Vu) of one of the ME bones, the malleus, over a wide frequency range (300 to 6000 Hz) using a reflected laser beam. The PI seeks to develop LDV measures as a new research area in line with his previous work in the assessment of ME function using wideband acoustic immittance (WAI) measurements. Because LDV measures the movement of one of the ossicles, it is inherently sensitive to ossicular chain disorders such as otosclerosis, and is thus a potentially useful diagnostic tool. LDV obtained at ambient pressure in the ear canal has been shown to result in similar diagnostic sensitivity to WAI, but has wide variability. The diagnostic capability of LDV may be enhanced by making measurements at tympanometric peak pressure (TPP) rather than ambient pressure to control for the effects of varying middle- ear pressure from test to retest and across subjects. This ME pressure related variability may mask underlying ME disorders. Moreover, a comparison of Vu at TPP with tympanometric tail pressures (e.g. ±200 daPa) may provide additional information about the ME status that previously has not been measured. This will be the first study to evaluate the use of tympanometric (varying ear canal pressure) LDV measures for the assessment of ME function. Aim 1 is to make the first repeated measures of Vu at TPP and tympanometric tail pressures in control subjects with normal ME function using a custom ear speculum developed at the VA National Center for Rehabilitative Auditory Research (NCRAR). These test-retest differences will be compared with measurements obtained at ambient pressure by fitting a hierarchical Gaussian process regression model to these data, as well as comparing the data to published test-retest differences for Vu at ambient pressure. Aim 2, using the data from Aim 1, will establish reference limits as a function of frequency for ambient pressure, TPP, ±100 daPa, and ±200 daPa, and for tympanometric peak-to-tail differences for ±100 daPa and ±200 daPa. In Aim 3 the reference limits established in Aim 2 will be applied to the Vu data obtained from 10 subjects with a diagnosis of otosclerosis for ambient pressure and pressurized measures. A Bayesian hierarchical regression model will be used to compare mean differences in Vu between the control group and the otosclerosis group at each of the 9 stimulus frequencies in each test condition. Subjects will be recruited using the NCRAR data repository, through approved flyers posted in the VA Portland Health Care System (VAPORHCS) and handouts provided to patients from audiologists or otolaryngologists in VAPORHCS clinics. Enrollment in the study is for two study visits for both control subjects and those with otosclerosis: The first visit involves hearing evaluation and tympanometry as well as measurements of LDV for both ears at ambient pressure, tympanometric peak pressure determined by 226 Hz tympanometry, and for tympanometric tail pressures at ±100 and ±200 daPa. At the second study visit approximately one month later all tests will be repeated. Based on preliminary data collection, we anticipate that each visit will last approximately 2 hours. Subjects will be tested in a sound-treated booth for all tests. A clinical audiometer will be used for hearing tests followed by tympanometry using a clinical tympanometer. LDV measurements will be completed with a Polytec OFV 534 laser vibrometer. Two research audiologists are required for each measurement: one to position the speculum and manipulate the laser, and the second to assist in computer data acquisition. Air pressure will be varied using the pressure pump from the tympanometer connected to the custom speculum with standard tubing to make measurements at TPP and ±100 and ±200 daPa. The study outcomes will inform the specific aims for a VA Merit Review or NIH R01 study to compare ambient and tympanometric LDV in the assessment of various ME disorders with the long- term goal of moving to a clinical trial of this technology for Veterans with ME disorders.

激光多普勒测振(LDV)是一种新兴的评估中耳功能的技术 在很宽的频率范围内检测ME骨骼之一--锤骨的声诱导速度(Vu (300至6000赫兹)使用反射的激光束。PI寻求发展LDV测量作为一项新的研究 该领域与他之前使用宽带声导抗(WAI)评估ME功能的工作一致 测量。因为LDV测量的是其中一个听小骨的运动，所以它对 听骨链疾病，如耳硬化症，因此是一个潜在的有用的诊断工具。LDV在以下位置获得 耳道周围压力已被证明对WAI具有类似的诊断敏感性，但 变异性很大。LDV的诊断能力可以通过在以下位置进行测量来增强 鼓室峰值压力(TPP)而不是环境压力，以控制不同中压的影响 耳压从测试到复测，以及不同受试者。这种与ME压力相关的变异性可能会掩盖潜在的 我有精神障碍。此外，TPP下的Vu与鼓室尾压(例如±200DAPA)的比较可以 提供有关以前未测量的ME状态的其他信息。这将是第一次 评价鼓室压(变化耳道压力)LDV测量在评估耳聋患者中的应用 我起作用了。目标1是在TPP和鼓室尾压下首次重复测量Vu 使用退伍军人管理局国家中心开发的定制耳镜控制ME功能正常的受试者 用于康复听觉研究(NCRAR)。这些重测的差异将与 通过拟合分层高斯过程回归模型获得的常压测量值 这些数据，以及与公布的数据进行比较，重新测试Vu在常压下的差异。目标 2，使用来自目标1的数据，将建立作为环境压力频率的函数的参考极限， TPP、±100 DAPA和±200 DAPA，以及±100 DAPA和±200 DAPA的鼓室峰尾差 达帕。在目标3中，目标2中建立的参考限值将应用于从10获得的Vu数据 被诊断为耳硬化症的受试者的环境压力和加压措施。贝叶斯理论 将使用分层回归模型来比较对照组和对照组之间的Vu的平均差异 耳硬化组在每个测试条件下的9个刺激频率中的每一个。 受试者将使用NCRAR数据库，通过在退伍军人管理局张贴的经批准的传单进行招募 波特兰医疗保健系统(VAPORHCS)和听觉学家或 VAPORHCS诊所的耳鼻喉科医生。参加这项研究的人是两个对照受试者的两次研究访问 而那些患有耳硬化症的人：第一次检查包括听力评估和鼓室导纳测量，以及 226赫兹鼓室压峰值压力下双耳LDV的测量 鼓室测压，以及在±100和±200 DAPA时的鼓室尾压。在第二次考察访问中 大约一个月后，所有测试都将重复进行。根据初步收集的数据，我们预计 每次访问将持续大约2个小时。受试者将在经过声音处理的隔间进行所有测试。一个 将使用临床听力计进行听力测试，然后使用临床鼓室测听仪进行鼓室测试。LDV 测量将使用Polytec OFV 534激光测振仪完成。两位研究听力学家是 每一次测量都需要：一次用于定位望远镜和操纵激光，另一次用于 协助计算机数据采集。空气压力将使用压力泵从 鼓膜计用标准管子连接到定制的内窥镜上，以便在TPP和 ±100和±200 DAPA。研究结果将为退伍军人事务部功绩审查或NIH R01的具体目标提供信息 环境LDV和鼓室导纳LDV在评估各种ME障碍中的比较研究 学期目标是将这项技术转移到患有ME障碍的退伍军人的临床试验中。