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: 10610345
• 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/10610345
• 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; diagnostic tool; diagnostic value; hearing impairment; improved; middle ear; middle ear disorder; normal hearing; pressure; recruit; sample fixation; sound; 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.

激光多普勒振动仪（LDV）是用于评估中耳（ME）功能的新兴技术， 在宽频率范围内检测ME骨骼之一锤骨的声致速度（Vu (300到6000 Hz）。PI寻求开发LDV测量作为一项新研究 与他以前使用宽带声导抗（阿威）评估ME功能的工作一致 测量.因为LDV测量其中一个听小骨的运动，所以它固有地对 听骨链疾病如耳硬化症，因此是一种潜在有用的诊断工具。LDV获得于 耳道中的环境压力已被证明导致与阿威相似的诊断灵敏度，但 广泛的可变性。通过在不同温度下测量，可以提高LDV的诊断能力。 鼓室峰值压力（TPP），而不是环境压力，以控制不同的中间- 从测试到重新测试和跨受试者的耳压。这种ME压力相关的变异性可能掩盖了潜在的 ME障碍。此外，TPP处的Vu与鼓室测尾压（例如，±200达帕）的比较可以 提供先前未测量的ME状态的附加信息。这将是第一 评价使用鼓室压（变化的耳道压力）LDV测量评估 ME功能。目的1是进行第一次重复测量Vu在TPP和鼓室尾压， 使用VA国家中心开发的定制耳镜，具有正常ME功能的对照受试者 参考听觉研究（NCRAR）这些重测差异将与 通过将分层高斯过程回归模型拟合到 这些数据，以及比较数据公布的测试，在环境压力下的Vu重测差异。目的 2，使用目标1的数据，将建立作为环境压力频率函数的参考限值， TPP、±100达帕和±200达帕，以及±100达帕和±200 daPa的鼓室导抗峰尾差 达帕。在目标3中，目标2中确定的参考限值将应用于从10 诊断为耳硬化症的受试者的环境压力和加压测量。贝叶斯 将使用分层回归模型比较对照组和 耳硬化组在每个测试条件下的9个刺激频率中的每一个。 将使用NCRAR数据存储库，通过VA中发布的经批准的传单招募受试者 波特兰医疗保健系统（VAPORHCS）和听力学家或 VAPORHCS诊所的耳鼻喉科医生。两名对照受试者入组研究均接受两次研究访视 耳硬化症患者：第一次就诊包括听力评估和鼓室压测定， 在环境压力下测量双耳的LDV，通过226 Hz确定鼓室峰值压力 在±100和±200达帕下进行鼓室压测试。第二次研究访视时 大约一个月后，将重复所有测试。根据初步数据收集，我们预计 每次访问将持续约2小时。受试者将在经过声音处理的隔间中接受所有测试。一 将使用临床听力计进行听力测试，然后使用临床鼓室计进行鼓室测定。LDV 测量将使用Polytec OFV 534激光振动计完成。两名研究听力学家是 每次测量所需的：一个用于定位窥器和操纵激光，第二个用于 协助计算机数据采集。空气压力将使用压力泵从 鼓室压计连接到具有标准管的定制窥器，以在TPP处进行测量， ±100和±200达帕。研究结果将告知VA Merit Review或NIH R 01的具体目标 研究比较环境和鼓室LDV在各种ME疾病的评估与长期- 长期目标是将这项技术用于ME疾病退伍军人的临床试验。