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

人体中部力学

• 批准号: 8901128
• 负责人: Hideko Heidi Nakajima
• 金额: $ 40.1万
• 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 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8901128
• 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; Health; 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; 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; relating to nervous system; research study; response; round window; sensor; sound; success; tool; transmission process; vibration

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：许多患者患有传导性听力损失（CHL），虽然他们的神经感觉系统是完整的，但难以治疗。圆窗（RW）和骨传导（BC）刺激已被证明可以为各种治疗失败的CHL提供改善的听力。然而，这些替代的刺激方法具有有限的成功。它们的应用受到以下两方面的阻碍：缺乏对声音通过这些刺激方法传输到耳蜗分区的独特机制的了解，以及它们应用的方式的限制。新鲜的人类尸体标本允许进行受控的侵入性实验，以阐明这些机制，模拟各种传导性疾病，并评估和改进设备和治疗。通过我们的颅内压测量新技术，我们可以更好地了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有很大不同。此外，压差刺激DP的确定允许在正常和交替刺激期间以及在内耳阻抗改变的疾病状况（例如上级半规管裂开（SCD））中监测对耳蜗的输入。我们采用这种技术来回答以前无法解决的问题：目的1）评估和改进刺激RW的方法。用粗略修改的中耳植入物进行RW刺激，帮助了许多其他方法无法帮助的CHL患者。然而，听力结果各不相同。我们将开发一个“耦合系统”的RW刺激，是特定的RW的独特解剖结构和机械性能。该系统将提供更安全、更有效和一致的RW刺激。通过在人体尸体制备的受控环境中测量DP，将我们的耦合系统的性能与其他RW刺激耦合方法进行定量比较，并确定手术实施的安全性、有效性、一致性和易用性的关键特征。此外，将确定优化RW致动器性能所需的机械规格。目的2）阐明BC刺激耳朵的机制，并确定BC如何受到不同病理的影响。BC刺激用于诊断感觉神经性听力损失和治疗传导性和混合性听力损失，但BC刺激的机制还不清楚。我们将通过测量人尸体标本中由BC刺激引起的颅内压差（DP）来促进对BC及其影响的理解。该研究将：1）确定听骨运动和耳蜗液的惯性效应以及周围骨的压缩效应对BC的贡献; 2）确定BC刺激的方向的影响;以及3）确定SCD对BC的影响。BC诱发的DP的测量将阐明BC的机制，提高BC的诊断和治疗的应用。