Middle-ear Mechanics in Normal and Pathological Ears

描述（由申请人提供）：我们的工作目标是了解正常、病变和重建中耳的声音传输，以便为中耳疾病患者制定更好的诊断测试和手术方法。中耳疾病，如慢性中耳炎（COM），影响着美国超过1000万人，是导致严重传导性听力损失的常见原因，严重程度可达60分贝。30-60分贝的听力损失对患者的生活和沟通能力有显著的不利影响。耳科外科医生普遍认为，耳廓缺损患者鼓室成形术后的听力效果往往不理想。导致手术失败的因素包括对重建耳的结构-功能关系缺乏清晰的认识，以及当前诊断测试（耳镜检查、听力学、鼓室测量）无法确定这种关系。在过去的五年中，我们利用了一种独特而强大的方法组合来研究中耳力学，包括激光多普勒振动测量，人体颞骨的超声测量以及基于物理的定量建模。我们的工作有：a)采用激光振动仪进行新的测试，以改善鼓膜完整患者听骨病变的术前鉴别诊断；b)提供特定的手术建议，以优化某些类型中耳手术（例如：III型鼓室成形术、镫骨切除术）的术后听力结果。在接下来的五年里，我们的目标是进一步发展和利用这些方法在a)正常耳，b)患病耳，鼓膜穿孔和上耳管开裂，以及c)听骨或鼓膜重建的耳。我们还将对一种新型的手持式探针进行体外评估，用于客观的术中听骨固定诊断。我们期望我们的工作将有助于更好地了解正常和病理中耳的结构-功能关系，改进传导性听力损失的鉴别诊断，更好的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.