Middle-ear Mechanics in Normal and Pathological Ears

我们工作的目标是了解声音在正常、患病和重建中耳中的传输 以便为中耳疾病患者开发更好的诊断测试和外科手术。中间 耳部疾病，如慢性中耳炎（COM），在美国影响超过1000万人，是 严重传导性听力损失的常见原因，严重程度高达60 dB。听力损失 30-60 dB对患者的生活和沟通能力有显著的不利影响。是 耳外科医生承认， COM往往不令人满意。导致手术失败的因素包括缺乏明确的 对再造耳结构-功能关系的理解和当前诊断的失败 检查（耳镜检查、听力测定、鼓室压测定）以确定这种关系。 在过去五年中，我们采用了一种独特而强大的方法组合， 中耳力学，包括使用激光多普勒测振仪的体外测量， 测量尸体的人类颞骨，和基于物理的，定量建模。我们的工作 a）采用激光振动测量法进行新的测试，以改善术前鉴别诊断， 完整鼓膜患者的听骨病变，和B）提供特定的手术 优化某些类型中耳手术术后听力结果的建议 （例如：III型鼓室成形术、镫骨切除术）。 在接下来的五年里，我们的目标是在a）正常耳，B） 患有鼓膜穿孔和上级耳道裂开的患病耳，以及c）患有 因COM接受听骨或鼓膜重建。我们还将在体外进行 评价一种新型手持式探针用于客观术中诊断听骨固定。 我们期望我们的工作将导致更好地理解正常的结构-功能关系， 提高了传导性聋的鉴别诊断水平， 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。

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 contributingto failures after surgical procedures include lack of clear understanding of structure-function relationshipsin 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, quantitativemodeling. 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-operativediagnosis of ossicular fixation. We anticipate that our work will lead to better understandingof 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.