Cochlear implants (CIs) have tremendously helped people with severe to profound hearing loss to g... more Cochlear implants (CIs) have tremendously helped people with severe to profound hearing loss to gain access to sound and oral-verbal communication. However, the electrical stimulus in the cochlea spreads easily and widely, since the perilymph and endolymph (i.e., intracochlear fluids) are essentially electrolytes, leading to an inability to focus stimulation to discrete portions of the auditory nerve, which blurs the neural signal. Here, we characterize the complex transimpedances of human cadaveric cochleas to investigate how electrical stimulus spread is distributed from 10 Hz to 100 kHz. By using electrochemical impedance spectroscopy (EIS), both the resistive and capacitive elements of human cochleas are measured and modeled with an electrical circuit model, identifying spread-induced and spread-independent impedance components. Based on this electrical circuit model, we implement a Laplace transform to simulate the theoretical shapes of the spread signals. The model is validated by experimentally applying the simulated stimulus as a real stimulus to the cochlea and measuring the shapes of the spread signals, with relative errors of <0.6% from the model. Based on this model, we show the relationship between stimulus pulse duration and electrical stimulus spread. This EIS technique to characterize the transimpedances of human cochleas provides a new way to predict the spread signal under an arbitrary electrical stimulus, thus providing preliminary guidance to the design of CI stimuli for different CI users and coding strategies.
Hearing loss affects one in six people in the UK and is a significant disease burden. In addition... more Hearing loss affects one in six people in the UK and is a significant disease burden. In addition to communication problems, there is also an association with depression and dementia. Clinical assessment with targeted history and examination can identify the characteristics and cause of hearing loss, and complementary audiological testing can confirm its type and severity. Retrocochlear screening is recommended for sudden, rapidly progressive or asymmetric sensorineural hearing loss. Medical or surgical therapies may be indicated in cases of conductive hearing loss, while hearing assistive devices and hearing aids are the mainstay of rehabilitation for sensorineural hearing loss.
Background and aims Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustach... more Background and aims Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD. Methods Index tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 3, 2018
The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to d... more The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to determine whether a 678 Hz probe tone is a more accurate indicator of Patulous ET (PET) than the 226 Hz probe tone when used in compliance over time (COT) testing. Twenty subjects (11 normal ET ears and 7 PET ears) were individually seated in an examination room and connected to a GSI TympStar Middle Ear Analyzer. The order of probe tone frequency (678 or 226 Hz) was randomized. Baseline "testing" COT recordings for each ear undergoing testing were completed. Subjects were instructed to occlude their contralateral nostril and to breathe forcefully in and out through their ipsilateral nostril until the test had run to completion. This process was repeated with the probe tone that had not been previously run. For the control group, each subject had one random ear tested. For the experimental group, only the affected ear(s) was tested. Wilcoxon rank rum tests were performed to dete...
Miniature high frequency ultrasound devices show promise as tools for clinical middle ear and bas... more Miniature high frequency ultrasound devices show promise as tools for clinical middle ear and basal cochlea imaging and vibrometry. However, before clinical use it is important to verify that the ultrasound exposure does not damage the cochlea. In this initial study, electrophysiological responses of the cochlea were measured for a range of stimulus frequencies in both ears of anesthetized chinchillas, before and after exposing the organ of Corti region of one ear to pulsed focused ultrasound for 30 min. Measurements were again taken after an 11 day survival period. Cochlear tissue was examined with a confocal microscope for signs of damage to the cochlear hair cells. No significant change in response thresholds due to exposure was found, and no signs of ultrasound-induced tissue damage were observed, although one animal (out of ten) did have a region of extensive tissue damage in the exposed cochlea. However, after further analysis this was concluded to be not likely a result of th...
This study aimed to determine the feasibility of combining high-frequency ultrasound imaging, aut... more This study aimed to determine the feasibility of combining high-frequency ultrasound imaging, automated insertion, and force sensing to yield more information about cochlear implant insertion dynamics. An apparatus was developed combining these aspects along with software to control implant and imaging probe positions. Decalcified unfixed human cochleas were implanted at various speeds, insertion sites, and implant models while imaging near the implant tip throughout insertion and recording force data from the cochlea mounting stage. Ultrasound video data were also captured. The basilar membrane (BM) was frequently penetrated by the implant in either the mid-basal or lower middle turn. Measurements were also performed of apical BM motion in response to upstream implant movement at varying insertion speeds. Increasing insertion speed resulted in greater BM displacement. Multiple insertions per cochlea increase the volume of data per specimen while also reducing variability due to dif...
The basilar membrane and organ of Corti in the cochlea are essential for sound detection and freq... more The basilar membrane and organ of Corti in the cochlea are essential for sound detection and frequency discrimination in normal hearing. There are currently no methods used for real-time high resolution clinical imaging or vibrometry of these structures. The ability to perform such imaging could aid in the diagnosis of some pathologies and advance understanding of the causes. It is demonstrated that high frequency ultrasound can be used to measure basilar membrane vibrations through the round window of chinchilla cochleas in vivo. The basic vibration characteristics of the basilar membrane agree with previous studies that used other methods, although as expected, the sensitivity of ultrasound was not as high as optical methods. At the best frequency for the recording location, the average vibration velocity amplitude was about 4 mm/s/Pa with stimulus intensity of 50 dB sound pressure level. The displacement noise floor was about 0.4 nm with 256 trial averages (5.12 ms per trial). Although vibration signals were observed, which likely originated from the organ of Corti, the spatial resolution was not adequate to resolve any of the sub-structures. Improvements to the ultrasound probe design may improve resolution and allow the responses of these different structures to be better discriminated.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 15, 2017
Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to dete... more Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to determine whether a newly developed sonotubometric test using clicks can reliably detect ET opening during swallowing in normal ET subjects, and patulous ET (PET) in subjects with ET dysfunction. Sixteen subjects (19 normal ET ears and 6 PET ears) were individually placed in a sound-isolated audiometry booth and subjected to a 1000Hz click train stimulus, played through the nose. PET subjects were identified through the ET clinic at our institution, while healthy subjects were recruited. Transmission through the ET was recorded by a microphone in the ear ipsilateral to the presenting nostril, during no swallow and swallow states, and this was used to compute a power ratio (power in the frequency range of interest to the whole frequency range). The power transmission ratio both before and after the swallow was averaged, and represented the baseline (BaseR). The power transmission ratio during...
The otolaryngologist is sometimes faced with a patient with an apparent conductive hearing loss o... more The otolaryngologist is sometimes faced with a patient with an apparent conductive hearing loss on audiometric testing who appears to have normal and mobile middle ear structures on ear exploration. Some causes of these "pseudoconductive" hearing losses can be diagnosed without resorting to surgery. This article reviews several possible mechanisms for this condition with diagnostic procedures to distinguish etiologic diseases. Conditions discussed include poor audiometry, functional hearing losses, "third window" causes, obliterated round window, abnormal inner ear connection with the cerebrospinal fluid space, inner ear mechanical conductive hearing loss, and apparent inner ear loss owing to missed middle ear pathology.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 30, 2016
Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surface... more Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma. A retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op. Twenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain midd...
Speech-in-noise testing relies on a number of factors beyond the auditory system, such as cogniti... more Speech-in-noise testing relies on a number of factors beyond the auditory system, such as cognitive function, compliance, and motor function. It may be possible to avoid these limitations by using electroencephalography. The present study explored this possibility using the N400. Eleven adults with typical hearing heard high-constraint sentences with congruent and incongruent terminal words in the presence of speech-shaped noise. Participants ignored all auditory stimulation and watched a video. The signal-to-noise ratio (SNR) was varied around each participant's behavioral threshold during electroencephalography recording. Speech was also heard in quiet. The amplitude of the N400 effect exhibited a nonlinear relationship with SNR. In the presence of background noise, amplitude decreased from high (+4 dB) to low (+1 dB) SNR but increased dramatically at threshold before decreasing again at subthreshold SNR (-2 dB). The SNR of speech in noise modulates the amplitude of the N400 e...
Cochlear implants (CIs) have tremendously helped people with severe to profound hearing loss to g... more Cochlear implants (CIs) have tremendously helped people with severe to profound hearing loss to gain access to sound and oral-verbal communication. However, the electrical stimulus in the cochlea spreads easily and widely, since the perilymph and endolymph (i.e., intracochlear fluids) are essentially electrolytes, leading to an inability to focus stimulation to discrete portions of the auditory nerve, which blurs the neural signal. Here, we characterize the complex transimpedances of human cadaveric cochleas to investigate how electrical stimulus spread is distributed from 10 Hz to 100 kHz. By using electrochemical impedance spectroscopy (EIS), both the resistive and capacitive elements of human cochleas are measured and modeled with an electrical circuit model, identifying spread-induced and spread-independent impedance components. Based on this electrical circuit model, we implement a Laplace transform to simulate the theoretical shapes of the spread signals. The model is validated by experimentally applying the simulated stimulus as a real stimulus to the cochlea and measuring the shapes of the spread signals, with relative errors of <0.6% from the model. Based on this model, we show the relationship between stimulus pulse duration and electrical stimulus spread. This EIS technique to characterize the transimpedances of human cochleas provides a new way to predict the spread signal under an arbitrary electrical stimulus, thus providing preliminary guidance to the design of CI stimuli for different CI users and coding strategies.
Hearing loss affects one in six people in the UK and is a significant disease burden. In addition... more Hearing loss affects one in six people in the UK and is a significant disease burden. In addition to communication problems, there is also an association with depression and dementia. Clinical assessment with targeted history and examination can identify the characteristics and cause of hearing loss, and complementary audiological testing can confirm its type and severity. Retrocochlear screening is recommended for sudden, rapidly progressive or asymmetric sensorineural hearing loss. Medical or surgical therapies may be indicated in cases of conductive hearing loss, while hearing assistive devices and hearing aids are the mainstay of rehabilitation for sensorineural hearing loss.
Background and aims Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustach... more Background and aims Eustachian tube dysfunction (ETD) is a commonly diagnosed disorder of Eustachian tube opening and closure, which may be associated with severe symptoms and middle ear disease. Currently the diagnosis of obstructive and patulous forms of ETD is primarily based on non-specific symptoms or examination findings, rather than measurement of the underlying function of the Eustachian tube. This has proved problematic when selecting patients for treatment, and when designing trial inclusion criteria and outcomes. This study aims to determine the correlation and diagnostic value of various tests of ET opening and patient reported outcome measures (PROMs), in order to generate a recommended diagnostic pathway for ETD. Methods Index tests included two PROMs and 14 tests of ET opening (nine for obstructive, five for patulous ETD). In the absence of an accepted reference standard two methods were adopted to establish index test accuracy: expert panel diagnosis and latent class analysis. Index test results were assessed with Pearson correlation and principle component analysis, and test accuracy was determined. Logistic regression models assessed the predictive value of grouped test results.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 3, 2018
The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to d... more The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to determine whether a 678 Hz probe tone is a more accurate indicator of Patulous ET (PET) than the 226 Hz probe tone when used in compliance over time (COT) testing. Twenty subjects (11 normal ET ears and 7 PET ears) were individually seated in an examination room and connected to a GSI TympStar Middle Ear Analyzer. The order of probe tone frequency (678 or 226 Hz) was randomized. Baseline "testing" COT recordings for each ear undergoing testing were completed. Subjects were instructed to occlude their contralateral nostril and to breathe forcefully in and out through their ipsilateral nostril until the test had run to completion. This process was repeated with the probe tone that had not been previously run. For the control group, each subject had one random ear tested. For the experimental group, only the affected ear(s) was tested. Wilcoxon rank rum tests were performed to dete...
Miniature high frequency ultrasound devices show promise as tools for clinical middle ear and bas... more Miniature high frequency ultrasound devices show promise as tools for clinical middle ear and basal cochlea imaging and vibrometry. However, before clinical use it is important to verify that the ultrasound exposure does not damage the cochlea. In this initial study, electrophysiological responses of the cochlea were measured for a range of stimulus frequencies in both ears of anesthetized chinchillas, before and after exposing the organ of Corti region of one ear to pulsed focused ultrasound for 30 min. Measurements were again taken after an 11 day survival period. Cochlear tissue was examined with a confocal microscope for signs of damage to the cochlear hair cells. No significant change in response thresholds due to exposure was found, and no signs of ultrasound-induced tissue damage were observed, although one animal (out of ten) did have a region of extensive tissue damage in the exposed cochlea. However, after further analysis this was concluded to be not likely a result of th...
This study aimed to determine the feasibility of combining high-frequency ultrasound imaging, aut... more This study aimed to determine the feasibility of combining high-frequency ultrasound imaging, automated insertion, and force sensing to yield more information about cochlear implant insertion dynamics. An apparatus was developed combining these aspects along with software to control implant and imaging probe positions. Decalcified unfixed human cochleas were implanted at various speeds, insertion sites, and implant models while imaging near the implant tip throughout insertion and recording force data from the cochlea mounting stage. Ultrasound video data were also captured. The basilar membrane (BM) was frequently penetrated by the implant in either the mid-basal or lower middle turn. Measurements were also performed of apical BM motion in response to upstream implant movement at varying insertion speeds. Increasing insertion speed resulted in greater BM displacement. Multiple insertions per cochlea increase the volume of data per specimen while also reducing variability due to dif...
The basilar membrane and organ of Corti in the cochlea are essential for sound detection and freq... more The basilar membrane and organ of Corti in the cochlea are essential for sound detection and frequency discrimination in normal hearing. There are currently no methods used for real-time high resolution clinical imaging or vibrometry of these structures. The ability to perform such imaging could aid in the diagnosis of some pathologies and advance understanding of the causes. It is demonstrated that high frequency ultrasound can be used to measure basilar membrane vibrations through the round window of chinchilla cochleas in vivo. The basic vibration characteristics of the basilar membrane agree with previous studies that used other methods, although as expected, the sensitivity of ultrasound was not as high as optical methods. At the best frequency for the recording location, the average vibration velocity amplitude was about 4 mm/s/Pa with stimulus intensity of 50 dB sound pressure level. The displacement noise floor was about 0.4 nm with 256 trial averages (5.12 ms per trial). Although vibration signals were observed, which likely originated from the organ of Corti, the spatial resolution was not adequate to resolve any of the sub-structures. Improvements to the ultrasound probe design may improve resolution and allow the responses of these different structures to be better discriminated.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 15, 2017
Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to dete... more Eustachian tube (ET) dysfunction can be very difficult to diagnose accurately. Our aim is to determine whether a newly developed sonotubometric test using clicks can reliably detect ET opening during swallowing in normal ET subjects, and patulous ET (PET) in subjects with ET dysfunction. Sixteen subjects (19 normal ET ears and 6 PET ears) were individually placed in a sound-isolated audiometry booth and subjected to a 1000Hz click train stimulus, played through the nose. PET subjects were identified through the ET clinic at our institution, while healthy subjects were recruited. Transmission through the ET was recorded by a microphone in the ear ipsilateral to the presenting nostril, during no swallow and swallow states, and this was used to compute a power ratio (power in the frequency range of interest to the whole frequency range). The power transmission ratio both before and after the swallow was averaged, and represented the baseline (BaseR). The power transmission ratio during...
The otolaryngologist is sometimes faced with a patient with an apparent conductive hearing loss o... more The otolaryngologist is sometimes faced with a patient with an apparent conductive hearing loss on audiometric testing who appears to have normal and mobile middle ear structures on ear exploration. Some causes of these "pseudoconductive" hearing losses can be diagnosed without resorting to surgery. This article reviews several possible mechanisms for this condition with diagnostic procedures to distinguish etiologic diseases. Conditions discussed include poor audiometry, functional hearing losses, "third window" causes, obliterated round window, abnormal inner ear connection with the cerebrospinal fluid space, inner ear mechanical conductive hearing loss, and apparent inner ear loss owing to missed middle ear pathology.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, Jan 30, 2016
Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surface... more Gas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma. A retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op. Twenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain midd...
Speech-in-noise testing relies on a number of factors beyond the auditory system, such as cogniti... more Speech-in-noise testing relies on a number of factors beyond the auditory system, such as cognitive function, compliance, and motor function. It may be possible to avoid these limitations by using electroencephalography. The present study explored this possibility using the N400. Eleven adults with typical hearing heard high-constraint sentences with congruent and incongruent terminal words in the presence of speech-shaped noise. Participants ignored all auditory stimulation and watched a video. The signal-to-noise ratio (SNR) was varied around each participant's behavioral threshold during electroencephalography recording. Speech was also heard in quiet. The amplitude of the N400 effect exhibited a nonlinear relationship with SNR. In the presence of background noise, amplitude decreased from high (+4 dB) to low (+1 dB) SNR but increased dramatically at threshold before decreasing again at subthreshold SNR (-2 dB). The SNR of speech in noise modulates the amplitude of the N400 e...
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