Objective measurements of skull vibration during bone conduction audiometry

Abstract

Background: Two different pathways of sound transmission to the inner ear are differentiated; air conduction (AC) and bone conduction (BC). The transmission pathway of AC, which is physiological for human hearing, implies the transmission of sound to the cochlea via the ear canal, eardrum, and middle-ear ossicles, while BC bypasses the Pinna, the external auditory canal and the middle ear. The transmission pathway by BC has not been fully understood and many aspects still remain questionable. The aim of this study is to characterize two ways of direct transmission of vibrations to the inner ear by measuring hearing thresholds and vibrations of the skull. The bone-vibrator, which is usually used to measure the BC hearing thresholds in contact with the mastoid, can also be used to simulate other contents of skull, such as the eye. Methods: Ten adults (age range of 25-40) with normal hearing and five patients (age range of 21-31) with single sided profound deafness (SSD) were included in this study. The AC audiometry by pure tones was measured using insert earphones and the BC audiometry was measured by stimulating four different locations of the skull; the forehead, the temporal region, the mastoid, and the ipsilateral eyeball with two different contact pressure magnitudes of 2N and of 5N. The vibrations of the skull bones induced by air and bone conduction stimuli were measured by an accelerometer positioned between an upper and lower front incisor tooth. Results: The BC hearing thresholds by stimulating the temporal region and the mastoid were the lowest in both of normal hearing and SSD subjects and the values by both stimulations were similar. Thresholds were significantly higher for stimulations on the forehead and the eye (p<0.05). The difference between the thresholds by stimulation at the mastoid or temporal region and at the eye was more pronounced in SSD subjects (p<0.01). The averaged BC thresholds of normal subjects by stimulation on the contralateral temporal region were significantly lower than the averaged BC thresholds of SSD subjects only at the frequency of 0.25 kHz (p<0.01). The BC thresholds by stimulation on the contralateral mastoid of the normal hearing subjects were significantly lower in 5 N headband than in 2 N headband at the whole frequency range (p<0.05). The BC thresholds by stimulation on the ipsilateral mastoid of the normal hearing subjects showed significant differences between the contact pressure forces of 5 N and 2 N at the frequencies of 1, 2, and 3 kHz (p<0.5). The stimulation on the contralateral mastoid with the 5 N headband resulted in a significantly lower BC threshold than the stimulation with 5 the 2 N headband at the entire frequency range (p<0.05). In SSD subjects, the stimulation on the ipsilateral mastoid side with the 5 N headband had a significantly lower BC thresholds than stimulation with the 2 N headband at all frequencies except for 0.5 and 4 kHz (p<0.05). The BC thresholds in normal hearing subjects were significantly lower with the ipsilateral temporal stimulation than with a corresponding contralateral stimulation for the all frequencies except for 0.5 and 1 kHz (p<0.01). For the SSD subjects, the BC thresholds with the ipsilateral temporal stimulation were significantly lower at 2, 3 and 4 kHz than those with the corresponding contralateral stimulation. Skull vibrations in the normal hearing subjects showed similar behaviors at low frequencies up to 2 kHz for all stimulations except for stimulation on the eye, where vibrations were smaller. In contrast, skull vibrations measured from stimulation at the eye were increasing with higher frequencies. Under 2 kHz skull vibrations at eye were significantly smaller than those from stimulation of the mastoid, but above 2 kHz, they were significantly bigger (p<0.05). Skull vibrations between stimulation at the ipsilateral mastoid and forehead were significantly different at 0.25, 3 and 4 kHz (p<0.05). The subjects with SSD showed similar patterns. Conclusion: The patterns of BC hearing thresholds were similar in normal subjects and subjects with SSD. Hearing thresholds in all subjects were significantly better for mastoid and temple stimulation compared to eye stimulation. One reason for that may be the different pressures applied. Skull vibrations as measured at teeth did not match the same pattern as the hearing thresholds. Eye stimulation induced low vibrations below 2 kHz, but high vibrations above 2 kHz. This finding demonstrates special acoustic properties of the living organism, the distance from stimulation might also contribute. Skull-bone vibrations decreased with increasing frequency for mastoid and temple stimulation. Stimulation of soft tissue, presumably including skull contents, seems to induce high frequency skull vibrations. That might be involved with the distance form the front teeth. The transcranial attenuation of vibration should be considered especially in high frequencies.