Intracochlear Pressure Research Articles

Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes.

To preserve residual hearing in cochlear implant candidates, the atraumatic insertion of the cochlea electrode has become a focus of cochlea implant research. In a previous study, intracochlear pressure changes during the opening of the round window membrane were investigated. In the current study, intracochlear pressure changes during opening of the round window membrane under dry and transfluid conditions were investigated. Round window openings were performed in an artificial cochlear model. Intracochlear pressure changes were measured using a micro-optical pressure sensor, which was placed in the apex. Openings of the round window membrane were performed under dry and wet conditions using a cannula and a diode laser. Statistically significant differences in the intracochlear pressure changes were seen between the different methods used for opening of the round window membrane. Lower pressure changes were seen by opening the round window membrane with the diode laser than with the cannula. A significant difference was seen between the dry and wet conditions. The atraumatic approach to the cochlea is assumed to be essential for the preservation of residual hearing. Opening of the round window under wet conditions produce a significant advantage on intracochlear pressure changes in comparison to dry conditions by limiting negative outward pressure.

Serrated needle design facilitates precise round window membrane perforation.

The round window membrane (RWM) has become the preferred route, over cochleostomy, for the introduction of cochlear implant electrodes as it minimizes inner ear trauma. However, in the absence of a tool designed for creating precise perforation, current practices lead to tearing of the RWM and significant intracochlear pressure fluctuations. On the basis of RWM mechanical properties, we have designed a multi-serrated needle to create consistent holes without membrane tearing or damaging inner ear structures. Four and eight-serrated needles were designed and produced with wire electrical discharge machining (EDM). The needle's ability to create RWM perforations was tested in deidentified, commercially acquired temporal bones with the assistance of a micromanipulator. Subsequently, specimens were imaged under light and scanning electron microscopy (SEM). The needles created consistent, appropriately sized holes in the membrane with minimal tearing. While a four-serrated crown needle made rectangular/trapezoid perforations, the octagonal crown formed smooth oval holes within the membrane. Though designed for single use, the needle tolerated repeated use without significant damage. The serrated needles formed precise perforations in the RWM while minimizing damage during cochlear implantation. The octagonal needle design created the preferred oval perforation better than the quad needle. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1633-1637, 2016.

Effects of Round Window Opening Size and Moisturized Electrodes on Intracochlear Pressure Related to the Insertion of a Cochlear Implant Electrode

Intracochlear pressure changes during the cochlear implant insertion are assumed to be an important contributor to hearing preservation. The aim was to observe intracochlear pressure changes by different round window opening sizes and different hydrophilic electrode conditions. The experiments were performed in a cochlear model with a micropressure sensor in the helicotrema area. Different artificial round window membrane and different moisturized electrode conditions were compared. A punctured round window causes a significantly higher and an indirect moisturized electrode condition a significantly lower intracochlear pressure change. The degree of round window opening and the hydrophilic character of an electrode during insertion affect the intracochlear pressure significantly in a model.

Effects of Different Insertion Techniques of a Cochlear Implant Electrode on the Intracochlear Pressure

To achieve a functional atraumatic insertion, low intracochlear pressure changes during the procedure are assumed to be important. The aim of this study was to observe intracochlear pressure changes due to different insertion techniques in a cochlear model. Cochlear implant electrode insertions were performed in an artificial cochlear model to record intracochlear pressure changes with a micropressure sensor to evaluate the maximum amplitude and frequency of pressure changes under different insertional conditions. We found statistically significant differences in the occurrence of intracochlear pressure peak changes comparing different techniques. Based on our model results, an insertion should be maximally supported to minimize micromovement-related pressure changes.

Postinsertional Cable Movements of Cochlear Implant Electrodes and Their Effects on Intracochlear Pressure.

Introduction. To achieve a functional atraumatic cochlear implantation, intracochlear pressure changes during the procedure should be minimized. Postinsertional cable movements are assumed to induce intracochlear pressure changes. The aim of this study was to observe intracochlear pressure changes due to postinsertional cable movements. Materials and Methods. Intracochlear pressure changes were recorded in a cochlear model with a micro-pressure sensor positioned in the apical region of the cochlea model to follow the maximum amplitude and pressure gain velocity in intracochlear pressure. A temporal bone mastoid cavity was attached to the model to simulate cable positioning. The compared conditions were (1) touching the unsealed electrode, (2) touching the sealed electrode, (3) cable storage with an unfixed cable, and (4) cable storage with a fixed cable. Results. We found statistically significant differences in the occurrence of maximum amplitude and pressure gain velocity in intracochlear pressure changes under the compared conditions. Comparing the cable storage conditions, a cable fixed mode offers significantly lower maximum pressure amplitude and pressure gain velocity than the nonfixed mode. Conclusion. Postinsertional cable movement led to a significant pressure transfer into the cochlea. Before positioning the electrode cable in the mastoid cavity, fixation of the cable is recommended.

Evaluation of Round Window Stimulation Performance in Otosclerosis Using Finite Element Modeling

Round window (RW) stimulation is a new type of middle ear implant's application for treating patients with middle ear disease, such as otosclerosis. However, clinical outcomes show a substantial degree of variability. One source of variability is the variation in the material properties of the ear components caused by the disease. To investigate the influence of the otosclerosis on the performance of the RW stimulation, a human ear finite element model including middle ear and cochlea was established based on a set of microcomputerized tomography section images of a human temporal bone. Three characteristic changes of the otosclerosis in the auditory system were simulated in the FE model: stapedial annular ligament stiffness enlargement, stapedial abnormal bone growth, and partial fixation of the malleus. The FE model was verified by comparing the model-predicted results with published experimental measurements. The equivalent sound pressure (ESP) of RW stimulation was calculated via comparing the differential intracochlear pressure produced by the RW stimulation and the normal eardrum sound stimulation. The results show that the increase of stapedial annular ligament and partial fixation of the malleus decreases RW stimulation's ESP prominently at lower frequencies. In contrast, the stapedial abnormal bone growth deteriorates RW stimulation's ESP severely at higher frequencies.

Intracochlear Scala Media Pressure Measurement: Implications for Models of Cochlear Mechanics

Models of the active cochlea build upon the underlying passive mechanics. Passive cochlear mechanics is based on physical and geometrical properties of the cochlea and the fluid-tissue interaction between the cochlear partition and the surrounding fluid. Although the fluid-tissue interaction between the basilar membrane and the fluid in scala tympani (ST) has been explored in both active and passive cochleae, there was no experimental data on the fluid-tissue interaction on the scala media (SM) side of the partition. To this aim, we measured sound-evoked intracochlear pressure in SM close to the partition using micropressure sensors. All the SM pressure data are from passive cochleae, likely because the SM cochleostomy led to loss of endocochlear potential. Thus, these experiments are studies of passive cochlear mechanics. SM pressure close to the tissue showed a pattern of peaks and notches, which could be explained as an interaction between fast and slow (i.e., traveling wave) pressure modes. In several animals SM and ST pressure were measured in the same cochlea. Similar to previous studies, ST-pressure was dominated by a slow, traveling wave mode at stimulus frequencies in the vicinity of the best frequency of the measurement location, and by a fast mode above best frequency. Antisymmetric pressure between SM and ST supported the classic single-partition cochlear models, or a dual-partition model with tight coupling between partitions. From the SM and ST pressure we calculated slow and fast modes, and from active ST pressure we extrapolated the passive findings to the active case. The passive slow mode estimated from SM and ST data was low-pass in nature, as predicted by cochlear models.

Cochlear Implant Electrode Effect on Sound Energy Transfer Within the Cochlea During Acoustic Stimulation.

Cochlear implants (CIs) designed for hearing preservation will not alter mechanical properties of the middle and inner ears as measured by intracochlear pressure (P(IC)) and stapes velocity (Vstap). CIs designed to provide combined electroacoustic stimulation are now available. To maintain functional acoustic hearing, it is important to know if a CI electrode can alter middle or inner ear mechanics because any alteration could contribute to elevated low-frequency thresholds in electroacoustic stimulation patients. Seven human cadaveric temporal bones were prepared, and pure-tone stimuli from 120 Hz to 10 kHz were presented at a range of intensities up to 110 dB sound pressure level. P(IC) in the scala vestibuli (P(SV)) and tympani (PST) were measured with fiber-optic pressure sensors concurrently with VStap using laser Doppler vibrometry. Five CI electrodes from two different manufacturers with varying dimensions were inserted via a round window approach at six different depths (16-25 mm). The responses of P(IC) and VStap to acoustic stimulation were assessed as a function of stimulus frequency, normalized to sound pressure level in the external auditory canal, at baseline and electrode-inserted conditions. Responses measured with electrodes inserted were generally within approximately 5 dB of baseline, indicating little effect of CI electrode insertion on P(IC) and VStap. Overall, mean differences across conditions were small for all responses, and no substantial differences were consistently visible across electrode types. Results suggest that the influence of a CI electrode on middle and inner ear mechanics is minimal despite variation in electrode lengths and configurations.

FINITE ELEMENT ANALYSIS OF THE EFFECT OF ACTUATOR COUPLING CONDITIONS ON ROUND WINDOW STIMULATION

The finite element (FE) method was used to analyze the effect of coupling conditions between the actuator and the round window membrane (RWM) on the performance of round window (RW) stimulation. A FE model of the human ear consisting of the external ear canal, middle ear and cochlea was firstly developed, and then validation of this model was accomplished through comparison between analytical results and experimental data in the literature. Intracochlear pressure were derived from the model under normal forward sound stimulation and reverse RW stimulation. The equivalent sound pressure of RW stimulation was then calculated via comparing the differential intracochlear pressure produced by the actuator and normal ear canal sound stimulus. The actuator was simulated as a floating mass and placed onto the middle ear cavity side of RWM. Two aspects about the actuator coupling conditions were considered in this study: (1) the cross-section area of the actuator relative to the RWM; (2) the coupling layer between the actuator and the RWM. The results show that smaller actuator size can improve the implant performance of RW stimulation, and size requirements of the actuator can also be reduced by introducing a coupling layer between the actuator and RWM, which will benefit the manufacture of the actuator.

FINITE ELEMENT MODELING OF THE HUMAN COCHLEA USING FLUID–STRUCTURE INTERACTION METHOD

In this paper, a 3D finite element (FE) model of human cochlea is developed. This passive model includes the structure of oval window, round window, basilar membrane (BM) and cochlear duct which is filled with fluid. Orthotropic material property of the BM is varying along its length. The fluid–structure interaction (FSI) method is used to compute the responses in the cochlea. In particular, the viscous fluid element is adopted for the first time in the cochlear FE model, so that the effects of shear viscosity in the fluid are considered. Results on the cochlear impedance, BM response and intracochlear pressure are obtained. The intracochlear pressure includes the scala vestibule and scala tympani pressure are extracted and used to calculate the transfer functions from equivalent ear canal pressures to scala pressures. The reasonable agreements between the model results and the experimental data in the literature prove the validity of the cochlear model for simulating sound transmission in the cochlea. Moreover, this model predicted the transfer function from equivalent ear canal pressures to scala pressures which is the input to the cochlear partition.

Human middle-ear model with compound eardrum and airway branching in mastoid air cells.

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25-13 kHz), equivalent input impedance at the eardrum (0.25-11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1-11 kHz), and reverse middle-ear impedance (0.25-8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold.

Assessment of the Effects of Superior Canal Dehiscence Location and Size on Intracochlear Sound Pressures

Superior canal dehiscence (SCD) is a defect in the bony covering of the superior semicircular canal. Patients with SCD present with a wide range of symptoms, including hearing loss, yet it is unknown whether hearing is affected by parameters such as the location of the SCD. Our previous human cadaveric temporal bone study, utilizing intracochlear pressure measurements, generally showed that an increase in dehiscence size caused a low-frequency monotonic decrease in the cochlear drive across the partition, consistent with increased hearing loss. This previous study was limited to SCD sizes including and smaller than 2 mm long and 0.7 mm wide. However, the effects of larger SCDs (>2 mm long) were not studied, although larger SCDs are seen in many patients. Therefore, to answer the effect of parameters that have not been studied, this present study assessed the effect of SCD location and the effect of large-sized SCDs (>2 mm long) on intracochlear pressures. We used simultaneous measurements of sound pressures in the scala vestibuli and scala tympani at the base of the cochlea to determine the sound pressure difference across the cochlear partition - a measure of the cochlear drive in a temporal bone preparation - allowing for assessment of hearing loss. We measured the cochlear drive before and after SCDs were made at different locations (e.g. closer to the ampulla of the superior semicircular canal or closer to the common crus) and for different dehiscence sizes (including larger than 2 mm long and 0.7 mm wide). Our measurements suggest the following: (1) different SCD locations result in similar cochlear drive and (2) larger SCDs produce larger decreases in cochlear drive at low frequencies. However, the effect of SCD size seems to saturate as the size increases above 2-3 mm long and 0.7 mm wide. Although the monotonic effect was generally consistent across ears, the quantitative amount of change in cochlear drive due to dehiscence size varied across ears. Additionally, the size of the dehiscence above which the effect on hearing saturated varied across ears. These findings show that the location of the SCD does not generally influence the amount of hearing loss and that SCD size can help explain some of the variability of hearing loss in patients. i 2014 S. Karger AG, Basel

Intracochlear pressure changes due to round window opening: a model experiment.

To preserve residual hearing in cochlea implantation, the electrode design has been refined and an atraumatic insertion of the cochlea electrode has become one aspect of cochlea implant research. The opening of the round window can be assumed to be a contributing factor in an atraumatic concept. The aim of our study was to observe intracochlear pressure changes due to different opening conditions of an artificial round window membrane. The experiments were performed in an artificial cochlea model. A round window was simulated with a polythene foil and a pressure sensor was placed in the helicotrema area to monitor intraluminal pressure changes. Openings of the artificial round window membrane were performed using different ways. Opening the artificial round window mechanically showed a biphasic behaviour of pressure change. Laser openings showed a unidirectional pressure change. The lowest pressure changes were observed when opening the artificial round window membrane using a diode laser. The highest pressure changes were seen when using a needle. The openings with the CO2 laser showed a negative intracochlear pressure and a loss of fluid. In our model experiments, we could prove that the opening of the artificial round window membrane causes various intracochlear pressure changes.

A simple electrical lumped-element model simulates intra-cochlear sound pressures and cochlear impedance below 2 kHz

Low-frequency sounds displace large parts of the basilar membrane (BM) and can have a modulating and possibly disturbing effect on hearing at other frequencies. A better understanding of the transfer of such sounds onto the BM is therefore desirable. Lumped-element models have previously been employed to determine the low-frequency acoustic properties of the cochlea. Although helpful in illustrating schematically the role of the helicotrema, BM compliance, and the round window on low-frequency hearing, these models, when applied quantitatively, have not been able to explain experimental data in detail. Building on these models, an extended electrical analog requires just 13 lumped elements to capture, in surprising detail, the physiologically determined frequency-dependence of intra-cochlear pressure and cochlear impedance between 10 Hz and 2 kHz. The model's verification is based on data from cat, guinea pig, and humans, who differ principally in their low-frequency cochlear acoustics. The modeling data suggest that damping within the helicotrema plays a less prominent role than previously assumed. A resonance feature, which is often observed experimentally near 150 Hz in these animals and near 50 Hz in humans, is presumably a phenomenon local to the apex and not the result of a standing wave between stapes and helicotrema.

Detection of Cochlear Amplification and Its Activation

The operation of the mammalian cochlea relies on a mechanical traveling wave that is actively boosted by electromechanical forces in sensory outer hair cells (OHCs). This active cochlear amplifier produces the impressive sensitivity and frequency resolution of mammalian hearing. The cochlear amplifier has inspired scientists since its discovery in the 1970s, and is still not well understood. To explore cochlear electromechanics at the sensory cell/tissue interface, sound-evoked intracochlear pressure and extracellular voltage were measured using a recently developed dual-sensor with a microelectrode attached to a micro-pressure sensor. The resulting coincident in vivo observations of OHC electrical activity, pressure at the basilar membrane and basilar membrane displacement gave direct evidence for power amplification in the cochlea. Moreover, the results showed a phase shift of voltage relative to mechanical responses at frequencies slightly below the peak, near the onset of amplification. Based on the voltage-force relationship of isolated OHCs, the shift would give rise to effective OHC pumping forces within the traveling wave peak. Thus, the shift activates the cochlear amplifier, serving to localize and thus sharpen the frequency region of amplification. These results are the most concrete evidence for cochlear power amplification to date and support OHC somatic forces as its source.

Mechano-acoustical measurement and modeling of the outer and middle ear

Mechano-acoustical measurement and modeling have evolved together. Most early measurements of the behavior of the outer and middle ear produced either spatial averages or single-point observations, which were amenable to modeling with uniform transmission lines and lumped circuits. A major step forward was the measurement of displacement patterns on the eardrum, which called for the use of finite-element models. Other major experimental steps forward included measuring spatial sound-pressure distributions, 3-D displacement patterns, and intracochlear pressures. Use of the finite-element method made it desirable to obtain detailed 3-D shape measurements, which were made much easier by the introduction of magnetic-resonance microscopy and x-ray microCT. The finite-element method has also made it possible to exploit measurements of material properties, and several different approaches have been used recently for making such measurements. The greatest challenges may be in dealing with very small dimensions and non-linear visco-elastic behavior. There is a need for more and better 3-D multipoint vibration measurements, and for material-property measurements that are more localized and that span a broader frequency range. Important directions for modeling include better use of available shape and material-property data, more attention to experimental animals and to variability, and better integration with cochlear models.

Fast waves, slow waves and cochlear excitation

In idealized cochlear models [especially, Peterson and Bogert, J. Acoust. Soc. Am. (1950)], intracochlear pressure is decomposed into two modes, the compression pressure (fast mode) and the traveling wave pressure (slow mode). Because the cochlear fluid is nearly incompressible, only the slow mode leads to significant motion. In the real cochlea, additional fast modes exist. These evanescent modes are similar to the traveling wave mode in driving significant fluid and tissue displacement. They are present in the region of the cochlear windows, where the anatomy is not the ideal symmetric structure of basic cochlear models. Evanescent modes also have emerged in experimental work in which cochleostomies are made in the apex. At high stimulus level fast modes are able excite hair cells, leading to auditory nerve responses. However, fast mode motions do not seem to be amplified by the cochlear amplifier. This observation supports the concept that the amplifier relies on traveling wave curvature, as has been proposed in cochlear models [for example, Yoon et al., Biophys. J. (2011)]. I will review experimental and theoretical results on the fast and slow waves, and propose experiments in which wavelength-based theories of amplification could be tested.

Finite element modelling of human auditory periphery including a feed-forward amplification of the cochlea

A three-dimensional finite element model is developed for the simulation of the sound transmission through the human auditory periphery consisting of the external ear canal, middle ear and cochlea. The cochlea is modelled as a straight duct divided into two fluid-filled scalae by the basilar membrane (BM) having an orthotropic material property with dimensional variation along its length. In particular, an active feed-forward mechanism is added into the passive cochlear model to represent the activity of the outer hair cells (OHCs). An iterative procedure is proposed for calculating the nonlinear response resulting from the active cochlea in the frequency domain. Results on the middle-ear transfer function, BM steady-state frequency response and intracochlear pressure are derived. A good match of the model predictions with experimental data from the literatures demonstrates the validity of the ear model for simulating sound pressure gain of middle ear, frequency to place map, cochlear sensitivity and compressive output for large intensity input. The current model featuring an active cochlea is able to correlate directly the sound stimulus in the ear canal with the vibration of BM and provides a tool to explore the mechanisms by which sound pressure in the ear canal is converted to a stimulus for the OHCs.

Comparison of forward (ear-canal) and reverse (round-window) sound stimulation of the cochlea

The cochlea is normally driven with “forward” stimulation, in which sound is introduced to the ear canal. Alternatively, the cochlea can be stimulated at the round window (RW) using an actuator. During RW “reverse” stimulation, the acoustic flow starting at the RW does not necessarily take the same path as during forward stimulation. To understand the differences between forward and reverse stimulation, we measured ear-canal pressure, stapes velocity, RW velocity, and intracochlear pressures in scala vestibuli (SV) and scala tympani (ST) of fresh human temporal bones. During forward stimulation, the cochlear drive (differential pressure across the partition) results from the large difference in magnitude between the pressures of SV and ST, which occurs due to the high compliance of the RW. During reverse stimulation, the relatively high impedance of the middle ear causes the pressures of SV and ST to have similar magnitudes, and the differential pressure results primarily from the difference in phase of the pressures. Furthermore, the sound path differs between forward and reverse stimulation, such that motion through a third window is more significant during reverse stimulation. Additionally, we determined that although stapes velocity is a good estimate of cochlear drive during forward stimulation, it is not a good measure during reverse stimulation.This article is part of a Special Issue entitled “MEMRO 2012”.

Intracochlear fluid pressure and cochlear input impedance from push-pull amplification model

Intracochlear fluid pressure and cochlear input impedance are simulated and compared with in-vivo physiological measurements. The objective of this work is to compare the calculations and measurements for the cochlear fluid pressure (PST) and related cochlear input impedance (ZC) with “push-pull” active cochlear model involving cochlear cytoarchitecture. Presented three-dimensional cochlear hydro-dynamic model is developed by implementing an active “push-pull” cochlear amplifier mechanism based on Y-shaped organ of Corti cytoarchitecture and using the time-averaged Lagrangian method. For the gerbil PST magnitude, the model results shows (i) the nonlinearity with 10 dB gain, (ii) the 2/3 octave shift in the active case, and (iii) the presence of peaks and valleys which are observed in gerbil in vivo measurement. Additionally, simulation results of chinchilla and cat cochlear |ZC| reflect overall trend of animal measurements, while the gerbil and human cochlear |ZC| are 10 dB lower (> 2 kHz) and 7 dB lower (< 2 kHz) than the measurements respectively.