Minimally invasive laser vibrometry (MIVIB) with a floating mass transducer – A new method for objective evaluation of the middle ear demonstrated on stapes fixation

Abstract

Ossicular fixation through otosclerosis, chronic otitis media and other pathologies, especially tympanosclerosis, are treated by surgery if hearing aids fail as an alternative. However, the best hearing outcome is often based on knowledge of the degree and location of the fixation. Objective methods to quantify the degree and position of the fixation are largely lacking. Laser vibrometry is a known method to detect ossicular fixation but clinical applicability remains limited. A new method, minimally invasive laser vibrometry (MIVIB), is presented to quantify ossicle mobility using laser vibrometry measurement through the ear canal after elevating the tympanic membrane, thus making the method feasible in minimally invasive explorative surgery. A floating mass transducer provides a clinically relevant transducer to drive ossicular vibration. This device was attached to the manubrium and drove vibrations at the same angle as the longitudinal axis of the stapes and was therefore used to assess ossicular chain mobility in a fresh-frozen temporal bone model with and without stapes fixation. The ratio between the umbo and incus long process was shown to be useful in assessing stapes fixation. The incus-to-umbo velocity ratio decreased by 15 dB when comparing the unfixated situation to stapes fixation up to 2.5 kHz. Such quantification of ossicular fixation using the incus-to-umbo velocity ratio would allow quick and objective analysis of ossicular chain fixations which will assist the surgeon in surgical planning and optimize hearing outcomes.

Comparison of hearing reconstruction techniques in tympanosclerosis with stapes fixation

“…The implementation of new, objective techniques to assess ossicular motility will provide more detailed and precise information about which technique should be applied. Wales et al [13] experimented with minimally invasive laser vibrometry for an objective evaluation of the ossicles in temporal bones. In the future, after mobilization, surgeons may utilize such methods to decide whether to perform an additional hearing reconstruction.…”

Az otoscleroticus eredetű hallócsontláncolati fixatiók klinikuma

“…A módszer új alternatívája, a minimálinvazív intraoperatív vibrometria (MIVIB) ezeket a hátrányokat küszöböli ki. Az eredmény értékelése során az incus umbóhoz viszonyított sebességének aránya fordítottan arányos a stapesfixatio fokával [19].…”

An Assembly Quality Inspection System for Bone Conduction Implant Transducers

“…However, MEI are not preferred by many patients with hearing loss because they require complicated invasive surgery, unlike noninvasive air conduction hearing aids. In addition, they cannot be applied in cases of hearing impairment where sound is not effectively transmitted to the cochlea due to damage to the auditory ossicles of the ear [17]- [20].…”