The laser-Doppler vibrometer (LDV) is a research tool that can be used to quickly measure the soundinduced velocity of the tympanic membrane near the umbo (the inferior tip of the malleus) in live human subjects and patients. In this manuscript we demonstrate the LDV to be a sensitive and selective tool for the diagnosis and differentiation of various ossicular disorders in patients with intact tympanic membranes and aerated middle ears. Patients with partial or total ossicular interruption or malleus fixation are readily separated from normal-hearing subjects with the LDV. The combination of LDV measurements and air-bone gap can distinguish patients with fixed stapes from those with normal ears. LDV measurements can also help differentiate air-bone gaps produced by ossicular pathologies from those associated with pathologies of inner-ear sound conduction such as a superior semicircular canal dehiscence.The key audiological tool for defining conductive hearing loss is the air-bone gap, which is the difference between air-conducted and bone-conducted hearing levels. The pathology associated with such gaps may, in certain cases, be readily observable during otoscopic examination, for example, cerumen impaction, perforations of the tympanic membrane (TM), acute otitis media, chronic otitis media, etc. However, the diagnosis of the precise pathology causing a conductive hearing loss in patients with an intact TM is difficult, and conclusive diagnosis is often only made at the time of exploratory middle ear surgery.Although there are tools available for presurgical diagnosis of such disorders, they have imperfect selectivity and sensitivity. Tympanometry and acoustic-reflex testing, in conjunction with audiometry, are sensitive to different ossicular disorders (Jerger, 1975;Margolis & Shanks, 1985), for example (1) a normal tympanogram coupled with a lack of ipsilateral acoustic reflex and a significant air-bone gap that is either flat or upward sloping with increasing frequency is usually associated with stapes fixation. (2) A hypomobile tympanogram with a loss of reflex thresholds and a mild to moderate conductive loss is often associated with malleus fixation. (3) A hyper-mobile tympanogram with a loss of ipsilateral reflex and either a 50-dB flat or downward sloping conductive loss is usually associated with either a total or partial ossicular disarticulation.A major problem with the above scheme is that standard single-frequency (226 Hz) tympanometry is relatively insensitive to ossicular disorders and many ears with fixed or Address for correspondence: John Rosowski, Eaton-Peabody Lab, Massachusetts Eye & Ear Infirmary, 243 Charles Street, Boston, MA 02114. E-mail: John_Rosowski@meei.harvard.edu.
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NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript interrupted ossicular chains are not reliably differentiated by this technique. The selectivity and sensitivity of tympanometry to ossicular disorders can be improved by measurements at multiple frequencies (Lily, 1984;...