Intra-operative quantification of the ossicle mobility could provide valuable feedback for the current status of the patient's conductive hearing. However, current methods for evaluation of middle ear mobility are mostly limited to the surgeon's subjective impression through manual palpation of the ossicles. This study investigates how middle ear transfer function is affected by stapes quasi-static stiffness of the ossicular chain. The stiffness of the middle ear is induced by a) using a novel fiber-optic 3-axis force sensor to quantify the quasi-static stiffness of the middle ear, and b) by artificial reduction of stapes mobility due to drying of the middle ear.Methods:
Middle ear transfer function, defined as the ratio of the stapes footplate velocity versus the ear canal sound pressure, was measured with a single point LDV in two conditions. First, a controlled palpation force was applied at the stapes head in two in-plane (superior-inferior or posterior-anterior) directions, and at the incus lenticular process near the incudostapedial joint in the piston (lateral-medial) direction with a novel 3-axis PalpEar force sensor (Sensoptic, Losone, Switzerland), while the corresponding quasi-static displacement of the contact point was measured via a 3-axis micrometer stage. The palpation force was applied sequentially, step-wise in the range of 0.1–20 gF (1–200 mN). Second, measurements were repeated with various stages of stapes fixation, simulated by pre-load on the stapes head or drying of the temporal bone, and with severe ossicle immobilization, simulated by gluing of the stapes footplate.Results:
Simulated stapes fixation (forced drying of 5–15 min) severely decreases (20–30 dB) the low frequency (<1 kHz) response of the middle ear, while increasing (5–10 dB) the high frequency (>4 kHz) response. Stapes immobilization (gluing of the footplate) severely reduces (20–40 dB) the low and mid frequency response (<4 kHz) but has lesser effect (<10 dB) at higher frequencies. Even moderate levels of palpation force (<3gF, <30 mN), regardless of direction, have negative effect (10–20 dB) on the low frequency (<2 kHz) response, but with less significant (5–10 dB) effect at higher frequencies. Force-displacement measurements around the incudostapedial joint showed quasi-static stiffness in the range of 200–500 N/m for normal middle ears, and 1000–2500 N/m (5–8-fold increase) after artificially (through forced drying) reducing the middle ear transfer function with 10–25 dB at 1 kHz.Conclusion:
Effects of the palpation force level and direction, as well as stapes fixation and immobilization have been analyzed based on the measurement of the stapes footplate motion, and controlled application of 3D force and displacement.