Etiologic diagnosis of sensorineural hearing loss in adults

Effect of ossicular chain deformity on reverse stimulation considering the overflow characteristics of third windows

Stimulating the round window membrane via an active actuator of the middle ear implant, named the reverse stimulation, has become an option to help patients with ossicular chain deformity (OCD) to restore hearing. However, there is still no concise description of how OCD affects reverse stimulation considering the overflow characteristics of third windows. In the present study, an impedance model considering the vestibular and cochlear aqueducts was used to investigate the dynamic response of the cochlea to reverse stimulation under OCD. First, a finite-element (FE) model of the middle ear and the ear canal was used to estimate the changes in reverse middle-ear impedance caused by ossicular chain fixation and ossicular chain interruption. Then, the impedance model was used to predict the reverse transfer function, which characterizes the effect of OCD on the dynamic response of the cochlea. The results show that ossicular chain fixation reduces the reverse stimulation's performance. Moreover, the existence of the third windows complicates the effect of ossicular chain fixation on the reverse stimulation and boosts obviously the reverse stimulation's performance at low frequencies. In contrast, regardless of the existence of third windows, ossicular chain interruption enhances the effect of reverse stimulation.

Research on coupling effects of actuator and round window membrane on reverse stimulation of human cochlea

An active actuator of a middle-ear implant coupled to the round window membrane (RWM), which transmits vibration to the cochlea, has been used to compensate for hearing loss in patients. However, various factors affect the coupling condition between the actuator and the RWM, resulting in coupling leakage. In this study, a coupling impedance model of the human ear and the actuator was used to investigate the effect of inefficient coupling during reverse stimulation. First, the three-port circuit network model of the actuator was coupled with the acoustic impedance model of human ear reverse sound transmission. Meanwhile, the inefficient coupling impedance was estimated. Then, the effect of the actuator's coupling on reverse stimulation was studied by comparing the reverse pressure transfer function. Furthermore, the inefficient coupling's influence in the ear with middle-ear disorder was also investigated by simulating two typical forms of middle-ear disorder: otosclerosis and ossicular chain disarticulation. The results show that the change of the inefficient coupling impedance plays a significant role during reverse stimulation. Inefficient coupling of the actuator and the RWM deteriorates the cochlear response of reverse stimulation over the entire frequency range. Additionally, the coupling effect of the actuator does not change the influence tendency of middle-ear disorder on reverse stimulation's performance, but changes the response amplitude of the reverse stimulation.

The Influence of Piezoelectric Transducer Stimulating Sites on the Performance of Implantable Middle Ear Hearing Devices: A Numerical Analysis

To overcome the inherent deficiencies of hearing aids, implantable middle ear hearing devices (IMEHDs) have emerged as a new treatment for hearing loss. However, clinical results show that the IMEHD performance varies with its transducer’s stimulating site. To numerically analyze the influence of the piezoelectric transducer’s stimulating sites on its hearing compensation performance, we constructed a human ear finite element model and confirmed its validity. Based on this finite element model, the displacement stimulation, which simulates the piezoelectric transducer’s stimulation, was applied to the umbo, the incus long process, the incus body, the stapes, and the round window membrane, respectively. Then, the stimulating site’s effect of the piezoelectric transducer was analyzed by comparing the corresponding displacements of the basilar membrane. Besides, the stimulating site’s sensitivity to the direction of excitation was also studied. The result of the finite element analysis shows that stimulating the incus body is least efficient for the piezoelectric transducer. Meanwhile, stimulating the round window membrane or the stapes generates a higher basilar membrane displacement than stimulating the eardrum or the incus long process. However, the performance of these two ideal sites’ stimulation is sensitive to the changes in the excitation’s direction. Thus, the round window membrane and the stapes is the ideal stimulating sites for the piezoelectric transducer regarding the driving efficiency. The direction of the excitation should be guaranteed for these ideal sites.

[Hereditary hearing loss: genetic counselling]

The aim of this review is to provide an updated overview of hereditary hearing loss, with special attention to the etiological diagnosis of sensorineural hearing loss, the genes most frequently mutated in our environment, the techniques available for their analysis and the clinical implications of genetic diagnosis. More than 60% of childhood sensorineural hearing loss is genetic. In adults, the percentage of hereditary hearing loss is unknown. Genetic testing is the highest yielding test for evaluating patients with sensorineural hearing loss. The process of genetic counselling is intended to inform patients and their families of the medical, psychological and familial implications of genetic diseases, as well as the risks, benefits and limitations of genetic testing. The implementation of any genetic analysis must be always preceded by an appropriate genetic counselling process.

Audiological and genetic features of the mtDNA mutations

CONCLUSIONS

Significant difference in the incidence of mitochondrial DNA (mtDNA) mutations was found between the Chinese and USA populations. The identification of the mtDNA A1555G mutation in a large proportion of Chinese probands with nonsyndromic sensorineural hearing loss (NSHL) provides a molecular explanation for the high prevalence of aminoglycoside-induced deafness in China.

OBJECTIVE

The aim was to characterize the audiological and genetic features of NSHL due to mutations in mtDNA.

SUBJECTS AND METHODS

The mtDNA and audiogram analyses were performed in 498 NSHL patients (290 from China and 208 from the USA) with and without history of aminoglycoside exposure. A PCR and restriction enzyme digestion protocol was used for mutational screening and the European Workshop on Genetic Hearing Loss criteria were applied for audiological classification.

RESULTS

All Chinese probands (15.5%) with mtDNA mutation were found to carry the homoplasmic mtDNA A1555G mutation, whereas four probands (1.9%) from the USA were found to carry the mtDNA A1555G and two (1%) had mtDNA G7444A. Approximately 63% of the probands with mtDNA mutations had post-lingual hearing loss and 56.8% of them had a medical history of exposure to aminoglycosides. Hearing losses are bilateral, sensorineural, and symmetric. The main audiogram shapes found were sloping.