The Audiometric and Mechanical Effects of Partial Ossicular Discontinuity

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dc.contributor.authorFarahmand, Rosemary B.
dc.contributor.authorMerchant, Gabrielle R.
dc.contributor.authorLookabaugh, Sarah A.
dc.contributor.authorRoeoesli, Christof
dc.contributor.authorUlku, Cagatay H.
dc.contributor.authorMcKenna, Michael J.
dc.contributor.authorde Venecia, Ronald K.
dc.date.accessioned2024-02-23T14:21:05Z
dc.date.available2024-02-23T14:21:05Z
dc.date.issued2016
dc.departmentNEÜen_US
dc.description.abstractObjectives: Ossicular discontinuity may be complete, with no contact between the disconnected ends, or partial, where normal contact at an ossicular joint or along a continuous bony segment of an ossicle is replaced by soft tissue or simply by contact of opposing bones. Complete ossicular discontinuity typically results in an audiometric pattern of a large, flat conductive hearing loss. In contrast, in cases where otomicroscopy reveals a normal external ear canal and tympanic membrane, high-frequency conductive hearing loss has been proposed as an indicator of partial ossicular discontinuity. Nevertheless, the diagnostic utility of high-frequency conductive hearing loss has been limited due to gaps in previous research on the subject, and clinicians often assume that an audiogram showing high-frequency conductive hearing loss is flawed. This study aims to improve the diagnostic utility of high-frequency conductive hearing loss in cases of partial ossicular discontinuity by (1) making use of a control population against which to compare the audiometry of partial ossicular discontinuity patients and (2) examining the correlation between high-frequency conductive hearing loss and partial ossicular discontinuity under controlled experimental conditions on fresh cadaveric temporal bones. Furthermore, ear-canal measurements of umbo velocity and wideband acoustic immittance measurements were investigated to determine the usefulness regarding diagnosis of ossicular discontinuity. Design: The authors analyzed audiograms from 66 patients with either form of surgically confirmed ossicular discontinuity and no confounding pathologies. The authors also analyzed umbo velocity (n = 29) and power reflectance (n = 12) measurements from a subset of these patients. Finally, the authors performed experiments on six fresh temporal bone specimens to study the differing mechanical effects of complete and partial discontinuity. The mechanical effects of these lesions were assessed via laser Doppler measurements of stapes velocity. In a subset of the specimen (n = 4), wideband acoustic immittance measurements were also collected. Results: (1) Calculations comparing the air-bone gap (ABG) at high and low frequencies show that when high-frequency ABGs are larger than low-frequency ABGs, the surgeon usually reported soft-tissue bands at the point of discontinuity. However, in cases with larger low-frequency ABGs and flat ABGs across frequencies, some partial discontinuities as well as complete discontinuities were reported. (2) Analysis of umbo velocity and power reflectance (calculated from wideband acoustic immittance) in patients reveal no significant difference across frequencies between the two types of ossicular discontinuities. (3) Temporal bone experiments reveal that partial discontinuity results in a greater loss in stapes velocity at high frequencies when compared with low frequencies, whereas with complete discontinuity, large losses in stapes velocity occur at all frequencies. Conclusion: The clinical and experimental findings suggest that when encountering larger ABGs at high frequencies when compared with low frequencies, partial ossicular discontinuity should be considered in the differential diagnosis.en_US
dc.description.sponsorshipNachwuchsforderungskredit of the University of Zurich; TUBITAK [2011-1059B191100156]; National Institutes of Health/National Institute on Deafness and Other Communication [R01DC004798, R03DC011158]en_US
dc.description.sponsorshipThis research is supported by the Nachwuchsforderungskredit of the University of Zurich (C.R.), TUBITAK (2011-1059B191100156; C.H.U.), and the National Institutes of Health/National Institute on Deafness and Other Communication-R01DC004798 (J.J.R.) and R03DC011158 (H.H.N.).en_US
dc.identifier.doi10.1097/AUD.0000000000000239
dc.identifier.endpage215en_US
dc.identifier.issn0196-0202
dc.identifier.issn1538-4667
dc.identifier.issue2en_US
dc.identifier.pmid26510125en_US
dc.identifier.scopus2-s2.0-84960346622en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage206en_US
dc.identifier.urihttps://doi.org/10.1097/AUD.0000000000000239
dc.identifier.urihttps://hdl.handle.net/20.500.12452/13440
dc.identifier.volume37en_US
dc.identifier.wosWOS:000371748300009en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherLippincott Williams & Wilkinsen_US
dc.relation.ispartofEar And Hearingen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAudiogramen_US
dc.subjectAir-Bone Gapen_US
dc.subjectOssicular Interruptionen_US
dc.subjectWideband Immittanceen_US
dc.subjectOssicular Discontinuityen_US
dc.subjectLaser Doppler Vibrometryen_US
dc.subjectOssicular Disruptionen_US
dc.titleThe Audiometric and Mechanical Effects of Partial Ossicular Discontinuityen_US
dc.typeArticleen_US

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