A finite element model to predict the consequences of endolymphatic hydrops in the basilar membrane.

Ménière's disease is an inner ear disorder, associated with episodes of vertigo, fluctuant hearing loss, tinnitus, and aural fullness. Ménière's disease is associated with endolymphatic hydrops. Clinical evidences show that this disease is often incapacitating, negatively affecting the patients' everyday life. The pathogenesis of Ménière's disease is still not fully understood and remains unclear. Previous numerical studies available in the literature related with endolymphatic hydrops, are very scarce. The present work applies the finite element method to investigate the consequences of endolymphatic hydrops in the normal hearing, associated with the Ménière's disease. The obtained results for the steady state dynamics analysis are in accordance with clinical evidences. The results show that the basilar membrane is not affected in the same intensity along its length and that the lower frequencies are more affected by the endolymphatic hydrops. From a clinical point of view, this work shows the relationship between the increasing of the endolymphatic pressure and the development of hearing loss.

On the hearing effects of a cholesteatoma growing: A biomechanical study.

Chronic otitis media enables the appearance of a benign middle ear tumor, known as a cholesteatoma, that may compromise hearing. To evaluate the influence of a cholesteatoma growth on the hearing function, a computational middle ear model based on the finite element method was used and three different size of cholesteatoma were modeled. The cholesteatoma solidification and the consequent degradation of the ossicles were also simulated as two condition that commonly occurs during cholesteatoma evolution. A sound pressure level of 80 dB SPL was applied in the tympanic membrane and a steady state analysis was performed for frequencies from 100 Hz to 10 kHz. The displacements of both the tympanic membrane and the stapes footplate were measured. The results were compared with a healthy case and it was shown that the cholesteatoma development leads to a decrease in the umbo and stapes displacements. The ossicles degradation simulation showed the higher difference comparing with the cholesteatoma in an initial stage, with lower displacements in the stapes footplate mainly for high frequencies. The observed displacement differences are directly connected to hearing loss, being possible to conclude that cholesteatoma evolution in the middle ear will lead to hearing problems, mainly in an advanced stage.

Influence of the basilar membrane shape and mechanical properties in the cochlear response: A numerical study.

Hearing impairment is one of the most common health disorders, affecting individuals of all ages, reducing considerably their quality of life. At present, it is known that during an acoustic stimulation a travelling wave is developed inside the cochlea. Existing mathematical and numerical models available in the literature try to describe the shape of this travelling wave, the majority of them present a set of approaches based on some limitations either or both of the mechanical properties used and the geometrical description of the realistic representation. The present numerical study highlights the distinctions of using a spiral model of the cochlea, by comparing the obtained results with a straight, or simplified model. The influence of the implantation of transversely isotropic mechanical models was also studied, by comparing the basilar membrane with isotropic and transversely isotropic mechanical properties. Values of the root mean square error calculated for all models show a greater proximity of the cochlear mapping to the Greenwood function when the basilar membrane is assumed with transversely isotropic mechanical properties for both straight and spiral model. The root-mean square errors calculated were: 2.05, 1.70, 2.72, 2.08 mm, for the straight-isotropic, straight-transversely isotropic, spiral-isotropic and spiral-transversely isotropic model, respectively.

A computational framework to simulate the endolymph flow due to vestibular rehabilitation maneuvers assessed from accelerometer data.

Vertiginous symptoms are one of the most common symptoms in the world, therefore investing in new ways and therapies to avoid the sense of insecurity during the vertigo episodes is of great interest. The classical maneuvers used during vestibular rehabilitation consist in moving the head in specific ways, but it is not fully understood why those steps solve the problem. To better understand this mechanism, a three-dimensional computational model of the semicircular ducts of the inner ear was built using the finite element method, with the simulation of the fluid flow being obtained using particle methods. To simulate the exact movements performed during rehabilitation, data from an accelerometer were used as input for the boundary conditions in the model. It is shown that the developed model responds to the input data as expected, and the results successfully show the fluid flow of the endolymph behaving coherently as a function of accelerometer data. Numerical results at specific time steps are compared with the corresponding head movement, and both particle velocity and position follow the pattern that would be expected, confirming that the model is working as expected. The vestibular model built is an important starting point to simulate the classical maneuvers of the vestibular rehabilitation allowing to understand what happens in the endolymph during the rehabilitation process, which ultimately may be used to improve the maneuvers and the quality of life of patients suffering from vertigo.

An alternative 3D numerical method to study the biomechanical behaviour of the human inner ear semicircular canal.

PURPOSE: The vestibular system is the part of the inner ear responsible for balance. Vertigo and dizziness are generally caused by vestibular disorders and are very common symptoms in people over 60 years old. One of the most efficient treatments at the moment is vestibular rehabilitation, permitting to improve the symptoms. However, this rehabilitation therapy is a highly empirical process, which needs to be enhanced and better understood. METHODS: This work studies the vestibular system using an alternative computational approach. Thus, part of the vestibular system is simulated with a three dimensional numerical model. Then, for the first time using a combination of two discretization techniques (the finite element method and the smoothed particle hydrodynamics method), it is possible to simulate the transient behavior of the fluid inside one of the canals of the vestibular system. RESULTS: The obtained numerical results are presented and compared with the available literature. The fluid/solid interaction in the model occurs as expected with the methods applied. The results obtained with the semicircular canal model, with the same boundary conditions, are similar to the solutions obtained by other authors. CONCLUSIONS: The numerical technique presented here represents a step forward in the biomechanical study of the vestibular system, which in the future will allow the existing rehabilitation techniques to be improved.

Finite element modelling of sound transmission from outer to inner ear.

The ear is one of the most complex organs in the human body. Sound is a sequence of pressure waves, which propagates through a compressible media such as air. The pinna concentrates the sound waves into the external auditory meatus. In this canal, the sound is conducted to the tympanic membrane. The tympanic membrane transforms the pressure variations into mechanical displacements, which are then transmitted to the ossicles. The vibration of the stapes footplate creates pressure waves in the fluid inside the cochlea; these pressure waves stimulate the hair cells, generating electrical signals which are sent to the brain through the cochlear nerve, where they are decoded. In this work, a three-dimensional finite element model of the human ear is developed. The model incorporates the tympanic membrane, ossicular bones, part of temporal bone (external auditory meatus and tympanic cavity), middle ear ligaments and tendons, cochlear fluid, skin, ear cartilage, jaw and the air in external auditory meatus and tympanic cavity. Using the finite element method, the magnitude and the phase angle of the umbo and stapes footplate displacement are calculated. Two slightly different models are used: one model takes into consideration the presence of air in the external auditory meatus while the other does not. The middle ear sound transfer function is determined for a stimulus of 60 dB SPL, applied to the outer surface of the air in the external auditory meatus. The obtained results are compared with previously published data in the literature. This study highlights the importance of external auditory meatus in the sound transmission. The pressure gain is calculated for the external auditory meatus.

Effects of the fibers distribution in the human eardrum: A biomechanical study.

The eardrum separates the external ear from the middle ear and it is responsible to convert the acoustical energy into mechanical energy. It is divided by pars tensa and pars flaccida. The aim of this work is to analyze the susceptibility of the four quadrants of the pars tensa under negative pressure, to different lamina propria fibers distribution. The development of associated ear pathology, in particular the formation of retraction pockets, is also evaluated. To analyze these effects, a computational biomechanical model of the tympano-ossicular chain was constructed using computerized tomography images and based on the finite element method. Three fibers distributions in the eardrum middle layer were compared: case 1 (eardrum with a circular band of fibers surrounding all quadrants equally), case 2 (eardrum with a circular band of fibers that decreases in thickness in posterior quadrants), case 3 (eardrum without circular fibers in the posterior/superior quadrant). A static analysis was performed by applying approximately 3000Pa in the eardrum. The pars tensa of the eardrum was divided in four quadrants and the displacement of a central point of each quadrant analyzed. The largest displacements of the eardrum were obtained for the eardrum without circular fibers in the posterior/superior quadrant.

Finite element analysis of the transfer of sound in the myringosclerotic ear.

This work presents a biomechanical study of myringosclerosis (MS), an abnormal condition of the ear that produces calcification of the lamina propria of the eardrum. The study researched the transfer of sound to the stapes depending on the localization, dimension and calcification degree of the MS plaques. Results were obtained using a validated finite element model of the ear. The mechanical properties of the lamina propria were modified, in order to model MS plaques, using the rule of mixtures for particle composites considering that the plaques are made of hydroxyapatite particles in a matrix of connective tissue. Results show that the localization and dimension of the plaques are a factor of higher importance than calcification for loss of hearing through MS. The mobility of the stapes decreased with the presence of larger plaques and also when the tympanic annulus and the area of the handle of the malleus were involved.

Comparison of otoacoustic emissions in patients with tinnitus having normal hearing versus mild hearing loss.

INTRODUCTION: Tinnitus is an auditory sensation whose source comes from external stimulus to the body. All studies that can help people with this disorder are very imperative. OBJECTIVE: This study investigates the cochlear function in patients with tinnitus, using Distortion Products Otoacoustic Emissions (DPOAE). MATERIAL AND METHODS: Ears where the subjects referred to feel the tinnitus were considered for the study group while other ears without this sensation of tinnitus acted as a control group. Fifty subjects suffering from unilateral or bilateral tinnitus with normal hearing sensitivity or mild hearing loss were recruited. RESULTS AND CONCLUSIONS: Where comparing the control and study group, the highest percentage of cases of DPOAE detected was in the control group, although these differences were not statistically significant. When the analyzed frequency is the same as the tinnitus frequency, the prevalence of detected DPOAE is in tinnitus ears (50.0 %). In ears where tinnitus was not perceived (73.5 %) a p value of 0.024 (< 0.05) was found, which means that the undetected DPOAE could be influenced by tinnitus. Based on the results, tinnitus might not be caused by changes in the outer hair cells but seems to be affected by that.

Numerical study of Hough technique in surgery of otosclerosis, using the finite element method.

PURPOSE: Otosclerosis is a metabolic bone disease of the otic capsule that can cause the stapes fixation, resulting in conductive hearing loss or, in a profound sensorineural deafness threshold. Surgery is one of the possible treatments for the otosclerosis. To repair small focus of otosclerosis in the anterior crus of the stapes, in 1960, Hough suggested the implementation of a technique in which part of the anterior crus is fractured and the stapes turned. As a result, the posterior crus of the stapes is the only connection with the inner ear. In this work, the outcome of Hough's surgical technique was simulated. METHODS: Based on computerized images, a finite element model of middle ear ossicles and tympanic membrane was created, as well as a model where the stapes has changed. The discretization of the tridimensional solid model was made using the ABAQUS software. The mechanical properties used were taken from the literature and adequate boundary conditions were applied. RESULTS: The results obtained with the Hough technique simulation were compared with a representative model of the normal ear, taking into account the displacements obtained on the central part of the stapes footplate and the maximum principal stress in the stapes crus. CONCLUSIONS: The results obtained are closer to the normal ear model, therefore Hough technique stands out as a good option to correct small focus of otosclerosis.

The biomechanical effects of stapes replacement by prostheses on the tympano-ossicular chain.

Hearing is a sequence of processes in which the ear translates sound waves into electrical signals, which are then sent to the brain where they are interpreted as sound. The ossicular chain of the middle ear is formed by three ossicles (malleus, incus, and stapes), of which the last and smallest, the stapes, vibrates, thus communicating with the inner ear through the stapes footplate. When abnormal bone formation immobilizes the stapes (otosclerosis), the passage of sound does not correctly occur and hearing can be compromised. In most cases, surgery is an option for its treatment. The stapes is totally or partially replaced by a prosthesis (stapedectomy or stapedotomy, respectively) allowing the passage of sound to the inner ear. This work presents a study on the behavior of different stapes prostheses, considering their biomechanical characteristics. The stapes was replaced by different prostheses, made of dissimilar materials: stainless steel, teflon, and titanium. The umbo and stapes footplate displacements for the models with these prostheses were obtained and compared with the displacements obtained with the model representative of the normal ear. In the models with prostheses, the displacements are found in the hole where the prosthesis is attached.

Segmentation algorithms for ear image data towards biomechanical studies.

In recent years, the segmentation, i.e. the identification, of ear structures in video-otoscopy, computerised tomography (CT) and magnetic resonance (MR) image data, has gained significant importance in the medical imaging area, particularly those in CT and MR imaging. Segmentation is the fundamental step of any automated technique for supporting the medical diagnosis and, in particular, in biomechanics studies, for building realistic geometric models of ear structures. In this paper, a review of the algorithms used in ear segmentation is presented. The review includes an introduction to the usually biomechanical modelling approaches and also to the common imaging modalities. Afterwards, several segmentation algorithms for ear image data are described, and their specificities and difficulties as well as their advantages and disadvantages are identified and analysed using experimental examples. Finally, the conclusions are presented as well as a discussion about possible trends for future research concerning the ear segmentation.

Application of a finite element model in the diagnosis process of middle ear pathologies.

The ear is a complex organ that can be affected by various pathologies that are still fairly misunderstood. This work tests the possibilities of studying the ear and its pathologies using a virtual environment and thus bypassing expensive and time-consuming clinical trial. A previous validated finite element model of the middle ear was employed to study two pathological states of the middle ear. It was shown that the model obtained results very close to the clinical evaluation thus proving of being a proper tool for further investigations of middle ear pathologies.

The influence of muscles activation on the dynamical behaviour of the tympano-ossicular system of the middle ear.

The human ear is a complex biomechanical system and is divided into three parts: outer, middle and inner ear. The middle ear is formed by ossicles (malleus, incus and stapes), ligaments, muscles and tendons, which transfers sound vibrations from the eardrum to the inner ear, linking with mastoid and Eustachian tube. In this work, a finite element modelling of the tympano-ossicular system of the middle ear was developed. A dynamic study based on a structural response to harmonic vibrations, for a sound pressure level (SPL) of 110, 120 and 130 dB SPL applied in the eardrum, is presented. The connection between the ossicles is made using a contact formulation. The model includes the different ligaments considering its hyperelastic behaviour. The activation of the muscles is based on the constitutive model proposed by previous work. The harmonic responses of displacement and pressure obtained on the stapes footplate, for a frequency range between 100 Hz and 10 kHz, are obtained simulating the muscle activation. The results are compared considering the passive and active states. The results are discussed and they are in accordance with audiological data published with reference to the effects of the middle ear muscles contraction.

A recombinant vaccine based on domain II of Plasmodium vivax Apical Membrane Antigen 1 induces high antibody titres in mice.

The Apical Membrane Antigen 1 (AMA-1) is considered a promising candidate for development of a malaria vaccine against asexual stages of Plasmodium. We recently identified domain II (DII) of Plasmodium vivax AMA-1 (PvAMA-1) as a highly immunogenic region recognised by IgG antibodies present in many individuals during patent infection with P. vivax. The present study was designed to evaluate the immunogenic properties of a bacterial recombinant protein containing PvAMA-1 DII. To accomplish this, the recombinant protein was administered to mice in the presence of each of the following six adjuvants: Complete/Incomplete Freund's Adjuvant (CFA/IFA), aluminium hydroxide (Alum), Quil A, QS21 saponin, CpG-ODN 1826 and TiterMax. We found that recombinant DII was highly immunogenic in BALB/c mice when administered in the presence of any of the tested adjuvants. Importantly, we show that DII-specific antibodies recognised the native AMA-1 protein expressed on the surface of P. vivax merozoites isolated from the blood of infected patients. These results demonstrate that a recombinant protein containing PvAMA-1 DII is immunogenic when administered in different adjuvant formulations, and indicate that this region of the AMA-1 protein should continue to be evaluated as part of a subunit vaccine against vivax malaria.

Plasmodium vivax apical membrane antigen-1: comparative recognition of different domains by antibodies induced during natural human infection.

The Apical Membrane Antigen-1 (AMA-1) of Plasmodium sp. has been suggested as a vaccine candidate against malaria. This protein seems to be involved in merozoite invasion and its extra-cellular portion contains three distinct domains: DI, DII, and DIII. Previously, we described that Plasmodium vivax AMA-1 (PvAMA-1) ectodomain is highly immunogenic in natural human infections. Here, we expressed each domain, separately or in combination (DI-II or DII-III), as bacterial recombinant proteins to map immunodominant epitopes within the PvAMA-1 ectodomain. IgG recognition was assessed by ELISA using sera of P. vivax-infected individuals collected from endemic regions of Brazil or antibodies raised in immunized mice. The frequencies of responders to recombinant proteins containing the DII were higher than the others and similar to the ones observed against the PvAMA-1 ectodomain. Moreover, ELISA inhibition assays using the PvAMA-1 ectodomain as substrate revealed the presence of many common epitopes within DI-II that are recognized by human immune antibodies. Finally, immunization of mice with the PvAMA-1 ectodomain induced high levels of antibodies predominantly to DI-II. Together, our results indicate that DII is particularly immunogenic during natural human infections, thus indicating that this region could be used as part of an experimental sub-unit vaccine to prevent vivax malaria.