Identifying Mechanisms Behind the Tullio Phenomenon: a Computational Study Based on First Principles.

Patients with superior canal dehiscence (SCD) suffer from events of dizziness and vertigo in response to sound, also known as Tullio phenomenon (TP). The present work seeks to explain the fluid-dynamical mechanisms behind TP. In accordance with the so-called third window theory, we developed a computational model for the vestibular signal pathway between stapes and SCD. It is based on first principles and accounts for fluid-structure interactions arising between endolymph, perilymph, and membranous labyrinth. The simulation results reveal a wave propagation phenomenon in the membranous canal, leading to two flow phenomena within the endolymph which are in close interaction. First, the periodic deformation of the membranous labyrinth causes oscillating endolymph flow which forces the cupula to oscillate in phase with the sound stimulus. Second, these primary oscillations of the endolymph induce a steady flow component by a phenomenon known as steady streaming. We find that this steady flow of the endolymph is typically in ampullofugal direction. This flow leads to a quasi-steady deflection of the cupula which increases until the driving forces of the steady streaming are balanced by the elastic reaction forces of the cupula, such that the cupula attains a constant deflection amplitude which lasts as long as the sound stimulus. Both response types have been observed in the literature. In a sensitivity study, we obtain an analytical fit which very well matches our simulation results in a relevant parameter range. Finally, we correlate the corresponding eye response (vestibulo-ocular reflex) with the fluid dynamics by a simplified model of lumped system constants. The results reveal a "sweet spot" for TP within the audible sound spectrum. We find that the underlying mechanisms which lead to TP originate primarily from Reynolds stresses in the fluid, which are weaker at lower sound frequencies.

The effect of rocking stapes motions on the cochlear fluid flow and on the basilar membrane motion.

The basilar membrane (BM) and perilymph motion in the cochlea due to rocking stapes motion (RSM) and piston-like stapes motion (PSM) is modeled by numerical simulations. The full Navier-Stokes equations are solved in a two-dimensional box geometry. The BM motion is modeled by independent oscillators using an immersed boundary technique. The traveling waves generated by both stimulation modes are studied. A comparison of the peak amplitudes of the BM motion is presented and their dependence on the frequency and on the model geometry (stapes position and cochlear channel height) is investigated. It is found that the peak amplitudes for the RSM are lower and decrease as frequency decreases whereas those for the PSM increase as frequency decreases. This scaling behavior can be explained by the different mechanisms that excite the membrane oscillation. Stimulation with both modes at the same time leads to either a slight increase or a slight decrease of the peak amplitudes compared to the pure PSM, depending on the phase shift between the two modes. While the BM motion is dominated by the PSM mode under normal conditions, the RSM may lead to hearing if no PSM is present or possible, e.g., due to round window atresia.

Vortical flow in the utricle and the ampulla: a computational study on the fluid dynamics of the vestibular system.

We present a computational study of the fluid dynamics in healthy semicircular canals (SCCs) and the utricle. The SCCs are the primary sensors for angular velocity and are located in the vestibular part of the inner ear. The SCCs are connected to the utricle that hosts the utricular macula, a sensor for linear acceleration. The transduction of angular motion is triggered by the motion of a fluid called endolymph and by the interaction of this fluid with the sensory structures of the SCC. In our computations, we observe a vortical flow in the utricle and in the ampulla (the enlarged terminal part of the SCCs) which can lead to flow velocities in the utricle that are even higher than those in the SCCs. This is a fundamentally new result which is in contrast to the common belief that the fluid velocities in the utricle are negligible from a physiological point of view. Moreover, we show that the wall shear stresses in the utricle and the ampulla are maximized at the positions of the sensory epithelia. Possible physiological and clinical implications are discussed.