Preliminary evaluation of a light-based contact hearing device for the hearing impaired.

OBJECTIVE: To assess the safety, stability, and performance of the broad-spectrum, light-based contact hearing device (CHD) on listeners with hearing impairment. STUDY DESIGN: Feasibility study. SETTING: Single-site research and development facility. PARTICIPANTS: Thirteen participants with symmetric mild-to-severe sensorineural hearing impairment had the CHD placed bilaterally. INTERVENTION: A custom-molded light-activated tympanic contact actuator (TCA) was placed into each ear by a physician, where it stayed in contact with the umbo and a portion of the medial wall of the ear canal for 4 months. Each CHD was calibrated and programmed to provide appropriate broad-spectrum amplification. MAIN OUTCOME MEASURES: Safety was determined through routine otologic examinations. Aided and pre-TCA-insertion unaided audiometric thresholds (functional gain), maximum gain before feedback, tympanic membrane damping, Reception Threshold for Sentences (RTS), and Abbreviated Profile of Hearing Aid Benefit (APHAB) measurements were made to characterize system performance as well as the benefits of amplification via the CHD. RESULTS: The TCAs remained on participants' ears for an average total of 122 days, without causing signs of inflammation or infection, and there were no serious device-related adverse events. Measured average maximum output of 90 to 110 dB SPL in the range of 0.25 to 10 kHz, average maximum gain before feedback of 40 dB, and functional gain through 10 kHz show extended-bandwidth broad-spectrum output and gain. RTS results showed significant aided improvements of up to 2.8 dB, and APHAB results showed clinically significant aided benefits in 92% of participants (11/12). CONCLUSION: The safety, stability, and performance demonstrated in this initial 4-month study suggest that the CHD may offer a feasible way of providing broad-spectrum amplification appropriate to treat listeners with mild-to-severe hearing impairment.

The EarLens system: new sound transduction methods.

The hypothesis is tested that an open-canal hearing device, with a microphone in the ear canal, can be designed to provide amplification over a wide bandwidth and without acoustic feedback. In the design under consideration, a transducer consisting of a thin silicone platform with an embedded magnet is placed directly on the tympanic membrane. Sound picked up by a microphone in the ear canal, including sound-localization cues thought to be useful for speech perception in noisy environments, is processed and amplified, and then used to drive a coil near the tympanic-membrane transducer. The perception of sound results from the vibration of the transducer in response the electromagnetic field produced by the coil. Sixteen subjects (ranging from normal-hearing to moderately hearing-impaired) wore this transducer for up to a 10-month period, and were monitored for any adverse reactions. Three key functional characteristics were measured: (1) the maximum equivalent pressure output (MEPO) of the transducer; (2) the feedback gain margin (GM), which describes the maximum allowable gain before feedback occurs; and (3) the tympanic-membrane damping effect (D(TM)), which describes the change in hearing level due to placement of the transducer on the eardrum. Results indicate that the tympanic-membrane transducer remains in place and is well tolerated. The system can produce sufficient output to reach threshold for those with as much as 60 dBHL of hearing impairment for up to 8 kHz in 86% of the study population, and up to 11.2 kHz in 50% of the population. The feedback gain margin is on average 30 dB except at the ear-canal resonance frequencies of 3 and 9 kHz, where the average was reduced to 12 dB and 23 dB, respectively. The average value of D(TM) is close to 0 dB everywhere except in the 2-4 kHz range, where it peaks at 8dB. A new alternative system that uses photonic energy to transmit both the signal and power to a photodiode and micro-actuator on an EarLens platform is also described.

The discordant eardrum.

At frequencies above 3 kHz, the tympanic membrane vibrates chaotically. By having many resonances, the eardrum can transmit the broadest possible bandwidth of sound with optimal sensitivity. In essence, the eardrum works best through discord. The eardrum's success as an instrument of hearing can be directly explained through a combination of its shape, angular placement, and composition. The eardrum has a conical asymmetrical shape, lies at a steep angle with respect to the ear canal, and has organized radial and circumferential collagen fiber layers that provide the scaffolding. Understanding the role of each feature in hearing transduction will help direct future surgical reconstructions, lead to improved microphone and loudspeaker designs, and provide a basis for understanding the different tympanic membrane structures across species. To analyze the significance of each anatomical feature, a computer simulation of the ear canal, eardrum, and ossicles was developed. It is shown that a cone-shaped eardrum can transfer more force to the ossicles than a flat eardrum, especially at high frequencies. The tilted eardrum within the ear canal allows it to have a larger area for the same canal size, which increases sound transmission to the cochlea. The asymmetric eardrum with collagen fibers achieves optimal transmission at high frequencies by creating a multitude of deliberately mistuned resonances. The resonances are summed at the malleus attachment to produce a smooth transfer of pressure across all frequencies. In each case, the peculiar properties of the eardrum are directly responsible for the optimal sensitivity of this discordant drum.