Strenger T, Brandstetter M, Stark T, Böhnke F
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Klinikum Augsburg (Süd), Sauerbruchstr. 6, 86179, Augsburg, Deutschland.
HNO-Praxis Holzkirchen, Holzkirchen, Deutschland.
HNO. 2018 Apr;66(4):265-279. doi: 10.1007/s00106-018-0473-x.
An instrument to measure vibration in the middle ear needs to be sensitive enough to detect displacement on a nanometer scale, yet not affect the vibration itself. Numerous techniques have been described in the literature, but laser Doppler vibrometry (LDV) has nowadays become established as the standard method in hearing research.
This article aims to present possible clinical applications of an LDV system in otology.
A commercially available single-point vibrometer was used. Measurements were carried out both with the sensor head mounted on an operating microscope and as a handheld device with the sensor head manually inserted in the ear canal. For the latter, a custom-made unit containing an electrically tunable lens was attached to the sensor head. Middle ear vibrations were measured in a temporal bone model as well as in patients during and after implantation of a Vibrant Soundbridge (VSB; MED-EL Corp., Durham/NC, USA).
Different types of middle ear pathologies can be distinguished by the frequency response of the umbo. The LDV technique can be used for intraoperative quantification of the coupling quality of the VSB's Floating Mass Transducer (FMT; MED-EL) to the ossicle chain during VSB implantation. Postoperatively, the method serves as a follow-up testing tool if a deterioration in aided hearing threshold occurs. The measurement can reveal changes in the umbo transfer function, e. g., due to middle ear scarring or dislocation of the FMT.
Many clinical questions in otology can be addressed by LDV. However, due to the high acquisition costs of an LDV system, the relatively large instrumental setup, and the large inter-ear variability of middle-ear function, the technique has not (yet) become established in clinical routine.
用于测量中耳振动的仪器需要足够灵敏，以检测纳米级别的位移，同时又不影响振动本身。文献中已描述了众多技术，但激光多普勒振动测量法（LDV）如今已成为听力研究中的标准方法。
本文旨在介绍LDV系统在耳科学中的可能临床应用。
使用了一款市售的单点振动计。测量时，传感器头既可以安装在手术显微镜上，也可以作为手持设备，将传感器头手动插入耳道。对于后者，在传感器头上连接了一个包含电可调透镜的定制装置。在颞骨模型以及植入了Vibrant Soundbridge（VSB；MED-EL公司，美国北卡罗来纳州达勒姆）的患者手术期间及术后，测量中耳振动。
通过鼓膜脐的频率响应可区分不同类型的中耳病变。LDV技术可用于术中量化VSB植入期间其浮动质量传感器（FMT；MED-EL）与听骨链的耦合质量。术后，如果助听阈值恶化，该方法可作为随访测试工具。测量可揭示鼓膜脐传递函数的变化，例如由于中耳瘢痕形成或FMT脱位导致的变化。
耳科学中的许多临床问题都可以通过LDV来解决。然而，由于LDV系统的购置成本高、仪器设置相对庞大，以及中耳功能在两耳间的变异性较大，该技术尚未成为临床常规应用方法。
