[Laser vibrometry. A middle ear and cochlear analyzer for noninvasive studies of middle and inner ear function disorders].

A complete battery of audiometric methods is required for the differential diagnosis of different hearing disabilities (including puretone audiometry, impedance, stapes reflex, speech audiometry, brainstam evoked response audiometry, otoacoustic emissions, etc.). In many cases, a comprehensive diagnosis is not possible. Here we describe a new technique based on a laser-Doppler vibrometer that has the potential for non-invasive diagnosis not only middle ear disease but also cochlear pathologies. Disturbance of cochlear function can be ascertained because the input impedance of the cochlea acts as a mechanical load on the middle ear and therefore influences motion of the umbo. In the present study vibration of the umbo and eardrum were measured with a commercially available laser-Doppler vibrometer coupled directly into a standard surgical microscope. The use of the microscope allowed non-invasive measurements of vibrations without having to introduce reflecting material onto the tympanic membrane. Sound pressure was measured with a calibrated probe microphone placed near the tympanic membrane. The displacement response and the specific acoustic impedance of the umbo were calculated from the velocity and sound pressure measured. For normal hearing subjects, the amplitude of the umbo's displacement for frequencies from 0.1 kHz to 1 kHz was 1 nm at 60 dB SPL and decreased with a slope of 6 dB/octave for frequencies between 1 and 5 kHz. A strong correlation was found between the specific acoustic impedance of the umbo and hearing thresholds for hearing-impaired subjects (having otosclerosis or sensorineural hearing losses). The frequency response of the umbo proved to be a means for evaluating the function of both the middle ear and the cochlea under pathological conditions. The measurement technique described is also suitable for intraoperative investigation of the frequency response of the opened middle ear, as well as for the in situ frequency response of partial and total ossicular replacement prostheses.