鼓膜穿孔导致听力下降的有限元模型分析

Finite Element Model Analysis of Hearing Loss Caused by Tympanic Membrane Perforation

丁家烨;陈克光;刘后广;黄新生;周雷

1:复旦大学附属中山医院耳鼻咽喉头颈外科

2:中国矿业大学机电工程学院

摘要
目的 探讨鼓膜穿孔导致听力下降的机制。方法 通过有限元分析法(finite element analysis, FEA)构建全耳有限元模型并验证;参照实际鼓膜穿孔病例,创建个性化的鼓膜穿孔有限元模型,模拟鼓膜穿孔导致的听力损失;使用基底膜的位移响应与基线的差异来模拟听力损失情况,分析中耳各个组分对听力损失的贡献程度,探讨鼓膜穿孔导致听力下降的机制。结果 如果将圆窗膜和中耳腔的耦合去掉,将导致低频约40 dB的听力下降,而高频段基本与基线情况下鼓膜穿孔所导致的听力损失持平;去除鼓膜内侧面和中耳腔气体的耦合,可部分减轻低频听力损失,而高频听力损失加重;切断外耳道气体和中耳腔气体之间的连续性,低频听力损失加重;但是去除圆窗膜和中耳腔之间耦合关系并且去除中耳腔气体和鼓膜内侧面的连接后,原先低频的40 dB听力损失将会恢复到10 dB左右;而去除中耳腔气体和听骨链之间的耦合,对听力损失无明显影响。结论 鼓膜穿孔导致听力下降的主要机制是鼓膜穿孔本身所导致的传声效能降低,以及鼓膜内外声压差的降低;圆窗膜处声压的增加可以部分弥补鼓膜穿孔所导致的听力损失。
关键词
鼓膜穿孔;有限元分析;听力下降
基金项目(Foundation):
国家自然科学基金青年基金(82000980、82101216);国家自然科学基金面上项目(52275296);; 上海市2021年度“科技创新行动计划”医学创新研究专项重大项目(21Y31900500)
作者
丁家烨;陈克光;刘后广;黄新生;周雷
参考文献

1 Casale G,Shaffrey E,Kesser BW.Correlation between hearing loss and middle ear volume in patients with a tympanic membrane perforation[J].Laryngoscope,2020,130(4):E228-E232.

2 Kim DK,Choi H,Lee H,et al.Effects of tympanic membrane perforation,middle ear cavity volume,and mastoid aeration on hearing impairment[J].Am J Otolaryngol,2021,42(3):102901.

3 Hussain M,Wasif M,Awan MS,et al.Use of endoscope in teaching of otolaryngology residents about site and size of tympanic membrane perforation and its impact on degree of hearing loss in adult patients:a cross sectional study[J].JPak Med Assoc,2020,70(12(B)):S14-S17.

4 Cai L,Stomackin G,Perez NM,et al.Recovery from tympanic membrane perforation:Effects on membrane thickness,auditory thresholds,and middle ear transmission[J].Hear Res,2019,384:107813.

5 Stomackin G,Kidd S,Jung TT,et al.Effects of tympanic membrane perforation on middle ear transmission in gerbil[J].Hear Res,2019,373:48-58.

6 Dong W,Stomackin G,Lin X,et al.Distortion product otoacoustic emissions:sensitive measures of tympanic-membrane perforation and healing processes in a gerbil model[J].Hear Res,2019,378:3-12.

7 Bevis N,Sackmann B,Effertz T,et al.The impact of tympanic membrane perforations on middle ear transfer function[J].Eur Arch Otorhinolaryngol,2022,279(7):3399-3406.

8 Dawood MR.Frequency dependence hearing loss evaluation in perforated tympanic membrane[J].Int Arch Otorhinolaryngol,2017,21(4):336-342.

9 Liu H,Zhao Y,Yang J,et al.The influence of piezoelectric transducer stimulating sites on the performance of implantable middle ear hearing devices:a numerical analysis[J].Micromachines(Basel),2019,10(11):782.

10 Yao W,Ma J,Huang X.Numerical simulation of the human ear and the dynamic analysis of the middle ear sound transmission[J].Journal of Instrumentation,2013,8 (6):C06009.

11万漠,刘稳,赵禹,等.空壁与开放式服突根治术后重复传导的有限元模型分析[J].听力学及言语疾病杂志,2022,30(5):480-485.

12张文伟,刘稳,刘后广,等.不同材料修补不同面积慢性鼓膜穿孔的有限元模型分析[J].听力学及言语疾病杂志,2022,30(1):58-63.

13 Gan RZ,Leckness K,Nakmali D,et al.Biomechanical measurement and modeling of human eardrum injury in relation to blast wave direction[J].Mil Med,2018,183(suppl_1):245-251.

14 Muyshondt PGG,Dirckx JJJ.How does prestrain in the tympanic membrane affect middle-ear function?A finite-element model study in rabbit[J].J MechBehav Biomed Mater,2022,131:105261.

15 Gentil F,Garbe C,Parente M,et al.Analysis of eardrum pathologies using the finite element method[J].Journal of Mechanics in Medicine and Biology,2014,14(3):1450034.

16 Marin KC,Berdich-Kun KN,Gentil F,et al.Application of a finite element model in the diagnosis process of middle ear pathologies[J].Rom J MorpholEmbryol,2014,55(4):1511-1514.

17 Xie P,Peng Y,Hu J,et al.Assessment of hearing loss induced by tympanic membrane perforations under blast environment[J].Eur Arch Otorhinolaryngol,2020,277(2):453-461.

18 Zhou L,Feng M,Wang W,et al.Study on the role of ossicular joint using finite element method[J].Journal of Mechanics in Medicine and Biology,2016,16(4):1650041.

19 Zhou L,Shen N,Feng M,et al.Study of age-related changes in Middle ear transfer function[J].Comput Methods Biomech Biomed Engin,2019,22(13):1093-1102.

20 Zhou L,Shen N,Feng M,et al.Morphology of human ear canal and its effect on sound transmission[J].Int J Numer Method Biomed Eng,2022,38(3):e3567.

21 Frear DL,Guan X,Stieger C,et al.Impedances of the inner and middle ear estimated from intracochlear sound pressures in normal human temporal bones[J].Hear Res,2018,367:17-31.

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