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Linearity and Lever Ratio of the Normal and Reconstructed Cadaveric Human Middle Ear

Hypothesis The linearity and the level ratio are different in reconstructed ears. Background The linearity of the reconstructed human middle ear (ME) has not been previously explored. It is important to analyze if high sound pressure levels (SPLs) result in distortion due to nonlinearities particularly because hearing aids have high-output SPLs. The diseased ME is reconstructed with prostheses. These diseased ears frequently need additional amplification with hearing aids, and it is unclear if reconstruction itself leads to nonlinear ME responses. Methods Eight fresh human cadaveric temporal bones were used. Pure tones of 70, 90, and 110 dB SPL at 500, 1,000, and 3,000 Hz were presented to the ear canal. Umbo and stapes displacements were measured by means of a laser Doppler vibrometer. After removing the incus, the tympanic membrane assembly to the stapes head prosthesis was placed, and measurements were repeated. Results Stapes footplate vibrations in the reconstructed ears are 10 to 15 dB lower than those of the normal ears. In both normal and reconstructed ears, the footplate vibrations are linearly related to SPL at the tympanic membrane between 70 and 110 dB SPL at the frequencies tested. For the lever ratio, intact ears are more efficient at transmission of umbo vibrations to the stapes compared with reconstructed ears. Conclusion To within acceptable limits, the ME seems to be linear between 70 and 110 dB SPL input levels, across the speech frequencies, and this does not change with reconstruction. The reconstructed human ME seems to have a less efficient lever ratio than the intact ME.