Exploring Mechanisms Underlying Unexplained Air-Bone Gaps Post-Myringoplasty: Temporal Bone Model and Finite Element Analysis.

Abstract

PurposeAir-bone gap (ABG) is an essential indicator of middle ear transfer function after myringoplasty. However, there is still uncertainty about the mechanisms behind unexplained ABGs in patients post-myringoplasty. The present study investigated these mechanisms using cadaveric temporal bone (TB) measurement and finite element (FE) modeling.MethodsThree conditions of tympanic membrane (TM) perforation were modeled with a perforated area of 6%, 24%, and 50% of the total TM area to simulate a small, medium, or large TM perforation of TB model. A piece of paper was used to patch the TM perforation to simulate the situation post-myringoplasty. In the FE model for post-operation, the material properties at the perforation area were changed. Measurement of TM vibration at the umbo was undertaken with a laser Doppler vibrometer (LDV).ResultsAs the perforated area increased vibration of the TM at the umbo decreased in both the TB and FE models. But the reduction of TM vibration is more minor in the FE model than in the TB model. After the perforation was repaired, the displacement of TM at the umbo could not be recovered totally in the TB and FE models. In the FE model, the displacement of TM at the umbo decreased markedly when the cone shape of TM flattened, and the reduction was almost the same as that in the TB model in the condition of large perforation.ConclusionThe material properties and the anatomical shape of the repaired TM could influence the TM's modal motion and wave motion. Except for appearance and shape current clinical instruments are unable to resolve factors that affect TM motion. Consequently the ABG seen post-myringoplasty remains unexplained.