Performance considerations of prosthetic actuators for round-window stimulation.

Round-window (RW) stimulation has improved speech perception in patients with mixed hearing loss. In cadaveric temporal bones, we recently showed that RW stimulation with an active prosthesis produced differential pressure across the cochlear partition (a measure related to cochlear transduction) similar to normal forward sound stimulation above 1 kHz, when contact area between the prosthesis and RW is secured. However, there is large variability in the hearing improvement in patients implanted with existing modified prosthesis. This is likely because the middle-ear prosthesis used for RW stimulation was designed for a very different application. In this paper, we utilize recently developed experimental techniques that allow for the calculation of performance specifications for a RW actuator. In cadaveric human temporal bones (N=3), we simultaneously measure scala vestibuli and scala tympani intracochlear pressures, as well as stapes velocity and ear-canal pressure, during normal forward sound stimulation as well as reverse RW stimulation. We then calculate specifications such as the impedance the actuator will need to oppose at the RW, the force with which it must push against the RW, and the velocity and distance by which it must move the RW to obtain cochlear stimulation equivalent to that of specific levels of ear-canal pressure under normal sound stimulation. This information is essential for adapting existing prostheses and for designing new actuators specifically for RW stimulation.