Semicircular canal fenestration - improvement of bone- but not air-conducted auditory thresholds.

Auditory stimulation can, under certain circumstances, activate the vestibular end organs and this is facilitated by fenestration of a semicircular canal (SCC). Several fenestrated profoundly deaf patients reported improvements in their bone- (BC) but not air-conducted (AC) thresholds. Bone conduction auditory thresholds have been reported to be better than normal in several patients with thinning or absence of bone over a SCC (dehiscence). This phenomenon was carefully studied in the fat sand rat (Psammomys obesus) by recording auditory brainstem evoked responses to BC and AC auditory stimulation, before and after SCC fenestration. Fenestration would be expected to decrease the pressure difference across the cochlear partition, causing a reduction in the amplitude of the classical base to apex input traveling wave, and should therefore lead to an elevation in AC and BC thresholds. Instead, BC thresholds decreased (i.e. improved) following fenestration (by 7.0+/-4.2 dB; P<0.005), while AC thresholds did not change. Thus the cochlea becomes more sensitive to BC, but not AC, stimulation in the presence of a SCC fenestration. This may be due to the removal by the fenestration of a factor impeding BC cochlear responses, or by the addition of a facilitating factor. The result that the SCC fenestration did not affect AC threshold provides support for the concept that at low intensities the outer hair cells are directly activated by components of the fluid pressures surrounding them, which alternate at audio-frequencies. These cochlear fluid audio-frequency pressures are induced by stapes footplate movement and not by a base to apex input traveling wave. The audio-frequency pressures would not be affected by SCC fenestration. The outer hair cell motility thus induced somehow excites the inner hair cells and the auditory nerve fibers. At low intensities the outer hair cell motility causes localized displacement at the appropriate position on the basilar membrane.