Superior-semicircular-canal dehiscence: effects of location, shape, and size on sound conduction.

The effects of a superior-semicircular-canal (SSC) dehiscence (SSCD) on hearing sensitivity via the air-conduction (AC) and bone-conduction (BC) pathways were investigated using a three-dimensional finite-element (FE) model of a human middle ear coupled to the inner ear. Dehiscences were modeled by removing a section of the outer bony wall of the SSC and applying a zero-pressure condition to the fluid surface thus exposed. At each frequency, the basilar-membrane velocity, vBM, was separately calculated for AC and BC stimulation, under both pre- and post-dehiscence conditions. Hearing loss was calculated as the difference in the maximum magnitudes of vBM between the pre- and post-dehiscence conditions representing a change in hearing threshold. In this study, BC excitations were simulated by applying rigid-body vibrations to the model along the directions of the (arbitrarily defined) x, y, and z axes of the model. Simulation results are consistent with previous clinical measurements on patients with an SSCD and with results from earlier lumped-element electrical-circuit modeling studies, with the dehiscence decreasing the hearing threshold (i.e., increasing vBM) by about 35 dB for BC excitation at low frequencies, while for AC excitation the dehiscence increases the hearing threshold (i.e., decreases vBM) by about 15 dB. A new finding from this study is that the initial width (defined as the width of the edge of the dehiscence where the flow of the fluid-motion wave from the oval window meets it for the first time) on the vestibular side of the dehiscence has more of an effect on vBM than the area of the dehiscence. Analyses of dehiscence effects using the FE model further predict that changing the direction of the BC excitation should have an effect on vBM, with vBM being about 20 dB lower due to BC excitation parallel to the longitudinal direction of the BM in the hook region (the x direction) as compared to excitations in other directions (y and z). BC excitation in the x direction and with a 'center' dehiscence located midway along the length of the SSC causes a reduction in the anti-symmetric component of the fluid pressure across the BM, as compared to the other directions of BC excitation, which results in a decrease in vBM at high frequencies. This article is part of a special issue entitled "MEMRO 2012".