The effect of round window reinforcement on human hearing

The compliant round window (RW) allows volume velocity to flow within the incompressible fluid of the cochlea as the oval window vibrates during sound stimulation. Recently, surgically stiffened RW is emerging as a treatment for various conditions such as superior canal dehiscence and hyperacusis. However, we lack the basic understanding of how reinforcing the RW affects sound transmission in the ear. The aim of this study is to clarify the effect of RW reinforcement on hearing. To study the effect of RW reinforcement with tissue and adhesive, we measured intracochlear pressures in scala vestibuli (Psv) and scala tympani (Pst) at the cochlear base together with stapes velocity in response to sound at the ear canal. The cochlear input drive (Pdiff = Psv - Pst, an estimate of hearing) was determined before and after RW reinforcement in a fresh human cadaveric ear. Results show that increasing the RW stiffness by reinforcement can affect the cochlear input drive in unexpected ways. Below 200 Hz, RW reinforcement resulted in reduced stapes motion, however an increase in cochlear drive, consistent with increase in hearing. At 200-1000 Hz, the hearing and stapes motion both were slightly decreased. Reinforcing the RW had no effect above 1 kHz. To understand the cochlear mechanical effects of RW reinforcement, we used a lumped-element model that simulated our findings.