The Hannover Coupler: Controlled Static Prestress in Round Window Stimulation With the Floating Mass Transducer.

Introduction: Stimulation of the cochlear round window (RW) with the floating mass transducer (FMT) still suffers from large variation in clinical outcomes. Beside the geometric mismatch between RW and FMT diameter that is a known limiting factor in achieving optimal coupling between actuator and RW membrane, the applied static force between FMT and RW is usually undefined. In this study, the feasibility and efficacy of a specially designed FMT coupler permitting application of static preloads to the RW membrane to optimize FMT-RW coupling was investigated. Methods: Experiments were performed in fresh human cadaveric temporal bones. The "Hannover Coupler" FMT-prosthesis has a spherical tip (d=0.5 mm) at the front end and a spring at the prosthesis back that enables the application of static preloads and mobility of the FMT at the same time. Stapes footplate (SFP) displacements in response to acoustic stimulation of the tympanic membrane and to RW stimulation by the FMT were measured by a Laser-Doppler vibrometer. Results: Average SFP displacement responses of ASTM standard F2504-05 compliant temporal bones to RW stimulation by the "Hannover Coupler" were dependent on the applied force (~0-100 mN) and increased by up to 25 dB at frequencies >= 1 kHz. When averaged at speech relevant frequencies (0.5, 1, 2, 4 kHz) SFP displacements showed a global maximum at RW preloads of ~4 mN. Conclusion: The coupling between FMT and RW membrane was improved by the application of static RW preloads as indicated by increased SFP amplitudes to RW stimulation. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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