The Clinical Application of Sound-Protection

Bekesy measured the sound transformation system of the middle ear 49 years ago. According to his reports, a ratio between the size of ear drum and the size of oval window is 17 : 1, and the lever function of the ossicles is physiologically 1.3 : 1. Therefore, the hearing might be aggravated to 27.5㏈ in the case of the vanishment of 3 ossicles. In 1952, Wullstein reported 5 types of tympanop-lasty and the fourth type among them was especially named for the sound-protection. The oval window is only exposed by the sound pressure and the round window is not exposed. According to the application by this idea, the post-operative hearing might be improved until 27.5㏈. Mean while, in 1942, Onchi verified through his experiment that the results of Bekesy's measurement was not completely conformed to Onchi result. Bekesy measured the sound pressure on the stapes plate of the oval window, on the other hand, Onchi measured the sound pressure on the surface of the perilymph of the oval window after removing the stapes plate(Fig. 1).(Figure omitted) The difference of their experiment is recognized that the impedance of the stapes plate exists or not (Fig. 1). Both Audiogrums are compared as Fig. 2. The result of IV type of tympanoplasty is success ful in 54% as the Table 1. (Table Omitted) The reason of unsatisfactory is caused by the thick and unmovable window-membrane and by the closing of air passage to the round window. The closing of the air passage to the round window is occurred by the adhesion between the grafting membrane and the surface of promontorium. In order to preserve this adhesion, I produce to transplantate the mucous membrane of the lip to the bone surface of tympanic cavity after removing the granulation tissue of the tympanic cavity and to form a membranous canal for the sake of air passage (Fig. 3). (Figure Omitted) The post-operative hearing by this method is shown as Fig. 4, 5. In other words, the post-operative sound pressure entered into the cochlea directly, by way of the oval window only, not by way of the round window, as a theorie of the sound protection. (Figure omitted)