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Factors contributing to bone conduction: The outer ear

Stefan Stenfelt,a) Timothy Wild,b) Naohito Hato,c) and Richard L. Goode


Division of Otolaryngology—Head and Neck Surgery, Stanford University Medical Center, Stanford,
California

共Received 2 May 2002; accepted for publication 4 November 2002兲


The ear canal sound pressure and the malleus umbo velocity with bone conduction 共BC兲 stimulation
were measured in nine ears from five cadaver heads in the frequency range 0.1 to 10 kHz. The
measurements were conducted with both open and occluded ear canals, before and after resection of
the lower jaw, in a canal with the cartilage and soft tissues removed, and with the tympanic
membrane 共TM兲 removed. The sound pressure was about 10 dB greater in an intact ear canal than
when the cartilage part of the canal had been removed. The occlusion effect was close to 20 dB for
the low frequencies in an intact ear canal; this effect diminished with sectioning of the canal. At
higher frequencies, the resonance properties of the ear canal determined the effect of occluding the
ear canal. Sectioning of the lower jaw did not significantly alter the sound pressure in the ear canal.
The sound radiated from the TM into the ear canal was investigated in four temporal bone
specimens; this sound is significantly lower than the sound pressure in an intact ear canal with BC
stimulation. The malleus umbo velocity with air conduction stimulation was investigated in nine
temporal bone specimens and compared with the umbo velocity obtained with BC stimulation in the
cadaver heads. The results show that for a normal open ear canal, the sound pressure in the ear canal
with BC stimulation is not significant for BC hearing. At threshold levels and for frequencies below
2 kHz, the sound in the ear canal caused by BC stimulation is about 10 dB lower than air conduction
hearing thresholds; this difference increases at higher frequencies. However, with the ear canal
occluded, BC hearing is dominated by the sound pressure in the outer ear canal for frequencies
between 0.4 and 1.2 kHz. © 2003 Acoustical Society of America. 关DOI: 10.1121/1.1534606兴
PACS numbers: 43.64.Bt, 43.64.Ha, 43.66.Ba 关LHC兴

I. INTRODUCTION hearing sensation: this is termed BC sound or hearing by BC.


The BC sound makes the skull vibrate relative to the sur-
Hearing by bone conduction as a physical phenomenon rounding air, which causes the surrounding air to be com-
can be divided into three general routes 共Tonndorf, 1966兲: pressed and expanded, and an air-borne sound is radiated
共1兲 the sound radiated into the external ear canal, termed the from the skull. Similarly, with BC stimulation, an air-borne
osseotympanic route, sound is set up in the external ear canal. The slight difference
共2兲 compression and expansion of the petrous bone, which between the sound radiated into the air surrounding the head
results in displacement of fluid into the cochlea and, con- and into the ear canal is that the ear canal itself is com-
sequently, basilar membrane motion, and pressed and expanded from the skull vibrations; this distor-
共3兲 the inertial effect of the middle ear ossicles and the inner tion of the ear canal walls is the source of the radiated sound
ear fluids. in the external ear canal.
Sound radiation into the ear canal with BC stimulation is
It is the first route that is the scope of this investigation, in well known and has been reported extensively in the litera-
particular the different parts of the external ear 共cartilage and ture. Berthold was one of the first to objectively present this
soft tissue part of the canal, bony part of the canal, and the phenomenon; he used a microphonic flame to show the al-
tympanic membrane兲 which contribute to the sound radiation ternating air pressure in the ear canal when a BC sound was
into the external ear canal. Moreover, the influence of the presented to the skull 共Bárány, 1938兲. Later, extensive inves-
sound radiated into the external ear canal on the total BC tigations of ear canal sound pressure with BC stimulation
hearing is estimated. were reported 共Bárány, 1938; Huizing, 1960; Békésy, 1960;
When the head is subjected to a vibration, the vibration Elpern and Naunton, 1963; Tonndorf, 1966; Khanna et al.,
is transmitted to the temporal bone of the skull and causes a 1976兲.
Conflicting theories and results on the influence of the
a兲 ear canal sound pressure 共ECSP兲 on hearing by BC have
Present address: Department of Signals and Systems, Chalmers University
of Technology, SE-412 96 Göteborg, Sweden. Electronic mail: been reported. Wever and Lawrence 共1954兲 describe the
stenfelt@s2.chalmers.se osseo-tympanic stimulation with BC as secondary to the in-
b兲
Present address: Department of Head and Neck Surgery, Kaiser Perma- ertial or compressional mode of BC stimulation. Kirikae
nente Medical Center, Vallejo, CA.
c兲
Present address: Department of Otolaryngology, Ehime University School 共1959兲 stated that inertial effects dominate low-frequency
of Medicine, Shitsukawa, Shigenobu-cho, Onsen-gun, Ehime, Japan. BC hearing and compressional effects dominate high-

902 J. Acoust. Soc. Am. 113 (2), February 2003 0001-4966/2003/113(2)/902/12/$19.00 © 2003 Acoustical Society of America
frequency BC hearing, i.e., ECSP does not have much effect TABLE I. Data on the five cadaver heads used in the study. The circumfer-
ence is measured in a line across the middle of the forehead, just above the
on BC hearing. Allen and Fernandez 共1960兲 believed that the
ear canal openings and across the occiput.
compressional component is the major BC response, while
Brinkman et al. 共1965兲 argued that the inertial effects on the Age Circumference Ear–ear via vertex Mass
ossicular chain and cochlear fluids are the major contributor No. Sex 共years兲 共cm兲 共cm兲 共kg兲
to BC sound. Huizing 共1960兲 found that the sound pressure 1 M 60–70 58 36 3.78
produced in the external ear canal following BC stimulation 2 M 60–70 56 31 3.43
was greater for frequencies below 0.5 kHz and less for fre- 3 M 60–70 53 31 3.25
quencies above 0.5 kHz, when compared with an AC stimu- 4 M 60–70 54 33 3.31
5 M 60–70 57 34 3.59
lation giving the same sensation, which indicates that the
outer ear contributes to BC hearing for frequencies below 0.5
kHz. Tonndorf 共1972兲 found a major contribution from the nal: 共1兲 the soft tissue part of the ear canal, 共2兲 the bony part
external ear component for frequencies below 2 kHz in cats. of the ear canal, 共3兲 the tympanic membrane 共TM兲, and 共4兲
Khanna et al. 共1976兲 showed that when an AC tone was sub- the condyle of the lower jaw. In addition, the effect on the
jectively cancelled by a BC tone, the sound in the external ECSP with BC stimulation after occlusion of the ear canal is
ear canal was also cancelled for frequencies below 0.8 kHz; measured. By using measurements of the ECSP together with
this indicates that the majority of low-frequency BC sound is the umbo motion, for BC as well as air conduction 共AC兲
transmitted through the external ear canal. However, clinical stimulation, the influence of the osseo-tympanic route on BC
findings in patients with congenital atresia, cholesteatoma, hearing is estimated.
serous otitis media, stapes otosclerosis, or ossicular discon-
tinuity often show normal or close to normal low-frequency
BC thresholds with air-bone gaps of 40 to 60 dB 共Ginsberg II. MATERIALS AND METHODS
and White, 1994兲. These clinical findings indicate that the
influence of the ECSP on BC hearing is insignificant. A. Whole head experiments
When the external ear canal is occluded at the opening, The ear canal sound pressure 共ECSP兲 was measured in
a low-frequency increase in subjective BC hearing, as well as nine ears from five human cadaver heads. The heads had
in objectively measured ECSP, is obtained 共Huizing, 1960; been severed between the third and fourth vertebra and were
Goldstein and Hayes, 1971兲. This result indicates that, even frozen at time of autopsy. Apart from being severed, the
if BC hearing is not caused by the ECSP in an open ear heads were left intact, i.e., there was no cutting or drilling of
canal, the BC hearing is dominated by the ECSP at low fre- the heads during the autopsy, and the soft tissues and brain
quencies 共below 1 kHz兲 when the ear canal is occluded. The were also left intact. The size and weight of the heads are
phenomenon of increased low-frequency hearing, after oc- presented in Table I. No history of the heads was known,
clusion of the ear canal, with BC stimulation is used in the except that they were male and between 60 and 70 years old.
Bing test: a vibrating tuning fork is applied to the skull and, They were defrosted 24 h prior to the measurements. At the
when the sound is no longer heard, the ear being tested is time of measurement, the ear was examined with an opera-
gently occluded. A perception of the increase of sound in the tion microscope; crust and hair in the ear canal was removed,
occluded ear indicates a functional middle ear. and the tympanic membrane 共TM兲 was inspected. One ear
The influence of the lower jaw on the ECSP has also was not used in this investigation since it had a perforated
been disputed in the literature. Békésy 共1960兲 argued that the TM. Small reflective targets 共glass sphere, Ø 5 ␮m兲 were
motion of the condyle of the lower jaw, part of which lies placed on the tip of the malleus umbo and on the bony wall
against the cartilage and soft tissues of the outer ear canal, of the ear canal 关Fig. 1共a兲兴. These targets were used for the
yields a motion relative to the skull which results in a sound velocity measurements made with a laser Doppler vibrome-
pressure in the ear canal. Franke 共1956兲 found that the reso- ter 共LDV兲. A hole was drilled in the bone and tapped, 35 mm
nance frequency for the lower jaw was somewhere between posterior to the ear canal opening, and a transducer was rig-
110 and 180 Hz, a fact later confirmed by Howell et al. idly attached to the skull by a threaded connector attached to
共1988兲. Consequently, below this resonance frequency, the the threaded hole. The transducer, referred to as the mini-
skull and lower jaw move in phase and only minor relative transducer, was a remodeled bone anchored hearing aid
motion arises; in contrast, far above the resonance frequency, transducer with screw attachment 共Tjellström et al., 2001兲.
the jaw is almost at rest which gives large relative motion During the measurements, the head was placed on an inflat-
between the jaw and skull. Tonndorf 共1966兲, who ascribed able pillow to avoid artifacts from the measurement table.
this phenomenon a minor role for the sound pressure in the An 8-mm-long tapered plastic speculum, with an inner-
ear canal with BC stimulation, argued that the major radia- end diameter of 6 mm and outer-end diameter of 13 mm, was
tion was from the bony part of the ear canal. In an experi- inserted into the ear canal 关Fig. 1共a兲兴. The speculum intruded
ment on the influence of the jaw with BC, it was concluded 3 to 5 mm into the ear canal and was surrounded by Vaseline
that ECSP was present in the ear canal even after the jaw had to provide a good sound seal. A glass cover fitted into the
been removed 共Howell and Williams, 1989兲. middle of the speculum was used to occlude the ear canal;
The aim of this study is to investigate the relative im- the glass cover provided a sound seal and also transmitted
portance of contributions to ear canal sound pressure 共ECSP兲 the laser beam. A probe tube microphone 共ER-7C, Etymotic
with BC stimulation, from four parts of the external ear ca- Research, Elk Grove Village, IL兲 was inserted into the ear

J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing 903
HLV-1000 was mounted with a joystick-controlled mirror on
an operating microscope, which enabled easy control of the
laser beam. The stimuli were provided by a PC-based soft-
ware, SYSid 6.5, using a DSP-16⫹ signal processing card
共www.sysid-labs.com兲. The output from the computer was
fed through a power amplifier 共D-75, Crown, Elkhart, IN兲 to
the mini-transducer.

B. Temporal bone experiments


The temporal bones were extracted from human cadav-
ers, within 48 h of death, using a Schuknecht bone saw at the
time of autopsy. The temporal bone specimens were wrapped
in gauze, placed in a 1:10 000 merthiolate solution in normal
saline and stored at 5 °C. All measurements on individual
bones were conducted on the same day within 6 days after
death. The TM and middle ear were inspected for each bone
using an operating microscope; bones with abnormal TMs or
middle ears were excluded from the investigation. Thirteen
temporal bones were studied; they were from 12 males and 1
female, with an average age of 60.2 years and a range from
52 to 75 years. Connective tissue and muscle were removed
and the bony external ear canal was drilled down to 2 mm
from the tympanic membrane annulus. The artificial external
ear canal assembly 共8.5 mm internal diameter, 25 mm long兲
used contained an earphone adapter on the side near the lat-
eral end and a probe tube opening 2 mm from the medial
end. This assembly was attached to the bony rim of the ear
canal with clay, so that the axis of the tube was perpendicular
to the annulus, while the remainder of the temporal bone was
embedded in Hydrock dental cement 共Kerr Co., Romulus,
MI兲, forming a solid airtight specimen block.
A reflective target 共glass sphere, Ø 5 ␮m兲 placed on the
malleus umbo increased the reflection for the laser measure-
FIG. 1. 共a兲 Measurement setup for whole head measurements with BC
ment. An ER-7C probe tube microphone was inserted into
stimulation. The BC stimulation is transmitted to the skull by a mini- the artificial ear canal with the probe tube opening 2 mm
transducer rigidly coupled to the skull 35 mm behind the ear canal opening. from the TM. The same SYSid measurement system was
A speculum, placed at the end of the ear canal, can put a glass cover in place used for the temporal bone measurements; however, when
as an occlusion device, and a probe tube microphone is positioned 2 mm in
front of the TM. The velocity of the skull bone and the malleus umbo is
measuring AC umbo motion, the output from the power am-
measured by a LDV, and reflective targets are used to enhance the reflection plifier was fed to an earphone 共83-13A/024, Tibbets Indus-
of the laser beam. The condyle of the lower jaw is positioned below the ear tries, Camden, ME兲 that was inserted in the adapter in the
canal to improve the visibility of ear structures. 共b兲 Setup for measurements artificial ear canal. The ECSP in the artificial ear canal was
of the malleus umbo velocity with AC stimulation. The temporal bone speci-
men is sealed in a block of dental cement; an artificial ear canal is glued measured with the probe tube microphone and the umbo mo-
onto the specimen perpendicular to the plane of the TM. An earphone pro- tion was measured with the HLV-1000 vibrometer 关Fig.
vides the sound stimulus at the lateral end of the artificial ear, the ECSP is 1共b兲兴.
measured 2 mm in front of the TM by a probe tube microphone, and the When the sound radiation from the TM was measured,
velocity of the malleus umbo is measured by a LDV. 共c兲 Setup for measure-
ment of the ECSP and umbo velocity when the ossicles are stimulated in the mini-transducer was extended by a 10-mm-long and 0.5-
reverse. The temporal bone specimen is sealed in a block of dental cement; mm-diam rod 关Fig. 1共c兲兴. The temporal bone was opened
an artificial ear canal is glued onto the specimen perpendicular to the plane from the internal ear canal, and a hole into the vestibule was
of the TM. The stimulation is provided by a mini-transducer extended by a
made so the stapes footplate was clearly visible. After the
rod that is glued to the vestibular side of the stapes footplate. The ECSP is
measured 2 mm in front of the TM by a probe tube microphone, and the cochlea was drained, the mini-transducer with the extended
velocity of the malleus umbo is measured by a LDV. rod was inserted with a micro-manipulator into the hole in
the vestibule. A drop of cyanoacrylate glue 共Loctite 430,
Loctite, Rocky Hill, CT兲 was put on the tip of the rod; when
canal and positioned about 2 mm from the TM; this micro- the rod made contact with the footplate, they were bonded
phone was used to measure the ECSP. The vibrations of both without adding any stress on the annular ligament. With this
the bony wall of the ear canal and the malleus umbo were assembly, the ECSP due to TM vibration alone was mea-
measured with the HLV-1000 laser Doppler vibrometer sured. The output from the computer was fed to the mini-
共Polytec, Waldbronn, Germany兲. The sensor head of the transducer, the ECSP was measured with the probe micro-

904 J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing
FIG. 2. Level 共a兲 and phase 共b兲 of the mechanical point impedance of the bone screw attached to the mastoid of the skull. The impedance level is defined as
20•log10 of the magnitude data. The position was approximately 35 mm behind the ear canal opening. The thick line represents the average values from nine
positions 共nine ears from five heads兲 and the thin lines are ⫾SD. Frequency resolution is 50 points/decade.

phone 2 mm in front of the TM, and the malleus umbo used to compensate for the mass above the force gauge in the
motion was measured with the HLV-1000 vibrometer. postprocessing of the impedance data. Figure 2 gives the
mechanical impedance for the nine positions 共five heads兲.
C. Calibration The results are similar to impedance measurements con-
ducted on living human heads with permanent titanium fix-
The calibration of the HLV-1000 vibrometer and the
tures at a similar position 共Håkansson et al., 1986兲.
ER-7C probe microphone is described in Stenfelt et al.
共2002兲. The mini-transducer was calibrated on a Skull Simu-
lator TU-1000 to obtain the correct force output 共Håkansson III. RESULTS
and Carlsson, 1989兲. Provided the point impedance of the
A. A Normal ear canal
connection point on the head is much larger than the output
impedance of the mini-transducer, the Skull Simulator TU- The average ear canal sound pressure produced by BC
1000 gives correct force data. To verify that the point imped- stimulation in nine ears with intact ear canals is presented in
ance at the bone screw used to attach the mini-transducer to Fig. 3. The results are shown for both open and occluded ear
the skull was similar to that of a normal living head, the canals. With the ear canal open, the level of the ECSP is
mechanical point impedance of the bone screw in situ was approximately flat for frequencies below 500 Hz; above this
measured. The mechanical impedance data were obtained by frequency the sound pressure rises by approximately 15 dB
a B&K type 8001 impedance head connected to a threaded per octave until the frequency reaches the resonance fre-
adapter for rigid attachment between the impedance head quency of the ear canal at 2.7 kHz 共quarter wavelength reso-
and the bone screw. The apparent mass 共force/acceleration兲 nance兲. With the ear canal occluded, the level of the ECSP is
of a known mass, approximately 30 times the mass above the some 10 to 15 dB greater at low frequencies. The difference
force gauge, was measured in order to calibrate the imped- between the ECSP for occluded and open ear canals starts to
ance head. The apparent mass of the impedance head with diminish at 1 kHz and is zero at 2 kHz. The quarter wave-
the adapter unloaded was then measured; these data were length resonance at 2.7 kHz becomes an antiresonance when

FIG. 3. Average level 共a兲 and phase 共b兲 of the sound pressure in an intact ear canal when the BC stimulation was at the mastoid. The solid line shows the result
in open ear canals, while the dashed line represents occluded ear canals. The vertical bars indicate ⫾1 standard error of the mean. Frequency resolution is 50
points/decade.

J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing 905
FIG. 4. Alteration of the level 共a兲 and phase 共b兲 of the ECSP in the intact open ear canal after resection of the lower jaw, when the BC stimulation was at the
mastoid. The data are obtained for two ears from one head. Frequency resolution is 50 points/decade.

the ear canal is occluded; a half wavelength resonance both ears. Above this frequency the phase drops to a mini-
around 5.5 kHz is visible in about half of the ears tested. An mum at 4.3 kHz: ⫺35 and ⫺70 degrees for the two ears. At
average sound pressure increase can therefore be found the higher frequencies, the phase difference decreases and
around 5.5 kHz with the ear canal occluded. The bars in the becomes approximately 10 degrees at 10 kHz. The results for
figure show the standard error of the mean, which is 2 to 5 the alteration in level and phase were similar whether the ear
dB in the frequency range 0.1 to 10 kHz. canal was open or occluded.
The phase of the ECSP relative to the input force, for an
open ear canal, shows a decaying response, indicating a time
delay 关Fig. 3共b兲兴. This time delay for the ECSP consists of C. Alteration of the ear canal
two components: one is the traveling time for BC vibration
in the skull, and the other is the time delay of the sound About one-third of the ear canal consists of cartilage;
pressure wave traveling from the radiation point in the ear when this was removed, an approximately 15–20-mm-long
canal to the probe tube microphone. These two components bony ear canal remained. The ECSP results with BC stimu-
cannot be separated by the current measurement. The ECSP lation at the mastoid after the pinna, cartilage, and soft tissue
phase shows similar behavior for both open and occluded ear parts of the ear canal were removed are given in Fig. 5.
canals; however, the phase with the ear canal occluded leads Compared with the intact ear canal 共Fig. 3兲, the ECSP level
that of an open canal by about 180 degrees. is 5 to 10 dB lower for frequencies below 1.0 kHz and 10 to
15 dB lower for frequencies between 1.0 and 4.0 kHz, with
the ear canal open. With the ear canal occluded, the sound
B. Alteration after resection of the jaw
pressure in the bony ear canal remnant is about 15 dB lower
For one head, after the measurement of the ECSP in at frequencies below 3 kHz than in an intact occluded ear
intact ear canals, the condyles of the lower jaw were re- canal. The occlusion effect with the cartilage part of the ear
sected. The jaw was pulled so there was about 1 cm of air canal removed is 5 to 10 dB for frequencies below 2 kHz,
space between the condyle and the cartilage and soft tissue of i.e., about 5 dB less than in an intact ear canal. Figure 5共b兲
the ear canal at both ears. Thereafter, the ECSP in both ears shows the phase of the ECSP relative to the input force at the
was remeasured with the ear canals open and occluded. The bone screw in the mastoid. The phases are similar for both
level and phase alterations of the ECSP for the two ears with open and occluded ear canals. Compared with the phase for
open ear canals after resection of the jaw are shown in Fig. 4. the intact ear canal in Fig. 3共b兲, the phase for the ear canal
In one ear, the ECSP difference is within 1 dB for frequen- with the cartilage removed decreased more rapidly.
cies below 2 kHz, while the other ear shows an increased The data in Fig. 6 were obtained after the cartilage, soft
ECSP of 4 dB, at the low frequencies, which falls off with tissue, and TM of the ear canal had been removed. The levels
frequency and vanishes at 1 kHz. Above 2 kHz, the ECSP in Fig. 6共a兲 are somewhat higher than the results obtained
after resection of the jaw increases and peaks at a level of 4 with only the cartilage removed in Fig. 5共a兲: with an open
dB at 2.3–2.5 kHz. Both traces show a decrease in ECSP ear canal, the levels are 5 to 10 dB greater for frequencies
levels of 2–3 dB at 4.0 kHz and have other peaks of 1 and 2 between 1.5 and 4 kHz, with a tendency to resonance around
dB at 5 kHz. The resonance pattern continues at the higher 3 kHz. This resonance is a result of the longer effective ear
frequencies with an ECSP decrease around 6.0 kHz and an- canal length after the TM is removed; the middle ear space is
other increase around 7.0 kHz. The increases and decreases a part of the total canal length. Occluding the ear canal at the
seen at the higher frequencies are within 2 dB. lateral end of the bony part increases the ECSP by up to 5 dB
The phase alteration of the ECSP after resection of the between 0.1 and 1.0 kHz and 5 to 10 dB for frequencies
jaw is around ⫹10 to ⫺10 degrees at the low frequencies. At between 1.0 and 2.0 kHz. Between 2.0 and 5.0 kHz, the
2.0 kHz, a peak of 20 degrees in phase alteration is seen in occlusion lowers the ECSP by up to 10 dB.

906 J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing
FIG. 5. Average level 共a兲 and phase 共b兲 of the sound pressure in the bony ear canal after removal of the ear canal cartilage and soft tissue. The BC stimulation
is applied at the mastoid. The solid line shows the result for an open ear canal, while the dashed line is for an occluded ear canal. The vertical bars indicate
⫾1 standard error of the mean. Frequency resolution is 50 points/decade.

Figure 6共b兲 displays the phase of the results after the tween the velocities of the umbo and temporal bone in-
cartilage, soft tissues, and TM were removed from the ear creased with frequency. Above 1.0 kHz the velocity of tem-
canal. The phases obtained are similar to the ones obtained poral bone became immeasurable.
with the intact ear canal shown in Fig. 3共b兲. For the three The measurements with the ossicles driven in reverse
conditions measured in Figs. 3, 5, and 6, the variance of the were conducted in temporal bone specimens at rest, whereas
measurements is similar: the standard error of the mean is the ECSPs with BC stimulation were measured in vibrating
within 5 dB for the frequency range 0.1 to 10 kHz. The skulls. Therefore, to facilitate comparing the results, the
standard error of the mean for the phase in the same figures ECSP is referenced to the relative velocity of the malleus
is also similar: 10 to 100 degrees in the frequency range 0.1 umbo. The relative umbo velocity is defined as the umbo
to 10 kHz.
velocity minus the bone velocity measured in the bony ear
canal, i.e., V rel,umbo⫽V umbo⫺V bone . For BC stimulation, the
D. Ossicles driven in reverse velocity difference between the umbo and the bony part of
The sound radiated from the TM alone was assessed by the ear canal was used to compute the relative umbo veloc-
driving the ossicular chain in reverse, with a small vibrator ity; whereas, with the reverse stimulation of the middle ear
共mini-transducer兲 attached to the vestibular side of the stapes ossicles, the relative umbo velocity was the same as the
footplate by a thin rod, while measuring the ECSP and the umbo velocity since the temporal bone was considered to be
malleus umbo motion. First, the motion of the temporal bone at rest.
specimen itself was measured by the LDV with a target on Figure 7 shows the ECSP level and phase relative to the
the bony annulus close to the TM. The measurement verified umbo velocity with an open ear canal for three conditions:
that the motion of the temporal bone specimen itself is 40 dB 共1兲 an intact ear canal with BC stimulation of the head, 共2兲
lower than the umbo motion at 100 Hz; the difference be- the cartilage part of the ear canal removed, with BC stimu-

FIG. 6. Average level 共a兲 and phase 共b兲 of the sound pressure in the bony ear canal after removal of the ear canal cartilage, soft tissue, and the TM. The BC
stimulation is applied to the mastoid. The solid line is the result with the ear canal open, while the dashed line is with the ear canal occluded. The vertical bars
indicate ⫾1 standard error of the mean. Frequency resolution is 50 points/decade.

J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing 907
FIG. 7. Average level 共a兲 and phase 共b兲 of ECSP relative to umbo velocity in an open ear canal. The straight line shows the result with a normal intact ear
canal and BC stimulation 共mean of nine ears兲, the dashed line shows the result when the cartilage and soft tissue of the ear canal have been removed and
stimulated by BC 共mean of nine ears兲, and the dash-dotted line shows the result from the TM radiation into an artificial ear canal when the middle ear ossicles
are stimulated in reverse 共mean of four temporal bone specimens兲. Also included are the ECSP relative to umbo velocity data from Stenfelt et al. 共2002兲 in
temporal bone specimens stimulated by shaking the entire specimen 共dotted line兲. Frequency resolution is 50 points/decade.

lation of the head, and 共3兲 TM radiation into an artificial ear cies; above 1.2 kHz, it becomes similar to the phase of the
canal in a temporal bone specimen when the ossicles are ECSP in an intact ear canal with BC stimulation.
driven in reverse. For comparison, data from Stenfelt et al.
共2002兲 for the ECSP in temporal bone specimens when the E. The occlusion effect
whole specimen is shaken is also included in Fig. 7.
The occlusion effect on the ECSP with BC stimulation,
The greatest ECSP relative to umbo velocity is obtained
共1兲 in an intact ear canal, 共2兲 when the cartilage and soft
with BC stimulation in an intact ear canal. The ECSP level
tissue part of the ear canal is removed, and 共3兲 in the bony
relative to umbo velocity, due to TM radiation alone, in-
canal when the TM is removed, is shown in Fig. 8. In addi-
creases by approximately 6 dB/oct for frequencies between
tion, a curve for the occlusion effect in the artificial ear canal
0.2 and 2.0 kHz and resonates around 2.5 kHz; this reso-
when the ossicles are driven in reverse is included in the
nance frequency corresponds to the quarter wavelength reso-
figure. The strongest effect of occluding the ear canal is ob-
nance of the total length of the artificial ear canal, including
tained with TM radiation alone in an artificial ear canal: an
the remnant of the bony canal. Although the ECSP drops
increase of over 20 dB at 100 Hz that falls off at about ⫺6
above the resonance frequency, it recovers around 7 kHz,
dB/oct. The attenuation of about 20 dB around 3 kHz is
which is a result from the three-quarter wavelength reso-
mainly due to the quarter wavelength resonance for the open
nance. Figure 7 shows that the radiation from the TM into
canal, which disappears when the canal is occluded; the in-
the ear canal is significantly lower than the ECSP with BC
crease of 15 dB at 5.5 kHz results from the half wavelength
stimulation in an intact ear canal, except near the ear canal
resonance, where the TM radiation is only 5 to 10 dB lower
than the ECSP with BC stimulation. The result for the bony
canal is not directly comparable with that of the TM radia-
tion, since the resonances at the high frequencies differ, due
to the canal length, for the two. In addition, at low frequen-
cies, the acoustic impedance into the ear canal seen from the
TM is influenced by the ear canal length.
The phase of the ECSP divided by the umbo relative
velocity reveals differences between reverse ossicular stimu-
lation in a temporal bone specimen and BC stimulation in a
skull 关Fig. 7共b兲兴. With reverse ossicular stimulation, the
ECSP phase increases from 80 degrees at 0.1 kHz to 220
degrees at 0.5 kHz. This phase stays close to 200 degrees up
to 2.0 kHz, after which it falls off to ⫺100 degrees at 8 kHz;
however, it recovers at the very high frequencies. With BC
stimulation in a head, the phase of the ECSP divided by the FIG. 8. The occlusion effect computed as the sound pressure level in the
occluded ear canal relative to the sound pressure level in the open ear canal.
relative umbo velocity increases from ⫺220 degrees at 0.1 Solid line: normal intact ear canal and stimulation by BC 共mean of nine
kHz to 150 degrees at 4.5 kHz. It then decreases slightly, ears兲. Dashed line: cartilage and soft tissue of the ear canal removed and
after which it starts to rise rapidly above 6.0 kHz and be- stimulation by BC 共mean of nine ears兲. Dotted line: cartilage, soft tissue, and
TM of the ear canal removed and stimulation by BC 共mean of nine ears兲.
comes 400 degrees at 10 kHz. The phase of the ECSP with
Dash-dotted line: Sound radiation from the TM into an artificial ear canal
BC stimulation, after removal of the cartilage and soft tissue when the ossicles were driven in reverse 共mean of four temporal bone speci-
in the ear canal, stays close to zero degrees at low frequen- men兲. Frequency resolution is 50 points/decade.

908 J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing
resonance in an occluded canal. The curve for the intact ear in the ear canal length cannot be verified, since ear canal
canal with BC stimulation is similar to the one with TM length was not measured.
radiation in an artificial ear canal. That the curves are not the
same may be a result from the different geometries of the B. The ECSP from the TM
two canals: the artificial canal is straight whereas the normal The contribution to the ECSP from the TM was assessed
ear canal is curved. Also, the damping imposed by the soft in two ways: the TM was removed, and the ECSP was mea-
part of the intact ear canal can cause divergence between the sured with BC stimulation in the whole head; also, the ECSP
two; the artificial ear canal is a hard plastic tube with little or from the TM was measured in temporal bone specimens
no damping. When either the cartilage part of the canal or the when the ossicles were stimulated in reverse. An increase in
TM is removed, the occlusion effect is less than for an intact ECSP level is found after removing the TM from the bony
ear canal. canal in the whole head experiments 共Fig. 6兲; the ECSP lev-
els are still lower than in the intact ear canal. Some of the
IV. DISCUSSION difference in the ECSP after removal of the TM can be ex-
plained by the change in acoustic properties for the length-
A. The ECSP with BC stimulation
ened canal and by the fact that the position of the probe tube
The relative contributions of three factors to the ECSP microphone opening is not altered; this opening is approxi-
with BC stimulation were investigated: 共1兲 the cartilage and mately in the middle of the new canal which encompasses
soft tissue part of the ear canal, 共2兲 the bony part of the ear both the bony part of the ear canal and the middle ear cavity.
canal, and 共3兲 the TM. The greatest ECSP in an open ear The measurement position in the ear canal can affect the
canal with BC stimulation is obtained in an intact ear canal ECSP obtained. However, the ECSP as a function of canal
共Fig. 3兲; removing the cartilage and soft tissue of the ear position was not investigated.
canal reduced the ECSP level 5 to 10 dB for frequencies The increase in measured ECSP after removal of the TM
below 1.0 kHz, 10 to 15 dB for frequencies between 1.0 and from the bony canal can also be a result of sound radiation
4.0 kHz, and some 5 dB for higher frequencies. The reduc- into the middle ear cavity. After removal of the TM, the
tion of the ECSP level at frequencies below 2.0 kHz, with sound radiated into the middle ear cavity increases the mea-
removal of the cartilage and soft tissue, indicates that the sured ECSP. This effect with BC stimulation was proposed
cartilage part of the ear canal is the greatest source of the by Groen 共1962兲 to be a major contribution to hearing by BC
ECSP with BC stimulation 共Fig. 5兲. It is difficult to compare at around 2.5 kHz. Stenfelt et al. 共2002兲 did not find any
the results at higher frequencies, since the shorter bony canal significant sound radiation into the middle ear canal when
has resonance properties that differ from those of the longer temporal bone specimens were shaken. Tonndorf 共1966兲,
intact canal. who measured the BC response in cats with both open and
The bony part of the ear canal has sometimes been con- closed middle ear cavities, found no difference in the re-
sidered the origin of the ECSP with BC stimulation 共Huizing, sponse. When he removed the TM, he found only small and
1960; Tonndorf, 1966兲. However, for frequencies below the nonsystematic changes of the ECSP. Hence, there is no sup-
first resonance of the skull 共0.8 –1.0 kHz, Håkansson et al., port, either in the Tonndorf 共1966兲 data on cats or in the
1994兲, the skull bone moves as a rigid body; there is no Stenfelt et al. 共2002兲 data on temporal bone specimens, for a
compression and expansion in the bony part of the external contribution to hearing by BC from sound radiation into the
ear canal. The cartilage and soft tissue part of the ear canal middle ear cavity.
are more compliant than the bone and can cause compression When the ossicles are driven in reverse, the low-
and expansion of the ear canal at frequencies far below the frequency ECSP relative to umbo velocity level is 10 to 30
resonance frequency of the skull. This is a further indication dB lower than in the bony canal with BC stimulation 共Fig.
that the cartilage and soft tissue part of the ear canal gener- 7兲. Since driving the ossicles in reverse causes an ECSP due
ates the ECSP with BC stimulation at the low frequencies, as only to the motion of the TM, the greater low-frequency
suggested by Naunton 共1963兲. Also, the finding that occlu- ECSP obtained in the bony ear canal indicates that this sound
sion of the bony part of the ear canal minimizes the per- pressure is caused by the bony part of the ear canal. How-
ceived occlusion effect concurs with the hypothesis that the ever, for frequencies below the skull resonance, there is no
soft tissue part of the ear canal dominates the ECSP with BC expansion and compression in the skull bone, hence there
stimulation at the low frequencies 共Békésy, 1941兲. should not be any sound radiation into the ear canal. The
With a shorter ear canal, the resonance frequencies are ECSP from temporal bone specimens with artificial ear ca-
altered: after the cartilage and soft tissue are removed, the nals 共plastic tubes, the same as in this study兲 is included in
quarter wavelength canal resonance should be between 4.5 Fig. 7; the specimens were shaken to simulate BC stimula-
and 5 kHz 共corresponds to a length of approximately 17–20 tion 共Stenfelt et al., 2002兲. The Stenfelt et al. 共2002兲 data
mm兲. However, Fig. 5共a兲 does not show any clear resonance show low-frequency ECSP levels similar to those in the bony
around that frequency for an open ear canal. An explanation canal, however they also show phase data similar to that
is that the length of the bony ear canal differed among the from stimulation of the ossicles in reverse. If the low-
measured ears, and the effect of the resonance disappears frequency ECSP from BC stimulation, as hypothesized, is
after averaging the results. This is supported by the indi- caused by the TM in the bony ear canal, the three conditions,
vidual data that show resonances between 4.0 and 5.5 kHz. 共1兲 bony ear canal in the skull with BC stimulation, 共2兲 the
The spread in resonance frequencies as a result of variation ossicles driven in reverse, and 共3兲 the shaking of a temporal

J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing 909
bone specimen with an artificial ear canal 共Stenfelt et al.,
2002兲, should show similar low-frequency ECSP data. This
is apparently not the case 共Fig. 7兲. However, at least two of
the phenomena involved in the three conditions differ, which
could, at least partly, explain the discrepancies: 共1兲 the inertia
effects of the TM itself and 共2兲 the sound radiated into the
surrounding air and subsequently transmitted to the open 共ar-
tificial兲 ear canal.
The TM has a small but nonzero mass 共14 mg, Wever
and Lawrence, 1954兲 which gives rise to a distributed force
that acts on the TM for BC stimulation or when the temporal
bone specimen is shaken. At the low frequencies, this force
on the TM acts in phase with the inertial forces of the os-
sicles, which gives higher ECSP levels than if the TM were FIG. 9. Increase of the ECSP level 共solid line兲 and umbo velocity level
driven only by the ossicles. Since they act in phase, the phase 共dashed line兲 with BC stimulation after occlusion of an intact ear canal
共mean of nine ears兲. Frequency resolution is 50 points/decade.
of the ECSP would be the same. When an object is vibrating,
it radiates sound into the surrounding air, i.e., both shaking a
temporal bone specimen and stimulating a head by BC gen- the greatest occlusion effect, whereas earphones containing
erates a sound in the surrounding air. This sound can be large air volumes did not cause any occlusion effect. Békésy
transmitted to the open ear canal. Since the head is a larger 共1941兲 found that when the occlusion was deep seated, i.e.,
structure than the temporal bone specimen, it generates all the way down to the bony part of the ear canal, the oc-
greater low-frequency sound for the same amount of bone clusion effect disappeared. Figures 3 and 5 show that the
vibration. The source of this sound is spatially different from ECSP with BC stimulation in an occluded bony ear canal is
the TM, and the resulting ECSP caused by sound radiation similar to the ECSP in an open intact ear canal. Thus, in an
into the surrounding air has a phase different from the sound intact ear canal, an occlusion down to the bony part of the
radiated from the TM. It should be noted that an occlusion of ear canal does not increase the ECSP with BC stimulation.
the ear canal removes this sound source from the ECSP. At Onchi 共1954兲 described two peaks in the occlusion ef-
low frequencies, the occlusion effect is lower for ear canals fect of the ear canal: one at 200 Hz which he ascribed to the
in the head with BC stimulation than for the reverse ossicular resonance of the ossicular chain, and the other at 800 Hz
stimulation. This difference can be caused by the sound ra- which was due to a resonance of the TM. The resonance
diation into the surrounding air being transmitted to the open frequency of the middle ear ossicles with BC stimulation was
ear canal but not the occluded canal 共Fig. 8兲. found to be around 1.5 kHz 共Stenfelt et al., 2002兲. Onchi’s
The difference between low-frequency ECSP from the explanations seem questionable, since neither of the peaks
reverse ossicular stimulation and from the shaking of the was found for occlusion of the ear canal in this study.
temporal bone in Fig. 7 can be explained in part by the Huizing 共1960兲 explained the occlusion effect by reso-
inertial effect of the TM: the ECSP level from shaking of the nance properties of the enclosed air in the ear canal: a closed
temporal bone specimen is greater than, but the ECSP phase tube has resonance properties that differ from those of an
is similar to, that of the reverse ossicular stimulation. Simi- open tube. Tonndorf 共1966兲 presented another explanation.
larly, the low-frequency ECSP difference between the bony The mass-effect of the air column in the ear canal together
canal and the reverse ossicular stimulation can be a combi- with the compliance of air in the ear canal and TM form a
nation of sounds, one of which radiates from the head into high-pass filter effect for the ECSP. When the ear canal is
the surrounding air and is transmitted to the open ear canal, occluded, the high-pass filter effect is eliminated, which re-
while the other is the inertial effect of the TM: this means a sults in an increase in low-frequency sound. Tonndorf’s ex-
greater low-frequency ECSP level for the bony canal and a planation is correct for the low frequencies where the mass
different phase, when compared with the reverse ossicular and compliance of the air in the ear canal determine the
stimulation. At the higher frequencies, the ECSP can be gen- acoustic properties, whereas Huizing’s explanation is correct
erated in the bony part of the ear canal, which is indicated by at higher frequencies where resonances and antiresonances
the similarity, in both magnitude and phase, of the intact ear determine the acoustic properties of the ear canal 共above 2
canal data and data from the ear canal with the cartilage and kHz for the human ear canal兲.
soft tissue removed 共Fig. 7兲.
D. The ECSP contribution to hearing by BC
C. Occlusion effect
With BC stimulation, the middle ear ossicles move rela-
The ECSP increase for an occluded intact ear canal is tive to the surrounding bone due to two phenomena. One is
similar to the results of Huizing 共1960兲, except at frequencies the inertial effect 共mass effect兲 of the ossicles themselves,
below 0.4 kHz where our data is about 10 dB lower. Huizing and the other is the ECSP acting on the TM, which results in
共1960兲 occluded, with a rubber plug, the outer end of the ear a motion of the ossicles. In an effort to determine their rela-
canal, a position similar to that used in this study. Elpern and tive influence on hearing by BC, the relative umbo velocity
Naunton 共1963兲 showed that the occlusion effect depends on was compared with the ECSP. Figure 9 shows the ECSP and
the type of device chosen: small supra-aural earphones gave relative umbo velocity level increase after occlusion of the

910 J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing
frequencies between 0.4 and 1.2 kHz when the ear canal is
occluded but not when it is open.
Huizing 共1960兲 found that the ECSP with BC stimula-
tion in an open ear canal was higher for frequencies below
500 Hz and lower for frequencies above 500 Hz than when
an AC stimulus caused the same sensation. He believed that
the sound pressure which arises in the external ear canal with
BC stimulation should not be considered a stimulus that pro-
duces BC via the AC route. Moreover, in patients with oto-
sclerosis of the stapes, the AC low-frequency hearing impair-
ment can reach 60 dB, whereas BC thresholds are hardly
affected 共Ginsberg and White, 1994兲; this is yet another in-
dication that the ECSP for an open ear canal is not a large
FIG. 10. Level of umbo velocity relative to ECSP. Solid line: open intact ear contributor to the total BC sensation. In a study of cats,
canal with BC stimulation 共mean of nine ears兲. Dashed line: occluded intact Brinkman et al. 共1965兲 found that for both large and small
ear canal with BC stimulation 共mean of nine ears兲. Dotted line: AC stimu-
perforations of the TM, there was only minor effect on the
lation in temporal bone specimens with an artificial ear canal 共mean of nine
temporal bone specimens兲. Frequency resolution is 50 points/decade. BC response, which further indicates that BC sound is not
caused by the ECSP.
Khanna et al. 共1976兲 placed the BC vibrator on the fore-
intact ear canal. The ECSP increased by a maximum of about head and measured the ECSP with a probe tube microphone,
18 dB for frequencies between 400 and 800 Hz. The rise of placed inside the ear canal when the ear was occluded and
the relative umbo velocity at those frequencies is approxi- just outside for an open ear canal. They reported the differ-
mately 8 dB. If the ECSP is the only origin of the umbo ence between the occluded and open ear canals to be over 20
motion, the increase of the relative umbo velocity should dB for the entire frequency range, which is inconsistent with
equal the increase of ECSP after occlusion of the ear canal. It our findings, as well as most reported results, for occlusion
should be noted here that an occlusion of the ear canal only of the ear canal 共see Sec. IV C兲. They further reported that
minimally affects the inertial response of the ossicles 共Sten- hearing by BC was dominated by the outer ear component
felt et al., 2002兲. Hence, the contribution of the ECSP to the for frequencies below 2 kHz, with the ear canal occluded,
umbo velocity is 10 dB lower than that of the inertial effects and below 800 Hz with an open ear canal. Figures 9 and 10
for an intact open ear canal with BC stimulation. This con- show that it is only when the ear canal is occluded, and for
curs with the results of both Goldstein and Hayes 共1971兲 and frequencies below 1.2 kHz, that the external ear component
Huizing 共1960兲, which show a greater ECSP increase for can dominate the BC response in humans. This difference in
occlusion of the ear canal than the subjectively perceived results could originate partly from the use of the mastoid as
occlusion effect: the difference was typically 5 to 15 dB for the stimulation position here, while the forehead is stimu-
frequencies below 1 kHz. lated in the study by Khanna et al.; the middle ear inertial
Another way to investigate the ECSP influence on hear- sensitivity for low frequencies can be 5 to 10 dB better when
ing by BC is to compare the input admittance 共umbo velocity BC is stimulated at the mastoid instead of at the forehead
divided by ECSP兲 of AC and BC stimulation. Figure 10 共Studebaker, 1962; Dirks and Malmquist, 1969; Goodhill
shows the relative umbo velocity divided by the ECSP for et al., 1970; Stenfelt et al., 2002兲. However, the skull moves
three situations: 共1兲 a normal intact open ear canal stimulated in more or less all dimensions in space wherever a BC stimu-
by BC, 共2兲 an occluded intact ear canal also with BC stimu- lation is applied to it; hence, it is unlikely that BC would be
lation, and 共3兲 a temporal bone specimen with an artificial more sensitive to inertial effects of the middle ear for stimu-
ear canal and stimulated by AC. The third is calculated from lation applied at the mastoid than for stimulation at the fore-
nine temporal bone specimens stimulated with a small AC head 共Stenfelt et al., 2000兲.
receiver in the artificial ear canal. The ECSP is obtained at
E. Influence of the jaw on ECSP
the same position for all three conditions 共2 mm in front of
the TM兲. For frequencies below 2 kHz, the relative umbo The ear canal sound pressure did not show any signifi-
velocity divided by the ECSP is about 10 dB higher with an cant change 共in two ears兲 after sectioning of the lower jaw
open ear canal than with an occluded one. For frequencies condyle: there was only a slight increase in ECSP of 4 dB
between 0.4 and 1.2 kHz, similar results are obtained for an around 3 kHz 共Fig. 4兲. Franke et al. 共1952兲 found that in an
occluded ear canal with BC stimulation as with AC stimula- occluded ear the ECSP was 5 to 10 dB higher between 100
tion. and 400 Hz when the mouth was open than for a closed
This result indicates that, for an open ear canal stimu- mouth. This effect of the jaw position almost vanished when
lated by BC, the inertial effect of the ossicles is about 10 dB the ear canal was open. The position of the lower jaw affects
greater than the contribution from the ECSP. However, when the overall compliance of the cartilage part of the ear canal;
the ear canal is occluded and stimulated by BC, for frequen- it may be that the difference in the stiffness of the cartilage
cies between 0.4 and 1.2 kHz, the relative velocity umbo is altered the ECSP when the lower jaw position was changed.
dominated by the ECSP. Consequently, the ECSP with BC However, Huizing 共1960兲 reported that there was no system-
stimulation can have a major influence on hearing by BC for atic change of the ECSP with position of the lower jaw.

J. Acoust. Soc. Am., Vol. 113, No. 2, February 2003 Stenfelt et al.: Outer ear contribution to hearing 911
Huizing 共1960兲 further reported about 10 dB higher stem of a tuning fork is applied to the mastoid, after which
ECSP after the jaw had been resected. Tonndorf 共1966兲 the patient’s ear canal opening is gently occluded with the
found insignificant and nonsystematic changes of the ECSP finger. If there is no conductive lesion of the ear, the tone
at the high frequencies after removal of the jaw in cats. How- 共below 1 kHz兲 should become louder due to the occlusion
ell and Williams 共1989兲 showed that ECSP exists in the ear effect. If no increase is detected, this should be taken as an
canal even after the jaw has been removed, while the results indication of a conductive loss at that ear.
from the present study show no significant difference in
ECSP with BC stimulation after resection of the jaw. Conse-
quently, the relative motion between the lower jaw and the V. CONCLUSIONS
skull, which was suggested by Békésy 共1932兲 to be a major
The ear canal sound pressure 共ECSP兲 and malleus umbo
contributor to the ECSP, has only a minor influence on the
velocity with bone conduction 共BC兲 stimulation were mea-
ECSP with BC stimulation, as predicted by Tonndorf 共1966兲.
sured in nine ears from five human cadaver heads. Further-
Nevertheless, the relative motion between the lower jaw and
more, four temporal bone specimens were used to measure
the skull can influence BC hearing in another way. There is a
the sound radiation from the TM, and nine temporal bone
ligament that connects the malleus with the tempero-
specimens to measure the malleus umbo velocity with air
mandibular joint 共Pinto, 1962兲. This ligament can transmit
conduction 共AC兲 stimulation. With a transducer rigidly at-
vibrations from the jaw to the middle ear ossicles, which
tached to the mastoid, the ECSP per unit applied force in an
might contribute to BC hearing at low frequencies.
open ear canal is ⫺35 dB re 1 Pa/N for low frequencies;
F. Clinical BC testing
above 500 Hz, the ECSP rises by 15 dB/oct until it reaches
the quarter wavelength resonance at 2.7 kHz. With the ear
It has been suggested that BC hearing threshold mea- canal occluded, the level of the ECSP is 15 to 20 dB higher
surement should be conducted with the ear canal occluded at frequencies below 1 kHz. At higher frequencies, the dif-
共Onchi, 1954兲. One reason for this is the theory that the ference between an open and an occluded ear canal is deter-
occlusion effect reduces the ambient masking. According to mined by the resonance properties of the ear canal.
this theory, the true BC thresholds are better measured with Removing the lower jaw does not significantly influence
the ears occluded; however, the theory is now known to be the ECSP with BC stimulation. The major contribution to the
erroneous. Another reason to use occluded ear canal testing ECSP is due to vibrations of the cartilage and soft tissues in
is that the masking procedures used in BC threshold mea- the ear canal; when the cartilage and soft tissues are removed
surement can give rise to occlusion effects, which suggests from the ear canal, the ECSP is reduced by 5–15 dB. With
that it might be better to make all measurements with the BC stimulation, the sound radiated from the TM is lower
ears occluded to reduce the uncertainties introduced by the than the ECSP in a normal intact ear canal. The slightly
masking procedure. The variability of the BC thresholds is greater ECSP found after removal of the TM is attributed to
similar for both open and occluded ear canals 共Dirks and the influence on resonance properties of the effective length
Swindeman, 1971兲. However, if the BC thresholds are mea- of the ear canal and possibly of sound radiation into the
sured with the ear canal occluded, the ECSP dominates the middle ear cavity.
BC hearing at low frequencies. Hence, what one measure is Moreover, it was found that when the ear canal is oc-
an AC signal produced in the ear canal by a mechanical cluded, the increase in relative umbo velocity with BC
vibration; a middle ear lesion affects the AC and BC thresh- stimulation does not correspond to the increase in ECSP; the
olds similarly. Consequently, if the measurement of BC relative umbo velocity increase was 10 dB less than the
thresholds is made with the ear canals occluded, it can be ECSP level increase. Comparing the umbo velocity and
difficult to distinguish between the conductive and senso- ECSP by using both BC and AC stimulation shows that, for
rineural losses from AC and BC threshold measurements. an intact open ear, the total BC stimulation of the inner ear is
Also, since there is no standard for BC hearing thresholds only minimally influenced by the ECSP. However, when the
with the ears occluded, the use of this method for BC testing ear canal is occluded, the ECSP caused by BC stimulation
is not advisable. can dominate hearing by BC for frequencies between 0.4 and
If, on the other hand, an insert phone is used to provide 1.2 kHz.
the masking stimulus, and the insert phone is positioned
down to the bony part of the ear canal, the occlusion effect is
minimized. As noted earlier, it is mainly vibrations in the ACKNOWLEDGMENTS
cartilage part of the ear canal that cause the ECSP; when this
source of the sound is removed, the ECSP caused by BC This work was supported in part by V.A. Merit Review
stimulation is lowered by some 15 dB. Consequently, the Grant No. GDE0010ARG and the Swedish Institute.
occlusion of the ear canal by an insert phone causes no BC
sound increase that influences the hearing, provided the in- Allen, G., and Fernandez, C. 共1960兲. ‘‘The mechanism of bone conduction,’’
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means of differentiating between conductive and sensorineu- durch knochenleitung 共Hearing theory of acoustic perception by bone con-
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