The second international symposium on middle-ear mechanics in research and Otosurgery was co-sponsored by the Department of Otolaryngology of Massachusetts Eye and Ear Infirmary and the Department of Continuing Medical Education of Harvard Medical School, and was held in Boston, Massachusetts, on October 21st-24th, 1999. The symposium was attended by 190 participants from 20 countries, and featured oral and poster presentations, as well as panel discussions concerning the function and mechanics of the normal, diseased, and reconstructed middle ear. The impetus for the symposium came from the successful first international symposium on middle-ear mechanics in research and otosurgery organized by Prof. Dr med. Karl-Bernd Hüttenbrink in Dresden, Germany in September, 1996. There was near unanimous opinion amongst the participants that the first meeting had a positive impact in both the basic science and clinical arenas and that it would be worthwhile organizing a second meeting. The objective of the second symposium was to bring together clinicians and basic scientists interested in middle ear mechanics with special emphasis on chronic otitis media. The symposium was targeted toward otolaryngologists, audiologists and basic scientists, as well as toward students of these disciplines. Fruitful collaboration between these disciplines can do much to improve the diagnosis and therapy of middle ear disease. Basic scientists are not generally familiar with the pathogenesis and hearing outcomes of middle ear disease, and clinicians often do not fully understand the mechanical and acoustical constraints on the ear that result from middle ear disease and its treatment. Even within the narrow confines of basic research, there are groups that investigate the biology of middle ear disease, and there are other groups that investigate only the physics and acoustics of the middle ear. The symposium brought together a well-represented faculty of experts in middle ear acoustics, middle ear biology and clinicians, to give overviews and to present state-of-the-art information within their respective areas. Emphasis was on free exchange of ideas between clinicians and basic scientists, as well as education of the two groups. Chronic otitis media was chosen to ensure a worthwhile exchange of views on a critical clinical topic. Another goal of the symposium was to encourage students and young investigators to become familiar with cutting edge research and with unsolved research challenges. This book is a compilation of symposium papers that were submitted for possible publication, and that successfully underwent scientific peer review. The book is organized into six sections covering various aspects of the mechanics and function of normal, diseased and reconstructed middle ears. The six papers on the normal ear include discussions of the homeostatic control of middle ear gases via eustachian tube function, measurements and models of sound transduction in the normal middle ear, and middle ear measurement techniques for both the clinic and the laboratory. The four papers on the diseased middle ear discuss the pathology of chronic otitis media and clinical tests of middle ear function in pathological ears. The five papers on middle-ear mechanics in the diseased ear discuss the effect of pathology on middle ear sound transmission via models and measurements. The ten papers on middle-ear reconstruction describe surgical techniques, and the postsurgical hearing results of several common middle ear reconstructive procedures. The five papers on middle-ear mechanics in reconstructed ears use measurements and models to describe how different reconstructive procedures affect middle ear function. Finally, four papers in new areas of research describe the latest efforts in implantable hearing aids and the use of laser vibrometry in the clinic. We gratefully acknowledge the support provided in the organization of the symposium and the publication of its proceedings by the National Institute on Deafness and Other Communication Disorders, the Deafness Research Foundation, the International Hearing Foundation, and the National Organization for Hearing Research.

Preface The normal middle ear Middle ear pressure regulation W.J. Doyle New insights into vibration of the middle ear W.F. Decraemer and S.M. Khanna Circuit models of middle ear function H. Hudde and C. Weistenhöfer The normal pressure-volume relationship of the middle ear system and its biological variation M. Gaihede and J. Kabel Human middle ear sound transfer function and cochlear input impedance R. Aibara, J.T. Welsh, S. Puria and R.L. Goode Methodology for laser vibrometer studies of stapes footplate displacement E.W. Abel, R.M. Lord, R.P. Mills and Z. Wang The diseased middle ear Otitis media and middle ear/inner ear interaction. Including considerations of chronic silent otitis media H.R. Djalilian and M.M. Paparella Histopathology of otitis media with an intact tympanic membrane C. Suzuki and I. Ohtani Detecting fibronectin and laminin in the serum and middle ear effusions with secretory otitis media. Clinical significance Q. Wang, D. Huang and W. Young Click-evoked otoacoustic emission stimulus waveform as an indicator of middle ear pathology in neonates P.J.A. de Jager, P. Brienesse, P. van Dijk and L.J.C. Anteunis Middle-ear mechanics in the diseased ear Mechanisms of sound conduction in normal and diseased ears J.J. Rosowski On the fine structure of multifrequency tympanograms. Evidence for multiple middle ear resonances T. Hocke, J. Pethe, A. Eiber, U. Vorwerk and H. von Specht On the relationship between multifrequency tympanometry patterns and the dynamic behavior of the middle ear A. Eiber, H.-G. Freitag and T. Hocke The diseased middle ear: effects on the fine structure of multifrequency tympanogram patterns. A clinical view U. Vorwerk, A. Eiber, T. Hocke and K. Begall Experimental investigations of ossicular joint ankylosis C.F.E. Offergeld, K.-B. Hüttenbrink, T. Zahnert and G. Hofmann Midde-ear reconstruction Histopathological correlates of residual and recurrent conductive hearing loss following tympanoplasty and stapedectomy J.B. Nadol, Jr Short- and long-term hearing results after middle ear surgery J. Hamilton and J. Robinson Surgery for congenital conductive deafness. A retrospective study of 37 cases T.-S. Huang Inactivated homografts in reconstructive middle ear surgery M.A. Hotz, T. Orr, A.D. Speirs and R. Häusler Cartilage interposition in ossiculoplasty with hydroxylapatite prostheses. A histopathological study in the guinea pig A.G.W. Meijer, J. Verheul, F.W.J. Albers and H.M. Segenhout Titanium in ossicular chain reconstruction. Morphological results in animal experiments and after implantation in the human middle ear K. Schwager Gold and Teflon in the oval window. A comparison of stapes prostheses R.A. Tange, A.J.G. de Bruijn and W.A. Dreschler Malleus-grip stapedectomy. Surgical technique and results R. Häusler and E. Oestreicher Short- and long-term results after stapes surgery for otosclerosis with a Teflon-wire piston prosthesis I. Kos, J.-P. Guyot and P.B. Montandon Stapedotomy piston diameter: is bigger better? E. Teig and H.H. Lindeman Middle-ear mechanics in reconstructed ears Changes in external ear resonance after mastoidectomy. Open mastoid cavity versus obliterated mastoid cavity C.-H. Jang On the coupling of prostheses to the middle ear structure and its influence on sound transfer A. Eiber, H.-G. Freitag, G. Schimanski and H.P. Zenner Analysis of the finite-element method of transfer function of reconstructed middle ears and their postoperative changes T. Koike, H. Wada and T. Kobayashi Assessment of vibration characteristics of different cartilage reconstruction techniques for the tympanic membrane using scanning laser vibrometry D. Mürbe, Th. Zahnert, M. Bornitz and K.-B. Hüttenbrink Physiological incus replacement with an `incus replica' prosthesis. Clinical and laboratory evaluation R.P. Mills, E. Abel and R. Lord New areas of research: active middle-ear implants & measurements of middle-ear mechanics Direct sound detection from the ossicular chain I.L. Grant and K. Kroll Middle ear electromagnetic implantable hearing device. Initial clinical results J.V.D. Hough, R.K. Dyer, Jr, K.J. Dormer, P. Matthews, R.Z. Gan and M.W. Wood1 Clinical measurements of tympanic membrane velocity using laser Doppler vibrometry. Preliminary results, methodological issues and potential applications S.N. Merchant, K.R. Whittemore, B. Poon, C-Y Lee and J.J. Rosowski The hearing laser vibrometer. Initial clinical results R.K. Dyer, Jr, K.J. Dormer, M. Pineda, K. Conley, J. Saunders and M. Dennis Index of authors