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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4507_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •1.3.4 The Eustachian Tube
- •1.3.5 Muscles
- •1.3.6 Innervation
- •1.3.7 Vascular Supply
- •1.4 The Inner Ear (Labyrinthine Cavity)
- •1.4.1 The Vestibule
- •1.4.2 Semicircular Canals
- •1.4.4 The Cochlea
- •1.4.5 Innervation
- •1.1 Introduction
- •1.2 The External Ear
- •1.2.1 The Auricle
- •1.2.3 The Eternal Auditory Canal/External Acoustic Meatus
- •1.3 The Middle Ear (Tympanic Cavity)
- •1.3.1 The Tympanic Membrane
- •1.3.3 Ossicles
- •1.4.6 Cochlea Nerve Anatomy
- •1.4.7 Vestibular Nerves
- •1.4.8 The Vestibulocochlear Nerve
- •1.5 The Central Hearing System
- •1.5.3 Auditory Input
- •1.5.4 The Auditory Nerve’s Descending Routes
- •References
- •2: Outer–Middle–Inner Ear Embryology
- •2.1 Introduction
- •2.2 Embryology
- •2.3.1 First Week
- •2.3.3 Third Week
- •2.3.4 Fourth Week
- •2.3.5 Sixth Week
- •References
- •3.1 Introduction
- •3.3 The Outer Ear
- •3.3.1 Anatomy
- •3.3.3 Localization
- •3.4 The Middle Ear
- •3.4.3 Middle Ear Muscles
- •3.4.4 The Eustachian Tube
- •3.4.5 Impedance Matching
- •3.5 The Inner Ear
- •3.5.1.1 Lateral Wall
- •3.5.1.2 Reissner’s Membrane
- •3.5.1.3 The Basilar Membrane
- •3.5.2.1 Hair Cells
- •Inner Hair Cells
- •Outer Hair Cells
- •3.5.3 The Tectorial Membrane
- •3.5.4 The Osseous Spiral Lamina
- •3.5.5 Cochlear Mechanics
- •3.5.5.1 Passive Mechanics
- •3.5.5.2 Active Mechanics
- •3.6.1 Auditory Nerve Fibers
- •3.6.2 The Subcortical Auditory Nuclei
- •3.6.2.1 The Cochlear Nucleus
- •3.6.2.2 The Superior Olivary Complex
- •3.6.2.3 The Lateral Lemniscus
- •3.6.2.4 Inferior Colliculus
- •3.6.2.5 The Medial Geniculate Body
- •3.6.3 The Auditory Cortex
- •3.7 Conclusion
- •References
- •4.1 Introduction
- •4.2 Eustachian Tube Anatomy
- •4.4 Eustachian Tube Dysfunction
- •References
- •5: Temporal Bone Radiology
- •5.1.1 Introduction
- •5.1.2 Computed Tomography (CT)
- •5.1.3 Temporal Bone CT Angiography
- •5.1.4 Magnetic Resonance Imaging (MRI)
- •5.1.5 Diffusion-Weighted Imaging (DWI)
- •5.1.6 Conclusion
- •5.2.1 Introduction
- •5.2.2.1 The External Auditory Canal (EAC)
- •5.2.3 Temporal Bone Fractures
- •5.2.4 Conclusion
- •5.3.1 Introduction
- •5.3.2 Necrotizing Otitis Externa
- •5.3.3 Middle Ear
- •5.3.3.2 Chronic Otitis Media
- •5.3.3.3 Cholesteatomas
- •5.3.3.4 Cholesterol Granulomas
- •5.3.4 Inner Ear
- •5.3.4.1 Labyrinthitis
- •5.3.4.2 Petrous Apicitis
- •5.3.5 Conclusion
- •5.4.1 Introduction
- •5.4.2.1 Cerebellopontine Angle Tumors
- •Vestibular Schwannomas
- •Arachnoid Cysts
- •Meningiomas
- •5.5.2 External Auditory Canal Aplasia
- •5.5.4 Inner Ear Malformations
- •5.5.4.1 Complete Labyrinthine Aplasia/Michel Anomaly
- •5.5.4.2 Rudimentary Otocysts
- •5.5.4.3 Common Cavity Malformation
- •5.5.4.4 Incomplete Partition (IP) Type I
- •5.5.4.5 Incomplete Partition Type II/Mondini Malformation
- •5.5.4.6 Incomplete Partition Type III
- •5.5.4.7 Cochlear Anomalies
- •5.5.4.8 Semicircular Canal Anomalies
- •5.5.6 Conclusion
- •5.6.1 Introduction
- •5.6.2 Otospongiosis/Otosclerosis
- •Epidermoids
- •5.4.2.2 The Middle Ear
- •5.4.2.4 Petrous Bone
- •5.4.2.5 Metastatic Tumors
- •5.4.3 Conclusion
- •5.5.1 Introduction
- •5.6.3 Third Window Lesions
- •5.6.4 Conclusion
- •References
- •6.1 Introduction
- •6.3.1 What Is Sound?
- •6.3.2 Sound Intensity
- •6.4 Psychoacoustics
- •6.4.1 Signal Detection Theory
- •References
- •7.1 Introduction
- •7.1.1 What Is Sound?
- •7.2 Fundamental Acoustic Concepts
- •7.2.3 Period
- •7.2.4 Frequency
- •7.2.5 Wavelength
- •7.3 Psychoacoustics
- •7.3.1 Loudness
- •7.3.2 Auditory Masking
- •7.3.2.1 Simultaneous Masking
- •7.3.2.2 Temporal Masking
- •7.4.2 Spatial Hearing
- •References
- •8.1 Introduction
- •8.2 Case History
- •8.3 The Audiology Test Room
- •8.4.1 Pure-Tone Audiometry
- •8.4.1.1 Masking
- •8.4.2 Speech Audiometry
- •8.4.3 Pediatric Assessment
- •8.5.1 Acoustic Immittance Audiometry
- •8.5.1.1 Tympanometry
- •Tympanogram Interpretation
- •8.5.1.2 Multifrequency Tympanometry
- •8.5.1.3 Wideband Tympanometry
- •8.5.1.4 Acoustic Reflex Test
- •8.5.1.5 The Reflex Decay Test
- •8.5.1.6 Eustachian Tube Evaluation
- •8.5.2 Otoacoustic Emissions
- •8.5.2.2 Performing Otoacoustic Emission Tests
- •8.5.3 Auditory Evoked Potentials
- •8.5.3.2 Auditory Evoked Brainstem Response
- •Stimulus Types
- •Stimulus Polarity
- •Stimulus Presentation Rate
- •Stimulus Intensity
- •Analysis Time (Recording Epoch)
- •Filters
- •Artifact Rejection Level
- •Electrodes
- •8.5.3.3 Auditory Steady-State Responses
- •8.5.3.4 Electrocochleography
- •Electrocochleography Analysis
- •8.5.3.5 Cortical Auditory Evoked Potentials
- •8.5.3.6 Event-Related Auditory Potentials
- •P300
- •Mismatch Negativity
- •Acoustic Change Complex
- •8.6 Conclusion
- •References
- •9.1 Introduction
- •9.2.3 Conductive Hearing Loss
- •9.2.4 Sensorineural Hearing Loss
- •9.2.4.1 Internal Acoustic Canal Tumors
- •9.2.4.2 Auditory Neuropathy Spectrum Disorder
- •9.2.4.3 Third Window Syndrome
- •9.2.4.4 Dead Region
- •9.2.5 Mixed Hearing Loss
- •9.3 Hearing Loss Configuration
- •9.3.3 Unilateral or Bilateral Hearing Loss
- •9.3.4 Symmetric or Asymmetric Hearing Loss
- •9.3.5 Fluctuating or Stable Hearing Loss
- •9.4 Diagnostic Tests
- •9.4.1 Pure Tone Threshold Testing
- •9.4.2 Speech Recognition Tests
- •9.4.3 Tympanometric Tests
- •9.4.4 Stapedial Reflex
- •9.4.5 Otoacoustic Emission Test
- •9.4.6 Auditory Brainstem Responses
- •9.6 Reporting Audiological Findings
- •9.7 Conclusion
- •References
- •10.1 Introduction
- •10.2.1 Anamnesis
- •10.2.2 Hearing Loss
- •10.2.3 Ear Pain (Otalgia)
- •10.2.4 Ear Discharge (Otorrhea)
- •10.2.5 Itchy Ear
- •10.2.8 Physical Examination
- •10.2.8.1 Inspection
- •10.2.8.2 Palpation
- •10.2.8.3 Otoscopy
- •10.2.12 Hearing Examination
- •10.2.13 Hearing Assessment
- •10.2.13.1 Whisper Test
- •10.2.13.2 Tuning Fork Tests
- •Rinne Test
- •Weber Test
- •Schwabach Test
- •Gelle Test
- •10.3 Conclusion
- •References
- •11.1 Introduction
- •11.2.1 Microphone
- •11.2.2 Amplifier
- •11.2.3 Receiver
- •11.2.4 Batteries
- •11.2.5 Earmolds/Domes
- •11.4 Hearing Aid Types
- •11.5.1 Directional Microphone Technologies
- •11.5.2 Digital Noise Reduction
- •11.5.3 Frequency Lowering
- •11.5.4 Feedback Canceller
- •11.5.5 Bluetooth
- •11.6 Other Hearing Aid Technologies
- •11.7 Pediatric Hearing Aid Application
- •11.7.3.7 Hearing Aid Fitting
- •Prescription Formula Preference
- •Objective Verification Tools
- •Subjective Verification Tools
- •Fine-Tuning
- •11.8 Adult Hearing Aid Application
- •11.8.1.1 Medical Evaluation
- •11.8.1.2 Audiological Evaluation
- •11.8.1.3 Physical Evaluation
- •11.8.1.4 Psychological Evaluation
- •11.8.2 Hearing Aid Application Process
- •11.8.2.1 Anamnesis
- •11.8.2.6 Hearing Aid Fitting
- •Fine-Tuning
- •11.9 Conclusion
- •11.10 Case Studies
- •11.10.1 Case 1
- •11.10.2 Case 2
- •11.10.3 Case 3
- •11.10.4 Case 4
- •References
- •12.1 Introduction
- •12.3.1 Pathophysiology
- •12.3.2 Management
- •12.3.3 Etiology
- •12.3.4 Epidemiology
- •12.3.5 Assessing
- •12.3.6 Treatment
- •References
- •13: Otoplasty
- •13.1 Introduction
- •13.2 General Information
- •13.2.1 Auricular Anthropometry
- •13.3 History
- •13.8.1 Conservative Treatment
- •13.8.2 Surgical Treatment
- •13.11 Patient Follow-Up
- •13.12 Case Examples
- •13.13 Complications
- •13.13.1 Early Complications
- •13.13.2 Late Complications
- •13.13.3.1 Telephone Ear Deformity
- •13.13.3.2 Reverse Telephone Ear Deformity
- •13.13.3.5 Antihelical Malposition
- •13.13.3.6 Tragal Prominence
- •13.13.3.7 Auricular Lines
- •13.14 Revision Otoplasty
- •References
- •14: External Ear Tract Diseases
- •14.1 Introduction
- •14.2.1 Atopic Dermatitis
- •14.2.2 Allergic Contact Dermatitis
- •14.2.3 Photoallergic Dermatitis
- •14.2.4 Psoriasis
- •14.2.5 Relapsing Polychondritis
- •14.2.6 Gout
- •14.3 Traumatic Disorders
- •14.3.1 Irritant Contact Dermatitis
- •14.3.2 Phototoxic Dermatitis
- •14.3.3 Phototrauma
- •14.4 Infectious Diseases
- •14.4.1 Otitis Externa
- •14.4.1.1 Background
- •14.4.1.2 Anatomy
- •14.4.1.3 Classification
- •14.4.1.5 Diagnosis
- •14.4.1.6 Management
- •References
- •15: Auricula Tumors
- •15.1 Introduction
- •15.2 Benign Tumors
- •15.2.1 Chondrodermatitis Nodularis Chronica Helicis
- •15.2.2 Cystic Chondromalacia
- •15.2.3 Ceruminous Gland Adenoma
- •15.3 Malign Tumors
- •15.3.1 Basal Cell Carcinoma (BCC)
- •15.3.2 Squamous Cell Carcinoma
- •15.3.3 Ceruminous Gland Adenocarcinoma
- •15.4 Conclusion
- •References
- •16: Acute Suppurative Otitis Media
- •16.1 Introduction
- •16.2 Pathophysiology
- •16.3 Etiology
- •16.3.1 Host Factors
- •16.3.1.1 Immune System
- •16.3.1.2 Hereditary Susceptibility
- •16.3.1.3 Mucins
- •16.3.1.4 Anatomic Abnormalities
- •16.3.1.5 Physiologic Dysfunction
- •16.3.2 Infectious Factors
- •16.3.2.1 Bacterial Pathogens
- •16.3.2.2 Viral Pathogens
- •16.3.3 Environmental Factors
- •16.3.3.1 Infant Feeding Methods
- •16.4 Classification
- •16.6 Diagnosis
- •16.7 Treatment
- •16.7.1 Antibiotic Therapy Versus Observation
- •16.7.2 Initial Antibiotic Therapy
- •16.7.3 Supplemental Programs
- •References
- •17.1 Introduction
- •17.2 Definition
- •17.4 Pathophysiology
- •17.5 Diagnosis
- •17.5.1 Clinical Evaluation
- •17.6 Treatment
- •17.6.1 Medical Treatment
- •17.6.2 Surgical Treatment
- •17.7 Conclusion
- •References
- •18: Chronic Suppurative Otitis Media
- •18.1 Introduction
- •18.2 Epidemiology
- •18.3 Pathophysiology
- •18.4 Microbiology
- •18.5 Histopathology
- •18.6 Clinical Manifestations
- •18.6.1 Tubotympanic Type
- •18.6.2 Atticoantral Type
- •18.7 Diagnosis
- •18.7.1 Anamnesis
- •18.7.2 Otoscopic Examination
- •18.7.3 Audiological Evaluation
- •18.7.4 Imaging
- •18.8 Treatment
- •18.8.1 Medical Treatment
- •18.8.2 Surgical Treatment
- •18.9 Complications
- •18.10 Future Directions
- •18.11 Conclusion
- •References
- •19: Cholesteatoma
- •19.1 Introduction
- •19.2 Definition
- •19.3 Epidemiology
- •19.4 Histopathology
- •19.7 Cholesteatoma Types
- •19.7.1 Congenital Cholesteatoma
- •19.7.2 Acquired Cholesteatoma
- •19.7.2.2 Epithelial Migration Theory
- •19.7.2.3 Basal Cell Hyperplasia Theory
- •Tos Staging
- •Sade Staging
- •19.7.3 Unclassified Cholesteatomas
- •19.7.4 Petrous Bone Cholesteatomas
- •19.8 Practical Classification
- •19.8.1 Attic Cholesteatomas
- •19.8.2 Sinus Cholesteatomas
- •19.8.3 Pars Tensa Cholesteatomas
- •19.9 Clinical Presentations
- •19.9.1 Cholesteatoma Microbiology
- •19.10 Diagnosis
- •19.10.2 Computed Tomography
- •19.10.3 Magnetic Resonance Imaging
- •19.10.4 Audiometric Evaluation
- •19.11.1 Closed Techniques
- •19.11.2 Open Techniques
- •19.12 Conclusion
- •References
- •20.1 Introduction
- •20.2 Physiology
- •20.2.4 Tympanic Isthmus
- •20.4 Pathophysiology
- •20.5 Clinical Picture
- •20.6 Management
- •20.6.1 Surgical Management
- •20.6.1.2 Tympanoplasty
- •20.6.1.3 Mastoid Surgery
- •20.7 Adhesive Otitis Media
- •20.7.1 Pathogenesis
- •20.7.2 Clinical Findings
- •20.7.3 Imaging
- •20.7.4 Treatment
- •20.8 Conclusion
- •References
- •21.1 Introduction
- •21.2 Intratemporal Complications
- •21.2.1 Acute Mastoiditis
- •21.2.2 Facial Nerve Paralysis
- •21.2.3 Labyrinthitis
- •21.2.4 Labyrinthine Fistula
- •21.2.5 Petrositis
- •21.3 Intracranial Complications
- •21.3.1 Meningitis
- •21.3.2 Lateral Sinus Thrombosis
- •21.3.3 Brain Abscess
- •21.3.4 Otitic Hydrocephalus
- •21.3.5 Epidural Abscess
- •21.3.6 Subdural Empyema
- •21.4 Conclusion
- •References
- •22: Basic Otological Surgical Techniques
- •22.1 Introduction
- •22.3 Atticotomy
- •22.4 Mastoidectomy
- •22.4.1 Simple (Cortical) Mastoidectomy
- •22.4.2 Canal Wall-Up Mastoidectomy
- •22.4.3 Canal Wall-Down Mastoidectomy
- •22.4.4 Retrograde Mastoidectomy
- •22.4.5 Modified Radical Mastoidectomy
- •22.4.6 Radical Mastoidectomy
- •22.4.7 Mastoid Obliteration
- •22.5 Petrosectomy
- •22.6 Conclusion
- •References
- •23: Tympanoplasty
- •23.1 Introduction
- •23.2.1 Chronic Otitis Media
- •23.2.2 Traumatic Perforations
- •23.5 Tympanoplasty Types
- •23.7 Graft Materials
- •23.8 Graft Techniques
- •23.8.1 The Perichondrium/Cartilage Island Graft
- •23.8.2 The Palisade Graft
- •23.8.3 The Temporalis Fascia Graft
- •23.9 Surgical Approaches
- •23.9.1 Microscopic Approach
- •23.9.2 Endoscopic Approach
- •23.10.1 Transmeatal Incisions
- •23.10.1.1 The Rosen Incision
- •23.10.1.3 Anterior Tympanomeatal Flap
- •23.10.2 Endaural Incision
- •23.10.3 Postauricular Incision
- •23.11 Pediatric Tympanoplasty
- •23.12 Prognostic Factors
- •23.14 Conclusion
- •References
- •24: Ossiculoplasty
- •24.1 Introduction
- •24.4 Indications/Contraindications
- •24.5 Reconstruction Materials
- •24.7 Surgical Preparation
- •24.8 Surgical Technique
- •24.9 Ossiculoplasty Results
- •24.10 Complications
- •24.11 Postoperative Care
- •24.12 Follow-Up
- •24.13 Conclusion
- •References
- •25: Tympanomastoidectomy
- •25.1 Introduction
- •25.2 Surgical Anatomy
- •25.4 Indications
- •25.5 Technique
- •25.5.1 Patient’s Preparation
- •25.5.3 Simple Mastoidectomy
- •25.5.4 Posterior Tympanostomy or Facial Recess Approach
- •25.5.5 Epitympanectomy
- •25.5.6 Endolymphatic Sac Procedures
- •25.5.8 Atticotomy-Atticoantrotomy

6 Sound andAcoustics: AnOverview
107
threshold measures do not reveal any problems, tests of hearing (such as speech
discrimination and intelligibility) performed in noisy environments do [4].
Experiments on animals have demonstrated that prolonged exposure to moderate
acoustic noise (~100dB for around 2h) can cause TTS and HHL [9]. The features
and connection between HHL and acoustic noise exposure in humans are still being
determined, and there are currently a lot of contradictory data [4].
6.3 Acoustic Properties ofSound
When we hear, our ear canals take in vibrations from the surrounding environment
and translate them into nerve impulses that travel to our brain, where they are processed as audible sounds. Sounds are created when an object that vibrates, like a
guitar string being plucked, causes pressure pulses of air molecules that vibrate,
called sound waves. The ear detects and analyzes many physical properties of the
waves to differentiate between subjective features of a sound, such as its volume and
pitch. The perceived frequency of sound waves, or pitch, is the number of wavelengths passing a xed place in one unit of time. The unit of measurement for frequency is hertz, which stands for cycles per second. While the human ear is most
acute and capable of picking up sounds in the 1000–4000Hz range, the full spectrum of audible sounds spans roughly 20–20,000Hz, at least for typically developing juvenile ears. While other mammals can hear them, sound waves with an even
higher frequency are called ultrasonic. The sense of the strength of sound, or the
pressure that sound waves impose on the tympanic membrane, is what we mean
when we talk about loudness. A sound’s force, intensity, and, by extension, volume
are all proportional to its amplitude or strength. One way to convey the relative
amplitude of a sound on a logarithmic scale is via its measurement in decibels (dB),
commonly used to report sound intensity. Decibels are a measure of good intensity
relative to one another and a reference sound audible to the average person at a frequency within the audible range. A human ear can detect sounds at around 130dB,
the threshold at which they start to feel discomfort, and at 0 dB, the threshold at
which they are nearly inaudible [10].
6.3.1 What Is Sound?
A combination of vibrations from a sound source or sources and the waves that
travel through the air to reach the ear is what we call sound. When a sound source
regularly vibrates back and forth, it creates the most basic sound wave: a sine wave.
Among the many characteristics of a sine wave are its frequency and amplitude [2].
The following picture shows a tuning fork producing a sine wave. The wave
begins at a neutral point, travels to an extreme position, turns about, travels back to
the neutral point, achieves its maximum at the other extreme, and, nally, returns to
the neutral point. As long as the tuning fork is vibrating, this vibration pattern—
called a cycle—will continue to recur. A wave’s period is the time it takes for one

108
Decibel level noise level dividedbyreference level=(10 10log
))
.
cycle to nish. The number of times a wave’s cycle completes in 1 s is called its
frequency, measured in hertz (Hz). How far a wave travels from its neutral point to
its maximum displacement position is its amplitude [2].
The practical ramications of these wave properties are signicant. A wave’s
amplitude is proportional to its loudness or intensity, whereas its frequency is what
we hear as pitch. Complex sine waves of varying frequencies and intensities make
up most of the sounds we hear. A mathematical description of these intricate sounds
could be found in a Fourier transformation. This method simplies audio by separating it into its component sine waves. When exposed to auditory stimuli, the ear
also conducts this analysis [2].
N. Sarı et al.
6.3.2 Sound Intensity
Research into human hearing typically centers on determining the lowest audible
volume. This is the auditory threshold. Although such measures are commonplace
in clinical and fundamental research settings, they are complicated due to the broad
frequency spectrum that the human ear can perceive. So, to make the units of measurement more manageable, the eld of hearing science employs a sound intensity
measurement. The decibel (dB) used in this intensity scale is dened as follows [2]:
Sound pressure divided by reference pressure equals 20 log10in decibels.
The following features of the decibel scale can be noted [2]:
It is a relative scale based on a ratio that compares sound pressure or intensity
with a specied reference level. The reference level is 20uPa (2×105N/m2), the
lowest sound pressure most people can hear. Therefore, the intensity level in decibels equals 20 log10 (sound pressure/20uPa) [2].
This scale is logarithmic not linear. Doubling sound pressure results in a “6-dB
increase in measured sound pressure”, while a “10-fold change in sound pressure”
is reected by a “20-dB change in measured sound pressure” [2].
The logarithm of 1 equals 0. Accordingly, 0-dB SPL does not represent silence
but rather the measurement of a wave with a sound pressure equal to the reference
sound pressure [2].
Sound pressure is measured in decibels SPL when the reference above the sound
pressure level is applied. There are alternative benchmarks. As a function of frequency, the human ear is most acutely attuned to audible sounds between 1 and 5
KHz. One uses the average hearing thresholds for all frequencies to nd a human’s
auditory threshold. Hearing levels are expressed in decibels (dB) when these reference values are utilized; a value of 0 dB HL indicates that the measured auditory
threshold is equivalent to the average human hearing level at the tested frequency [2].

6 Sound andAcoustics: AnOverview
109
6.4 Psychoacoustics
Hearing and sound are the subjects of psychoacoustics. Investigations into the functions of the auditory system, how different parts of sounds inuence perception, and
the processes by which sounds are detected and identied are all part of this eld.
Understanding the signal is fundamental to the area of psychoacoustics. As part of
this process, the spectral and temporal characteristics of the auditory stimuli and
their amplitude and point of origin must be described. To address inquiries about
hearing, one must know the sound signal. To illustrate this, a psychoacoustician
could inquire about the minimum audible volume by asking, “How loud is a tone
before it is heard?” A straightforward signal detection test with multiple trials can
answer this question. Problems can be signal-plus-noise, in which a tone is presented alongside background noise, or noise-only, in which background noise is the
sole element. The listener is then asked to determine if each trial was just noise or if
there was both signal and noise. One of the most basic psychoacoustic tests is the
tone-detection-in-noise task. Using the listener’s sensitivity (the d’ score or discriminability as determined by signal detection theory methods) or percentage of correct
responses (PC or percent correct), the psychoacoustician can estimate the signal-tonoise ratio needed for a listener to detect the tone consistently. This unit’s discussion
on loudness perception shows that even a seemingly fundamental issue like this can
have a complicated response that depends on factors like the signal’s frequency and
location [11].
6.4.1 Signal Detection Theory
The application of signal detection theory to derive a trustworthy measure of signal
detectability has superseded threshold-nding approaches that attempted to tackle
this issue. A bias-free way to quantify sensitivity to any stimulus is provided by
signal detection theory [11].
Signal and noise trials are assumed to follow normal distributions in simple signal detection theory. The observer is tasked with determining the likelihood that the
data points to a signal or noise trial, given a certain level of signal evidence displayed on the x-axis (or “internal response” on the graph). The “criterion response”
thick line represents the observer’s adoption of a criterion. “Signal” trials are those
in which the internal reaction is higher than the criterion, while “noise” trials are
those in which it is lower [11].
6.4.2 Level ofDistress fromVarious Pitches
We will go into the critical band in the following unit, but, as a general rule of
thumb, it is about one-third of an octave. If we hear two tones simultaneously, which
are more than a critical band apart in frequency, the resultant loudness will be
approximately equal to the sum of the loudness of the two components. Applying

110
N. Sarı et al.
Stephens’ power law to the intensity of the sum of the loudnesses can approximate
the loudness if the two tones are within a critical region. Because the power in
Stephens’ power law is <1, the volume of two techniques that are very close together
will be quieter than two tones far apart in frequency, presuming that the amplitudes
of the two sets of styles are equal [11].
6.4.3 Spectra andVolume
We have shown that the auditory system may affect how loud something is rather
than that loudness itself being an absolute entity. Spectral content is another component that affects loudness alongside frequency. Two tones, one simple (sine tone)
and the other more complicated (harmonic), are audible in the following example.
Although their waveforms demonstrate equal amplitude, which produces a more
substantial audible output? [11]
6.4.4 Time andVolume
The ear does a type of temporal integration in addition to the spectral integration
that we just covered. The difference in perceived volume between a short (50ms)
and extended (200ms) version of the same sound—with identical amplitude—is
because our auditory brains process sounds differently. This effect is practical for
noises <250ms but ineffective in sounds more than 250 ms [11].
6.4.5 Determinants ofAmbient Noise Level
Most people will perceive a distant scream as loud, even though the actual amplitude of the sound is relatively low because of the distance. We could tell the artist
was playing forte rather than piano, even from a great distance, since the tuba’s
brightness increased with its volume. A scream has different spectral content and is
louder than a speaking voice; the same holds for the human voice. This allows us to
deduce the source of a sound (whether it was someone screaming or speaking or the
volume of a tubist) and its approximate distance from our ears [11].
References
1. Kurokawa H, Goode RL.Sound pressure gain produced by the human middle ear. Otolaryngol
Head Neck Surg. 1995;113(4):349–55.
2. Bruns AD.Middle ear function. In: Meyers AD, editor. Medscape; 2021. Updated: Nov 16,
2021 https://emedicine.medscape.com/article/874456- overview#a1 (Accessed online at July
23, 2023).
3. Schuknecht HF.Pathology of the ear. 2nd ed. Philadelphia: Lea and Febiger; 1993.

6 Sound andAcoustics: AnOverview
4. McJury MJ.Acoustic noise and magnetic resonance imaging: a narrative/descriptive review. J
Magn Resonance Imaging. 2022;55(2):337–46.
5. Lin TR, O’Shea P, Mechefske CK.Reducing MRI gradient coil vibration with rib stiffeners.
Concepts Magn Reson Part B. 2009;35B:198–209.
6. Brummett RE, Talbot JM, Charuhas P.Potential hearing loss resulting from MR imaging.
Radiology. 1988;169:539–40.
7. Liberman MC.Hidden hearing loss: primary neural degeneration in the noise-damaged and
aging cochlea. Acoust Sci Tech. 2020;41:59–62.
8. Kohrman DC, Wan G, Cassinotti L, Corfas G.Hidden hearing loss: a disorder with multiple
etiologies and mechanisms. Cold Spring Harb Perspect Med. 2020;10:a035493.
9. Hickox AE, Larsen E, Heinz MG, Shinobu L, Whitton JP.Translational issues in cochlear
synaptopathy. Hear Res. 2017;349:164–71.
10. The physiology of hearing. Britannica. https://www.britannica.com/science/ear/The-
physiology- of- hearing (Accessed online at July 23, 2023).
11. No authors listed. Unit 3: Fundamentals of Psychoacoustics. https://mutor- 2.github.io/
MUTOR/units/03.html (Accessed online at July 23, 2023).
111

Acoustics, Psychoacoustics,
andProperties ofSound
MustafaYüksel, OnursalÖnen, andBernhardU.Seeber
7.1 Introduction
Acoustics is the science that investigates the generation, transmission, reception,
control, and effects of sound in uids, such as air, and as mechanical waves in elastic media. Often, the term “sound” is associated with vibrations that can be perceived through our human hearing system—audible sound or “audio” [1].
“Psychoacoustics” derives its essence from the fusion of two disciplines: “psych”
referring to psychology, the science of understanding human behavior and perception, and “acoustics,” the study of sound and its transmission. This multidisciplinary
eld sits at the intersection of these two realms, focusing on the complex relationship between auditory stimuli and their perception. Psychoacoustics is a branch of
psychophysics, which investigates the complex perceptual aspects of sound, examining the ways in which individuals perceive auditory stimuli.
In this chapter, we will discuss the fundamental aspects of sound, acoustics, and
psychoacoustics from the perspective of otology and audiology. Our emphasis will
be on explaining crucial concepts, establishing frequent connections between theory and practice, and providing readers with a robust understanding of the key
principles.
7
M. Yüksel (*)
Department of Audiology, Ankara Medipol University, School of Health Sciences,
Ankara, Turkey
e-mail: mustafa.yuksel@ankaramedipol.edu.tr
O. Önen
Metapax Acoustic, Ankara, Turkey
e-mail: oonen@metapax.com.tr
B. U. Seeber
Technical University of Munich, School of Computation, Information and Technology, Audio
Information Processing, Munich, Germany
e-mail: seeber@tum.de
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
M. T. Kalcioglu et al. (eds.), Otology Updates, Comprehensive ENT,
https://doi.org/10.1007/978-3-031-76173-7_7
113

114
M. Yüksel et al.
7.1.1 What Is Sound?
The denition of sound is conventionally approached from two perspectives: physical and perceptual. Physically, sound is a wave—a mechanical wave that traverses
elastic media and, from a vibrating surface, continues as a pressure wave in air
before reaching our ears. Elastic media transfer motional energy through their internal structure and return to their original state afterward [2]. From a perceptual angle,
sound is what we hear. Anatomically, electric pulses generated in the cochlea, the
inner ear, are transmitted via the auditory nerve to brain structures and are subsequently perceived as sound.
7.1.2 What Is aWave?
According to Webster’s dictionary, a “wave” is dened as “a disturbance or variation that transfers energy progressively from point to point in a medium and that
may take the form of an elastic deformation or of a variation of pressure, electric or
magnetic intensity, electric potential, or temperature.” One famous and easily visualized example of a wave is the Mexican wave, commonly observed in stadiums
worldwide. In a Mexican wave, a group of people on a hypothetical vertical line
stand up and sit back down harmoniously within a few seconds, creating a continuous, wavelike motion that travels around the stadium seats.
The term “elastic medium” refers to the people attending the game and sitting in
the stadium. This audience is considered “elastic” because, after standing up to create or transfer the disturbance, they return to their original positions, resembling an
elastic material. The people in the stadium do not move with the wave as it travels—
they remain at their “equilibrium” positions. The wave, illustrated by a Mexican
wave in this example, has distinct characteristics such as speed, representing its
travel around the audience; period, indicating the time for it to reach the same line
or people; and amplitude, determining how high the audience stands up. In the
upcoming sections, we will delve into a detailed exploration of these terms.
7.1.3 What Is theSound Wave WeHear?
The sound wave reaching our ears is a pressure wave that propagates through air. A
pressure wave can be described as a change in pressure within the medium it travels
through, causing pressure uctuations. Pressure is dened as force per unit area,
measured in pascals (Pa), equivalent to newtons (N) divided by area (square meters,
m2). However, how does the pressure uctuation in a sound wave take shape?
Air, like any other continuous matter, consists of basic building blocks—molecules formed by atoms. While air comprises various molecules such as nitrogen,
oxygen, hydrogen, etc., for simplicity and in terms of the size of the molecules and
composition of air, we can consider air as a homogeneous mixture of these molecules. Visualizing an air column, we can picture randomly dispersed molecules.

7 Acoustics, Psychoacoustics, andProperties ofSound
115
Assume that the air column is excited by the continuous sinusoidal movement
induced on the column by the red line back and forth, which creates regions of compression and rarefaction of molecules in the medium. In this case, the regions of
compression and rarefaction are moving to the right as wavefronts. The depicted
motion of the molecules is sinusoidal, which means that the particles and the wave
motion follow the pattern of a sine function [2]. Unlike the motion in a Mexican
wave, as described in the previous section, the air particles move back and forth in
the direction of the wave propagation.
7.2 Fundamental Acoustic Concepts
7.2.1 Speed ofSound
Sound is readily conducted in elastic media such as gases, liquids, and solids. The
speed of sound in air at 20°C, and, at sea level, it is 343m/s. Each material, depending on its internal structure, the type of propagating wave, and the environmental or
external conditions, has a unique speed of sound. The speed of sound is affected by
mechanical properties (such as modulus, density, compressibility), temperature, and
humidity. In air, the speed of sound depends strongly on the temperature, increasing
0.6m/s per kelvin temperature increase, and thus on altitude; hence, the temperature
should be recorded in acoustic measurements [1, 2]. The speed of sound does not
change with frequency, given a specic state and condition.
Solids usually have the highest speed of sound values, followed by liquids. For
example, the speed of sound in pure water at sea level is 1481m/s, whereas in steel
it is around 6000m/s and in air only 343m/s.
7.2.2 Amplitude ofSound Waves
Acoustic pressure is the deviation from the atmospheric pressure p
at sea level). The pressure amplitude of the acoustic wave is pac (Pa), and it corresponds to the maximum pressure of the wave that varies between +pac and −pac, as
seen in Fig.7.1. The actual pressure changes between p
Fig. 7.1 A sinusoidal
wave illustrating period.
The Y-axis represents
pressure, and the X-axis
represents time. Period is
the time it takes for one
complete cycle of the wave
+pac and p
atm
(101.325kPa
atm
−pac, but
atm

116
S
cf
()
=
()
×
()
λ
we are only interested in and only hear the variations around the atmospheric equilibrium pressure. Since the average sound pressure is zero and peak amplitudes are
hard to dene, sound amplitude is usually measured by rst squaring the instantaneous amplitude, then averaging it over time, followed by applying the root, thus
yielding the root mean square (r.m.s.) amplitude. For sinusoids, it is a factor 0.707
of the peak amplitude. The human ear can sense an acoustic pressure below 20 μPa
(20×10−6Pa), i.e., 0 decibel sound pressure level (dB SPL).
M. Yüksel et al.
7.2.3 Period
Period, denoted as T, of any wave is the time it takes for the wave to complete one
full cycle or pass through to the same state. The period of a simple sine wave is
illustrated in Fig.7.1. Its unit is time, usually expressed in seconds (s).
7.2.4 Frequency
Frequency represents the rate of repetition of a phenomenon or any action within a
unit time sequence. In acoustics and many physical sciences, frequency is denoted
as the number of repetitions in 1s and can be calculated using the reciprocal of the
period T (f= 1/T). Its unit is 1/s, and this unit is referred to as hertz or Hz. The
human auditory system is capable of sensing sound in the frequency range of
20–20,000Hz. These values are used for ease of communication, and it is essential
to note that this range may vary based on factors such as individual differences, age,
and hearing loss. Frequencies below 20 Hz are designated as infrasonic, those
between 20 and 20,000Hz are sonic, and those above 20,000Hz are classied as
ultrasonic frequencies.
7.2.5 Wavelength
The sine wave depicted in Fig.7.1 represents the time domain. The graph shows
pressure variations over time at one specic point in space. However, the wave is
also propagating: the pressure change travels. The wavelength (λ) is the distance a
wave travels during the time it takes to complete one cycle. In the position domain,
it corresponds to the distance between two peaks, as shown in Fig.7.2.
The wavelength of a 100-Hz wave is 3.43m at sea level.
peed of Sound Frequency Wavelength

In
()
=
()
()
/.
ref
Pa
7 Acoustics, Psychoacoustics, andProperties ofSound
Fig. 7.2 A sinusoidal
wave illustrating the
wavelength. The Y-axis
represents pressure, and
the X-axis represents
distance. The wavelength
is the spatial length of one
complete cycle of the wave
117
7.2.6 Power andIntensity
Loudspeakers and ampliers are typically rated with a power value: in loudspeakers, it reects the input electrical power the loudspeaker can handle without being
damaged, and, in ampliers, it is the electrical output power it can maximally
deliver. Power reects the amount of energy transferred per second, measured in
watts (W).
Power signies the total energy, while intensity, a directional function of power,
represents the amount of power passing through a unit area, measured in watts per
meter squared (W/m2). Intensity is directional and often relies heavily on the characteristics of the sound source. For instance, loudspeakers are designed to project
acoustic energy toward the front, resulting in higher acoustic intensity in the frontal
direction and less toward the back of the loudspeaker.
tensity IPower WAream
2
7.2.7 Levels andDecibels
In audio, the pressure amplitudes of interest range between 20 μPa and 200Pa,
covering the regular hearing range of humans. This presents an eight- order- ofmagnitude (108) difference between the largest and smallest amplitudes. Therefore,
in acoustics, levels are commonly employed. The decibel is the unit of the decadic
logarithmic representation of a quantity relative to a reference value. In acoustics,
frequently used levels include sound pressure level (SPL or Lp), sound power level
(SWL or LW), and sound intensity level (SIL LI). Reference values for calculations
are p
=20×10−6Pa, W
ref
=1×10
ref
level calculations, the root mean square (r.m.s.) values of these quantities are used,
and the calculation formulas are provided below:
L
=
10 20 10
p
−12
W, and I
2
p
log,
rms
10
p
ref
p
ref
=1×10
=×
−12
W/m2, respectively. In
−
6
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