The Effect of Soft Tissue Stimulation on Skull Vibrations and Hearing Thresholds in Humans

Shai Chordekar, Ronen Perez, Cahtia Adelman, Haim Sohmer, Liat Kishon-Rabin

Research output: Contribution to journalArticlepeer-review


Hypothesis:Hearing via soft tissue stimulation involves an osseous pathway.Background:A recent study that measured both hearing thresholds and skull vibrations found that vibratory stimulation of soft tissue led to hearing sensation that correlated with skull vibrations, supporting the hypothesis of an osseous pathway. It is possible, however, that a lower application force of the vibrator on the stimulated soft tissue would not be sufficient to elicit skull vibration suggesting hearing via a nonosseous pathway. The purpose of the present study was to confirm the osseous pathway by measuring skull vibrations and behavioral thresholds using a low application force on a layer of ultrasound gel. Gel was used to mimic soft tissue because of its similar acoustic impedance and to control for variability between participants.Methods:Hearing thresholds and the skull vibrations of five patients who were implanted with bone-Anchored implants were assessed in two conditions when the bone vibrator was applied on the forehead: 1) direct application with 5N force; 2) through a layer of ultrasound gel with minimal application force. Skull vibrations were measured in both conditions by a laser Doppler vibrometer focused on the bone-Anchored implant.Results:Skull vibrations were present even when minimal application force was applied on soft tissue. The difference in skull vibrations when the vibrator was directly on the forehead compared with the gel condition was consistent with the variability in hearing thresholds between the two conditions.Conclusion:These results reinforce the hypothesis that skull vibrations are involved in hearing when sound is transmitted via either soft tissue or bone.

Original languageEnglish
Pages (from-to)598-605
Number of pages8
JournalOtology and Neurotology
Issue number4
StatePublished - 1 Apr 2021


  • Bone conduction
  • Bone-Anchored implant
  • Hearing thresholds
  • Skull vibrations
  • Soft tissue conduction

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Sensory Systems
  • Otorhinolaryngology


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