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PubMed2002

An animal model for assessment of amniotic fluid clearance from the middle ear.

HYPOTHESIS: To determine the time needed for clearance of amniotic fluid from the middle ear after birth, an animal model study was performed. BACKGROUND: Before birth, the middle ear is full of amniotic fluid, and there is controversy about the time it takes for it to clear postnatally. This is of importance because it is suspected that amniotic fluid in the middle ear of the newborn may affect results of screening of hearing when using otoacoustic emissions. METHODS: Adult and neonatal guinea pigs underwent a right-side cochleotomy followed by baseline otoscopy, tympanometry, and auditory nerve- and brainstem-evoked response (ABR) measurements of the left ear. Subsequently, the animals' left middle ears were filled with saline through a hole drilled in the bulla. Over the next few days, assessment of saline clearance was conducted by repeated left-side otoscopy, tympanometry, and measurement of ABR. RESULTS: After filling the middle ear with saline, the tympanic membrane was opaque, a type B tympanogram was obtained, and the ABR threshold was elevated. After an average of 6.3 +/- 3.0 days, air bubbles were seen in otoscopy, a type C tympanogram was obtained, and the ABR threshold improved. Finally, after an average of 9.5 +/- 2.7 days, all 3 parameters returned to their baseline values. CONCLUSION: Taking into consideration that this is an animal study, the results suggest that clearance of amniotic fluid from the newborn middle ear takes longer than has been generally thought. In addition, an animal model for assessing the clearance of fluid from the middle ear has been developed.

Acoustic Impedance Tests↗
PubMed1989

Provision of hearing aids: does specialist assessment cause delay?

OBJECTIVE: To identify the main delay in the provision of hearing aids for people with impaired hearing and identify possible problems and short-comings caused by a community based hearing aid dispensing service. DESIGN: Prospective cohort analysis based on data collected from patients on the duration of hearing impairment, from the referral letters in respect of the general practitioners' findings on otoscopy, and from the ear, nose, and throat assessment in the clinic with respect to the outcome of specialist otoscopy and management of the hearing impairment. SETTING: General ear, nose, and throat outpatient clinic. PATIENTS: 100 Consecutive patients aged 19-94 referred by general practitioners for the provision of hearing aids or for assessment and treatment of impaired hearing. RESULTS: Most patients with impaired hearing did not seek medical advice for at least a year. The time from referral by the general practitioner to the provision of a hearing aid was under two months. General practitioners consistently recognised normality on otoscopy but failed to recognise abnormality in eight of 45 cases. Seven patients required further investigation to exclude serious disease and nine had conditions amenable to surgery. CONCLUSIONS: The main cause of delay in treating impaired hearing is failure by patients to seek help promptly. Specialist assessment of patients with impaired hearing is preferable and does not necessarily cause delay in providing hearing aids. The provision of hearing aids should remain a hospital based service.

Adult↗
PubMed1998

Evaluation of the canine tympanic membrane by positive contrast ear canalography.

Positive contrast ear canalography was described briefly in 1973 as a method for detecting rupture of the tympanic membrane in dogs with otitis media. The purpose of this study was to evaluate the sensitivity and usefulness of the technique. The ears of 10 normal canine cadavers and 31 dogs with clinical signs of ear disease were examined using otoscopy, radiography and contrast radiography after infusing 2 to 5 ml of positive contrast medium into the ear canals. These examinations were repeated in the cadavers after the tympanic membrane had been punctured with a Spreull needle. In the cadavers 14 of 19 (74 per cent) of the tympanic membranes were visible otoscopically; contrast medium did not enter the tympanic bulla of any of the ears before the tympanic membrane was ruptured, but was visible in the bulla in every ear after rupture. In the clinical study, 40 of 61 (66 per cent) of the tympanic membranes were visible otoscopically, and 12 appeared to be ruptured. Radiographic signs of otitis media (increased opacity and/or thickening of the tympanic bulla) were identified in seven ears. Canalography was positive for rupture of the tympanic membrane in 13 ears, including four in which it appeared to be intact otoscopically. In normal canine ears, canalography was a more accurate method for detecting iatrogenic tympanic membrane rupture than otoscopy. In dogs with ear disease, canalography may be more sensitive for otitis media than either otoscopy or survey radiography.

Animals↗
PubMed1976

[Tympanometry in chronic otitis media].

We present an analysis of the otological and audiological findings in 63 patients (113 ears) in which a myringotomy for suspected serous otitis media has been performed. In 98 ears (87%) the impedance data correlated with otoscopy. Tympanograms did not give further information than otoscopy alone in 49 patients with reliable pure-tone audiometrical results, whereas tympanograms would have missed 6 out of 78 ears containing fluid and 6 out of 49 ears who improved in hearing following myringotomy and transtympanic tube therapy. We feel, however, that, in patients who are too young or too retarded to be tested audiometrically, tympanometry in combination with otoscopy could eventually be helpful in settling the indication for a myringotomy, since 3 out of 83 ears with middle ear fluid and hearing improvement following transtympanic tube therapy had pathological tympanograms in spite of normal-seeming ear drums.

Audiometry↗
PubMed1985

Purulent otitis media--a "silent" source of sepsis in the pediatric intensive care unit.

Septicemia is common in patients in the pediatric intensive care unit (ICU) who have nasotracheal tubes. Although it is frequently caused by middle ear effusion (MEE), pneumatic otoscopy is not routinely performed in these patients. To demonstrate the value of this procedure, 46 pediatric ICU patients with nasotracheal tubes were followed daily with pneumatic otoscopy for 11 to 98 days and compared with 25 controls without nasotracheal tubes, 12 of whom had nasogastric tubes. Myringotomy was performed whenever blood culture became positive. MEE was significantly more frequent in patients with nasotracheal tubes (87%) than in patients with controls (23%) and occurred first on the side of intubation. Blood bacteria were identical to middle ear pathogens in 80% of patients. Nasogastric tubes were not significant in causing MEE. The high incidence of MEE resulting from nasotracheal intubation indicates the importance of including pneumatic otoscopy in the daily examination of these high-risk patients.

Child, Preschool↗
PubMed1999

Otological evaluation of newborns who failed otoacoustic emission screening.

Early identification of congenital hearing loss and early rehabilitation is extremely important. Otoacoustic emissions (OAE) are an efficient tool for hearing screening. Previous studies using click evoked otoacoustic emissions (CEOAEs) for newborn hearing screening resulted in approximately 70% pass rate, reflecting intact hearing. The aim of our study was to perform a detailed otological evaluation of newborns who failed OAE screening, using otoscopy, tympanometry and ABR. CEOAEs were recorded from 257 newborns prior to their release from the hospital. Those babies who did not pass the CEOAE were examined by DPOAE, otoscopy, tympanometry and ABR, if needed. 73% of all the newborns had CEOAE in both ears. 20% had CEOAE in only one ear. When the test was administered again three days postpartum, the CEOAE pass rate increased; 98% passed in at least one ear. Most of the newborns (84%) who failed had an obstruction of the external ear canal (collapsed ear canal or debris). There was a good correlation between the otoscopy and the tympanometry. Based on the above results, a newborn hearing screening protocol was introduced.

Deafness↗
PubMed2006

[Diagnosis and treatment on osteoradionecrosis of temporal bone in cases with nasopharyngeal carcinoma after radiotherapy].

OBJECTIVE: To discuss the diagnosis and treatment on osteoradionecrosis of temporal bone in case with nasopharyngeal carcinoma (NPC) after radiotherapy. METHOD: The clinical data of 21 cases (22 ears) diagnosed as osteoradionecrosis of temporal bone with NPC were studied, including 17 ears of localized type and 5 ears of diffuse type. Minimally surgical debridement with otoscope was performed on 17 ears of localized type and 1 ear of diffuse type. Four ears of diffuse type underwent the modified radical mastoidectomy and obliteration with vascularized fascia flaps. RESULT: The common clinical features were foul-smelling otorrhea and otalgia. Otoscopy revealed the exposed bone and bony sequestration in the external auditory canal with impacted keratotic debris, granulation tissue and cholesteatoma accumulation. It was with erosion or/and orifice to the mastoid. CT scan demonstrated the presentations: osteomyelitis, bone destruction as the islet-appearance and soft tissue mass. Among the 17 ears of localized type, 12 ears (70.6%) showed complete epithelization of the raw surface, 4 ears (23.5%) not fully epithelized were followed up without sequestration, and 1 ear (5.9%) was developing progressively. As for the 5 ears of diffuse type, 1 ear received the minimally surgical debridement and another 3 ears treated with mastoidectomy and obliteration were healed. Only 1 ear needed secondary surgery because of re-sequestration. CONCLUSION: Both otoscopy and CT scan can offer the diagnostic value with different characteristics. The minimally surgical debridement of the sequestration by otoscopy can obtain good effects on localized type. It should be careful to select the surgery recipient on the diffuse type, and mastoid obliteration with vascularized flaps from regional tissue may be warranted after mastoidectomy. Regular follow up is needed because of possibility of the progressive development of the disease.

Adult↗
PubMed2003

The role of ventilation tube status in the hearing levels in children managed for bilateral persistent otitis media with effusion.

The study determined the effects on hearing of the status of ventilation tubes, using a combination of otoscopy and tympanometry to determine function, in children managed for bilateral persistent otitis media with effusion (OME). The subjects were aged between 3.5 and 7 years and had a documented history of bilateral OME over a 12-week watchful waiting period associated with a hearing impairment in both ears of >or= 20 dB HL. The children reported are those randomized to the two surgical arms, both of which had bilateral myringotomy, aspiration of middle ear fluid and insertion of Shepard ventilation tubes. One arm furthermore received adenoidectomy. The data were analysed 'as treated' to document therapeutic progress. Tubes confirmed to be functioning on otoscopy and tympanometry only partially alleviate the conductive impairment associated with childhood OME (AC mean 12 dB HL, SD 4; ABG 13 dB, SD 7, 3 months post operation). Thus, children with a functioning ventilation tube cannot be considered to have 'normal' hearing. Once the tube has extruded, ears that no longer have OME still have a small conductive hearing impairment (at 12 months AC 14 dB HL, SD 6; ABG 16 dB, SD 9) but this improves with time. In children with bilateral tubes, both remain functioning for a median duration of 21 weeks (IQR 10-40) and at least one for a median of 40 weeks (IQR 24-61). Tube blockage significantly (P = 0.001) increases the risk of extrusion (84% versus 44%). When inserted in children between 3.5 and 7 years for OME, the otoscopic incidence of tube infection is low (1%).

Acoustic Impedance Tests↗
PubMedDate not supplied

Missed opportunities for a diagnosis of acute otitis media in Aboriginal children.

OBJECTIVE: Severe otitis media and its sequelae are common in rural and remote Aboriginal children. Identification of acute otitis media (AOM) is likely to reduce the number of children who go on to develop chronic suppurative otitis media and associated complications. The aim of this study was to compare the diagnoses made by researchers with that documented in the medical records of children admitted to the paediatric isolation ward of the Royal Darwin Hospital, Darwin, Northern Territory. METHODS: Children aged <8 years admitted to Royal Darwin Hospital were eligible for assessment by pneumatic otoscopy, video-otoscopy and tympanometry. A diagnosis was made for each child according to the state of their worst ear. Comparisons were made between the researcher diagnoses of ear disease and those documented in the hospital notes by medical staff. RESULTS: Thirty-one children were enrolled during 32 admissions. Most were aged <2 years, Aboriginal, and resided in remote communities. Sixty-one video-otoscopic assessments were attempted and sufficiently good images to allow diagnosis were obtained in 105 of 122 ears. Acute otitis media was diagnosed by the research team in 20 of 32 child admissions. Of 29 children who had ear examinations documented by hospital staff, only seven had a diagnosis of AOM recorded. Overall, the research team were almost three times more likely to make this diagnosis (relative risk 2.9, 95% confidence interval 1.6, 5.2). This difference was unlikely to have occurred by chance (P = 0.0002, McNemar's Chi-squared test). CONCLUSIONS: In this small study, young Aboriginal children with clear bulging of their tympanic membrane were not diagnosed with AOM by medical staff. Further training in diagnosis, including cleaning of the ear canal, may lead to more accurate assessment and appropriate recommendations for ongoing management.

Child↗
PubMed2003

Predictive validity and reliability of adult hearing screening techniques.

The purpose of this study was to evaluate and compare the efficacy of hearing screening tools to identify hearing loss in the older adult population. The test-retest reliability of both the AuDX DPOAE hand-held screener and subjective otoscopic ratings of percent earwax accumulation were evaluated. Additionally, the predictive validity was investigated for five hearing screening tools: the DPOAE hand-held screener, pure-tone screening, screening otoscopy, self-assessment of communication, and case history screening. The research was conducted through typical community hearing screenings on normal-hearing and hearing-impaired volunteer subjects. The screening subjects included 67 adults aged 49 to 89 years. Of those, 44 returned for a full audiologic evaluation. Key findings include: (1) Pure-tone screening had predictive validity for actual hearing loss in the older adult population when a 25 dB HL fence is used; (2) Screening otoscopy ratings were highly reliable across time and raters; (3) Self-assessment scores did not predict compliance with referral recommendations; (4)The AuDX DPOAE hand-held screener proved to be reliable in the overall pass/refer outcome, but lacked predictive validity for actual hearing loss in older adults.

Adult↗
PubMed2005

Pressure-equalizing earplugs do not prevent barotrauma on descent from 8000 ft cabin altitude.

INTRODUCTION: The aim of this study was to evaluate the effect of pressure-equalizing earplugs available in major airports and drugstores. No previous study has focused on preventing barotrauma using these earplugs. METHODS: Blinded and double-blinded, one type of pressure-equalizing earplugs (JetEars) was studied in 27 volunteers disposed to ear barotrauma. They acted as their own controls with an active earplug in one ear and a placebo earplug in the other ear at random. All were exposed to the same well-defined pressure profile for 1 h at 8000 ft, comparable to the environment in civil commercial air travel in a pressurized cabin. Satisfaction was assessed by questionnaire and objective results were evaluated prior to and after the pressure exposure by tympanometry and otoscopy using the Teed classification. RESULTS: The majority of the volunteers (78%) reported a pleasant noise-reducing feeling using the earplugs. However, 75% also experienced ear pain during descent. In comparing the middle ear pressure before and after pressurization, a decrease was found in ears with both active earplugs and placebo earplugs. No difference between the active and the placebo earplugs were found. Furthermore, after evaluation of the two groups of ears using otoscopy, no prevention of barotrauma was found. In fact, the ears using an active pressure-equalizing earplug scored significantly worse (p = 0.033). CONCLUSIONS: Feelings of noise reduction were reported, but no prevention of barotrauma could be demonstrated with the use of pressure-equalizing earplugs. Pressure-equalizing earplugs cannot be recommended in air travel for preventing ear barotrauma.

Acoustic Impedance Tests↗
PubMed1976

Audiometric, impedance, and otoscopic findings in children with cleft palates.

We examined the prevalence of hearing loss and/or middle ear disease among 34 children with cleft palates, using pure-tone audiometry, acoustic impedance, and pneumatic otoscopy. The overall incidence of hearing loss and otitic complications varied from 57% to 68%, depending on the procedure used. Of the three clinical procedures used in this study, pure-tone audiometry exhibited the poorest diagnostic efficiency. Close predictive agreement was found between impedance and otoscopy.

Adolescent↗
PubMed1985

Otitis media and language performance in a cohort of Apache Indian children.

Language performance was evaluated in 167 healthy Apache Indian children aged 6 to 8 years, who had contrasting histories of otitis media and who had been followed since birth. All children received pneumatic otoscopy, tympanometry, pure tone audiometry, and a battery of language measures. Groups were similar with respect to age, sex, school experience, family income, housing, primary language spoken, and nonverbal intelligence. No statistically or clinically significant differences in language performance were observed between groups of children with frequent episodes of otitis media and those from the same cohort with infrequent otitis. While frequent otitis media was associated with abnormalities on tympanometry and otoscopy, bilateral hearing loss (greater than 25 dB) was observed in only 1% of the children.

Acoustic Impedance Tests↗
PubMed1993

Secretory otitis media and mastoid air cell development.

Controversy continues over the factors involved in the development of the mastoid air cell system (MACS). This study examines the effect of persistent secretory otitis media with effusion (SOME) on the development of the MACS. Thirty-one children, aged 4, were drawn from a cohort of cleft palate children in a multi-centre, prospective otological study set up in 1984. The initial presence of SOME was assessed by otoscopy, tympanometry and bilateral myringotomy, performed under the same anaesthetic as surgical repair of the cleft lip or palate. Only one ear in each child was ventilated with a tube and the other, the control ear, was assessed by regular follow-up otoscopy and tympanometry. The persistence of SOME after palate repair in over 70% of the non-ventilated ears in 4 years olds and the presence of a contralateral ventilated middle ear provides the perfect model for assessing the effect of SOME on MACS development. Plain, lateral mastoid X-rays were assessed by planimetry to give a well accepted measurement of mastoid pneumatization. Nine children were excluded from analysis as they did not meet the strict criteria of one persistently ventilated middle ear and one with persistent SOME. 22 children (44 ears) were available for analysis, 9 children were tubed at 3 months and 13 were tubed at 12 to 16 months. In 19 of the 22 ears the mastoid air cell system was larger on the tubed side.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1994

Middle ear measures as predictors of hearing loss in Australian aboriginal schoolchildren.

This study sought to establish the value of tympanometry and otoscopy for predicting significant conductive hearing loss in remote-area Aboriginal children, and also to measure the range of hearing loss which can be expected with middle ear disease, with or without a tympanic membrane (TM) perforation. A field study is reported of 255 Aboriginal children aged up to 16 years who were examined with pneumotoscopy and tympanometry and whose hearing was tested under controlled acoustic conditions. Results showed that pneumatic otoscopy for detection of middle ear effusion and identification of perforations resulted in the best rate of prediction of significant conductive hearing loss. Furthermore, the hearing of children with perforated TMs (mean pure-tone average 30.0 dB; S.D. 11.1) was significantly worse than those in which tympanometry suggested middle ear effusion (mean pure-tone average 20.3 dB; S.D. 9.6), and both differed significantly from ears showing normal tympanograms (mean pure-tone average 11.2 dB; S.D. 5.9). Implications for community-based hearing screening and classroom management of affected children are discussed.

Acoustic Impedance Tests↗
PubMed1999

A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children.

BACKGROUND: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims. OBJECTIVE: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion. METHODS: This study was a prospective, parallel-group, observer-blinded, randomized feasibility study. Twenty-two patients, ages 6 months to 6 years, received either active chiropractic SMT or placebo chiropractic SMT. Otoscopy and tympanometry were used to create a middle ear status profile, and daily diaries were collected. RESULTS: Five newspaper advertisements over 6 months generated 105 responses. Twenty patients subsequently qualified and were randomized into the study. Collection of tympanometric and otoscopic data proved to be challenging. Compliance with the treatment and evaluation protocols and daily diaries was excellent. There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments. CONCLUSION: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies.

Child↗
PubMed2001

Negative pressure tympanograms in children less than 2 years of age--different bacterial findings in otitis media by tympanometric results.

OBJECTIVE: The interpretation of negative pressure tympanograms as indicators of the presence of middle ear fluid has been ambiguous. Our purpose was to assess the occurrence and implications of negative pressure tympanograms and to study their association with bacterial pathogens in otitis media. METHODS: Altogether 329 infants were enrolled at a well-baby clinic for the Finnish Otitis Media Cohort Study, a longitudinal prospective cohort study. The children were closely followed in a special study clinic from 2 to 24 months of age for respiratory diseases, especially acute otitis media. Children were examined at the study clinic with tympanometry and pneumatic otoscopy whenever visiting the study clinic for respiratory disease. Myringotomy with aspiration was performed if middle ear fluid was suspected in otoscopy. Occurrence of middle ear fluid in ears with negative pressure tympanograms (less than -100 daPa) was assessed. Nested case control design matched by visit type (acute or follow-up visit) and month of visit was used for analysis of association of bacterial pathogens and tympanometric results. RESULTS: Middle ear fluid was encountered in 15% of ears with negative tympanometric peak pressure, a lower proportion than described previously. In otitis media with a negative tympanometric peak pressure, 71% of bacterial cultures remained negative for the main pathogens, compared to 36% in matched controls (P<0.001). Especially Streptococcus pneumoniae but also Haemophilus influenzae were rarely found in samples from negative pressure ears. Moraxella catarrhalis was equally often found. CONCLUSIONS: Negative pressure tympanogram is a poor indicator for the presence of middle ear fluid. Furthermore, if otitis media is diagnosed with negative tympanometric peak pressure negative middle ear bacterial culture for the main pathogens is highly probable. Expectant follow-up might be more appropriate than routine antibiotic treatment.

Acoustic Impedance Tests↗
PubMed2002

A pilot case control follow-up study on hearing in children treated with tobramycin in the newborn period.

OBJECTIVE: To assess the occurrence of hearing loss in children due to neonatal exposure to long courses of tobramycin and/or high tobramycin serum concentrations. METHODS: This was a pilot case-control study in 3-4-year old children. Data on tobramycin administration were abstracted from the patient files of an earlier study. Patients exposed in the neonatal period to either long courses (>7 days) or high serum concentrations of tobramycin constituted the study group. The control group consisted of patients without tobramycin exposure. Patients were matched for other risk factor according to criteria of the joint committee on infant hearing. All patients underwent the following investigations: otoscopy and pneumatic otoscopy, followed by impedance audiometry, to exclude middle ear effusion. Click-evoked oto-acoustic emissions (ce-OAE) as well as distortion product oto-acoustic emissions (dp-OAE), tested at f2 frequencies ranging from 1 to 10 kHz, were measured to assess hearing. All patients with abnormal ce-OAE results underwent brainstem electric response audiometry (BERA) as well. Since aminoglycoside ototoxicity is usually bilateral, results were compared per patient and not per ear. RESULTS: A total of 29 patients were tested. Eleven patients were excluded due to middle ear effusion. Data for 18 patients were analyzed. In the tobramycin treated group (n=9) both ce-OAE and dp-OAE (at all tested frequencies) were not detectable in six ears of three patients. All other patients had normal ce-OAE's as well as normal dp-OAE's in this frequency range. Difference between the tobramycin treated and control group for OAE as well as dp-OAE showed a trend (P=0.08). In all three patients with undetectable emissions BERA confirmed a cochlear loss of 60-70 dB at 3 kHz in both ears. These three patients had the longest total exposure to tobramycin: 20-24 days and 84-92 mg/kg, respectively. No relation to either peak or trough serum concentrations could be detected. CONCLUSION: There was no statistical relation between hearing loss and tobramycin exposure, probably due to sample size. Our results do indicate a need for a case-control follow-up study of hearing in neonates exposed to long courses of aminoglycosides.

Acoustic Impedance Tests↗