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At least 127 records · Page 7Linked to original sources
PubMed2000

External and middle ear effects on infant hearing screening test results.

This study investigated the relationship between external and middle ear factors and hearing screening results by automated auditory brain stem response (ABR) and transient-evoked otoacoustic emissions (EOAEs). The ears of 200 healthy newborns aged 5 to 48 hours underwent screening by ABR and EOAE, followed by otoscopic examination. The pass rates for ABR and EOAE were 91% and 58.5%, respectively. On otoscopic examination, 28% (112/400) ears had occluding vernix obscuring the view of the tympanic membrane. Cleaning of vernix was successfully performed in all but 2 ears that had occluding vernix. Cleaning of vernix significantly increased the pass rates of all 400 ears for ABR and EOAE to 96% and 69%. Decreased tympanic membrane mobility was found in 22.7% (90/396) of ears that were evaluated otoscopically. Decreased tympanic membrane mobility had a significant effect on EOAE screening; only 33.4% of ears passed EOAE testing. Decreased tympanic membrane mobility did not significantly affect pass rates for ABR screening; 95% of these ears passed the automated ABR screen. Implications for newborn hearing screening are discussed.

Cerumen↗
PubMed1997

A role for otoacoustic emissions in screening for hearing impairment and middle ear disorders in school-age children.

OBJECTIVE: The primary purpose of this study was to investigate the potential role of transient-evoked otoacoustic emissions (TEOAEs) for screening for hearing impairment and middle ear disorders in school-age children. Because TEOAEs are present in ears with normal cochlear and middle ear function and typically are absent or reduced in ears with cochlear and/or middle ear disorders of even mild degree, TEOAE screening could serve as a first-stage screening to separate from the general population of school-age children those at greater risk for hearing impairment and/or middle ear disorder. There were two secondary objectives. First, the relationship between TEOAE measurement variables and measures of middle ear immittance in ears declared clinically normal was investigated. Second, the performance of TEOAEs in screening was compared with the performance of the pure-tone hearing and tympanometric screening protocol commonly used in the schools. DESIGN: Sixty-six children (ages 5 to 10 yr) participated. TEOAEs, pure-tone hearing screening, acoustic immittance (single-frequency and multi-frequency tympanometry), and an otoscopic exam by a pediatrician, who previously had been "validated" for identification of middle ear effusion, were done on each child under typical school hearing screening conditions. Performance of the TEOAE screening was determined based on the pediatrician's determination of middle ear status and the pure-tone hearing screening as the gold standards. RESULTS: Of the 66 subjects, 61 completed the study. Fifty-six children passed the hearing and otoscopic screenings bilaterally, and five children did not pass either or both the hearing screenings or otoscopic examination in at least one ear. A variety of TEOAE criteria were examined with respect to their ability to identify ears with either hearing impairment and/or middle ear disease. Several different otoacoustic emission criteria performed well according to our diagnostic criteria. Correlations between TEOAE variables and immittance measures of middle ear function were all low. In addition, tympenometric data were used to compare the TEOAE screening with the American Speech-Language-Hearing Association's (ASHA) recommended protocol for the same ears. The ASHA protocol, as recommended, did not do as well as the TEOAE screening. Using slightly modified criteria, the ASHA protocol did as well as TEOAEs. CONCLUSION: There were some screening criteria based on TEOAE measurement that produced good sensitivity and specificity. A TEOAE screening for hearing impairment and middle ear disease performed as well as or better than the ASHA-recommended protocol, which requires a minimum of two different tests, even when the ASHA protocol was modified to optimize performance. The results suggest that the TEOAE test has the potential to be incorporated successfully into hearing screening programs for school-age children and may have advantages over current screening protocols. Finally, no relationship between TEOAEs and middle ear function, as measured using single-frequency and multifrequency tympanometry, could be determined in ears with normal hearing and normal middle ear function.

Acoustic Impedance Tests↗
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↗
PubMedDate not supplied

Efficacy of acoustic reflectometry in detecting middle ear effusion.

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.

Acoustic Impedance Tests↗
PubMed1990

The otologic significance of cleft palate in a Sri Lankan population.

The otologic findings from 197 subjects with repaired and unrepaired clefts and 121 noncleft controls are presented. All data were collected in Sri Lanka during a 3-week period attached to the Sri Lanka Project in 1986. Subjects were examined otoscopically and also tested audiometrically if they were able to perform a pure-tone audiogram, a performance test, or a distraction test. Subjects with clefts of the palate were found to have fewer otoscopically normal ears than the controls. A comparison between subjects with unrepaired and repaired palates revealed a similar rate of otoscopically normal ears in subjects older than 10 years of age. Comparisons for younger ages could not be performed because of a lack of subjects less than 10 years of age who had repaired palates. The impedance data were used to verify the accuracy of otoscopy in detecting effusion.

Acoustic Impedance Tests↗
PubMedDate not supplied

Endoscopy of the maxillary sinus. A new, simple technique.

A new, simple and inexpensive technique of endoscopy of the maxillary sinus is presented. With this technique the expensive modern optical systems for maxillary antrum endoscopy are replaced by a common otoscope and a trocar specially designed to fit into the lumen of the otoscope. They are introduced into the maxillary sinus through the canine fossa. After the removal of the trocar the otoscope remains in the sinus and endoscopy of all the maxillary sinus can be performed very easily and quickly.

Endoscopes↗
PubMed2006

Video otoscopy: bringing otoscopy out of the "black box".

BACKGROUND: Several billion dollars are spent each year on otitis media, a diagnosis for which educational approaches and diagnostic skills are suboptimal. The Center for Disease Control has identified improvement in otoscopy skills as a key intervention to curb inappropriate antibiotic usage. Educators are looking for interventions to both improve and assess otoscopy skills. Video otoscopy (VO) uses endoscopic technology to project the image of the ear onto a monitor for all to see, offering unexplored educational opportunity. The objective of this study is to perform an evaluation of VO systems in medical education from a review of the literature and hands-on experience of available technology. METHODS: The evaluation will focus on the technical acceptability (user requirements), clinical appropriateness (validity, reliability, feasibility), operational effectiveness (training requirements and implementation), and equipment selection. RESULTS: The technical requirements in pediatric education exceed those available in some VO systems, specifically pneumatic capability, sophisticated cameras and optics, and pediatric-sized ear speculums. VO images are comparable to the conventional otoscopic and otomicroscopic examinations. VO is feasible in a primary care setting and can be integrated into resident and medical student education. The technology in VO systems is changing rapidly, necessitating comparison of systems before equipment is purchased. CONCLUSIONS: VO is technically acceptable, clinically appropriate and can be integrated into the otoscopic education of residents and medical students. VO provides an opportunity to bring the pediatric ear examination out of the "black box," potentially improving diagnostic skills, quality of care, and reducing antibiotic overuse.

Child↗
PubMed1998

Intranasal beclomethasone as an adjunct to treatment of chronic middle ear effusion.

BACKGROUND: Following otitis media, 10% to 50% of children develop residual middle ear effusion with concurrent hearing loss and potential cognitive, behavioral, and language impairment. Prophylactic antibiotics and tympanostomy tubes are currently recommended treatments for chronic middle ear effusion. OBJECTIVE: In a double-blind, placebo-controlled, randomized study of chronic middle ear effusion, we assessed the effectiveness of topical intranasal beclomethasone as an adjunct to prophylactic antibiotic therapy. METHODS: Sixty-one children, aged 3 to 11 years with persistent middle ear effusion greater than 3 months, were randomized into three treatment groups: (1) prophylactic antibiotics; (2) prophylactic antibiotics plus intranasal beclomethasone (336 micrograms/day); and (3) prophylactic antibiotics plus intranasal placebo. Patients were evaluated with aeroallergen skin tests at entry; and tympanogram, otoscopic examination, and symptom questionnaire at 0, 4, 8, and 12 weeks. RESULTS: While middle ear pressures, otoscopic examinations, and symptom scores were improved for each treatment group over 12 weeks of therapy, the beclomethasone plus antibiotics group improved all three measures more rapidly than the antibiotics-alone and placebo nasal spray plus antibiotics groups over the first 8 weeks. Only the beclomethasone group significantly improved left (P = .004) and right (P = .01) middle ear pressures over 12 weeks. Resolution of chronic middle ear effusions was more frequent in the beclomethasone group (P < or = .05 at 4 and 8 weeks). No difference in response to nasal steroids was observed between atopic and nonatopic subjects. CONCLUSIONS: We conclude that intranasal beclomethasone may be a useful adjunct to prophylactic antibiotic treatment of chronic middle ear effusion.

Acoustic Impedance Tests↗
PubMed2002

Ventilation time of the middle ear in otitis media with effusion (OME) after CO2 laser myringotomy.

OBJECTIVE: The aim of this study was to investigate the transtympanic ventilation time, the healing course of the tympanic membrane, the early and late complications, and the recurrence rate of otitis media with effusion (OME) within 6 months after CO2 laser myringotomy with the CO2 laser otoscope Otoscan. STUDY DESIGN: Prospective clinical study. MATERIALS AND METHODS: In this study, laser myringotomy was performed with the CO2 laser otoscope Otoscan in a patient population comprising 81 children (159 ears) with a history of otitis media with effusion (OME) associated with adenoidal and sometimes tonsillar hyperplasia. The procedure on the tympanic membrane was accordingly combined with an adenoidectomy, a CO2 laser tonsillotomy, or a tonsillectomy and therefore performed under insufflation anesthesia. In all ears, approximately 2 mm circular perforations were created in the lower anterior quadrants with a power of 12 to 15 W, a pulse duration of 180 msec, and a scanned area of 2.2 mm in diameter. RESULTS: None of the children showed postoperative impairment of cochleovestibular function such as sensorineural hearing loss or nystagmus. Otomicroscopic and videoendoscopic monitoring documented the closure time and healing pattern of tympanic membrane perforations. The mean closure time was found to be 16.35 days (minimum, 8 days; maximum, 34 days). As a rule, an onion-skin-like membrane of keratinized material was seen in the former myringotomy perforations at the time of closure. At the follow-up 6 months later, the condition of the tympanic membrane of 129 ears (81.1%) could be checked by otomicroscopy and videoendoscopy and the hearing ability by audiometry and tympanometry. The CO2 laser myringotomy sites appeared normal and irritation-free. Two of the tympanic membranes examined (1.6%) showed atrophic scar formation, and 1 (0.8%) had a perforation with a diameter of 0.3 mm. The perforation was seen closed in a control otoscopy 15 months postoperatively. OME recurred in 26.3% of the ears seen intraoperatively with mucous secretion (n = 38) and in 13.5% of the ears with serous secretion (n = 37; P <.05). CONCLUSION: The most important principle in treating OME is ventilation of the tympanic cavity. CO2 laser myringotomy achieves this through a self-healing perforation in which its diameter roughly determines the duration of transtympanic ventilation. Laser myringotomy competes with ventilation tube insertion in the treatment of OME. It may be a useful alternative in the surgical management of secretory otitis media.

Child↗
PubMed1997

[Application of the myringoscope and myringophotography in forensice medical identification].

In analysis of tympanitio membrane injury, we have compared conventional otoscope with myringoscope and found that the myringoscope has an advantage over the conventional otoscope. The myringoscope can show the whole tympanitic membrane, the positions, shapes and characteristics of tympanitic membrane injuries more clearly. The pictures of myringophotography could be preserved and offered to court as an important forensic medical evidence.

Adult↗
PubMed2001

Transoral intratracheal inoculation method for use with neonatal rats.

BACKGROUND AND PURPOSE: Studying the effects of toxic and infective compounds on the respiratory system requires a reliable method for delivering inoculum into the distal region of the lung. Although transoral intratracheal inoculation methods have been well documented for adult rats, to the authors' knowledge, a reliable method has not been validated for neonatal rats. The purpose of the study reported here was to develop a simple method for transoral inoculation in rat neonates. METHODS: Seven-day-old Fischer 344 rats were anesthetized with halothane, and a spinal needle was inserted in the tracheal lumen, by use of illumination and a modified otoscope. Meconium was injected into the lungs as a marker, and the neonates were kept under close observation. After euthanasia at 24 h, lungs were removed and fixed in formalin, and the microscopic distribution of the inoculum was assessed in the left, right cranial, middle, median, and caudal lung lobes. RESULTS: Microscopic examination of lungs indicated that intratracheal inoculation was achieved in 100% of neonatal lungs and the inoculum was consistently distributed in the alveoli of all pulmonary lobes. Important complications or mortality were not observed in the neonates. CONCLUSIONS: Intratracheal inoculation of neonatal rats is possible by use of a modified otoscope for transoral illumination. This technique is simple and reproducible and ensures, without complications, widespread distribution of inoculum in the lungs of neonatal rats.

Anesthesia, Inhalation↗
PubMed1981

Positive middle ear pressure shown by tympanometry.

The incidence and implications of positive middle ear pressure shown by tympanometry have been sparsely reported in the literature. A series of 13 patients (16 ears) exhibited middle ear pressures that exceeded +49 mm H2O. Clinical, otoscopic, audiologic, and pathologic findings are reviewed. Otalgia or fullness and pharyngitis were the most commonly reported symptoms. Acute middle ear pathologic conditions were otoscopically confirmed in 13 ears. Effusion was present in five of six ears that were selected for myringotomy. The clinical implications of positive middle ear pressure would be particularly important when screening in a nonmedical setting and in the examination of infants. These findings are also important for considering the role of positive middle ear pressure in the pathogenesis of otitis media.

Acoustic Impedance Tests↗
PubMed1978

Pneumatic otoscopy and impedance studies in middle ear diagnosis.

The direct inspection of the tympanic membrane and its movement with Siegle pneumatic otoscopy through the binocular microscope and the electroacoustic measurements of impedance at the tympanic membrane give valuable information in the diagnosis of tympanic membrane and middle ear disorders. Problems such as otosclerosis and tympanosclerosis with ossicular chain fixation, ossicular discontinuities, ossicular chain prosthesis defects and perilymph fistulas, and the problems of middle ear fluid can be identified and differentiated. Frequently a precise diagnosis can be determined prior to surgical exploration. The use of these instruments enables the otologist to anticipate surgical findings and plan a specific procedure, thereby avoiding operative surprises. The routine use of the pneumatic otoscope and an electroacoustic impedance bridge is recommended in every case of suspected tympanic membrane or middle ear disorder, particularly where an operation is being considered. The combined information obtained through use of the two diagnostic techniques is almost always greater than that obtained by either instrument alone. Pressure recordings were made in a series of examinations with the pneumatic otoscope using the ear microscope. These pressures, both positive and negative, are acceptable and well within the range utilized by clinical electroacoustic impedance bridges. Contraindications to the use of pneumatic otoscopy and the electroacoustic impedance bridge are discussed.

Acoustic Impedance Tests↗
PubMed2006

[Hearing impairment in children and adolescents with Down's syndrome].

BACKGROUND: There are controversial opinions about the incidence of hearing impairment of children and adolescents with Down's syndrome as an additional cause for obstruction in social and communicative live. Next to congenital diseases of the inner ear, functional limitations can often lead to conductive hearing disorders in patients with Down's syndrome. PATIENTS AND METHODS: The hearing ability, otoscopic and audiometric characteristics of 115 patients aged 3.2+/-2.9 years were analysed retrospectively over 42 months. RESULTS: A total of 86 children showed morphologic otoscopic peculiarities: transitory evoked otoacoustic emissions (TEOAE) were often non-reproducible, even in patients with normal hearing abilities(14.1% of cases), and were not evaluable in 32.8% of cases. Half of the patients showed hearing loss, 82% of whom suffered from a conductive hearing loss, 6.9% from a combined, and 8.6% from isolated sensorineural hearing loss. Hearing loss was first diagnosed when the children were 4.6+/-3.4 years old. CONCLUSION: The frequent occurrence of hearing loss justifies and requires an early and continuous pedaudiological examination. As a common screening examination, TEOAE is limited due to its cost, however, it fulfils its purpose as a means of distinguishing healthy children from those with possible hearing disorders. In most cases, objective and subjective audiometric methods must be combined in order to precisely define the hearing ability.

Adolescent↗
PubMed2004

[Otological findings in adults with isolated cleft palate or cleft lip, jaw, and palate].

BACKGROUND: Children with cleft palate often develop middle ear ventilation disorders due to chronic Eustachian tube dysfunction. This may lead to hearing loss. The insertion of ventilation tubes is a widely accepted measure to avoid sequelae of middle ear ventilation disorders and hearing loss. On the other hand, long-term therapy with ventilation tubes may inflict iatrogenic complications. The objective of the study was the evaluation of otoscopic and audiometric long-term findings in adult cleft patients who had been treated with ventilation tubes since childhood when chronic otitis media with effusion had been observed. PATIENTS AND METHODS: Ninety-two cleft palate patients had been followed up otoscopically and audiometrically for years. The average age was 19.3 years (minimum: 14, maximum: 39 years) at the time the last status was taken. RESULTS: Otoscopy revealed a perforation of the tympanic membrane in 3.8% of the 184 ears. 12% of the patients developed cholesteatoma, however three quarters of these occurred after age 11. 86.4% of the 92 patients had normal hearing in pure tone audiometry. CONCLUSION: Compared with adult cleft patients who did not receive ventilation tubes, our patients had a similar low incidence of eardrum perforations but a higher incidence of cholesteatomas while hearing loss occurred less often. Whether the higher incidence of cholesteatomas is caused iatrogenically or due to a longer follow-up period remains unclear. Whether the use of long-lasting ventilation tubes affects the incidence of cholesteatomas must be proved in further studies.

Adolescent↗
PubMed2000

Tympanometry and acoustic reflectometry in ears with chronic retraction without effusion.

OBJECTIVE: Purpose of this study was to find out test accuracy and predictivity of tympanometry (TYMP) and parameters (reflectivity and curve angle) of acoustic reflectometry (AR) in the ears with prior clinic and otoscopic evidences of effusion in which no effusion was detected by myringotomy, by comparing with the data found in normal ears and in those with effusion. METHODS: While study group included 31 ears with chronic retraction in which no effusion was detected by myringotomy, control group included 150 fully normal ears and 150 ears with effusion confirmed by myringotomy. B tracings in TYMP, and values of reflectivity higher than 5 and curve angle lower than 75 degrees in AR were accepted as indicators of effusion; in the combined test, the ears with non-B tracings in which curve angle higher than 75 degrees were accepted as those without effusion. RESULTS: False positivity values of TYMP, reflectivity and curve angle and the combined test found in the ears with chronic retraction without effusion (29, 23, 19 and 35% respectively; chi(2)-test, P > 0.1) were significantly higher than normal ears (chi(2)-test, P < 0.001), but lowe than those of effusion (chi(2)-test, P<0.0001). Further, although negative predictivity values of TYMP, reflectivity and curve angle were found to be lower in these ear, compared to normal ears (chi(2)-test, P < 0.01), the combined test reached to a perfect negative predictivity, as much as in normal ears. On the other hand, positive predictivity values were decreased in the ears with chronic retraction without effusion by only reflectivity. CONCLUSIONS: By both TYMP and AR alone, it is more difficult to find out the ears without effusion among the ears clinically and otoscopically diagnosed as otitis media than to find out normal ears. Therefore, in clinical work, false positivity of these devices were higher, and their specificity and negative predictivity were lower; although the combined test solved problem of low negative predictivity, high number of false positive ears in clinical work, that is lower specificity, continues to be an unsolved problem by either TYMP or AR alone, or both together.

Acoustic Impedance Tests↗
PubMed2003

Ear examination findings at the Yeditepe School for the Deaf.

OBJECTIVE: To find out the prevalence and etiologies of middle ear disease among deaf children in a school for the deaf. METHODS: A total of 162 students with hearing impairment attending a school for the deaf during the school year of 2001-2002 were admitted to this study. The range of age was from 6 to 20 years. The examination consisted of inspection of the auricle and external auditory canal, and otoscopic, audiometric and tympanometric evaluation. School performance was assessed using the results of end-of-year school examination and continuous assessments obtained from the school administration. RESULTS: The demographic properties of the study group revealed that 81 (60.9%) of children were male and 52 (39.09%) were female. Most of the children (45%) were in the group of 9-13 years of age. On pure tone audiometric evaluation, sensorineural hearing loss (HL) was found in 99 (85.3%) and mixed type HL in 17 (14.6%) of 116 cases. Impacted wax was the most common pathology and was seen in 15 (39.4%) of children. Middle ear diseases were detected in 38 (28.5%) of children with otoscopic examination. CONCLUSION: This study shows that hearing impairment and preventable ear diseases are important health problems among the school children for the deaf. It is essential to start the school education early in time and to start using hearing aid before 2.5 year of age.

Acoustic Impedance Tests↗
PubMedDate not supplied

Differential otomanometry.

Management of otitis media, both acute and chronic, is one of the most common problems in clinical medicine. Among the many unresolved issues in otitis media research is accurate diagnosis which, in turn, depends heavily on valid otoscopic observation. Yet even today clinical otoscopy remains more of an art than a science. Because precise therapy is predicated on precise diagnosis, efforts to improve the validity and reliability of otoscopic techniques are warranted. Of great importance to the otoscopist is the visual estimate of tympanic membrane mobility secondary to hand-generated pneumatic pressure (pneumotoscopy). The degree of motion is usually graded in relative terms. In addition to pneumotoscopy, tympanometry is also used to assess the status of the middle ear. This is done indirectly through the plot of induced pressure versus acoustic immitance (tympanogram). Thus, both procedures depend on the differential application of induced pneumatic pressure on the tympanic membrane. If the middle ear is air-containing and the tympanic membrane is normal, even a slight pressure rise in the ear canal will displace the membrane. If the middle ear is fluid-filled, even large amounts of pressure produce no motion of the tympanic membrane. The pressure gradients, normal threshold, and optimal frequency of application for pneumotoscopy have not been studied previously in humans. Data are presented to compare the sensitivity, specificity, and predictive value of pneumotoscopy and tympanometry in the detection of effusion due to chronic secretory otitis media. In addition, preliminary data obtained by a new procedure, quantitative pneumotoscopy, are discussed.

Acoustic Impedance Tests↗