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PubMed1985

Tympanometry screening in developmentally delayed individuals.

Residents of the Huronia Regional Centre for the developmentally disabled (N:900) underwent otoscopic screening (canal "clear" vs "not clear") and tympanometric screening, including tympanometry and physical volume measures (Ss exhibiting Type B tympanograms were classified "hard positive"). Results showed that (1) by otoscopy, 53.2% of all Ss examined had canals "not clear". (2) Overall, degree of retardation was loosely related to prevalence of abnormal otoscopy. (3) The etiologies for mental retardation of "metabolism" and "chromosomal abnormalities" (including all Down's Syndrome cases) were most prone to be in the "not clear" otoscopic category. By tympanometry, 25.8% were classified "hard positive". Overall, conductive disorders as assessed by tympanometry increased significantly with degree of mental retardation. Chromosomal abnormalities yielded a significantly higher proportion of "hard positive" cases (43%) than any other etiology. Identification of sub-populations at risk for conductive disorders, such as those of chromosomal abnormalities and/or more severe developmental delays will enable the employment in the future of more efficient auditory screening techniques.

Acoustic Impedance Tests↗
PubMed1993

Tympanometry as a screening tool in the NICU: is it effective?

This study assess the usefulness of the tympanogram as a screening tool for identifying otitis media and serous otitis media in preterm infants. Twenty-six infants from the NICU were assessed on the same day by two examiners using tympanometry and pneumatic otoscopy. The results were recorded separately and compared after all infants were tested. An audiologist independently interpreted each of the tympanogram strips. There was very little agreement between tympanometry and otoscopy results. The tympanogram was not found to be a repeatable or a reliable screening tool for assessing otitis media and serous otitis media in the NICU population. It was concluded that the NICU nurse must be aware of the signs and symptoms of otitis media and serous otitis media. If this diagnosis is raised for an infant in the NICU, careful visualization of the tympanic membrane should be carried out along with referrals to ear, nose, and throat and audiology experts.

Acoustic Impedance Tests↗
PubMed1993

Microtympanometry, microscopy and tympanometry in evaluating middle ear effusion prior to myringotomy.

OBJECTIVE: To determine the accuracy of a hand-held microtympanometer (Microtymp, Welch Allyn) used by a general practitioner when compared with findings at myringotomy. METHOD: Independent preoperative assessment of children's ears using microtympanometry by a general practitioner, microscopy and pneumatic otoscopy by a specialist otologist and impedance bridge tympanometry by a specialist audiologist were performed and compared with findings at myringotomy. SUBJECTS: Fifty children (100 ears) on the waiting list for bilateral myringotomies and ventilation tube insertion for recurrent acute otitis media or otitis media with effusion. RESULTS: Microscopy with pneumatic otoscopy had a 90.9% sensitivity and a 92.9% specificity in detecting middle ear effusions. Impedance bridge tympanometry had a 94.4% sensitivity and a 71.8% specificity if type B and C2 were combined to predict middle ear effusion. Microtympanometry had 100% sensitivity and 75% specificity if type B and C tympanograms were combined; if type B tympanograms alone were used, a sensitivity of 83.4% and specificity of 75% in predicting middle ear effusions was obtained. CONCLUSION: The Microtypm is a useful instrument in general practice for assessment of middle ear effusions as no ears with fluid were missed in this study if type B and C tympanograms were considered abnormal. The Microtymp would also be useful as a screening instrument by suitably trained personnel.

Acoustic Impedance Tests↗
PubMed1990

[Curietherapy of the Eustachian tube using Ir-192 in chronic otitis of tubal origin].

Failure of chronic otitis surgery, especially tympanoplasty, are mainly related to Eustachian tube dysfunction. A new technique of anti-inflammatory irradiation of the Eustachian tube was designed in 1985 in Créteil to improve the Eustachian tube function. The Eustachian tube is catheterized during the tympanoplasty using a plastic tube, 1.6 mm in diameter; this tube is closed at the external end. The other end of the tube is open and goes through the opposite nasal cavity. The plastic tube is loaded 24 h later with a 4.5 cm long irridium 192 wire to deliver a dose of 3 Gy on the reference isodose, 4 mm in diameter, in approximately 3 h. The tube is then gently withdrawn through the nasal cavity. Seventy-four patients, 16 years old or more, took part in the study. The method was performed successfully in 62 patients. Fifty-six patients were followed up; mean follow-up was more than 20 months. The follow-up assessment included otoscopy, audiometry, impedancemetry and residual Rinne measurement. Otoscopy results were adequate in 86% of patients. Hearing was improved in 44% of patients. Impedancemetry was adequate in 70% of patients and residual Rinne lower than 20 dB in 56%. These results are better if compared with those of a series of 30 tympanoplasties performed without intracavitary irradiation in 1984: the tympanoplasty failure rate then was 73%. In conclusion, this new procedure proved to be safe and simple and led to an improvement of the functional results of complex tympanoplasty.

Adolescent↗
PubMed1996

Screening for hearing loss in juvenile detention centers.

Results of hearing screenings for 226 incarcerated adolescents are presented. Screenings consisted of visual otoscopy check, pure-tone screening, and tympanometry. Failures were defined as excessive cerumen impeding a clear view of the tympanum, failure to respond at 25 dB HL for 1000 through 6000 Hz, or a Jerger Type B or C tympanogram. An overall failure rate of 35.5 percent was found, with 9.8 percent failing otoscopy, 7.5 percent failing tympanometry, and 25.3 percent failing pure-tone screening. Implications for medical and audiologic evaluation in the population are discussed.

Adolescent↗
PubMed1977

[A comparison of tympanometric with audiometric and otoscopic findings (author's transl)].

An analysis is reported of the assessment of 233 ears by otoscopy from which the tympanic membrane appearances were classed into five groups, audiometry, tympanometry and in 57 cases middle-ear-puncture. Although observer errors must be acknowledged the findings were that the type B tympanogram does not conform to a specific pathology and may occur with different degrees of conductive hearing loss. Furthermore in the diagnosis of middle ear effusion the tympanogram does not supercede careful otoscopy and pure tone audiometry.

Acoustic Impedance Tests↗
PubMed1999

Magnetic resonance imaging and audiologic assessment of middle ear effusions in patients with nasopharyngeal carcinoma before radiation therapy.

OBJECTIVE: The aim of this study was to assess the performance of clinical methods, viz. otoscopy, pure-tone audiometry, and tympanometry in diagnosing middle ear effusions (MEEs) using magnetic resonance imaging as a reference standard. STUDY DESIGN: A retrospective study of 46 patients with newly diagnosed nasopharyngeal carcinoma was performed comparing clinical evaluation and audiometry results with magnetic resonance imaging findings obtained before radiation therapy. RESULTS: Twenty-two (25%) of the temporal bones imaged had both MEE and mastoid effusions, 24 (27%) had only middle ear fluid, and 29 (33%) had mastoid fluid alone. The sensitivity for tympanometry, audiometry, and otoscopy in detecting fluid in the middle ear was 96%, 92%, and 80%, respectively. Although tympanometry was most sensitive in diagnosing MEE, there was no statistically significant difference when comparing the overall accuracy of pure-tone audiometry air-bone gap and tympanometry (p = 0.7, chi-square test). Flat curve tympanograms (type B) only achieved a sensitivity of 45% but were of high specificity (92%). Forty-nine percent with negative pressure tympanograms (mean air pressures > -100 daPa) had no MEE. CONCLUSIONS: Using magnetic resonance imaging as a reference standard, tympanometry is the most sensitive audiologic test in detecting the presence of MEE. The overall accuracy of tympanometry, pure-tone audiometry air-bone gap, and otologic examination was, however, not significantly different.

Acoustic Impedance Tests↗
PubMed2003

The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study.

CONTEXT: Hearing impairment affects many older adults, but the incidence is unknown. OBJECTIVE: To determine the 5-year incidence and progression of hearing impairment. DESIGN: A longitudinal, population-based study of adults aged 48 to 92 years at baseline examination. Hearing sensitivity was measured twice, 5 years apart. SETTING: Testing was conducted at the Beaver Dam Community Hospital, Beaver Dam, Wis. PARTICIPANTS: A total of 1636 participants without hearing loss and 1085 participants with hearing loss at the baseline examination in 1993-1995 were reexamined in 1998-2000. MAIN OUTCOME MEASURES: The examinations included otoscopy, screening tympanometry, and tone air- and bone-conduction audiometry. Incidence of hearing impairment was defined as a pure-tone average (PTA) of thresholds at 500, 1000, 2000, and 4000 Hz (PTA 0.5, 1, 2, and 4 kHz) greater than 25 dB HL (hearing level) in either ear at follow-up among those without hearing loss at baseline. Progression was defined as a change of more than 5 dB in the PTA 0.5, 1, 2, and 4 kHz among those with hearing loss at baseline. RESULTS: The 5-year incidence of hearing impairment was 21%. More than half of those with hearing loss at baseline experienced a decline in hearing. Age was an important risk factor for both incidence and progression. Male sex, occupation, and education were associated with the incidence of hearing loss after adjusting for age. CONCLUSIONS: Older adults have a high risk of developing hearing loss. Among those with hearing loss, most experience further declines in hearing sensitivity over time. These data indicate that hearing impairment is an important public health problem and underscore the need for appropriate hearing screening and treatment.

Acoustic Impedance Tests↗
PubMed2004

The genetic component of middle ear disease in the first 5 years of life.

OBJECTIVE: To determine the genetic component of time with middle ear effusion (MEE) and episodes of MEE and acute otitis media. DESIGN: Prospective twin/triplet cohort. SETTING: Research center at a tertiary pediatric hospital. PARTICIPANTS: A total of 168 healthy same-sex twin and 7 same-sex triplet sets were recruited by age 2 months. INTERVENTIONS: Longitudinal assessment of middle ear status by pneumatic otoscopy and tympanometry at monthly evaluations, and at examinations during upper respiratory tract infections or symptoms of middle ear disease. OUTCOME MEASURES: Proportion of time with MEE and episodes of acute otitis media and MEE. RESULTS: Of the 140 sets for which zygosity was obtained, 114 were followed up to age 3 years and 83 sets to age 5 years. The heritability estimate for proportion of time with MEE in the first 5 years of life was 0.72 (P<.001). The correlation of proportion of time with MEE between children within a set was significantly higher in monozygotic sets (0.65-0.77) than in dizygotic sets (0.31-0.39) for each year to age 3 years. In the fourth and fifth years of life, the correlations decreased in both monozygotic and dizygotic twin sets. CONCLUSIONS: Findings for the first 2 years of follow-up have been previously published and indicate a strong genetic component to the proportion of time with MEE. In the present report, which details the entire 5-year follow-up, the effect of this component appears to attenuate after the third year but its cumulative effect remains significant after 5 years.

Acoustic Impedance Tests↗
PubMed2006

Spectral gradient acoustic reflectometry in the diagnosis of middle-ear fluid in children.

Diagnosis of otitis media is based on detection of middle-ear fluid (MEF) and is both important and difficult to achieve. Also non-infectious MEF is important to detect, since it can compromise hearing. In this prospective, blinded study, spectral gradient acoustic reflectometry (SG-AR) was evaluated as an indicator of MEF among children. Sensitivity, specificity and positive and negative predictive values of SG-AR in detecting MEF were calculated in children undergoing ambulatory surgery for recurrent or secretory otitis media using otomicroscopic myringotomy as the reference method of confirming middle-ear status. Final study material consisted of 376 ears. Pattern recognition of SG-AR curves reached the best combination of sensitivity and specificity (69 and 97%, respectively), and the best combination of positive (PPV) and negative (NPV) predictive values (93 and 83%, respectively), in detection of MEF. With a spectral gradient value of <80 degrees , the sensitivity was 75% and specificity 71%. With <50 degrees , PPV was 78%, and with >or=100 degrees , NPV was 86%. The diagnostic power of SG-AR was comparable to that reported with pneumatic otoscopy and tympanometry. It was equally effective in detecting both MEF cases and healthy ears. Pattern recognition seems to improve its performance. We recommend the use of pattern recognition of SG-AR as a screening method for MEF among children.

Acoustics↗
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↗
PubMed2003

Diagnostic accuracy of otitis media and tympanocentesis skills assessment among pediatricians.

The comparative study presented here evaluated pediatricians from Italy, Greece, South Africa, and a reference group in the USA to determine (i) their ability to accurately diagnose acute otitis media (AOM) and otitis media with effusion (OME) using otoscopy, (ii) their knowledge of antibiotics, and (iii) their technical competence in performing tympanocentesis. The participants included 66 pediatricians from Italy, 115 from Greece, 36 from South Africa and 2,190 from the USA (reference group). Each pediatrician viewed nine video-recorded otoscopic examinations of tympanic membranes, after which their ability to differentiate AOM, OME and normal was ascertained. Questions were posed regarding appropriate, pathogen-directed antibiotic selection for AOM. A mannequin model was used to assess the technical proficiency of each pediatrician in performing tympanocentesis. Results were recorded for each group as the mean percentage +/- standard deviation. The correct diagnosis was made by each group of pediatricians in the following frequencies: Italy, 54+/-27% (range, 18-94%); Greece, 36+/-12% (range, 23-56%); South Africa, 53+/-21% (range, 22-88%); and the USA, 51+/-11% (range, 29-72%). The difference between results from Greece and the US reference group was statistically significant ( P=0.002). Pediatricians from each group over-diagnosed AOM with the following frequencies: Italy, 18+/-19% (range, 2-49%); Greece, 34+/-13% (8-50%); South Africa, 23+/-14% (7-44%); and the US reference group, 26+/-19% (7-51%). Pediatricians correctly selected an antibiotic recommended for treatment of AOM caused by drug-resistant Streptococcus pneumoniae as follows: Italy, 89%; Greece, 77%; South Africa, 82%; and the USA, 80%. For treatment of beta-lactamase-producing Haemophilus influenzae, the results were: Italy, 90%; Greece, 70%; South Africa, 81%; and the USA, 77%. Tympanocentesis was optimally performed by >/=86% of all pediatricians. The results indicate that pediatricians may often misdiagnose OME as AOM, but they select appropriate antibiotics about 80% of the time and can be trained to accurately perform tympanocentesis.

Anti-Bacterial Agents↗
PubMed2005

Sensorineural hearing loss in patients with inflammatory bowel disease: a subclinical extraintestinal manifestation.

Isolated case reports in which symptomatic hearing loss develops suddenly during the course of inflammatory bowel disease (IBD) have been reported, but the presence of subclinical sensorineural hearing loss (SNHL) associated with IBD has been investigated in only two preliminary studies. In order to research this further, we aimed to investigate the presence of subclinical SNHL in IBD by comparison with a control group and to examine possible relations between the bowel disease parameters and hearing loss.Otoscopy, tympanometry, and pure tone audiometry were carried out in 39 patients with IBD (21 Crohn's disease [CD], 18 ulcerative colitis [UC]) and 25 healthy age- and sex-matched controls. All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD.

Adolescent↗
PubMed2005

Effect of myringotomy on prognosis in pediatric acute otitis media.

OBJECTIVE: In children with acute otitis media (AOM), we compared clinical outcomes between groups with and without myringotomy to elucidate the effect of this procedure on long-term clinical course and prognosis. METHODS: Fifty-nine children (29 male, 30 female) with tympanic membrane bulging or middle ear fluid (MEF) at initial presentation were assigned to one of two treatment groups. Group A received oral antibiotics and also underwent myringotomy at initial enrollment (36 cases), while group B received oral antibiotics without myringotomy (23 cases). Clinical outcomes were evaluated by otolaryngologic specialists using pneumatic otoscopy and tympanometry at 5, 10, 15, 30 days and 12 weeks and then every 2 weeks after the initial treatment. Otitis media with effusion (OME), early recurrence and recurrent AOM were used as the evaluation criteria for the prognosis. RESULTS: In group A, 6 children (16.7%) showed transition to OME, 11 (30.6%) showed early recurrence of AOM, and 9 (25.0%) developed recurrent AOM. In group B 10, 8, and 3 (43.5%, 34.8%, and 13.0%) showed these respective adverse outcomes. While early recurrence rates and recurrent AOM rates did not differ significantly between groups, progression of OME was significantly less frequent in group A than group B (P = 0.036). CONCLUSIONS: Lower rates of progression to OME in the group undergoing myringotomy suggested that myringotomy might be effective in preventing this outcome.

Acoustic Impedance Tests↗
PubMed2004

Current challenges in diagnosis of acute otitis media.

Diagnosis of acute otitis media is difficult: circumstances and equipment for diagnosis are often compromised, the child may be uncooperative, signs and symptoms of acute otitis media and those of the common cold are mostly the same, and parents appear to have strong opinions concerning correct diagnosis and treatment. Many clinicians have received inadequate pre- and postgraduate education about diagnosis. On the other hand, they are aware of the worldwide problem of antimicrobial resistance resulting from antibiotics unwisely prescribed for viral infections. We performed a systematic search to summarize what is known about diagnosis of acute otitis media and suggest ways to improve one's diagnostic skills. With the combination of appropriate and well-maintained diagnostic equipment for tympanometry and pneumatic otoscopy, strict diagnostic criteria, and open communication with each child's parents it is possible to increase accuracy in acute otitis media diagnosis. Recent public health campaigns both among clinicians and parents, plus increased knowledge of diagnostics reveal the possibility of significantly decreasing the number of acute otitis media diagnoses in children which will lead to reduced prescription of antibiotics.

Acoustic Impedance Tests↗
PubMed2005

Validation of tele-otology to diagnose ear disease in children.

OBJECTIVE: To determine if digitised still eardrum images, with a clinical history, and audiometry and tympanometry data provide sufficient information to an ear specialist to make an assessment of a patient. METHODS: 66 children (9 months to 16 years) from remote communities were assessed by an ear specialist by standard otoscopy, using a clinical history, audiometry and tympanometry. Up to five images of each ear were digitised. At a later date, the ear specialist made observations, diagnoses and recommendations for management from the images and clinical data. RESULTS: There was a significant correlation (p<0.01) between image quality and age of the subject. There were significant agreements for the clinically important observations of otorrhea, perforation, retracted tympanic membrane and atrophy of the tympanic membrane (p<0.05). There were significant agreements for the diagnoses of acute otitis media, chronic suppurative otitis media, otitis media with effusion and Eustachian tube dysfunction. The rate of recommendations for review or referral after a tele-otology assessment were between 4 and 16% higher than those in made in the field. The agreements between the various forms of advice or recommendations made in the field to those made by tele-otology were statistically significant (p<0.01). CONCLUSIONS: A tele-otology system that incorporates good quality digitised images of the tympanic membrane, audiological and tympanometric data, and a comprehensive clinical history provides the ear specialist with sufficient information to make a confident diagnose of existing middle ear disease, and provide management advice to the patients' primary care provider.

Acoustic Impedance Tests↗
PubMed2005

Diagnostic value of tympanometry using subject-specific normative values.

OBJECTIVE: Tympanometry has proven valuable in the diagnosis of otitis media in infants. The classification used in the Finnish otitis media studies has resulted in high specificity yet only moderate sensitivity. We aimed to explore the benefit of using each subject's individual previous test results (obtained at previous visits of the children when diagnosed healthy) as normative values. Specific aim was to assess this approach in increasing sensitivity in the diagnosis of otitis media. METHODS: We used tympanometric (GrasonStadler GSI 38) results of children in the Finnish otitis media vaccine trial obtained at pre-scheduled 7-month visits (if ears found healthy) and at the first subsequent sick visit with respiratory infections and potential otitis media within a 90-day period after the 7-month visit. Children with recent otitis media within the previous month and tympanometric tests with documented interfering factors were excluded. Pneumatic otoscopy was used as the reference method for the diagnosis of otitis media. RESULTS: Altogether 2476 children at the 7-month visits were examined; after exclusions data on 1759 children were available for analysis. Of these children, 630 were brought to at least one sick visit defined above. Finally, data on 906 ears were available for analysis. Entirely flat type B tympanograms predicted otitis media accurately; also high-peaked tympanograms were accurate in predicting normal middle ear status. For the moderate-peaked curves in-between, absolute and relative changes in the tympanometric variables from the 7-month visit to the sick visit were explored for accurate prediction of otitis media; decrease in curve height by at least 2/3 was found most valuable. Sensitivity of the type B tympanogram was 61% and specificity 99% at the sick visit. The sensitivity increased to 67% with a specificity of 98%, if results with the ratio of static acoustic admittance (height of the curve) at the sick visit compared to the previous healthy visit <0.35 were also considered abnormal together with type B curve in indicating otitis media. CONCLUSIONS: The subject-specific normative values were not found especially useful, although a slight increase in sensitivity was achieved without compromizing specificity.

Acoustic Impedance Tests↗
PubMed2006

A high prevalence of new onset otitis media during parent diagnosed common colds.

INTRODUCTION: Past studies suggest that the majority of new otitis media (OM) diagnoses is a complication of a colds/flu. A prospective format was used to determine the coincidence of otitis media and parent diagnosed cold/flu episodes in young children followed over a typical cold/flu season. METHODS: Eighteen families with children aged 1-8 years were followed from October 1 to April 30 using parent-completed daily diaries focused on cold/flu signs and weekly examinations using pneumatic otoscopy for diagnosis of the presence/absence of otitis media. RESULTS: Overall, 108 cold episodes were documented in 36 enrolled children with 20 colds (19%) occurring during a pre-existing OM episode and 40 colds (37%) complicated by a new OM episode. Conversely, there were 82 new OM episodes, 40 (49%) were associated with a cold in the individual child and 18 (22%) with a concurrent cold in a family member. The median duration of the OM episodes was approximately 2 weeks but this was longer for OM episodes where earache was reported. CONCLUSION: The results confirm past observation relating new OM episodes to a concurrent cold/flu but show these episodes to usually be of short duration. Two sources of potential bias were identified for point prevalence study formats: the presence of a pre-existing OM for a new onset cold/flu and the possibility of subclinical colds in patients with new OM episodes. These biases reinforce the need for longitudinal study formats to address this important relationship.

Child↗