Abstract
Ultrasound detection of middle ear effusion (MEE) is an emerging technique in otolaryngology. This study proposed using ultrasound characterization of the mastoid to noninvasively measure MEE-induced mastoid effusion (ME) as a new strategy for determining the presence of MEE. In total, 53 patients were enrolled (Group I: normal, n = 20; Group II: proven MEE through both otoscopy and tympanometry, n = 15; Group III: patients with MEE having effusions observed during grommet surgery, n = 18). A 2.25-MHz delay-line transducer was used to measure backscattered signals from the mastoid. The Nakagami parameter was estimated using the acquired signals to model the echo amplitude distribution for quantifying changes in the acoustic structures of mastoid air cells. The median Nakagami parameter and interquartile range were 0.35 (0.34–0.37) for Group I, 0.39 (0.37–0.41) for Group II, and 0.43 (0.39–0.51) for Group III. The echo amplitude distribution observed for patients with MEE was closer to Rayleigh distribution than that without MEE. Receiver operating characteristic (ROC) curve analysis further revealed that the area under the ROC was 0.88, sensitivity was 72.73%, specificity was 95%, and accuracy was 81.13%. The proposed method has considerable potential for noninvasive and comfortable evaluation of MEE.
Highlights
Attenuation of ultrasound, which is another possible reason affecting ultrasound measurements because of a poor signal-to-noise ratio
The difference in the signal intensity and waveform between different groups may be attributed to Mastoid effusion (ME), which can be treated as the change in the acoustic structures of the mastoid caused by MEE
This study proposed ultrasound characterization of the mastoid as a noninvasive approach for determining the presence of MEE
Summary
Attenuation of ultrasound, which is another possible reason affecting ultrasound measurements because of a poor signal-to-noise ratio. MEE-induced effusions in the mastoid changes the acoustic impendence of air cells, changing the intensity of ultrasound signals reflected from the mastoid. This can be supported by our previous study in human cadavers, which showed that ME changes the amplitude of ultrasound signals[20]. In a relatively complex mastoid structure, the interaction between air cells and the incident wave tends to produce ultrasound scattering; the received ultrasound echoes backscattered from the air cells may be considered random signals. Based on the randomness of ultrasound backscattering, statistical distributions have been widely used to model the echo amplitude distribution for tissue characterization[21]. Ultrasound backscattered signals were acquired from the mastoid for estimating the Nakagami parameter. This study discussed clinical values of the proposed method for the future diagnosis of MEE
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