Diagnosis Of Middle Ear Disease Research Articles

Diagnosis of middle ear disease using tympanograms and digital imaging

Otolaryngology–Head and Neck SurgeryVolume 129, Issue 2 p. P132-P132 Tuesday, September 23, 2003, 9:30 am to 10:30 am Room OCCC 202 Scientific Sessions: General 9:30 am Diagnosis of Middle Ear Disease Using Tympanograms and Digital Imaging Stanley E Thawley MD, Stanley E Thawley MDSearch for more papers by this authorMichael D Poole moderators MD PhD, Michael D Poole moderators MD PhDSearch for more papers by this authorAnna Aronzon presenter MD, Anna Aronzon presenter MD Philadelphia, PASearch for more papers by this authorAdam T Ross MD, Adam T Ross MD Philadelphia, PASearch for more papers by this authorKen Kazahaya MD, Ken Kazahaya MD Philadelphia, PASearch for more papers by this authorMasaru Ishii MD PhD, Masaru Ishii MD PhD Baltimore, MDSearch for more papers by this author Stanley E Thawley MD, Stanley E Thawley MDSearch for more papers by this authorMichael D Poole moderators MD PhD, Michael D Poole moderators MD PhDSearch for more papers by this authorAnna Aronzon presenter MD, Anna Aronzon presenter MD Philadelphia, PASearch for more papers by this authorAdam T Ross MD, Adam T Ross MD Philadelphia, PASearch for more papers by this authorKen Kazahaya MD, Ken Kazahaya MD Philadelphia, PASearch for more papers by this authorMasaru Ishii MD PhD, Masaru Ishii MD PhD Baltimore, MDSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/S0194-59980301108-2Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume129, Issue2August 2003Pages P132-P132 RelatedInformation

9:30 am Diagnosis of Middle Ear Disease Using Tympanograms and Digital Imaging

9:30 am Diagnosis of Middle Ear Disease Using Tympanograms and Digital Imaging

Diagnostic Accuracy of Otitis Media

To the Editor.—The recent article by Pichichero1 is very humbling. It is interesting that the average pediatric resident was correct only 41% of the time when diagnosing otitis media and pediatricians managed a score of only 51%. This seems even more incredible when you consider the bias. The participants of the Outcomes Management Educational Workshops on otitis media are obviously physicians who are interesting in improving their diagnostic skills. They are not average primary care providers. Dr Pichichero and his colleagues have tested >2000 pediatricians, but that is less than a 5% sample of those in practice. He has a lot more to accomplish. Having taken the course twice, I can attest to it being a superbly intellectually stimulating continuing medical education process. Everyone I have talked to who has taken the course agrees.However, it would be unfair to extrapolate the survey to what goes on in private practice. I believe that the average pediatrician is correct more than 50% of the time when the diagnosis of acute otitis media (AOM) is made. Dr Pichichero mentions that the history of the patients was not available and states, “Symptoms that predict AOM are neither sensitive nor specific.” That is true of individual symptoms. However, the literature is replete with evidence that the more criteria that are used in making a diagnosis, the more accurate the diagnosis becomes.Perhaps the most important limiting aspect of the videos that are the core of the course is that only 1 ear is shown. Most primary care providers look at both ears. AOM is unilateral about 50% of the time, and the diagnosis is easy. When bilateral, AOM is most commonly asymmetrical and generally not difficult to diagnose. Otitis media with effusion (OME) is often bilateral, symmetrical, and silent. OME is difficult, and without pneumatic otoscopic examination and/or objective technology, it may be missed.I commend Dr Pichichero and his associates for doing a wonderful job in putting the diagnosis of otitis media in such a practical format. Fewer than 20% of pediatricians follow the 1994 Agency of Health Care Policy for OME.2 I suspect that those who do would test well by Dr Pichichero and those that don’t would not. It would be interesting to find out if pediatricians who use objective technology to diagnose otitis media would fare better in his course. I suspect they would and suggest that this variable be assessed in the future. The recommendations for the judicious use of antibiotics in AOM3 state, “Newer tools such as tympanometry and acoustic reflectometry can aid in establishing the presence of fluid and in validating the examiner’s skills through repeated use and comparison with visual observations.” Dr Klein believes that tympanometry and acoustic reflectometry are important adjunctive technologies in the diagnosis of middle ear disease.4 I would like to see more emphasis on these technologies for the practicing pediatrician.

Diagnosis of middle ear disease with eardrum perforation by a newly developed sweep frequency measuring apparatus.

Dynamic characteristics of an artificial middle ear model with and without eardrum perforations were measured with our newly developed sweep frequency measuring apparatus. Then, the dynamic characteristics of patients with chronic otitis media having eardrum perforations and with traumatic perforations were measured with this apparatus, and the results were compared with those of the artificial middle ear model with an eardrum perforation. The comparison leads to the conclusion that the middle ear condition of patients with eardrum perforations can be distinguished on the basis of their measurement results. Furthermore, the ossicular chain conditions of patients with eardrum perforations can be diagnosed after putting a paper patch on the eardrum perforation. Therefore, this apparatus seems to be highly useful in the diagnosis of both ossicular chain disorders and eardrum perforations.

Dynamical characteristics measurement of the middle ear of normal subjects and patients with new developed measuring equipment.

The traditional measuring equipment called "Tympanometer", which measures the dynamical characteristics of the middle ear, is widely used, but its reliability is insufficient. Therefore, an attempt is made here to develop new measuring equipment which will give us more detailed information, and the dynamical characteristics of the middle ear of normal subjects and patients are measured with this equipment. The results show a significant dependence on the dynamical characteristics of the middle ear upon external auditory meatus pressure and the large individual difference of the middle ear dynamical characteristics, in spite of normal subjects.The possibility exists of the clinical application of this newly developed measuring equipment to the diagnosis of middle ear diseases.

Tympanometry and middle ear effusion: A cohort-study in three-year-old children

Myringotomy was done on 44 three to four-year-old children out of a total of 463 three-year-olds in a geographically defined area, because these 44 children persistently showed abnormal screening-tympanometry over 6 months. The findings were correlated to middle ear pressure, absolute compliance, absolute gradient and relative gradient parameters. As regards the state of effusion in the middle ear, all parameters showed a high predictive value. A reverse proportionality of compliance parameters and the content of fluid in the tympanic cavity, each related to the magnitude of associated hearing loss, was demonstrated. The significance of the findings in the tympanometric diagnosis of middle ear disease in young children is outlined, and a revised classification system of the tympanogram, predicting middle ear effusion with a sensitivity of 91% and a specificity of 84%, is recommended.

Tympanometry in three-year-old children. III. Correlation between tympanometry and findings at paracentesis in a prospectively followed population of otherwise healthy children aged 3--4 years.

Paracentesis was performed on 46 three- to four-year-old children out of all 523 three-year-olds in a geographically defined area, because these 46 children had persistently showed abnormal tympanograms over a 6-month period. The findings were correlated to the parameters middle ear pressure, absolute compliance, absolute gradient, and relative gradient. As regards the state of effusion in the middle ear, all these parameters--except for the middle ear pressure--showed a high predictive value. The significance of the findings in the tympanometric diagnosis of middle ear disease in the younger age groups is outlined.

Differential Diagnosis of Middle ear Diseases by Tympanogram

Differential Diagnosis of Middle ear Diseases by Tympanogram

Ultrasonics in otolaryngology. An aid in the diagnosis of middle ear fluid.

In this study of diagnostic ultrasound as an aid in the diagnosis of middle ear disease a hand-held transducer with an external diameter of 3 mm was placed in the external ear of cadavers, volunteers, and patients. The resultant A-scan demonstrated echoes from the tympanic membrane when the middle ear was devoid of fluid. When fluid was present in cadaver and patient ears, echoes were returned from both the tympanic membrane and the middle ear. Additional echoes were returned when the fluid-filled middle ear also contained air bubbles. Retraction of the drum can also be quantitatively evaluated with ultrasound. It is hoped that this technique will be employed for the detection of fluid in the middle ear when clinical signs are equivocal or when tympanosclerosis prevents visualization of the events in the middle ear.