Impedance Tympanometry Research Articles

Predictive value of the Eustachian Tube Dysfunction Questionnaire-7 for identifying obstructive Eustachian tube dysfunction: A systematic review.

ObjectiveTo perform a systematic review to determine if a total score of ≥14.5 (mean score ≥ 2.1) on the ETDQ‐7 accurately identifies patients with obstructive Eustachian tube dysfunction (OETD) on impedance tympanometry (peak compliance <0.2 mL or middle ear pressure of −100 daPa) or other objective measures of OETD.MethodsA systematic review without a meta‐analysis was performed of studies in four electronic databases (Pubmed, Embase, Web of Science, and Scopus) that used the ETDQ‐7 and at least one objective measure of OETD.ResultsSix‐hundred and fifty‐two studies were identified in the initial literature search. s from 337 studies were screened, followed by full‐text review of 61 studies, and qualitative synthesis of 12 studies. Tympanometry was used as an objective measure in ten studies. Eight of the 12 included studies had patient cohort selection bias. Eight studies administered the ETDQ‐7 in cohorts of patients with or without OETD, already confirmed on tympanometry, and found a sensitivity of 91%‐100% and specificity of 67%‐100%. Four studies administered the ETDQ‐7 to patients who had not previously undergone objective testing and found a sensitivity of 49%‐80% and specificity of 24%‐78%.ConclusionsThe ETDQ‐7 is an important patient‐reported outcome measure. However, based upon existing literature, the ETDQ‐7 appears limited as a diagnostic tool for OETD or as an objective measure of Eustachian tube function.

Vestibular impact of Friedreich ataxia in early onset patients

BackgroundFriedreich ataxia (FRDA) is the most frequent form of inherited ataxias. Vestibular and auditory assessments are not commonly part of the check up for these patients despite hearing and balance complaints. Screening of vestibular and auditory function was performed in a large group of young patients with genetically confirmed FRDA.MethodsOur study included 43 patients (7–24 years of age). A complete vestibular assessment was performed including the canals function evaluation at 3 head velocities (bithermal caloric test, earth vertical axis rotation (EVAR) and head impulse test (HIT)) and otolith function evaluation (cervical vestibular evoked myogenic potentials). Information regarding the hearing evaluation of the patients were also retrieved including impedance tympanometry, distortion product otoacoustic emissions (DPOAEs), air and bone conduction audiometry and auditory brainstem response (ABR).ResultsVestibular responses were impaired for canal responses (only at high and middle head velocities) and vestibulospinal otolithic responses. Abnormal neural conduction in the central auditory pathways was frequently observed. Oculomotor abnormalities were frequent, mostly hypermetric saccades and gaze instability. Inhibition of the vestibulo-ocular reflex by fixation was normal.ConclusionsWe show that Friedreich ataxia, even at onset, frequently associate saccadic intrusions, abnormal ABRs and decreased vestibulo-ocular and vestibulospinal responses progressing over time. These sensory impairments combined with ataxia further impair patient’s autonomy. These vestibular, auditory and visual impairments could be used as markers of the severity and progression of the disease. Adding vestibular and auditory testing to Friedreich patient’s evaluation may help physicians improve patient’s management.

The effectiveness of adenoidectomy in the treatment of glue ear: a randomized controlled trial

One hundred children with glue ear, in whom surgical treatment was indicated, were randomly allocated to 1 of 4 treatment groups. Children in 2 of the groups underwent adenoidectomy plus various combinations of ear operations while in the other 2 groups surgery was confined to the ears. The effect of adenoidectomy was assessed 6 weeks, 6 months and 1 year after surgery by means of audiometry, impedance tympanometry and parental opinion. Improvements in hearing were greater in those children who underwent an adenoidectomy than in those who did not (4.0 dB at 6 weeks; 2.4 dB at 6 months; 0.7 dB at 1 year). However, these differences are of little clinical significance and were only statistically significant (P < 0.05) 6 weeks after surgery. Middle ear function, measured by tympanometry, revealed a similar pattern of response to treatment. Despite this, 6 months after surgery a higher proportion of parents were satisfied with their child's condition if an adenoidectomy had been performed. Possible explanations of this discrepancy between clinical and parental assessments of outcome are discussed.

A Case of Middle Ear Lipoma

We present a case report of primary middle ear lipoma diagnosed in right ear of a 25-month-old girl with right otitis media. We identified injection and retraction at right ear drum. Impedance tympanometry of right ear was type B and temporal bone CT was suggestive of a congenital cholesteatoma. During the tympanoplasty, a mass of tissue obstructing the eustachian tube orifice was noted in the middle ear. We have treated a case of a lipoma that originated from the middle ear; only 5 such cases have been reported worldwide. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:273-5)

Progression of tympanometry and acoustic reflectometry. Findings in children with acute otitis media.

The presence of middle ear effusion (MEE) following acute otitis media (AOM) has been assessed by impedance tympanometry and acoustic reflectometry but has not been assessed serially from the time of presentation for AOM in the same group of patients. This descriptive study examined serial measurements by tympanometry and reflectometry in children with clinical AOM at the time of diagnosis, 3 to 5 days later, and at final follow-up 12 to 15 days after diagnosis. The study entry criteria were conservative in order to represent obvious cases of AOM and included 90 patients representing 107 ears. The objective was to describe the evolution of instrumental findings and to attempt to identify unique patient subpopulations with differing prognoses. We found that combined use of initial tympanometry and reflectometry, while yielding intriguing results, does not allow for identification of subpopulations with good or poor progression for MEE clearance at 2-week follow-up. It is our conclusion that initial tympanometry and reflectometry add to the cost of AOM diagnosis without clear benefit for the individual patient.

Incidence and progress of middle ear effusion in allergy practice as detected by acoustic otoscope reflectometry.

The incidence and progress of middle ear effusion (MEE) in allergy practice is not well established in prospective studies. A total of 393 patients were screened for MEE by history and physical including pneumatic otoscopy, prick and intradermal skin tests, acoustic otoscope reflectometry (AOR), impedance tympanometry (IT), and audiometry for those with established MEE. The primary diagnosis of the screened patients was intrinsic asthma in 70 or 18%, allergic rhinitis in 134 or 34%, allergic rhinitis and asthma in 80 or 21%, miscellaneous in 103 or 26%. Twenty patients were receiving immunotherapy (5%), and 89 (23%) had middle ear effusion (MEE). Among the MEE group were 52 males (58%), 37 females (42%), with an average age of 13 years, median of 8 years, and range of 6 months to 13 years. The MEE group was statistically different demographically from the initial group (P < .05) for age and history of recurrent otitis. The MEE group's primary diagnosis was similar to that of the initial group, except that there was a statistically significant difference in the number of patients on immunotherapy (P < .05) and those in the MEE group, with 11 (12%) versus 20 or 5% in the initial group. MEE resolved in 91% of cases which could be followed to resolution, with average duration of nasal steroid of 4 weeks, average duration of effusion 8 weeks, median 4 weeks, range 1 week to 6 months. Effusions in 8 patients (9%) were intractable with duration greater than 3 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Body volume changes during simulated microgravity: auditory changes, segmental fluid redistribution, and regional hemodynamics.

Space adaptation syndrome (SAS), manifested by cephalad fluid shifts, spacial disorientation, nausea, and vomiting, is of varied expression and uncertain etiology. One theory is that fluid shift to the upper body alters the function of the vestibular apparatus to create an entity similar to Meniere's disease. Since clinical vestibular dysfunction syndromes are mirrored by altered cochlear function, this experiment was undertaken to study the relation between fluid redistribution and the auditory effects of initial antiorthostatic bed rest. Manual and bone audiometry, impedance tympanometry, and brain-stem evoked potentials were used to monitor auditory changes prior to, during, and following short term exposure to -6 degrees head down tilt. Impedance plethysmography was performed to assess the segmental and intracranial fluid redistribution and hemodynamic changes during short-term head down tilt simulated microgravity. Even though significant cephalad fluid shift produced marked intracranial congestion and the subjects exhibited SAS symptoms, no clinically significant changes in the auditory system could be detected.

Prophylaxis for recurrent acute otitis media: a Brazilian study

We enrolled 60 children with recurrent acute otitis media (AOM) in a study of the effectiveness of antimicrobial prophylaxis. All children were entered into the study following an acute episode of infection treated with amoxacillin (AMX) for 10 days. Following therapy, the children were re-examined, and then randomly assigned to receive either trimethoprim-sulfamethoxazole (TMP-SMX), amoxacillin (AMX) or a placebo (PLA). Twenty children were included in each group. Each drug was administered once a day at bedtime, at 1/3 the therapeutic dose, for 3 months. Children were re-evaluated with pneumootoscopy during episodes of acute illness and with pneumootoscopy and impedance tympanometry (TYMP) at monthly intervals. We observed a significantly increased rate of recurrent AOM in children receiving placebo compared with those who received antibiotics (50% vs. 17% P < 0.005). Both prophylactic antibiotics were equally effective in preventing recurrent AOM (recurrence rate 20% TMP-SMX, 15% AMX). We also observed that recurrences in children receiving placebo occurred earlier in the study period than in those receiving antibiotics. These results suggest that antimicrobial prophylaxis in children with recurrent acute otitis media is effective in reducing subsequent disease. The similar efficacy of both antibiotics tested suggests that the less expensive agent should be used.

ERRATUM

In the article, "Impedance Tympanometry and Acoustic Reflectometry at Myringotomy," by Babonis et al, which appeared in the April issue of Pediatrics (1991;87:475-480), the parenthetical explanations in the legend of Figure 3 on page 477 are reversed. The legend should read: Fig 3. Frequency distribution of ears without fluid (lower panel) or with fluid (upper panel) by acoustic reflectivity in half-unit intervals.

Impedance Tympanometry and Acoustic Reflectometry at Myringotomy

A total of 220 ears undergoing myringotomy and pressure-equalizing tube placement were studied with impedance tympanometry and acoustic reflectometry in a direct comparison for detection of middle-ear effusion. Impedance tympanometry and acoustic reflectometry were equally accurate, detecting the presence or absence of middle-ear effusion in 73% and 72% of ears, respectively. The presence of effusion in ears with tympanographic patterns other than type A and type B was not consistently and reliably predicted. The higher sensitivity of impedance tympanometry (90%) compared with that for acoustic reflectometry (58%) contrasted with the opposite findings for specificities (54% vs 88%). It is concluded that impedance tympanometry and acoustic reflectometry measure different events at the tympanic membrane and their utility lies in the fact that they complement each other. These instruments can aid the experienced otoscopist in confirming a clinical impression and assist the less experienced clinician in validating or improving otoscopic skills.

External ear resonance in children with otitis media with effusion

A middle ear effusion has been shown, in KEMAR, to increase the height of the resonant peak of the external auditory canal by 6 dB SPL. It has also been shown that the hearing impairment due to otitis media with effusion is related to the volume of middle ear fluid. Therefore, it was hypothesized that measurement of the height of the resonant peak of the external auditory canal could be used as a method of assessing the magnitude of any hearing impairment due to otitis media with effusion. 182 ears from 182 children aged 3-12 (mean 6.3) years were studied. Pure-tone audiometry and impedance tympanometry were performed, and the acoustics of the external auditory canal were measured using the Rastronics CC1-10 frequency response analyser. The mean height of the resonant peak (17.9 dB SPL) of children with a type A tympanogram was significantly different from the mean value (23.6 dB SPL) of those with a type B tympanogram. There was a significant correlation between the height of the resonant peak and the speech frequency average of the pure-tone thresholds. The sensitivity and specificity of using the height of the resonant peak to detect hearing impairments in different age groups were calculated and compared with the sensitivity and specificity of tympanometry. The test did not provide the same degree of sensitivity as tympanometry but was more specific. The additional advantages of the test are that it is quick, taking less than 1 min per ear, and is well tolerated by children in whom there was a 99% compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

A randomised controlled trial of surgery for glue ear.

To assess the effect of five different surgical treatments for glue ear (secretory otitis media) on improvement in hearing and, assuming one or more treatments to be effective, to identify the appropriate indications for surgery. Randomised controlled trial of children receiving (a) adenoidectomy, bilateral myringotomy, and insertion of a unilateral grommet; (b) adenoidectomy, unilateral myringotomy, and insertion of a unilateral grommet; (c) bilateral myringotomy and insertion of a unilateral grommet; and (d) unilateral myringotomy and insertion of a grommet. Children were followed up at seven weeks, six months, 12 months, and 24 months by symptom history and clinical investigations. Otolaryngology department in an urban hospital. 149 Children aged 4-9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils, adenoids, or ears and no evidence of sensorineural deafness. Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22. Mean hearing loss (dB) of the three worst heard frequencies between 250 and 4000 Hz, results of impedance tympanometry, and parental views on their child's progress. In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term (for at least six months) than those in which no grommet had been inserted, irrespective of any accompanying procedure. Most of the benefit had disappeared by 12 months. Adenoidectomy produced a slight improvement that was not significant, though was sustained for at least two years. The ears of children who had had an adenoidectomy with myringotomy and grommet insertion, however, continued to improve so that two years after surgery about 50% had abnormal tympanometry compared with 83% of those who had had only myringotomy and grommet insertion, and 93% of the group that had had no treatment. Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery. Other variables contributed little additional predictive power. If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice. The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing. When deciding appropriate indications for surgery, a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention. Preoperative audiometry scores might be the best predictor in helping to make this decision.

Impedance tympanometry and the home environment in seven-year-old children

The distribution of tympanogram types among 872 seven-year-old children from a random population sample was related to 14 features of the home environment reported by parents in a questionnaire. Parental smoking was an important determinant of middle ear underpressure and effusion, and accounted for much of the associations observed with dampness, crowding and rented accommodation. Gas cooking was associated with a higher prevalence of effusion, but a lower prevalence of underpressure; this may deserve further study. After adjustment for seasonal variation, tenure and household smokers, the weekly mean temperature in the bedrooms of 34 children with Type B tympanograms was 18.2 degrees C, compared to 17.9 degrees C for 190 children with Type A tympanograms. The equivalent figures for bedroom relative humidity were 51.8 per cent and 52.7 per cent. It is unlikely that heating or ventilation of the home is an important determinant of middle ear effusion and underpressure in this age-group.

Single vs. double acoustic reflectometry tracings.

Impedance tympanometry and acoustic reflectivity tests were obtained on 503 infants and children ranging from 3 months to 12 years of age during a 6-week period in a solo primary care practice. One hundred eighty-five of 1005 tracings from the acoustic otoscope with recorder demonstrated 2 reflectivities. This phenomenon occurred more commonly in infants than in older children and was not seen with reflectivities higher than 7 units. One hundred thirty-eight of the 185 double reflectivity tracings were associated with abnormal impedance tympanometry. The double reflectivity phenomenon may be important in helping to explain the false negative results occasionally seen with this technology in low and intermediate reflectometry scores. Future clinical research involving acoustic reflectometry should utilize the recording device and single and double reflectivity tracings should be handled separately in any analysis of data. Use of the recorder will also prevent false positive errors in the interpretation of some intermediate reflectivities.

Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children.

To assess the contribution of passive exposure to tobacco smoke to the development of middle ear underpressure and effusion. Cross sectional observational study. One third of the primary schools in Edinburgh. 892 Children aged 6 1/2 to 7 1/2 were examined, and satisfactory tympanograms were obtained in 872. Results of assay of salivary cotinine concentrations were available for 770 children, and satisfactory tympanograms were available for 736 of these. Correlation of the prevalence of middle ear underpressure and effusion with concentrations of the marker of nicotine, cotinine, in the saliva of the children. Middle ear pressure and compliance were measured in both ears by impedance tympanometry. Salivary cotinine concentrations were assayed by gas-liquid chromatography. Cotinine concentrations increased with the number of smokers in the household. Girls had higher concentrations than boys, and children living in rented housing had higher concentrations than those living in housing owned by their parents. There was a trend towards more abnormal tympanometric findings with increasing cotinine concentration, the odds ratio for a doubling of the cotinine concentration being 1.14 (95% confidence interval 1.03 to 1.27). After adjustment for the sex of the child and housing tenure the odds ratio for a doubling of the cotinine concentration was 1.13 (1.00 to 1.28). The results of this study are consistent with those of case-control studies of children attending for an operation to relieve middle ear effusion. They indicate that the disease should be added to the list of recognised hazards associated with passive smoking. About one third of the cases of middle ear effusion in this study were statistically attributable to exposure to tobacco smoke.

Monitoring middle ear pressure by tympanometry. A study of middle ear pressure variation through seven hours.

The aim of this investigation was to monitor fluctuations in middle ear pressure, to study tympanometric signs of Eustachian tube functioning and to assess the validity of the tympanometric readings. In 20 patients with a low initial middle ear pressure (-150 daPa or lower) and 5 normals, impedance tympanometry was performed every 3 min through 7 h. Median pressure for the patients was -150 daPa (range 100 to -400 daPa) and for the normals 0 daPa (range 50 to -50 daPa). A remarkable pressure increase was seen after changing the body position to the supine. The patients were arranged into three groups according to the lowest middle ear pressure registered. Median pressures for the groups were running at a rather constant level. However, the individual pressure fluctuations in many patients were so great that a single tympanometric reading has to be considered unreliable when selecting patients for insertion of ventilation tubes. Thirteen patients never equalized their negative middle ear pressure, indicating that their Eustachian tube did not open during the test period. In spite of this the pressure did not decrease to lower values, indicating that maintaining a relative constant middle ear pressure is independent of opening of the Eustachian tube.

Acoustic Reflectometry in the Detection of Middle Ear Effusion

Acoustic reflectometry, a new technique for detecting middle ear effusion, was compared with results from tympanocentesis or myringotomy in 75 patients (141 ears). There was a highly significant association (P less than .0001) for ears having middle ear effusion with high reflectivity (5 through 9 units) and for ears having no middle ear effusion with low reflectivity (0 through 4 units). In a pediatric population with middle ear effusion present in 98 of 141 ears and using reflectivity readings greater than 4 to indicate middle ear effusion, the sensitivity of this technique was 86.7% and the specificity was 69.8%. False-positive errors usually occurred in ears with thick tympanic membranes, or in ears in which reflectivity was determined prior to the induction of anesthesia. False-negative errors usually occurred in ears with both air and fluid. This technique was validated by direct comparison with tympanocentesis or myringotomy and can be used with pneumatic otoscopy and impedance tympanometry to follow children with middle ear effusion.

The use of impedance measurements in the diagnosis of serous otitis media.

The use of impedance tympanometry is discussed as part of an integrated hearing conservation programme for children. A research project in Worcester followed through a cohort of over 1000 children and tested them in three phases-pre-school entrance; school entrance and approximately 8-12 months after school entrance. At each phase of the programme 3 stages of test were devised to ensure that the ENT facilities were not overloaded with false positive cases of OME. The problems of the staging are discussed, including reasons why cases were probably missed in earlier phases. 25 cases of persistent OME were found which were confirmed at operation. 9 passed through phase 1 and persisted into phases 2 and 3 of the test series. The conclusion is reached that in 18 of the 25 cases the condition persisted from the pre-school phase.

Temporomandibular joint dysfunction in children presenting as otalgia.

Thirty-one children between the ages of 6 and 16 years with otalgia but normal eardrums were investigated for temporomandibular joint dysfunction. Ear disease was excluded by microscopic examination, pure tone audiometry and impedance tympanometry. Dental disease was excluded by clinical and radiographic examination. Temporomandibular joint dysfunction was diagnosed by finding tenderness of the joint or masticatory muscles in at least two separate sites at one examination. Twenty-one patients were assessed as having joint dysfunction and in 18 of these the diagnosis was made when the child was seen in pain. Tympanometry on painful ears did not reveal any abnormality or trend in the values for compliance or middle ear pressure. Simple methods of treatment were effective in all cases. Temporomandibular joint dysfunction should be suspected in any child who complains of recurrent otalgia in the absence of dental and otological disease.

Tympanic membrane retraction and middle-ear pressure.

MHA assessment and LR observation are poor indicators of MEP. Clinical assessment of the MHA in normal living ears, within the range 30 degrees to 75 degrees, correlates poorly with MEP measured by impedance tympanometry, within the range of -300 to +160 mm H2O. Variation of MEP in fresh temporal bones demonstrated that MHA, LR and postero-superior segment retraction remained unchanged between -50 and -400 mm H2O and between +50 and +400 mm H2O. The change in position of the TM over the range +50 to -50 mm H2O corresponded to the maximum compliance change on the tympanogram i.e. the width of the tympanometric notch.