Normal Middle Ear Status Research Articles

Single-Sided Deafness at a Tertiary Care Rehabilitation Centre: A Cross-Sectional Retrospective Study.

To estimate the Single-sided deafness (SSD) among sensorineural hearing loss (SNHL) in Tertiary Care Rehabilitation Centre. To determine the audiological characteristics, associated and medical problems, and rehabilitative approaches among SSD. A retrospective study was conducted to report on demographic details, audiological evaluation, and hearing aid management among SSD clients. A total of 11,534 cases of SNHL were reported to the Audiology department at the tertiary care rehabilitative center at Mysuru between January 2014 and December 2017. A total of 225 were diagnosed as having SSD, accounting for approximately two cases of SSD in a cohort of 100 SNHL cases (225/11,534*100). In addition, males are affected more than females. SSD is found to have more in the right ear than the left ear. Their major complaints were tinnitus and vertigo, apart from reduced hearing sensitivity from the affected ear. In the side of the ear with profound hearing loss among SSD clients showed normal middle ear status with absent acoustic reflexes, otoacoustic emissions, and auditory brainstem response. Only 54 individuals (24%) out of 225 SSD clients underwent a hearing aid trial. Twenty-one (9%) SSD clients purchased a hearing aid, and a minuscule seven (3%) of 225 SSD clients are using a hearing aid. The preference for hearing aid uptake was low because of the experience of vibratory sensation and having near-normal hearing in one ear. Two cases of SSD were observed among SNHL and they are less likely to get benefits from the hearing aid.

Validation of an integrated pressure level measured earmold wideband real-ear-to-coupler difference measurement

Objective To validate measurement of predicted earmold wideband real-ear-to-coupler difference (wRECD) using an integrated pressure level (IPL) calibrated transducer and the incorporation of an acoustically measured tubing length correction. Design Unilateral earmold SPL wRECD using varied hearing aid tubing length and the proposed predicted earmold IPL wRECD measurement procedure were completed on all participants and compared. Study Sample 22 normal hearing adults with normal middle ear status were recruited. Results There were no clinically significant differences between probe-microphone and predicted earmold IPL wRECD measurements between 500 and 2500 Hz. Above 5000 Hz, the predicted earmold IPL wRECD exceeded earmold SPL wRECDs due to lack of standing wave interference. Test-retest reliability of IPL wRECD measurement exceeded the reliability of earmold SPL wRECD measurement across all assessed frequencies, with the greatest improvements in the high frequencies. The acoustically measured tubing length correction largely accounted for acoustic effects of the participant’s earmold. Conclusions IPL-based measurements provide a promising alternative to probe-microphone earmold wRECD procedures. Predicted earmold IPL wRECD is measured without probe-microphone placement, agrees well with earmold SPL wRECDs and is expected to extend the valid bandwidth of wRECD measurement.

Predicting children’s real-ear-to-coupler differences based on tympanometric data

Objective Paediatric hearing-aid verification relies on measures of output obtained from the ear canal or in a coupler with the child’s real-ear-to-coupler difference (RECD). Measured RECD cannot always be completed in children, leading to fitting inaccuracies. Audiologists often have tympanometry data that characterises the child’s ear-canal acoustics. The goal of this study was to determine if tympanometry can be used to improve predictions of measured RECD. Design A retrospective analysis of RECD and admittance, tympanometric peak pressure, and equivalent ear-canal volume from 226 Hz tympanometry collected as part of a longitudinal study of children with hearing loss were modelled with Bayesian hierarchical regression. Study sample Two-hundred sixty-six children with mild-to-severe hearing loss contributed data. Results Age-based average RECD models were within 3 dB of measured RECD values in 54% of cases with normal middle ear status and 50.6% of cases with abnormal middle ear status. Immittance-predicted RECD were within 3 dB in 69.6% of cases with normal middle ear status and 74.4% of cases with abnormal middle ear status. Conclusion Immittance-predicted RECD was more accurate than age-based average RECD, particularly in children with abnormal middle ear status. The findings suggest that 226 Hz tympanometry could be used clinically to improve predictions of measured RECD when it cannot be measured.

Intraoperative Electrocochleography in Subjects Affected by Vestibular Schwannoma and Ménière’s Disease: Comparison of Results

Objectives: Histologic reports of temporal bones of ears with vestibular schwannomas (VSs) have indicated findings of endolymphatic hydrops (ELH) in some cases. The main goal of this investigation was to test ears with VSs to determine if they exhibit electrophysiological characteristics similar to those of ears expected to experience ELH. Design: Fifty-three subjects with surgically confirmed VS aged ≥18 and with normal middle ear status were included in this study. In addition, a second group of adult subjects (n = 24) undergoing labyrinthectomy (n = 6) or endolymphatic sac decompression and shunt (ELS) placement (n = 18) for poorly controlled vestibular symptoms associated with Meniere’s disease (MD) participated in this research. Intraoperative electrocochleography (ECochG) from the round window was performed using tone burst stimuli. Audiometric testing and word recognition scores (WRS) were performed preoperatively. ECochG amplitudes, cochlear microphonic/auditory nerve neurophonic (ANN) in the form of the “ongoing” response and summation potential, were analyzed and compared between the two groups of subjects. In addition, to evaluate any effect of auditory nerve function, the auditory nerve score was calculated for each subject. Pure-tone averages were obtained using the average air conduction thresholds at 0.5, 1, and 2 kHz while WRS was assessed using Northwestern University Auditory Test No. 6 word lists. Results: In the VS group the average pure-tone averages and WRS were 59.6 dB HL and 44.8%, respectively, while in the MD group they were 52.3 dB HL and 73.8%. ECochG findings in both groups revealed a reduced trend in amplitude of the ongoing response with increased stimulus frequency. The summation potential amplitudes of subjects with VS were found to be less negative than the MD subjects for nearly all test frequencies. Finally, the VS group exhibited poorer amounts of auditory nerve function compared to the MD group. Conclusions: The current findings suggest cochlear pathology (e.g., hair cell loss) in both groups but do not support the hypothesis that VSs cause ELH.

Distortion product otoacoustic emissions in very preterm infants: A longitudinal study

BackgroundVery preterm infants are at a greater risk of developing neurodevelopmental impairments such as neuro-motor delays, vision and hearing deficits (Roze and Breart, 2004; Saigal and Doyle, 2008) [1,2]. The hearing difficulties in preterm infants vary depending on the co-morbid conditions. However, prematurity itself is considered as a risk factor that influence the functioning of auditory system. AimThe current study aims to compare the DPOAEs in very preterm infants and term infants at 1 month, 3 months and 6 months of age (corrected age in preterm infants). MethodDPOAEs were recorded in 72 very preterm infants and 30 term infants at 1 month, 3 months and 6 months of age. All these infants had obtained ‘pass’ results in newborn hearing screening using ABR. DPOAE f2 test frequency was measured at six frequencies (1500 Hz, 2000 Hz, 3000 Hz, 4500 Hz, 6000 Hz and 8000 Hz) with primary tone stimulus intensity L1 equal to 65 dBSPL and L2 equal to 55 dBSPL with primary tone f2/f1 frequency ratio of 1.2. Otoscopic examination and tympanometry was performed prior to DPOAE testing, to ascertain normal middle ear status. ResultsDPOAE amplitude did not change significantly between two groups from 1 month till 6 months of age (p > 0.05). DPOAE amplitude and noise floor in very preterm infants were not different from term infants and DPOAE amplitude did not vary significantly across f2 frequencies at various time periods. ConclusionThe current study findings provided evidence that prematurity did not constitute as a factor to influence the results of DPOAE in very preterm infants who passed newborn hearing screening test. Any significant reduction in DPOAE amplitude or absence of DPOAE in very preterm infants has to be considered and monitored effectively, as it may not reflect a developmental process of cochlear function; instead it could indicate the presence of inner ear or middle ear pathology.

Standard and multiple-frequency tympanometric norms in Chinese young and older adults

ABSTRACT The normative data of standard and multiple-frequency tympanometry should be established depending on gender, age, race and specific recording parameters. However, the lack of normative data of standard and multiple-frequency tympanometry was documented in Chinese older adults. Previous studies which conducted the normative data from Southern Chinese young adults may not represent the Chinese young and older adults in Taiwan. The purpose of this study is to establish the norms of standard and multiple-frequency tympanometry in Chinese young and older adults. The effects of age and gender are investigated for understanding the characteristics of normative data of tympanometry. A total of 100 young adults and 100 older adults with normal middle ear status were recruited from the community in Taiwan. The data of peak Ytm, Vea and TW were obtained by a 226 Hz probe tone. Multiple-frequency tympanometry was recorded by 226, 678 and 1000 Hz probe tones and categorized by the Vanhuyse model. The resonance frequency was obtained by the method of sweep-pressure. The two-way independent ANOVA was used separately to examine the effects of age and gender on each of the tympanometric measures. The effect of gender was found in Ytm, Vea and TW, while the effect of age was only found in Vea. Older adults have more complex patterns of multiple-frequency tympanometry and have significantly lower resonance frequency than young adults do. Results suggest that the middle ear system status changes with aging. The norms, especially gender-specific norms, are needed for Chinese older adults for interpretation.

Study on wideband tympanometry and absorbance within a Danish cohort of normal hearing adults.

The objectives of this study was to present wideband tympanometry (WBT) data and absorbance with normal hearing and normal middle ear status. Data were collected in 99 adult Caucasians with normal hearing and middle ear status. Energy absorbance was measured with an Interacoustics© Titan® using clicks for 1/24-octave frequency-intervals (0.226-8kHz) with the ear canal air pressure alternated using a descending pressure sweep from + 250 to -350 daPa. From the wideband energy absorbance tympanograms, the mean energy absorbance tympanogram, wideband averaged tympanogram and parameters such as ear canal volume, middle ear pressure and resonance frequency were determined. This study established a dataset containing descriptive analysis of wideband tympanograms and its derived parameters in Caucasian adults with normal hearing and normal middle ear conditions. The data presented in this study may serve as a future reference for WBT studies with Caucasian adults.

Age Effects on Cochlear Reflectance in Adults.

Cochlear reflectance (CR) is the cochlear contribution to ear-canal reflectance. CR is a type of otoacoustic emission that is calculated as a transfer function between forward pressure and reflected pressure. The purpose of this study was to assess effects of age on CR in adults and interactions among age, sex, and hearing loss. Data were collected from 60 adults selected for their age (e.g., 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 years) and normal middle ear status. A wideband noise stimulus presented at three stimulus levels (30, 40, 50 dB SPL) was used to elicit CR. Half-octave bands of CR signal magnitude (CRM), CR noise, and the CR signal-to-noise ratio (CR-SNR) were extracted from the wideband CR response. Regression analyses were conducted to assess interactions among CR, age, sex, and pure-tone thresholds at closely matched frequency bands across stimulus levels. Although increased age was generally associated with lower CRM and CR-SNR at some band frequencies and stimulus levels, no significant effects of age remained after controlling for effects of pure-tone thresholds. Increases in pure-tone thresholds were associated with lower CRM and CR-SNR at most frequency bands and stimulus levels. Effects of hearing sensitivity were significant at some frequencies and levels after controlling for age and sex. When effects of age were controlled, adults with better hearing had significantly larger CRM and CR-SNR than those with poorer hearing. In contrast, when effects of hearing were controlled, no significant effects of age on CRM and CR-SNR remained.

Impact of otorrhoea and ossicular status on the effect of tympanoplasty

<p><strong>Background: </strong>The objective of the study<strong> </strong>was to assess the effect of otorrhoea, osscicular and middle ear status on anatomical and functional results in patients undergoing tympanoplasty with or without mastoidectomy for chronic otitis media mucosal disease</p><p><strong>Methods: </strong>This was a prospective study conducted on 100 patients<strong> </strong>with otological complaints (otorrhoea, hearing loss) attending the out-patient Department of ENT, at Mamata Medical College and Research Hospital, Khammam Telangana state during the period from December 2015 to July 2017. All the patients underwent a detailed general physical, otoneurological evaluation, hearing assessment by pure-tone audiometry prior to surgery. As per MERI the patients were evaluated for factors preoperatively and intraoperatively. Postoperatively the patients were followed up at 3 and 6 months to ascertain the structural (graft take up) and functional (hearing improvement) success.<strong></strong></p><p><strong>Results: </strong>Otorrhoea was the most common complaint observed (48%). As per Belluci's classification of otorrhoea, maximum number of patients (52%) had a dry ear, wet ears (48%) and persistently wet ears (8%). According to Austin-Kartush classification 50 patients had an intact ossicular chain, defects of the incus in 36 patients, defects in both malleus and incus, stapes and incus was seen in 7 patients each. Majority of the patients 79% had normal middle ear status while 21% of them had middle ear effusion present. Majority of the patients belonged to the group of mild risk MERI (l-3) (n=69) patients, moderate risk category MERI (4-6) (n=26) severe risk (7-12) (n=5). Graft uptake was successful in 78 patients and failure in 22 patients. Hearing Improvement was noticed in 78 patients.</p><p><strong>Conclusion: </strong>Otorrhoea and middle ear cleft status have an impact on the success of the tympanoplasty, while ossicular status did not have a significant effect on the outcome.</p>

Tone perception in Mandarin-speaking school age children with otitis media with effusion.

ObjectivesThe present study explored tone perception ability in school age Mandarin-speaking children with otitis media with effusion (OME) in noisy listening environments. The study investigated the interaction effects of noise, tone type, age, and hearing status on monaural tone perception, and assessed the application of a hierarchical clustering algorithm for profiling hearing impairment in children with OME.MethodsForty-one children with normal hearing and normal middle ear status and 84 children with OME with or without hearing loss participated in this study. The children with OME were further divided into two subgroups based on their severity and pattern of hearing loss using a hierarchical clustering algorithm. Monaural tone recognition was measured using a picture-identification test format incorporating six sets of monosyllabic words conveying four lexical tones under speech spectrum noise, with the signal-to-noise ratio (SNR) conditions ranging from -9 to -21 dB.ResultsLinear correlation indicated tone recognition thresholds of children with OME were significantly correlated with age and pure tone hearing thresholds at every frequency tested. Children with hearing thresholds less affected by OME performed similarly to their peers with normal hearing. Tone recognition thresholds of children with auditory status more affected by OME were significantly inferior to those of children with normal hearing or with minor hearing loss. Younger children demonstrated poorer tone recognition performance than older children with OME. A mixed design repeated-measure ANCOVA showed significant main effects of listening condition, hearing status, and tone type on tone recognition. Contrast comparisons revealed that tone recognition scores were significantly better under -12 dB SNR than under -15 dB SNR conditions and tone recognition scores were significantly worse under -18 dB SNR than those obtained under -15 dB SNR conditions. Tone 1 was the easiest tone to identify and Tone 3 was the most difficult tone to identify for all participants, when considering -12, -15, and -18 dB SNR as within-subject variables. The interaction effect between hearing status and tone type indicated that children with greater levels of OME-related hearing loss had more impaired tone perception of Tone 1 and Tone 2 compared to their peers with lesser levels of OME-related hearing loss. However, tone perception of Tone 3 and Tone 4 remained similar among all three groups. Tone 2 and Tone 3 were the most perceptually difficult tones for children with or without OME-related hearing loss in all listening conditions.ConclusionsThe hierarchical clustering algorithm demonstrated usefulness in risk stratification for tone perception deficiency in children with OME-related hearing loss. There was marked impairment in tone perception in noise for children with greater levels of OME-related hearing loss. Monaural lexical tone perception in younger children was more vulnerable to noise and OME-related hearing loss than that in older children.

CT imaging of the eustachian tube using focal contrast medium administration: a feasibility study.

ObjectivesWe aim to develop an imaging technique for visualization of the Eustachian tube (ET) lumen.Study DesignA prospective, experimental study in an animal model and in human cadaver specimens.MethodsApplying iodixanol to the middle ear in two human temporal bone specimens, followed by computed tomography (CT) examinations, we optimized contrast dilution, CT algorithm, and head positioning for visualization of contrast passage through the ET.Myringotomy was performed on eight rabbits. Based on the cadaver study, a 20% iodixanol solution was applied to the middle ear, and subsequent CT scans were performed to observe iodixanol in the epipharynx. For some animals, the procedure was repeated on the contralateral ear. We performed the procedure twice on four subjects. Twenty examinations were included.Iodixanol appearance in the ET and the epipharyngeal orifice was assessed qualitatively on CT scans. The tympanic membrane was inspected after 1 or 2 weeks, and histopathological examination of six contrast‐exposed temporal bones was performed.ResultsThe cadaver study provided information on imaging technique and contrast dosage. In rabbits, iodixanol passed through the ET in 19 of the 20 ears. Qualitatively, optimal visualization was seen after 9 to 12 minutes. Clinical inspection after 1 or 2 weeks revealed normal middle ear status. Histopathological samples showed no sign of inflammatory reaction in the tympanic membrane, middle ear, or ET.ConclusionIodixanol application to the middle ear is feasible, safe, and demonstrates patency of the ET.Level of EvidenceN/A.

Hearing configuration in children with cCMV infection and proposal of a flow chart for hearing evaluation

Objective: This study had three main goals: (1) to determine the hearing configuration in hearing-impaired children born with a congenital CMV (cCMV) infection, (2) to see whether auditory neuropathy spectrum disorder (ANSD) was present, and (3) to propose a flow chart for the follow-up of hearing in children with cCMV. Design: Hearing configuration and the presence of ANSD in cCMV infected children was analysed. Selection criteria were: hearing-impaired children with a regular audiometric follow-up for at least 36 months, no other major risk factors for hearing loss, a normal middle-ear status, and an appropriate behavioral response to the given pure-tone stimuli. Study sample: Out of a cohort of 206 cCMV infected children, 18 hearing-impaired children were selected. Results: Audiograms of all children showed a flat configuration of SNHL: the slope between octave bands was never greater than 10 decibels. None of the 18 children were found to have ANSD. Conclusions: Hearing impairment in cCMV infants affected all frequencies equally and ANSD does not appear to be a feature of cCMV infection. A flow chart for hearing follow-up in children with cCMV infection was suggested in order to provide guidance, improve uniformity in follow-up, and to make results easier to compare.

Functional Correlations of Tympanic Membrane Perforation Size

The correlation between tympanic membrane perforations and hearing loss was studied. Prospective data from 220 patients, who underwent primary surgery for simple chronic otitis media with a perforated eardrum, were analyzed. Tertiary referral center. One hundred fifty-one patients with 155 eardrum perforations, which were checked for correct diagnosis, normal middle-ear status, and integrity of the ossicular chain, were included. All patients underwent primary myringoplasty. Preoperative conductive hearing loss due to eardrum perforations. Hearing loss shows a linear relationship with increasing eardrum perforation size. Umbo involvement shows a worsening of the hearing by 5 to 6 dB (p < 0.0001). The least impact of a perforation is seen at the resonance frequency of 2 kHz. Above and below 2 kHz, an 'inverted V shape' of the air-bone gap is a consistent finding. If the air-bone gap exceeds the 'inverted V-shape' pattern, additional pathology behind the eardrum must be assumed and addressed. We propose using standardized photographs or drawings to document preoperative perforation sizes. A linear relationship between the size of a perforation and the conductive hearing loss does exist. Umbo involvement at the perforation margin may worsen the hearing by 5 to 6 dB, whereas the position of the perforation itself does not play a role. The least impact of a perforation is seen at the resonance frequency of 2 kHz. An "inverted V-shape" pattern, above and below 2 kHz, of the air-bone gap is a consistent finding. If the air-bone gap exceeds this pattern, additional pathology behind the eardrum perforation must be assumed and addressed.

Longitudinal posturography and rotational testing in children three to nine years of age: Normative data

Objective To obtain normative longitudinal vestibulo-ocular and balance test data in children from ages three to nine years with normal middle ear status. Study Design Prospective, longitudinal cohort. Setting Tertiary care pediatric hospital. Subjects and Methods Three-year-old children were entered and tested yearly. Subjects underwent earth vertical axis rotation testing using sinusoidal and constant velocity stimuli and performed the Sensory Organization Test. Results One hundred forty-eight children were entered, and usable data were collected on 127 children. A linear increase in the vestibulo-ocular reflex gain as children aged was found, without a change in the phase of the response. An age-related linear increase in equilibrium scores, indicating reduced postural sway, was also observed. Conclusion These normative data can be used in the evaluation of dizziness and balance disorders in children.

Wideband Reflectance in Normal Caucasian and Chinese School-Aged Children and in Children with Otitis Media with Effusion

Wideband reflectance (WBR) is a middle ear analysis technique that quantifies frequency-specific sound conduction over a wide range of frequencies. One shortcoming of WBR is that there is limited normative data, particularly for pediatric populations and children with middle ear pathology. The goals of this study were to establish normative WBR data for early school-aged children; to determine whether WBR differs significantly between Caucasian and Chinese children, male and female children, and children and adults (experiment 1); and to compare the normative pediatric WBR data with the WBR data obtained from children with abnormal middle ear conditions (experiment 2). WBR was measured from 78 children with normal middle ear status with an average age of 6.15 yrs and 64 children with abnormal middle ear status with an average age of 6.34 yrs. Control group subjects and subjects without previously diagnosed middle ear pathology were recruited from eight elementary schools in the Greater Vancouver Area. Subjects with known middle ear pathology were recruited through the British Columbia Children's Hospital Otolaryngology department. Middle ear effusion (MEE) was identified in one of the two ways. In the British Columbia Children's Hospital group, MEE was diagnosed by a pediatric otolaryngologist (OTL) using pneumatic otoscopy and video otomicroscopy. These cases (21 ears) were classified as OTL confirmed. Subjects who were assessed through screenings at their elementary schools and suspected to have MEE based on audiological test battery results including elevated air conduction thresholds, flat low- and high-frequency tympanograms, and absent transient-evoked otoacoustic emissions were classified as not OTL confirmed (21 ears). Data were statistically analyzed for effects of gender, ethnicity (Caucasian versus Chinese), age (child versus adult), and middle ear condition. WBR equipment used for this study was from Mimosa Acoustics (RMS-system, version 4.03). Data were averaged in one-third octave bands collected from 248 frequencies ranging from 211 to 6000 Hz. Control group subject data (experiment 1) revealed no effects of gender or ear, and their interactions with frequency were not significant. There was a significant interaction between ethnicity (Caucasian versus Chinese) and frequency. Chinese children had lower energy reflectance (ER) values over the mid-frequency range. ER was significantly different between pediatric data and previously collected adult data. Diseased group ER was significantly different among all four middle ear conditions (normal, mild negative middle ear pressure, severe negative middle ear pressure, and MEE) (experiment 2). The overall test performance of ER was objectively evaluated using receiver operating characteristic (ROC) curve analyses; it was compared across frequencies averaged in one-third octave bands. Statistical comparison of the area under ROC (AUROC) plots revealed that ER above 800 Hz (except for ER at 6300 Hz) had better test performance in distinguishing normal middle ear status from MEE compared with ER at 630 and 800 Hz. Although not statistically different from other frequencies between 800 and 5000 Hz, ER at 1250 Hz had the largest AUROC curve (sensitivity of 96% and specificity of 95%) and was selected for further analysis. Comparison of AUROC curves between WBR at 1250 Hz and static admittance at 226-Hz probe tone frequency revealed significantly better test performance for WBR in distinguishing between healthy ears and MEE. A preliminary set of normative ER data have been generated for a pediatric population between the ages of 5 and 7 yrs, which were significantly different from previously gathered normative adult ER data. In this study, pediatric normative data were warranted for testing children, but ethnic-specific norms were not required to detect middle ear pathology and changes in middle ear status. WBR shows promise as a clinical diagnostic tool for measuring the mechanoacoustic properties of the middle ear and the changes that result in the presence of negative middle ear pressure or MEE.

Longitudinal Changes in Real-Ear to Coupler Difference Measurements in Infants

The real-ear-to-coupler difference (RECD) measurement is a commonly used clinical procedure that quantifies the difference in sound pressure level between a 2 cc coupler and an individual's ear canal. The SPL levels in infant ears are highly variable and significantly higher than the SPL levels present in average adult ears, making the quantification of SPL levels in infant ears extremely important for threshold determination and fitting of amplification. It is unknown how much the RECD changes in an individual infant over time, whether that change is within test-retest reliability of the RECD measure, and whether RECD values are predictable from other outer and middle ear measures. The purposes of this study were to examine longitudinal changes in RECD values in newborn infants to determine whether a significant change in RECD values takes place over a one-month period, how the change in RECD relates to test-retest variability of the measure, and whether RECD values are predictable from the infant's corrected age, or measures of static admittance and equivalent ear canal volume (EECV). Fourteen infants (seven females, seven males) aged 7 to 25 days were recruited through community prenatal classes, physicians, hospital nurseries, and word of mouth. All infants had normal middle ear status. Infants were tested on two separate visits, first when the infant was approximately two to three weeks old and then approximately one month later. Each visit lasted one to two hours, during which time otoacoustic emissions, 226 Hz and 1000 Hz probe-tone tympanometry, and two RECD measures were made for each ear. A multivariate analysis of variance revealed a significant change in RECD values over a one-month interval. Regression analyses revealed that final RECD values were partially predictable from age, initial RECD value, static admittance; and EECV. RECD test-retest variability was not large but larger than longitudinal RECD changes over a one-month period. It may be unnecessary to remeasure an RECD to account for changes in ear canal acoustics for repeated assessments, no more than one month apart, when the same test transducer is used. The RECD should, however, be measured at one of these assessments because RECD values are not predictable from an infant's age or measures of static admittance and ear canal volume.

Diagnostic value of tympanometry using subject-specific normative values

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. 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. 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. The subject-specific normative values were not found especially useful, although a slight increase in sensitivity was achieved without compromizing specificity.

Hearing levels in infants and young children in relation to testing technique, age group, and the presence or absence of middle-ear effusion.

As part of a prospective study of possible effects of early-life otitis media on speech, language, cognition, and psychosocial development, we evaluated hearing both during episodes of middle-ear effusion (MEE) and when MEE was not present. The objective of this report is to describe age-specific hearing threshold levels in relation to the presence or absence of MEE in a large sample of young children. Participants were 1,055 children drawn from a sample of 6,350 children who were enrolled in the larger study by 2 mo of age. Otologic evaluation of each child was conducted at least monthly. The protocol of the larger study called for hearing evaluations 1) after 8 wk of continuous unilateral or bilateral MEE and every 4 wk thereafter until one test had been conducted when MEE was no longer present; 2) immediately before developmental testing; and 3) in a sample of children without MEE to obtain age-specific normative data. Results are presented by testing technique, age group, and middle-ear condition. In general, hearing threshold levels were highest in the youngest children tested with visual reinforcement audiometry and lowest in the oldest children tested with conventional audiometry. In general also, thresholds were lowest in children with normal middle-ear status, intermediate in children with unilateral MEE, and highest in children with bilateral MEE. On average, the presence of bilateral MEE was associated with hearing threshold levels 10 to 15 dB higher than the normative values for the corresponding age group. In infants and young children, audiometric results are influenced by testing technique, age group, and the presence or absence of effusion in each ear.

Intranasal fluticasone propionate does not prevent acute otitis media during viral upper respiratory infection in children

Background: Acute otitis media (AOM) is the most common complication of a viral upper respiratory infection (URI) in children. The virus-induced host inflammatory response in the nasopharynx plays a key role in the pathogenesis of AOM. Suppression of this inflammatory process might prevent the development of AOM as a complication. Objective: We sought to assess the effect of intranasally administered fluticasone propionate on prevention of AOM during a viral respiratory infection. Methods: A total of 210 children (mean age, 2.1 years; range, 0.7-3.9 years) with normal middle ear status and URI of 48 hours’ duration or less were randomly allocated to receive either fluticasone (100 μg twice daily) or placebo for 7 days. The specific viral cause of the infection was determined from nasopharyngeal aspirates obtained at the first visit. The children were re-examined at the end of the 7-day medication period. Results: In the fluticasone group AOM developed in 40 (38.1%) of 105 children compared with 29 (28.2%) of 103 children receiving placebo (P = .13). The viral cause of the respiratory infection was determined in 167 (86.1%) of 194 children from whom a nasopharyngeal aspirate was obtained. In children with rhinovirus infection, AOM developed significantly more often in the fluticasone group (45.7%) than in the placebo group (14.7%, P = .005). Conclusion: Intranasally administered fluticasone does not prevent the development of AOM during URI but may increase the incidence of AOM during rhinovirus infection. (J Allergy Clin Immunol 2000;106:467-71.)

Nasopharyngeal bacterial flora in otitis prone children treated with immunoglobulin.

The present study was undertaken to evaluate possible beneficial effects of regularly given, long term immunoglobulin prophylaxis of children below 2 years of age with recurrent acute otitis media (RAOM). The nasopharyngeal bacterial flora and the frequency of acute otitis media (AOM) and secretory otitis media SOM were studied. Every second of 44 children with 3 or more periods of AOM during the last year received immunoglobulin intramuscularly (Gammaglobulin Kabi 165 mg/l, 0.45 ml/kg b.w.) every third week for 6 months, while the other 22 children served as controls. All children were followed for 12 months. Immunoglobulin prophylaxis neither influenced the nasopharyngeal flora, nor the frequency of AOM or SOM periods. Children with AOM or SOM more often harbored bacterial pathogens in their nasopharynx than children with normal middle ear status. Also, the immunoglobulin prophylaxis did not influence the increased frequency of bacterial pathogens in the nasopharynx of children attending public day care or family day care as compared to those taken care of at home.