Normal Tympanograms Research Articles

Hearing impairment after acute bacterial meningitis in children.

Objective:To determine the incidence of hearing loss after acute episode of meningitis in childrenMethods:A descriptive study carried out in the Department of Pediatric Medicine of The Children’s Hospital Lahore, Pakistan from January 2014 to July 2016. A total of 175 children one month to 13 years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry and culture sensitivity were sent. CT scan brain was done if required. Hearing assessment was done two weeks after admission using otoacoustic emissions in the patients having normal tympanogram. Hearing impairment was classified as sensorineural if otoacoustic emissions were absent while tympanometry was normal.Results:Of 175 children, 58% were males and 42% were females. Mean age was 2.1 years. Orientation as assessed by Glasgow comma scale (GCS) was normal in 63% while 5% had GCS<8 and 32% had GCS between 8 and 15. Signs of meningeal irritation were seen in 58% while focal signs only in 4%. In 15 % cases CT scan was done, out of which 73% showed abnormal findings. Otoacoustic emissions were absent in 22% of cases. Risk factors of hearing deficit were stay duration of more than 10 days (p=0.04), low GCS at presentation (p=0.009) and meningitis with complications (p=0.008).Conclusion:The frequency of hearing loss is 22% following acute episode of meningitis which necessitates the need for implementation of screening assessment after meningitis in Pakistan. Prolonged stay, low GCS and complicated meningitis are risk factors for hearing impairment.

Prognostic and influencing factors of tinnitus in chronic otitis media after tympanoplasty.

The purpose of this study is to investigate what characteristics of tinnitus in patients with chronic otitis media was reduced after tympanoplasty and to assess the relationship between post-operative tinnitus reduction and pre-operative tinnitus tone, tinnitus duration, post-operative hearing recovery, and tympanogram. Medical records were prospective between March 2013 and May 2016. Audiologic evaluation by pure tone audiometry and acoustic impedance and tinnitus assessment using scores on the Tinnitus Handicap Inventory (THI) was conducted preoperatively and 6months post-operatively. The data were analyzed using the Wilcoxon test, Student's and paired t test, and ANOVA. The pre-operative incidence of tinnitus in patients with COM was 47%. There was a very significant difference between pre-operative and post-operative mean THI scores (p<0.05). Tinnitus was reduced or alleviated in 83% of tinnitus patients. Pre-operative low-tone tinnitus was significantly reduced 6months after surgery. After surgery, air-conducted hearing improvement at 250, 500, and 1000Hz in the tinnitus significant recovery group was greater than the tinnitus non-significant recovery group (p<0.05). Tinnitus reduction in tympanogram A was significantly greater than in tympanograms B or C (p<0.05). There was no statistically significant correlation between tinnitus duration and tinnitus reduction (p>0.05). There was no significant effect of presence cholesteatoma and dry period on the gain THI (p>0.05). The types of tympanoplasty had no effect on tinnitus improvement (p>0.05). No patients experienced new tinnitus after surgery. Following tympanoplasty, most patients experienced a reduction in tinnitus. Pre-operative low-tone tinnitus is easier to reduce after tympanoplasty. Post-operative normal tympanogram and improved low-frequency AC hearing were important to tinnitus reduction.

Normative data for TM electrocochleography measures

ObjectiveEstablish normative data for tympanic electrocochleography (TM ECochG) parameters in normal hearing adults without Ménière's disease's (MD) symptoms. Describe TM ECochG variables that help to distinguish normal from MD ears. Material and methodsWe enrolled 100 subjects (N = 200 ears), 59 females, aged between 19 and 71 years from 09/2010 to 04/2014. Inclusion criteria: normal otomicroscopy, hearing thresholds ≤25 dB nHL from 250 to 4000 Hz, normal tympanogram, no symptoms of MD according to the AAO-HNS 1995 criteria and Gibson's score <7. We excluded subjects with dizziness, aural fullness or other symptoms of endolymphatic hydrops. The following parameters were analyzed: SP/AP amplitude ratio, SP/AP area ratio and the difference between AP latency with rarefaction and condensation stimuli. ResultsThere was no significant difference between right and left ears (Intraclass correlation coefficient < 0.6). SP/AP amplitude ratio varied between 0.084 and 0.356 and SP/AP area ratio between 0.837 and 1.671 (percentiles 5 and 95). The AP latency difference to rarefaction and condensation clicks was between 0.0 and 0.333 ms. ConclusionNormative data for TM ECochG parameters were established in 100 normal hearing subjects without MD. These data can be used to distinguish normal from pathological findings and in follow-up of MD patients.

Tympanometric measurements in conscious sheep - a diagnostic tool for pre-clinical middle ear implant studies

Objective: To investigate and establish the use of tympanometry in conscious sheep to provide a means of objective assessment of tympanic membrane integrity, middle ear ventilation and functioning of the Eustachian tube (ET). Design: After conditioning the sheep for four weeks, tympanometric measurements at 226 Hz were carried out weekly for 13 weeks. Before measurements, the external ear canal had been cleaned. Resultant curves were classified according to human reference values. Study Sample: Tests were performed on 12 female blackface sheep. Results: After cleaning of the external ear canal under otoscopic control, tympanic membranes were intact with no evidence of acute or chronic middle ear inflammation, middle ear effusion or retraction. Cleaning ensured valid, objective and reproducible measurements. As the majority of normal tympanograms were notched without the appearance of any malformation, an additional tympanogram type (AN) was introduced. The notched appearance can most likely be explained by the anatomy of the middle ear of the sheep and the test frequency that was used. Conclusion: The current study demonstrated how tympanometry can be used to evaluate treatment modalities for middle ear and ET function in conscious sheep. This provided a large animal model for further human research in otology.

Sinonasal Polyposis and Its Effect on Eustachian Tube Function

ABSTRACT Objective/hypothesis Nasal and paranasal sinus disease can cause Eustachian tube (ET) dysfunction leading to middle ear (ME) hypoventilation. Persistent ME hypoventilation can result in ME conditions like retraction of tympanic membrane, otitis media with effusion, and chronic ME disease. Aim Aim of this study was to evaluate the ET function in cases of sinonasal polyposis. Evaluation was done by doing tympanometry. Materials and methods This was a hospital-based prospective study consisting of 42 patients (84 ears) of nasal polyposis, of which 27 patients had antrochoanal (AC) polyp and 15 patients had ethmoidal polypi. After thorough history and detail clinical examination, tympanometry was done in all patients 1 day prior to surgery and 4 to 6 weeks after surgery. Results Preoperatively in 30 ears (15 patients) of ethmoidal polypi had normal tympanogram (A type) in 40% ears and abnormal tympanogram (B and C) in 60% ears. Postoperatively 80% had A tympanograms and 20% had abnormal tympanogram. There was significant improvement on removal of polypi (p = 0.004). Preoperatively 54 ears (27 patients) of AC polyp had normal tympanogram (type A) in 55.56% ears and abnormal tympanogram (B and C) in 44.44% ears. Postoperatively normal tympanogram was seen in 81.48% and abnormal tympanogram in 18.52% ears, so there was significant improvement after functional endoscopic sinus surgery (p = 0.007). Conclusion Eustachian tube dysfunction was present preoperatively in 60 and 44.44% in ethmoidal and AC polypi respectively, while in postoperative period dysfunction was 20 and 18.52%. So function improves on removal of polyp. How to cite this article Mane SB, Dasgupta KS. Sinonasal Polyposis and Its Effect on Eustachian Tube Function. Clin Rhinol An Int J 2016;9(2):77-80.

Wideband reflectance in Down syndrome

ObjectiveChildren with Down syndrome (DS) have a high incidence of middle ear disorders and congenital abnormalities of the external, middle and inner ear. Energy reflectance (ER), a wideband acoustic immittance (WAI) measurement parameter, can measure the sound energy reflected or absorbed in the ear canal over a wider range of frequencies more efficiently and faster than conventional single-tone 226 Hz tympanometry. The aim of the present study was to compare the WAI measurements of children with DS with those of typically developing, normal-hearing children according to their tympanometric findings. MethodsFour groups of children with Down syndrome (age range: 2 years and 4 months to 16 years and 3 months; mean age: 8.5 yr) with normal tympanograms (19 ears), flat tympanograms (13 ears), mild negative pressure tympanograms (6 ears between −100 and −199 daPa at the admittance peak) and severe negative pressure tympanograms (4 ears at −200 daPa or lower at the admittance peak) were assessed. All findings were compared with data obtained from 21 ears of a healthy control group (age range: 3 years and 1 month to 13 years and 11 months; mean age: 7.9 yr). The subjects underwent tympanometry with a 226-Hz probe tone frequency and ER measurements along the 200–6,000 Hz range with a chirp stimulus using the Middle-Ear Power Analyzer (MEPA3 – HearID) by Mimosa Acoustics (Champaign, IL), software, version 3.3 [38]. ResultsStatistically significant differences were observed in the ER curves for some comparisons between the studied groups. There was also a negative correlation between the static acoustic admittance at the tympanic membrane level and ER measured with a chirp stimulus at 500 and 1,000 Hz. The discriminant analysis technique, which used a chirp stimulus at 1,000 and 1,600 Hz to classify the participants' data based on ER values, achieved a correct classification rate of 59.52% for participants with DS. ConclusionWhile groups with abnormal middle ear status, as indicated by tympanometry, showed higher ER values compared to the DS tymp A group and the control group, similar reflectance curves were observed between control group and the DS tymp A group. WAI shows promise as a clinical diagnostic tool in investigating the impact of middle ear disorders in DS group. However, further research is required to investigate this issue in narrower age range group and a larger sample size.

Does cleft palate repair reduce the incidence of middle ear pathology?

Introduction: In an infant, cleft palate usually affects his/her feeding, speech, eustachian tube, and middle ear physiology. The incidence of otitis media with effusion is particularly very high in the children having cleft palate. Repair of cleft palate is believed to reduce this incidence. Objective: This study was conducted to assess the effect of cleft palate repair on middle ear physiology. Methodology: The study sample was divided into two groups: Group A consists of patients who are 6 years and older with unrepaired cleft palate and Group B of the patients whose cleft palate were repaired before the age of 2 years and completed at least 4 years after surgery. There were thirty patients in each group. All of them were evaluated clinically, by otoscopy and tympanometry. Clinical assessment included examination of the palate in terms of the presence of scarring, fistula, length of soft palate (visual assessment only), mobility of the soft palate, and speech scoring by Pittsburgh weighted speech score. Results: About 21% of operated patients had velopharyngeal incompetence. Thirty-four ears (56.6%) in Group A and 24 ears (40.6%) in Group B had normal otoscopy finding. Normal tympanogram (Type A curve) was found in exactly similar proportion of ears examined in both the groups (20% each). Conclusion: Early repair of cleft palate did not have any beneficial effect on middle ear pathology.

An open randomised study of autoinflation in 4- to 11-year-old school children with otitis media with effusion in primary care.

Otitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment. To determine the clinical effectiveness of nasal balloon autoinflation for the treatment of OME in children. A pragmatic, two-arm, open randomised controlled trial. Forty-three general practices from 17 UK primary care trusts recruited between January 2012 and February 2013. School children aged 4-11 years with a history of OME symptoms or related concerns in the previous 3 months, and a type B tympanogram, diagnostic of a middle ear effusion, in one or both ears. Three hundred and twenty children were randomised, 160 to each group, using independent web-based computer-generated randomisation (with minimisation based on age, sex and baseline severity of OME) to either nasal balloon autoinflation performed three times per day for 1-3 months plus usual care, or usual care alone. The proportion of children demonstrating clearance of middle ear fluid in at least one ear (with normal tympanograms) at 1 and 3 months, assessed blind to treatment. An ear-related measure of quality of life (QoL) [a 14-point questionnaire on the impact of OME (OMQ-14)], weekly diary recorded symptoms, compliance and adverse events were all secondary outcomes. At 1 month, the proportion of children with normal tympanograms was 47.3% (62/131) in those allocated to autoinflation and 35.6% (47/132) in those receiving usual care [adjusted relative risk (RR) 1.36, 95% confidence interval (CI) 0.99 to 1.88]. At 3 months, the proportions were 49.6% (62/125) and 38.3% (46/120), respectively (adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). The change in OMQ-14 also favoured the intervention arm (adjusted global score difference -0.42; p = 0.001). Reported compliance was good: 89% in the first month and 80% in months 2 and 3. Adverse events included otalgia in 4% of treated children compared with 1% in the control group. Minor nosebleeds (14% vs. 15%) and respiratory tract infections (18% vs. 13%) were noted. We found the use of autoinflation in young children with OME to be feasible in primary care and effective in both clearing effusions and improving child and parent ear-related QoL and symptoms. This method has scope to be used more widely. Further research is needed for very young children, and to inform prudent use in different health settings.

Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care: an open randomized controlled trial.

Otitis media with effusion is a common problem that lacks an evidence-based nonsurgical treatment option. We assessed the clinical effectiveness of treatment with a nasal balloon device in a primary care setting. We conducted an open, pragmatic randomized controlled trial set in 43 family practices in the United Kingdom. Children aged 4-11 years with a recent history of ear symptoms and otitis media with effusion in 1 or both ears, confirmed by tympanometry, were allocated to receive either autoinflation 3 times daily for 1-3 months plus usual care or usual care alone. Clearance of middle-ear fluid at 1 and 3 months was assessed by experts masked to allocation. Of 320 children enrolled, those receiving autoinflation were more likely than controls to have normal tympanograms at 1 month (47.3% [62/131] v. 35.6% [47/132]; adjusted relative risk [RR] 1.36, 95% confidence interval [CI] 0.99 to 1.88) and at 3 months (49.6% [62/125] v. 38.3% [46/120]; adjusted RR 1.37, 95% CI 1.03 to 1.83; number needed to treat = 9). Autoinflation produced greater improvements in ear-related quality of life (adjusted between-group difference in change from baseline in OMQ-14 [an ear-related measure of quality of life] score -0.42, 95% CI -0.63 to -0.22). Compliance was 89% at 1 month and 80% at 3 months. Adverse events were mild, infrequent and comparable between groups. Autoinflation in children aged 4-11 years with otitis media with effusion is feasible in primary care and effective both in clearing effusions and improving symptoms and ear-related child and parent quality of life. ISRCTN, No. 55208702.

The Otalgia Point: A Novel Clinical Gesture in Otolaryngology.

In cases of otalgia without any accompanying findings, some patients locate their otalgia below the attachment of the lobule, at the apex of the jugulodigastric region. To present a series of these patients for whom nasal steroids or myringotomy usually ameliorated their pain. Thirty-two patients with normal physical examinations, tympanograms, and age-appropriate audiograms spontaneously indicated otalgia at "the otalgia point." Inspection of the oropharynx and nasal airway, palpation of the neck and temporal mandibular joints, and nasopharyngoscopy/laryngoscopy ruled out referred causes of otalgia. Patients were offered either nasal steroid spray or trial myringotomy followed by tympanostomy tube. Otalgia improved in all 10 (100%) patients who selected nasal steroids. Otalgia resolved in 17 of 20 (85%) myringotomy participants. Three patients declined intervention. In all, symptoms improved in 27/29 treated patients (93%). This description of "the otalgia point" introduces a new otolaryngologic gesture in physical examination that can aid in the therapeutic management of some patients with otalgia and normal examinations. This is an uncontrolled case series that serves as a pilot study for further exploration of this gesture.

Characterization of middle-ear condition of Oporto daycare children up-to 3 years-old: A cross sectional study

ObjectiveThe aim of this study was to determine tympanometric values of children who attend Oporto daycare centers and further analyze any relations with host and environmental factors. MethodsCross sectional study in a randomly selected sample of 117 daycare children up-to 3-years old from Oporto. Tympanometric measures were collected. ResultsChildren presented in left ear (LE) a mean peak pressure (PP) of −156.53daPa and a mean compliance of 0.16cm3. Right ear (RE) revealed a PP of −145.61daPa and a compliance of 0.19cm3. Normal tympanograms (type A) had a lower frequency than abnormal tympanograms (type B and type C). There was a positive association between age and compliance (LE: p=0.016; RE: p=0.013) and between the presence of rhinorrhea and PP (LE: p=0.002; RE: p<0.05). Abnormal tympanograms were more frequent in Spring (RE: p=0.009), in younger children (LE: p=0.03) and in children that had rhinorrhea (LE: p=0.002; RE: p=0.044).Healthy children had a mean PP of −125.19daPa and a mean compliance of 0.21cm3 in LE and a mean PP of −144.27daPa and a mean compliance of 0.22cm3 in RE. ConclusionTympanometric measures presented in this paper may be applicable to Oporto daycare children up-to 3 years-old. Most of daycare children revealed abnormal tympanograms. Age, rhinorrhea and season influenced children's middle-ear condition.

Auditory pathway maturational study in small for gestational age preterm infants.

To follow up the maturation of the auditory pathway in preterm infants small for gestational age (SGA), through the study of absolute and interpeak latencies of auditory brainstem response (ABR) in the first six months of age. This multicentric prospective cross-sectional and longitudinal study assessed 76 newborn infants, 35 SGA and 41 appropriate for gestational age (AGA), born between 33 and 36 weeks in the first evaluation. The ABR was carried out in three moments (neonatal period, three months and six months). Twenty-nine SGA and 33 AGA (62 infants), between 51 and 54 weeks (corrected age), returned for the second evaluation. In the third evaluation, 49 infants (23 SGA and 26 AGA), with age range from 63 to 65 weeks (corrected age), were assessed. The bilateral presence of Transient Evoked Otoacoustic Emissions and normal tympanogram were inclusion criteria. It was found interaural symmetry in both groups. The comparison between the two groups throughout the three periods studied showed no significant differences in the ABR parameters, except for the latencies of wave III in the period between three and six months. As for the maturation with tone burst 0.5 and 1 kHz, it was found that the groups did not differ. The findings suggest that, in the premature infants, the maturational process of the auditory pathway occurs in a similar rate for SGA and AGA. These results also suggest that prematurity is a more relevant factor for the maturation of the auditory pathway than birth weight.

Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: a placebo-controlled trial.

Antimicrobial treatment reduces the symptoms of acute otitis media (AOM). The effect of antimicrobial treatment on the duration of middle ear effusion (MEE) and concomitant hearing impairment is not known. To determine whether the antimicrobial treatment of AOM reduces the duration of MEE. This randomized, double-blind, placebo-controlled trial involved a total of 84 children with AOM between 6 months and 15 years of age. Participants were recruited from September 14, 1999, to January 4, 2000; October 10, 2005, to December 16, 2005; and September 22, 2009, to June 4, 2012, from among children attending an AOM prevention trial and children visiting local outpatient clinics in Oulu, Finland. Children were randomly allocated to receive either 40 mg/kg of amoxicillin-clavulanate or a placebo mixture per day for 7 days. The primary outcome measure was the time to the disappearance of MEE as defined by a normal tympanogram finding (A curve) from both ears on 2 consecutive measurement days. Parents performed daily tympanometry at home. The study physician performed tympanometry and otoscopy at study entry, after 3 and 7 days, and then weekly until both ears were healthy. The main secondary outcome measures were the time to normal otoscopy findings and the proportion of children without persistent MEE at 14 days and 2 months. Middle ear effusion disappeared 2.0 weeks (13.7 days) earlier (P = .02) in the antimicrobial group (mean time, 2.7 weeks; 95% CI, 1.7-3.7) than in the placebo group (4.7 weeks; 95% CI, 3.6-5.7). Normal otoscopy findings were observed 1.4 weeks sooner in the antimicrobial group than in the placebo group (P = .02). On day 14, 69% of children in the antimicrobial group and 38% in the placebo group had normal tympanometry findings (number needed to treat, 3.2; 95% CI, 2.0-10.5). On day 60, 2 children (5%) in the antimicrobial group and 10 children (24%) in the placebo group had persistent MEE (P = .01). Antimicrobial treatment effectively reduced the duration of MEE and possible concomitant hearing impairment in children with AOM. Antimicrobial treatment also reduced the risk for persistent MEE. clinicaltrials.gov Identifier: NCT01244581.

In Preliminary Data, Cell Phone Users Have Longer ABR Latencies

In Preliminary Data, Cell Phone Users Have Longer ABR Latencies

The prevalence of audiometric notches in adolescents in Germany: The Ohrkan-study

Although there is concern about increasing hearing loss in adolescents caused by leisure noise exposure, prevalence data are scarce. In an US study, about 16-17% of adolescents were affected by audiometric notches. To estimate the prevalence of audiometric notches in adolescents in Germany, baseline data of the cohort study Ohrkan, recruitment during the school years 2009/2010 and 2010/2011 were analyzed. All students in grade 9 visiting any school in the city of Regensburg were eligible for participation. Data was collected via standardized questionnaires from students and their parents. In addition, students were asked to visit the University Clinics of Regensburg for ear examination including a tympanogram and the determination of hearing thresholds in air conduction audiometry. The prevalence of audiometric notches was determined in students with normal tympanogram in both ears and complete audiometry data. Audiometric notches were defined according to criteria used to analyse US data. Overall, 2149 students (1158 girls, 991 boys mainly aged 15-16 years) of the 3846 eligible adolescents (56%) participated. Among the 1843 adolescents with complete audiometry and tympanometry data, the prevalence of audiometric notches was 2.4% (95% confidence interval 1.7-3.1%). We could not confirm the high prevalence of audiometric notches as reported in National Health and Nutrition Examination Surveys for adolescents in the US. Differences in prevalence might be at least partly due to methodical differences in audiometry. Even if empirical evidence is presently ambiguous, it is reasonable to educate young people about the potential risks of high leisure noise exposure.

Hearing Impairment in a Tertiary-Care-Level Population of Mexican Rheumatoid Arthritis Patients

The objectives of this study were to assess characteristics of hearing impairment (HI) in Mexican Mestizo patients with rheumatoid arthritis. One hundred thirteen consecutive patients (101 women, aged 43.3 ± 13.1 years) without previously identified HI diagnosis had a structured interview and complete rheumatic and audiologic evaluations, which included at least a pure-tone audiometry and standard and high-frequency tympanometry. Hearing impairment was defined if the average thresholds for at least 1 of low-, mid-, or high-frequency ranges were 25-dB hearing level or greater in 1 ear (unilateral) or both ears (bilateral). Hearing impairment was classified as mild or moderate/severe. Appropriate statistics, multivariate analysis, and receiver operating characteristic curves were used. Hearing impairment was detected in 27 patients (24%), was sensorineural-type HI in 25 (93%), bilateral in 14 (52%), and mild in 20 of them (74%). Normal tympanograms (type A) were found in 93 patients (82%), although high-frequency tympanometry was abnormal in 80 patients (71.4%). Patients with HI were significantly older (51.8 ± 14.1 vs. 40.7 ± 11.7 years, P ≤ 0.001), had more frequent rheumatoid nodules (37% vs. 12.8%, P = 0.001), and had more (median [range]) comorbidities per patient (2 [1-2] vs. 1 [0-2], P = 0.03). Multivariate analysis showed that HI was significantly associated to age (odds ratio, 1.1; 95% confidence interval, 1.03-1.15; P ≤ 0.001). The best cutoff level for HI was 50 years of age and increased to 59 years for moderate/severe HI. A significant proportion of Mexican Mestizo outpatients with rheumatoid arthritis had previously undiagnosed HI, mainly of sensorineural type, of mild severity, and bilateral. Older age was the only prognosticator of HI.

Stimulus level effects on speech-evoked obligatory cortical auditory evoked potentials in infants with normal hearing

ObjectiveTo determine stimulus level effects on speech-evoked cortical auditory evoked potentials (CAEPs) in infants for a low (/m/) and high (/t/) frequency speech sound. MethodsCAEPs were recorded for two natural speech tokens, /m/ and /t/. Participants were 16 infants aged 3–8months with no risk factors for hearing impairment, no parental concern regarding hearing or development, and normal tympanograms and otoacoustic emissions. Infants were either tested at levels of 30, 50, and 70dB SPL or at 40, 60, and 80dB SPL, in counterbalanced order. ResultsInput–output functions show different effects of increasing sound level between stimuli. There were minimal changes in latency with increase in level for /t/. For /m/, there were approximately 50–60ms latency increases at soft compared to loud levels. Amplitudes saturated at moderate–high levels (60–80dB SPL) for both stimuli. ConclusionsInfants’ CAEP input–output functions differ for /t/ versus /m/ and differ from those previously reported for adults for other stimuli. Effects of stimulus and level on CAEPs should be considered when using CAEPs for hearing aid or cochlear implant evaluation in infants. SignificanceSpeech-evoked CAEPs provide an objective measure of central auditory processing. Possible differences in CAEP growth between infants and adults suggest developmental effects on intensity coding by the auditory cortex.

Effect of orthognathic surgery on middle ear condition

ObjectivesThe aim of this study was to determine the effects of orthognathic surgery on middle ear condition assessed by tympanometry. Materials and methodsThe subjects were 239 patients in whom jaw deformities were surgically corrected. Bilateral sagittal split osteotomies were performed in 80 patients and a combination of Le Fort I osteotomy and bilateral sagittal split osteotomies was used in 159 patients. Tympanometry was performed before surgery and one day, three days, five days, seven days and nine days after surgery. Tympanometric peak pressure and static compliance were used to assess Eustachian tube function, and the tympanograms were divided into three basic types. ResultsTympanometric peak pressure significantly decreased one day after surgery and gradually recovered within nine days after surgery. Tympanometric peak pressure immediately after surgery in the two-jaw surgery group was significantly lower than those in the one-jaw surgery group. The percentage of normal tympanogram decreased immediately after surgery, especially in the two jaw surgery group, and gradually recovered by nine days after surgery. The percentages of normal tympanogram in the patients with ear symptoms were significantly lower than those in the patients without ear symptoms for the entire period. ConclusionOrthognathic surgery, especially maxillary osteotomy, can cause Eustachian tube dysfunction, though it is mild and transient and requires no intervention in most cases. However, 13% of patients had Eustachian tube dysfunction at the end of the study. These results suggest the importance of careful monitoring middle ear condition in patients undergoing orthognathic surgery.

Crianças com fenilcetonúria: avaliação audiológica básica e supressão das otoemissões

OBJETIVO: Avaliar a via auditiva de crianças com fenilcetonúria tratadas precocemente, por meio de audiometria, imitanciometria e supressão das emissões otoacústicas transientes. MÉTODOS:Estudo prospectivo transversal comparativo com amostra composta por 28 crianças, sendo 12 com fenilcetonúria e 16 sem a doença. Foi realizada a pesquisa dos limiares de audibilidade por via aérea e óssea, logoaudiometria, imitanciometria e supressão das emissões otoacústicas transientes. RESULTADOS: A audiometria e a logoaudiometria estiveram normais em todos os participantes. Foram encontrados piores resultados para o índice de reconhecimento de fala (IRF) no grupo com fenilcetonúria. A imitanciometria revelou curva normal para todas as crianças, mas a pesquisa dos reflexos estapedianos demonstrou que as crianças do grupo com fenilcetonúria apresentaram aumento nos seus limiares nas frequências de 2 e 4 kHz. A supressão das emissões otoacústicas transientes não revelou diferença na comparação entre os grupos. CONCLUSÃO: A avaliação audiológica básica não identifica alterações na audição das crianças com fenilcetonúria, mas há pior discriminação ao IRF e aumento nos limiares de reflexos estapedianos nessas crianças, podendo indicar distúrbios do processamento auditivo. O estudo da supressão das otoemissões demonstra integridade do sistema eferente olivococlear medial nas crianças com fenilcetonúria.

Hearing Screening in Children With Skeletal Dysplasia

To determine the prevalence of hearing loss and abnormal tympanometry in children with skeletal dysplasia. Clinical screening program. National convention of the Little People of America. Convenience sample of volunteers aged 18 years or younger with skeletal dysplasias. Hearing screening with behavioral testing and/or otoacoustic emissions, otoscopy, and tympanometry. A failed hearing screen was defined as hearing 35 dB HL (hearing level) or greater at 1 or more tested frequencies or by a "fail" otoacoustic emissions response. Types B and C tympanograms were considered abnormal. A total of 58 children (aged ≤18 years) with skeletal dysplasia enrolled, and 56 completed hearing screening. Forty-one children had normal hearing (71%); 9 failed in 1 ear (16%); and 6 failed in both ears (10%). Forty-four children had achondroplasia, and 31 had normal hearing in both ears (71%); 8 failed hearing screening in 1 ear (18%), and 3 in both ears (7%). Tympanometry was performed in 45 children, with normal tympanograms found in 21 (47%), bilateral abnormal tympanograms in 15 (33%), and unilateral abnormal tympanograms in 9 (20%). Fourteen children with achondroplasia had normal tympanograms (42%); 11 had bilateral abnormal tympanograms (33%); and 8 had unilateral abnormal tympanograms (24%). For those children without functioning tympanostomy tubes, there was a 9.5 times greater odds of hearing loss if there was abnormal tympanometry (P=.03). Hearing loss and middle-ear disease are both highly prevalent in children with skeletal dysplasias. Abnormal tympanometry is highly associated with the presence of hearing loss, as expected in children with eustachian tube dysfunction. Hearing screening with medical intervention is recommended for these children.