Otoscopic Abnormalities Research Articles

Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States.

This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids. The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used. The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates. Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.

Assessment of Outer and Middle Ear Pathologies in Lilongwe, Malawi.

Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018-2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases' was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy.

Otoscopic Abnormalities for the U.S. Population Aged 6-80+ Years: Prevalence and Consequences for Hearing.

U.S. national data for otoscopic examinations of 13,055 individuals aged 6-80+ years included in the National Health and Nutrition Examination Survey surveys for 2011-2012, 2015-2016, and 2017-2020 were analyzed and described. Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined. Overall, the prevalence of abnormal otoscopy was approximately 12%-15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6-19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age. Abnormal otoscopy, typically excessive cerumen, was observed in about 12%-15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.

Long-term follow-up of patients with extensive segmental infantile hemangioma of the cervical or facial region: A French single-center prospective study

BackgroundInfantile hemangiomas (IHs) can be part of PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, eye anomalies) syndrome when they are segmental, extensive, and located on the face or neck. The initial assessment is codified and well known, but there are no recommendations for the follow-up of these patients. The aim of this study was to assess the long-term prevalence of different associated abnormalities. MethodsPatients with a history of large segmental IHs of the face or neck. diagnosed between 2011 and 2016 were included in the study. Each patient underwent an ophthalmological, dental, ENT (ear, nose, and throat), dermatological, neuro-pediatric, and radiological assessment at inclusion. Eight patients including five with PHACE syndrome were prospectively evaluated. ResultsAfter a mean follow-up of 8.5 years, three patients presented with an angiomatous aspect of the oral mucosa, two with hearing loss, and two with otoscopic abnormalities. No patients developed ophthalmological abnormalities. The neurological examination was altered in three cases. Brain magnetic resonance imaging follow-up was unchanged in three out four patients and revealed atrophy of the cerebellar vermis in 1 patient. Neurodevelopmental disorders were found in five of the patients and learning difficulties were observed in five patients. The S1 location appears to be associated with a higher risk of neurodevelopmental disorders and cerebellar malformations, while the S3 location was associated with more progressive complications, including neurovascular, cardiovascular, and ENT abnormalities. ConclusionOur study reported late complications in patients with a large segmental IH of the face or neck, whether associated with PHACE syndrome or not, and we proposed an algorithm to optimize the long-term follow-up.

Otitis media related hearing loss in Indonesian school children

ObjectiveThere are scant recent studies from low middle-income countries that investigate the impact of otitis media (OM) on hearing loss (HL) in school children. MethodsThis was a prospective epidemiological survey conducted by otorhinolaryngologists and audiologists in a sample of 7005 public school children (6–15 years) from 6 urban and rural sub-districts, in Indonesia. Children with otoscopic abnormalities or who failed a hearing-screening test conducted at school, underwent diagnostic audiometry and tympanometry. ResultsOM was detected in 172 children (2.5%), acute otitis media - AOM (17%), otitis media with effusion - OME (15%), and chronic suppurative otitis media - CSOM (67%). The overall rate of HL in the school children was 181/10,000, which was almost three-fold higher in rural (273/10,000) than urban areas 92.6/10,000. OME accounted for much of the mild HL, while CSOM accounted for most of the moderate HL. There was a significantly higher rate of OM related HL in rural areas (116.2/10,000), than in urban areas (47.4/10,000), p = 0.002. OM related disabling HL was found at a rate of 44.2/10,000, mostly due to CSOM (37.1/10,000). ConclusionOtitis media contributed to 57% of all HL in school children, and posed a significant burden on Indonesian school children. Most of the disabling HL was due to CSOM. Efforts to find these children and offer ear and hearing care are important.

A program evaluation of Kids2Hear, a student-run hearing screening program for school children.

BackgroundHearing deficits in children are demonstrably negatively associated with language acquisition and cognition. Although universal neonatal hearing screening exists, it is not offered equally across Canada. Additionally, children emigrating from other countries are often not assessed. The objective of this study is to evaluate Kids2Hear, a free hearing screening program run by medical students at elementary schools, and to determine the rate of hearing deficits that were identified and referred for evaluation.MethodsRetrospective analysis of screening program data from 228 participants seen at three inner-city elementary schools over six months.ResultsIn our sample, the mean age was 5.8 ± 1.0 years with 48 % males. Approximately 21 participants (9.3 %) were screened positive for a hearing deficit and required referral for supplementary audiological evaluation. About 44 participants (19.3 %) were referred to a family physician for otoscopic abnormalities. Females were significantly more likely to be identified for both hearing deficits and otoscopic abnormalities.ConclusionsHearing deficits and otoscopic abnormalities are common among young children. Female children may be at higher risk for developing hearing issues or otoscopic abnormalities compared to males. Additional research is needed to determine the effectiveness of hearing screening programs.

Otoscopic and audiological findings in different populations of 5–14 year-old schoolchildren in Colombia

ObjectiveTo present the otoscopic and audiological findings of studies carried out in groups of 5–14 year old schoolchildren in diverse indigenous, White, and African descended communities in the Republic of Colombia. Materials and methodsThe present study is descriptive and cross-sectional. We obtained a convenience sample for the analysis. We define acute otitis media (AOM), (bulging or redness); tympanic perforation (TP), (disruption of continuity in the tympanic membrane) and sequelea (scarring, myringosclerosis, retractions, secrections). Our results are described as frequencies in percentages. Audiometry was performed in every student. Readings were taken at 250, 500, 1000, 2000, 4000, and 8000Hz for air-conduction and bone-conduction thresholds. Normal hearing is considered up to 20dB, mild sensorineural hearing loss between 21 and 39dB, moderate between 40 and 59dB, severe between 60 and 89dB and profound more than 90dB. For conductive hearing loss the air–bone gap is measured. Results3052 otoscopies were conducted in 1526 schoolchildren. Males predominated in each group except in the Wayuu group. Otoscopic abnormalities rates varied between 1.5% in Providencia group, up to 9.6% in the Amazon groups. No perforations were found in the Wayuu Indian schoolchildren and the highest frequency of Tympanic perforations (1.2%) and sequelaes (8.2)% in the Amazon groups. Audiometric findings were normal in 94–98% of cases. Conductive hearing loss (CHL) was found in 5.5% of Amazon groups and the lowest (1.4%) in the Wayuu groups. Slight to moderate Neurosensorial Hearing Loss (NHL) were found in 1.3% in the Arhuaca communities and moderate 0.9% in the Amazon groups. ConclusionsThe present study is the first conducted in Colombia to evaluate the frequency of ear diseases and sequelae in populations of 5–14 year old children.High prevalences of sequelaes were found in the indigenous groups of the Amazon and the lowest in the Black schoolchildren on the island of Providencia.It is recommended that medical anthropological studies be conducted in these areas, and evaluation done on the probable connection between these types of diseases and processes of intercultural interaction.

Wpływ zmian strukturalnych błony bębenkowej na wyniki audiometrii impedancyjnej i tonalnej w rozszerzonym zakresie częstotliwości

The aim of the study is to analyze the relationship between otoscopic tympanic membrane abnormalities, results of impedanace and extended-high-frequency audiometry in subjects with history of treatment of secretory otitis media (SOM) and ventilation tube insertion. 97 subjects treated because of SOM were examined in years 1999-2000. Videootoscopic examinations, extended-high-frequency audiometry and tympanometry with ispilateral acoustic reflex were performed in each patient. The results were analysed in three groups: no otoscopic abnormalities (BZO), retraction pockets (KR) and atrophy and myringosclerosis (AM). The results were compared to otologicaly healthy control group in the same age. The most common tympanic membrane abnormality were focal atrophy (64.7%) of ears and myringosclerosis (37.2%). Mean pure-tone audiometric threshold were significantly higher in groups KR and AM than in control and BZO groups. Low degree of positive correlation was found between the presence of myringosclerosis and atrophy and audiometric thresholds above 1 kHz. No such correlation was observed with the presence of retraction pockets. In the BZO group middle ear admittance was observed significantly higher than in control group. The absent ipsilateral stapedial reflex was observed in 10.8% ears in BZO group, 16.9% in AM and 33.3% in KR. No correlation was found between the parameters of tympanometric evaluation and results of extended-high-frequency audiometry. In ears treated because of SOM with ventilation tube insertion the middle ear compliance is higher. In the presence of myringosclerosis and atrophy higher audiometric thresholds are observed. Tympanic membrane abnormalities have been more clearly indicated by the absent ipsilateral stapedial reflex than tympanometry.

Acute sensorineural hearing loss and severe otalgia due to scrub typhus

BackgroundScrub typhus is an acute febrile illness caused by Orientia tsutsugamushi.Case presentationsWe encountered a patient with sensorineural hearing loss complicating scrub typhus, and three patients with scrub typhus who complained of otalgia, which was sudden onset, severe, paroxysmal, intermittent yet persistent pain lasting for several seconds, appeared within 1 week after the onset of fever and rash. The acute sensorineural hearing loss and otalgia were resolved after antibiotic administration.ConclusionWhen patients in endemic areas present with fever and rash and have sensorineural hearing loss or otalgia without otoscopic abnormalities, clinicians should suspect scrub typhus and consider empirical antibiotic therapy.

Antiviral and Antibiotic Prescribing for Influenza in Primary Care

Anti-influenza antiviral medications reduce influenza-related morbidity, but may often be used inappropriately. To measure the rate of antiviral and antibiotic prescribing, the appropriateness of antiviral prescribing, and evaluate independent predictors of antiviral and antibiotic prescribing for influenza in primary care. Retrospective analysis of 958 visits of clinician-diagnosed influenza in 21 primary care clinics in eastern Massachusetts from 1999 to 2007. We considered antiviral prescribing appropriate if patients had symptoms for 2 or fewer days, had fever, and any 2 of headache, sore throat, cough, or myalgias. Clinicians prescribed antivirals in 557 (58%) visits and antibiotics in 104 visits (11%). Of antiviral prescriptions, 38% were not appropriate, most commonly because of symptoms for more than 2 days (24% of antiviral prescriptions). In multivariate modeling, selected independent predictors of antiviral prescribing were symptom duration of 2 or fewer days (odds ratio [OR], 12.4; 95% confidence interval [CI], 8.3 to 18.6), year (OR, 1.4 for each successive influenza season; 95% CI, 1.3 to 1.7), patient age (OR, 1.3 per decade; 95% CI, 1.2 to 1.5), and, compared to having no influenza testing, having a negative influenza test (OR, 5.5; 95% CI, 3.4 to 9.1) or a positive influenza test (OR, 11.4; 95% CI, 6.7 to 19.3). Independent predictors of antibiotic prescribing included otoscopic abnormalities (OR, 3.3; 95% CI, 1.8 to 6.0), abnormal lung examination (OR, 4.0; 95% CI, 2.1 to 6.2), and having a chest x-ray performed (OR, 2.2; 95% CI, 1.3 to 3.8). Primary care clinicians are much more likely to prescribe antivirals to patients with symptoms for 2 or fewer days, but also commonly prescribe antivirals inappropriately.

Otologic findings in patients with cleft lip and palate or isolate cleft palate

Objectives: The incidence of middle ear diseases is high in patients with cleft palate. Our objective is to describe otologic findings in 180 patients with cleft lip and palate or isolated cleft palate evaluated and followed at Hospital de Clinicas, Porto Alegre. Methods: From August 2001 to October 2002, 180 patients were studied at our Otolaryngology and Cleft Palate Clinic. Patients were evaluated with a detailed history and accurate registration of the otoscopic and otomicroscopic findings. Statistical analysis was performed with Student’s t, Chi-square and Fisher’s exact tests. Results: At initial evaluation, 130 patients (72.2%) had no otolaryngologic complaints; 109 patients (70.3%) had both lip and palate clefts, while 46 (29.7%) had isolated cleft palates. The overall incidence of otoscopic abnormalities was 77.5%. In 80 patients (46.2%), there was middle ear effusion, in 11 (6.4%) there was chronic cholesteatomatous otitis media, and in 9 (5.2%) noncholesteatomatous otitis media. In 24 patients (13.9%), moderate to severe retraction of the tympanic membrane was the main finding. There was a linear correlation between patient age and the presence of otolaryngologic findings; middle ear effusions were less frequent with increasing age, whereas the occurrence of chronic conditions such as moderate/severe retraction and otitis media with or without cholesteatoma were more common among older patients. Conclusion: Continued otolaryngological evaluation of the patients with cleft palate allows for early intervention and for the preservation of the integrity of the middle ear of these patients.

Efficacy and safety of cefprozil versus cefaclor in the treatment of acute otitis media in pediatric patients

OBJECTIVE: To evaluate the efficacy and safety of two oral cephalosporins, cefprozil and cefaclor, in the treatment of acute otitis media in children.METHODS: Forty children with clinical diagnosis of acute otitis media were randomized in two groups. Twenty-one children were given cefprozil at the dose of 30/mg/kg/day, in two equally divided doses every twelve hours, for ten days. Nineteen children were given cefaclor at the dose of 40/mg/kg/day in three divided doses every eight hours, for ten days. Efficacy evaluation of the antibiotic was analyzed by the presence or absence of symptoms, fever and otoscopic abnormalities while the safety and tolerability were evaluated by spontaneous information for possible adverse events.RESULTS: There was a significant decrease in the number of observed alterations between days 3 and 5 of treatment among those of the cefprozil group in comparison to the cefaclor group, while between days 10 and 14 of treatment the observed cure rate was clinically similar in both groups. Both medications presented adequate safety profiles. Only three children receiving cefprozil presented mild adverse events, such as nausea and vomit, none of which required treatment interruption.CONCLUSIONS: The clinical efficacy of both cephalosporins was similar although a more rapid activity was observed for cefprozil between days 3 and 5 of treatment. The favorable clinical results, the low incidence of adverse events and the twice a day dose regimen suggest that cefprozil is one more antimicrobial of choice for the treatment of acute otitis media in children, when this therapeutic is indicated.

Otalgia occurring without the associated otoscopic abnormalities in Meniere's disease patients

Otalgia occurring without the associated otoscopic abnormalities in Meniere's disease patients

Tympanometric evaluation of middle ear barotrauma during recreational scuba diving.

We report the first prospective evaluation of middle ear barotrauma in experienced recreational scuba divers. In this pilot study, tympanometric and otoscopic evaluations were performed daily on two experienced scuba divers engaged in multi-day repetitive diving. Middle ear pressures decreased in proportion to diving frequency, demonstrating eustachian tube dysfunction which promptly reversed upon cessation of diving Otoscopic evidence of traumatic injury to the middle ear occurred in proportion to diving frequency, and also readily reversed upon cessation of diving. Tympanic membrane compliance remained normal, often despite pronounced otoscopic abnormalities. Otologic symptoms and impairment of acuity were not observed. Tympanometry appears to be a valuable modality for the verification of middle ear hemorrhage or tympanic membrane rupture. This preliminary data should assist investigators in planning more comprehensive studies of middle ear barotrauma, including clinical trials of treatment and prophylactic interventions for this common condition.

Abnormalities of the neonatal ear: otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid.

It is unknown whether childhood ear disease could be present long before symptoms provoke an initial otoscopic examination. A newborn middle ear might or might not start in a pristine, privileged state. The clinician evaluating later infant and childhood ear disease is often unaware of the status of a patient's ear from the neonatal period, the earliest time at which the tympanic membrane can be evaluated. Adding to the physician's handicap, normative otoscopic and histologic data on the neonatal ear are incomplete. In order to test the hypothesis that disease in the neonatal middle ear may be more common than is generally appreciated, the population of critically ill neonates was selected for study since this group can provide both clinical as well as histologic data. This manuscript is divided into three parts. Clinically, otoscopic observations were analyzed on infants in an intensive care unit. Histologically, neonatal temporal bones were studied for normal anatomy and pathology of the middle ear and antrum. Experimentally, an animal study was performed to evaluate the potential effect of amniotic fluid cellular contents aspirated into the middle ear. I. Clinical Otoscopic Observations. Daily otoscopic examination was conducted on 44 neonates in an intensive care unit. Specific parameters of the otoscopic examination were evaluated to compare with the normal, translucent tympanic membrane of the older child. The otoscopic appearance was found to be abnormal in 97.7% of neonatal ears. Of the otoscopic parameters evaluated, right ears averaged 2.6 abnormalities and left ears averaged 2.5 otoscopic abnormalities. The otoscopic appearance of the neonate in the neonatal intensive care unit is nearly universally abnormal. II. Temporal Bone Histologic Observations. One hundred eleven temporal bones from 56 neonates were collected for histologic study by light microscopy. Mesenchyme filling more than 60% of the middle ear space was found in 13 bones. Amniotic fluid cellular content was detected in 90 bones. Purulent otitis media was detected in 24 bones. Varying amounts of blood were found in the middle ear space of 34 bones. Only 7 of the bones had no significant middle ear abnormality. It is concluded that in the critically ill neonate, the middle ear and antrum usually contain cellular or fluid material, often in significant volume, that would not be considered normal in the older patient. III. An Animal Model Simulating Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of middle-ear dysfunction and disease on hearing and language in high-risks infants

The effect of middle-ear dysfunction and disease on hearing and language development at one year of age was evaluated for 143 high-risk infants. These infants were categorized as normal or abnormal based on otologic history, otoscopic examinations, and on tympanometric examinations. Language was significantly related to gestational age, being delayed by approximately the amount of prematurity. Language scores were therefore adjusted for gestational age. Speech-detection threshold was not related to gestational age, and was used as the measure of hearing. Hearing levels were negatively correlated with adjusted language quotients. Infants with abnormal otologic histories reported were not different from infants with normal histories in either hearing or language development. Infants with bilateral otoscopic abnormalities had significantly higher speech-detection thresholds, but did not differ in language development from those with bilaterally normal otoscopy. Infants who were abnormal bilaterally by tympanometric examination had significantly higher speech-detection thresholds as well as significantly delayed language development. A significant effect on both hearing and language was found among those infants bilaterally abnormal by tympanometry for whom evidence of middleear disease was not visualized by otoscopic examination. Implications of these findings are discussed.