Tympanometry Research Articles

Oral and otolaryngological complications of radiotherapy for head and neck cancers among patients attending Ocean Road Cancer Institute, Tanzania

Background The prevalence of head and neck cancers is on the increase worldwide. Treatment modalities include surgery, radiotherapy and chemotherapy. The aim of this study was to determine the proportion of acute oral and otolaryngological complications of radiotherapy with or without chemotherapy for head and neck cancers. Methods A retrospective cross-sectional, hospital based study was done to 80 patients with head and neck cancers who have just completed radiotherapy with or without chemotherapy at Ocean Road Cancer Institute (ORCI). Data was collected using a structured questionnaire within one week after completion of radiotherapy. Patients who reported hearing loss underwent otoscopy and audio-logical assessment including tympanometry and pure tone audiometry. Data was analyzed using SPSS program. Results The proportion of males was higher than that of females in the ratio of 2:1 and majority of the patients involved were in the 6th decade of life, (27.5%). Out of the 80 study participants, 80% were found to have oropharyngeal mucositis, 90% were found to have xerostomia and 50% were found to have dysphagia. In addition, 76.2% of patients reported to have developed taste disorders after radiotherapy and 43.1% reported to have developed voice disorders. The proportion of hearing loss following radiotherapy was 21.9% though this should be taken with caution since there was no before and after intervention taken. Patients with sinonasal cancers had the least proportion of oral and oropharyngeal mucositis (50%), xerostomia (64.3%) and voice disorders (14.3%). Most of patients who developed hearing loss had nasopharyngeal cancer (85.6%) and salivary gland cancer (66.7%) while patients with oropharyngeal cancer, hypopharyngeal cancer and laryngeal cancer did not develop hearing loss at all. Conclusion Oral and otolaryngological complications of radiotherapy with or without chemotherapy for head and neck cancers at ORCI are quite prevalent. Prevention of complications should be highly regarded especially by using shield protectors on uninvolved areas and advanced radiotherapy machines should be considered to minimize such complications. Key words: Oral, otolaryngological, head, neck, cancers, Tanzania.

Tympanometric changes before and after treatment with functional endoscopic sinus surgery in cases of chronic sinusitis

Objective The aim was to detect the effect of chronic rhinosinusitis (CRS) on eustachian tube function and evaluate the tympanometric changes in these cases after functional endoscopic sinus surgery. Background CRS can alter the function of eustachian tube and the middle ear pressure. Materials and methods This prospective study was carried out on 60 patients from the otorhinolaryngology departments of El-Hussien University Hospital and Bab El Shaeria University Hospital and at the audiology unit of Al Azhar University. The patients included in this study were classified into two groups: group I included 40 patients diagnosed as having CRS with or without nasal polyposis, and group II (control group) included 20 patients who were ENT free at the time of examination. Tympanometry and eustachian tube patency function test (EFT) before and 3 and 6 months after functional endoscopic sinus surgery were done in group 1 and at the time of first presentation in the control group. Results A significant effect of nasal obstruction on middle ear pressure and EFT was noticed (P > 0.005). There was no significant relation between laterality of nasal obstruction and the result of tympanometry and EFT preoperatively. Not all the cases with type A tympanogram had good EFT, and this indicted that cases with type A tympanogram may have good or poor EFT, that is, not always good EFT. The changes of the type of tympanometry between before and after operation from type C to type A were statistically highly significant. Conclusion CRS causes eustachian tube dysfunction, and surgery of nasal obstruction had a significant effect in improving the middle ear pressure and the EFT.

Otitis media with effusion

This study was conducted to analyze the variety of pathological processes leading to OME and to assess the results of different treatment modalities. Patients aged between two years and fifty years with hearing difficulty were included in the study. Study showed that males were 1.72 times more affected than females. Nasal obstruction was an associated symptom in 24(20%) patients. All the patients were subjected to detailed history, thorough clinical otolaryngological examination. Every patient was investigated by pure tone audiometery and tympanometry. A total number of 120 patients were studied. 76(63.3%)were male and 44(36.6%)were females. The mean age was 26 years.

Detection of the Presence of Middle-ear Effusion with Wideband Absorbance Tympanometry

This study evaluated the ability of wideband absorbance (AB) to predict the presence of middle-ear effusion (MEE) in ears with a flat (type B) 226 Hz tympanogram (TG). AB measures were obtained in a no MEE group of 8 ears with a flat TG and a MEE group of 19 ears also with a flat TG. AB was significantly small at frequencies 2 and 4 kHz in the MEE group than in the no MEE group. Based on our results, it appeared that AB could detect MEE with higher specificity than conventional tympanometry. The presence or absence of MEE could be distinguished based on the average AB using 1, 2, and 4 kHz, with 40% as the cutoff point.

Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation.

Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors. Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes. At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients. The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.

ULTRASONIC EXAMINATION OF VENTILATION TUBES PATENCY IN PATIENTS WITH OTITIS MEDIA WITH EFFUSION AFTER TIMPANOSTOMY

The aim of this study was to improve the accuracy and sensitivity of methods for ventilation tube patency evaluation after timpanostomy. New method of one-dimensional ultrasound middle ear sonography was developed. We studied ventilation tubes patency in 40 patients with otitis media with effusion, after timpanostomy. All patients tympanometry and one-dimensional ultrasound sonography was obtained at 4, 7th and one month after surgery. After timpanostomy in children with the otitis media with effusion, at 4 days after the surgery one-dimensional ultrasound sonography detected normal function of ventilation tubes in 75% patients. At the same time, according to tympanometry ventilation tube patency was recorded in 80% patients. On 7th day after surgery one-dimensional ultrasound sonography detected normal function of ventilation tubes in 85% patients. According to tympanometry the 90% patients demonstrated normal ventilation tube function. One month after surgery one-dimensional ultrasound sonography detected normal function of ventilation tubes in 92.5% patients. At the same time, according to tympa nometry ventilation tube patency was recorded in 95% people. Calculation of ultrasound sonography sensitivity and specificity showed that the sensitivity of this process is 97.4%, specificity – 100%. The statistical significance of differences in ventilation tube patency assessment is not determined. Thus, we have proved one-dimensional ultrasound sonography the sensitive method for ventilation tubes patency validation. The method is simple, requires a bit of time for application, so it can be widely recommended for outpatient network.

Screening questionnaire for noise induced hearing loss among military personnel

Objectives: To study the effect of noise exposure on hearing sensitivity of the screened groups, analysis of questionnaire of noise exposure and to compare hearing impairment in different noise exposure categories. Materials and Methods: As a first part of the screening study, 1879 subjects were evaluated, 860 land-force, 358 air-forcc, 378 air-defense and 283 from navy. First noise exposure survey filled by the study group. Then screening air conduction pure tone audiogram was done for each participant. Patients who did not pass the screening air conduction pure tone audiogram were referred to the ENT and audiology unit for further evaluation, complete history, otological examination, and tympanometry. Results: the average duration of duty for the study group was 10.26 ± 8.06 years. 33.9 % of the study group was cigarette smoker. One hundred eighty eight subjects out of 1879 (10 %) did not pass the screening air conduction pure tone audiogram and thev were referred to audiolonv clinic. Discussion and Conclusion: 10 % of the high-risk noise exposed subjects had high frequencies hearing loss. This hearing loss could be minimized with the proper use of the hearing protective devices on exposure to intense noise level, as noise induced hearing loss is preventable disease by proper use of the hearing protective devices.

Comparison of the tympanogram and otoscopic findings in effusions of middle ear

Amac: Efuzyonlu otitis media supheli olgularda timpa­nogram bulgularinin otoskopik muayene bulgulari ile karsilastirilarak timpanogram testinin rutin kullanimdaki yerinin sorgulanmasi. Gerec ve yontem: Efuzyonlu otitis media suphesi ile Ku­lak Burun Bogaz (KBB) poliklinigimize ayaktan basvuran 64 olgunun 128 kulagina otoskopik muayene ve sonra­sinda timpanometrik inceleme yapildi. Otoskopik mua­yeneyi yapan hekimlerin timpanogramda cikacak sonuc hakkinda tahminleri ile gercek timpanogram sonuclari karsilastirildi. Bulgular: Incelemeye dahil edilen toplam 128 otoskopik muayenenin 29\'unda (%22,6) hekimin otoskopik muaye­ne tahmini ile timpanogram sonucu ayni cikmadi. Ancak bu otoskopik muayenelerin sadece dordunde hekim ta­rafindan efuzyon olmadigini dusunduren Tip A timpanog­ram tahmini yapilirken, timpanogram isleminde efuzyon varligini dusunduren Tip B veya Tip C sonuclari elde edil­mistir. Sonuc: Timpanogram testinin otolojik muayenenin bir parcasi olarak rutin olarak her hastaya uygulanmasi za­man ve maddi kayip sebebidir. Bu nedenle oncelikli sece­negimiz otoskopik muayene olmalidir.

Role of oxidative stress in chronic otitis media with effusion in children

Chronic otitis media with effusion (OME) is a common pathologic condition characterized by nonpurulent fluid in the middle ear (ME) that leads to moderate conductive hearing loss and flat tympanogram. During OME inflammatory cells generate large amounts of superoxide radicals to improve bactericidal activity. Overproduction of oxygen-derived free radicals induces oxidative damage in humans. Glutathione (GSH) is one of the major components of the antioxidant system that protects cells from oxidative stress. The aim of the study was to evaluate oxidative stress in chronic OME by investigation of ME fluids collected during myringotomy. During myringotomy, fluid was collected from the ME to evaluate lipid peroxide levels in the effusion. Immunohistochemical study was also performed to assess the anatomical features of tympanic membrane. Fifty-nine children with ME effusion without any resolution after repeated medical treatments were enrolled in the study. No morphological significant changes were observed. Lipid peroxide levels in all samples were high (mean 11.5 nmole/million cells), similar to the values found in other chronic diseases. GSH might be employed during surgery while applying ventilation tubes and after surgery to prevent oxidative stress. The high oxidant levels in chronic OME observed in our research and the improvement seen in children after antioxidant treatment suggest that oxygen-derived free radicals play an important role in chronic OME.

Audiologic features of mitochondrial DNA A3243G mutation and its correlation with mutation rate

To summarize the clinical audiologic features of patients with mitochondrial DNA (mtDNA) A3243G mutation and explore the lesion location of hearing loss so as to examine its correlation with the related syndrome. A total of 44 patients with mtDNA A3243G mutation from 2009-2011 were studied. Audiological evaluations consisted of measurements of pure-tone and speech audiometry, tympanometry, distortion-product otoacoustic emissions and auditory brainstem response. We investigated a possible correlation between the degree of hearing loss and gender, age and mutation rate. (1) Pure tone test was performed in 41 patients and showed normal hearing or symmetrical sensorineural hearing loss. Pure tone audiogram (PTA) showed high-frequency loss and descending curve in a majority of patients. There were 75 ears with hearing loss in 82 ears (91.46%), 22 ears with abnormal speech audiometry in 26 ears, 77 ears with abnormal distortion product otoacoustic emissions (DPOAE)testing in 86 ears, including 5 ears with normal PTA, 31 ears with abnormal electrocochleography in 75 ears, 25 ears with abnormal auditory brainstem response (ABR) in 82 ears. The abnormal ABR showed elevated threshold in 10 ears, delayed interpeak latencies of wave I-V in 2 ears and disappearance of wave V before wave I in 1 ear. In addition, there were 2 ears with speech audiometry abnormal but with normal ABR. (2) The correlation between the severity of hearing and gender did not reach statistical significance, nor the severity of hearing and mutation ratio. Age could influence the hearing of A3243G-induced MELAS. The predominant lesions of mtDNA A3243G is at cochlea and retrocochlear sites. Significant variations in clinical manifestation of hearing are the prominent features in patient with A3243G mutation. There was no correlation between the degree of hearing loss and mutation load. However, hearing impairment is the most common symptom of A3243G mutation.

Clinical analysis of middle ear function and nursing intervention for children patients with obstructive sleep apnea hypopnea syndrome

Objective To explore effective nursing intervention through clinical analysis of middle ear function of children with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods Tympanogram was obtained from both pre-operation and post-operation in 413 OSAHS cases(the OSAHS group).Audiogram was conducted if the tympanogram was abnormal.There were 279 cases of normal children in the control group.The incidence of middle ear function loss of two groups were compared.Results 288 cases(328 ears) had some degree of middle ear dysfunction,accounting for 69.73％.69 cases had some degree of hearing loss,accounting for 16.71％.The incidences of middle ear dysfunction and degree of hearing loss in the OSAHS group were higher than 7.53％ and 1.43％ of the control group.The hearing ability was gained after operation in both groups.Conclusions The incidence of middle ear dysfunction is higher in children with obstructive sleep apnea hypopnea syndrome.But the bad influence alleviated with age.Therefore,early detection,timely treatment and effective nursing can achieve good effect. Key words: Obstructive sleep apnea hypopnea syndrome; Middle ear function; Nursing care

Digital auto acoustic control tympanometry on ear system

Objective To keep the intensity of sound constant and reduce the effect of ear canal difference on detection process.Methods Real-time detection of the probe tone in ear canal was carried out and by control ling the output circuit of the probe tone through the digital signal compensation algorithm,to realize real-time digital tympanometry of ear system and the function of constant pressure control.Results The results showed that the probe tone remained constant at 226 Hz for the measurement of middle ear and tympanometry was accurate.Conclusion The study simplified system configuration and provides basis for the clinical application. Key words: Tympanometry; Digital; Probe tone; Middle ear

Toll-like receptor 2 and Toll-like receptor 4 participates in mediation of acute otitis media and mortality in pneumococcal infections in mice

To investigate the roles of Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) in host defense against Streptococcus pneumoniae infection in the middle ear. Wild-type (WT) C57BL/6J, TLR2-deficient (TLR2(-/-)) and TLR4-deficient (TLR4(-/-)) mice were inoculated with Streptococcus pneumoniae (1 × 10(6)CFU) through the tympanic membrane. All animals were tested the mouse ABR thresholds and tympanometry measurement before, and 1 day, 3 days and 7 days following pneumococcal challenge. Blood bacterial titer were determined by plating 50 µl volumes of 10-fold diluted blood. Histological analysis of middle ear and inner ear were performed by fixation, decalcification, embedded section, and counterstained with hematoxylin/eosin and toluidine blue staining. Semi-quantitative RT-PCR was applied to determine mRNA accumulation of TLR2 and TLR4 related genes. Forty of 68 TLR2(-/-) mice and twenty-one of 59 TLR4(-/-) mice showed bacteremia and died within 3 days after the pneumococcal challenge, however, only 9 of 52 WT mice died. The survive mice were shown have more severe hearing loss in the TLR2(-/-) and TLR4(-/-) mice than in the WT mice, indicated by ABR thresholds, at 3 or 7 days postinoculation. The histological pathology was characterized by effusion and tissue damage in the middle ear, and in the TLR2(-/-) and TLR4(-/-) mice, the outcome of infection became more severe at 7 days. At both 3 and 7 days after challenge, the TLR2(-/-) mice had higher blood bacterial titers than WT mice (P < 0.05). Temporal bone histopathologic change indicated that 3 days after the pneumococcal challenge, the TLR2(-/-) and TLR4(-/-) mice showed effusion and tissue damage in the middle ear, and the infection became more severe at 7 days postinoculation. TLR2(-/-) mice showed severe inflammatory cell infiltration in the cochlear, the organ of Corti showed the outer hair cells damage, the tectorial membrane swelling, degeneration of the stria vascularis, and severe loss of spiral ganglion cells; However, the WT mice was not found the cell infiltration and tissue damage in the cochlear, the organ of Corti shown normal of outer hair cells. Mast cells were not found in the middle ear mucosa of TLR2(-/-) mice, but in the TLR4(-/-) and WT mice, more mast cells were found in the middle ear mucosa of effusion ear by 3 and 7 days postchallenge. Moreover, by 3 days postchallenge, the mRNA accumulation levels of NF-κB, tumor necrosis factor alpha (TNFα), interleukin1β, MIP-1α, MUC5AC and MUC5B were significantly lower in the ears of TLR2(-/-) mice than that in WT and TLR4(-/-) mice. TLR2(-/-) mice may produce relatively low levels of proinflammatory cytokines following pneumococcal challenge, thus hindering the clearance of bacteria from the middle ear and leading to sepsis and high mortality rate. This study indicated that TLR2 and TLR4 are important in the molecular pathogenesis and host response to otitis media.

Reliability of the Acoustic Otoscope and Comparison with Tympanometry

Reliability of the Acoustic Otoscope and Comparison with Tympanometry

Audiology characteristics in newborns and infants who failed in the hearing screening by transiently evoked otoacoustic emissions: 89 cases study

The present study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions (DPOAE) and other hearing testing methods were also evaluated. The participants consisted of eighty-nine infants, with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following groups based on the test results from distortion product otoacoustic emissions: group A (normal all-frequency), group B (abnormal low-frequency), group C (abnormal high-frequency), and group D (abnormal all-frequency). Obtained from these groups were compared to results of other hearing tests including the latency of ABR wave I, 40 Hz auditory event related potential (40 Hz AERP), 226 Hz and 1000 Hz tympanometry, and acoustic reflex. Results In six hearing tests in the 123 ears, seven ears (5.7%) were normal, while 116 ears (94.3%) were abnormal. No significantly differences were detected between boys (93.9%) and girls (95.1%), as well as between left (93.1%) and right ears (95.4%). The proportion of abnormal test results ranked as follows: 59 ears in group D (48.0%), 34 ears in group B (27.6%), 20 ears in group A (16.3%), and 10 ears in group C (8.2%). The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40.0% for group A, 55.9% for group B and 66.1% for group D respectively. The highest abnormal rate in group C was the latency of ABR wave I (50.0%). Distribution of low-frequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing loss. The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.

Screening Tympanometry: Criteria for Medical Referral: Original Papers

Tympanograms were obtained from normal preschool and adult subjects with a prototype hand-held tympanometer to obtain normative values for four tympanometric variables: static admittance, equivalent ear canal volume, tympanometric peak pressure, and gradient. Effects of age group, sex, and pump speed (200 or 400 daPa/s) were determined. The results were incorporated into a four-part screening protocol (history, visual inspection, audiometry, and tympanometry) designed to reduce the excessive error rates associated with screening strategies that rely exclusively on tympanometry.

Frequency of Otitis Media with Effusion in recurrent upper respiratory tract infection in children.

To determine the frequency of Otitis Media with Effusion (OME) in children with recurrent upper respiratory tract infections. A descriptive study. Combined Military Hospital, Gujranwala, from September 2003 to September 2005. Children of either gender suffering from more than 2 episodes of upper respiratory tract infection in the last 12 weeks were studied. The inclusion criteria were mild intermittent ear pain, fullness or "popping" of the ear drum; poor response to normal speech, inattentiveness, behavioural changes; irritability, sleep disturbances; balance problems and poor school performance. Diagnosis of OME was confirmed by pneumatic otoscopy while tuning-fork tests, tympanometry, pure tone audiometry were used as adjunct investigations. Results were described in percentage and 95% confidence interval was determined. Out of the 350 referred cases, pneumatic otoscopy by otolaryngologists diagnosed OME in 147 (42%, 95% CI=37.9-47.1). Out of these, 112 (76%) had retracted tympanic membrane, 25 (17%) had bulging of tympanic membrane and 10/147 (6.08%) cases showed dullness of tympanic membrane with no additional features. Tympanometry confirmed fluid behind the tympanic membrane in 145/147 (98.6%) cases. Tuning-fork tests showed negative Rinne's test in 122 (83%). Pure tone audiometry diagnosed deafness in 138/147 (93.8%) cases. OME with hearing loss is common in children having recurrent upper respiratory tract infection and nonspecific ear-related symptoms.

Tympanometry or Reflectometry for Confirming Middle Ear Effusion

Accurate diagnosis of acute otitis media (AOM) or otitis media with effusion depends on the presence of middle ear effusion (MEE). Tympanometry and spectral gradient acoustic reflectometry (SGAR) are noninvasive methods for detecting MEE. To compare the accuracy of the two methods, researchers analyzed data from an AOM vaccine study in …

When a tympanogram looks too “flat”

When a tympanogram looks too “flat”

Tympanometry and acoustic reflectometry in ears with chronic retraction without effusion

Objective: Purpose of this study was to find out test accuracy and predictivity of tympanometry (TYMP) and parameters (reflectivity and curve angle) of acoustic reflectometry (AR) in the ears with prior clinic and otoscopic evidences of effusion in which no effusion was detected by myringotomy, by comparing with the data found in normal ears and in those with effusion. Methods: While study group included 31 ears with chronic retraction in which no effusion was detected by myringotomy, control group included 150 fully normal ears and 150 ears with effusion confirmed by myringotomy. B tracings in TYMP, and values of reflectivity higher than 5 and curve angle lower than 75° in AR were accepted as indicators of effusion; in the combined test, the ears with non-B tracings in which curve angle higher than 75° were accepted as those without effusion. Results: False positivity values of TYMP, reflectivity and curve angle and the combined test found in the ears with chronic retraction without effusion (29, 23, 19 and 35% respectively; χ 2-test, P>0.1) were significantly higher than normal ears ( χ 2-test, P<0.001), but lower than those of effusion ( χ 2-test, P<0.0001). Further, although negative predictivity values of TYMP, reflectivity and curve angle were found to be lower in these ear, compared to normal ears ( χ 2-test, P<0.01), the combined test reached to a perfect negative predictivity, as much as in normal ears. On the other hand, positive predictivity values were decreased in the ears with chronic retraction without effusion by only reflectivity. Conclusions: By both TYMP and AR alone, it is more difficult to find out the ears without effusion among the ears clinically and otoscopically diagnosed as otitis media than to find out normal ears. Therefore, in clinical work, false positivity of these devices were higher, and their specificity and negative predictivity were lower; although the combined test solved problem of low negative predictivity, high number of false positive ears in clinical work, that is lower specificity, continues to be an unsolved problem by either TYMP or AR alone, or both together.