Otoacoustic emissions in children with otitis media with effusion

OBJECTIVES: Otoacoustic emissions (OAE) are transmitted from the cochlea to the ear canal via the middle ear and the transmission properties of the middle ear directly influence OAE characteristics. The purpose of this study was to establish the mechanisms of changes occurred in middle ear by tympanometric, audiometric and OAE examination. METHODS: Audiometric and tympanometric examination were performed and otoacoustic emissions were recorded from 22 normal ears and 52 ears with middle ear effusions and repeated 3 months later. RESULTS: Results of the air conduction in study group were significantly different from the control group and we found significant recovery in 3 months. When we analysed the DPOAE evaluation results in our study, some of the DPOAE parameters were found to be different between the control and the study group at low frequencies. Changes in the amplitude, especially at low frequencies, were statistically significant after 3 months. CONCLUSION: The results of this study revealed that measurement of otoacoustic emissions, especially distortion product otoacoustic emissions, is helpful in evaluating the condition of middle ear during the treatment.     

Otoacoustic emissions and tympanometry in children with otitis media

OBJECTIVE: To examine otoacoustic emission and tympanometric findings in children with surgically confirmed middle ear effusion (MEE). DESIGN: A total of 102 children aged 0.7 to 11.4 yr undergoing surgery because of otitis media were included in the study. A tympanometric examination and transient evoked otoacoustic emission (TEOAE) measurement were performed on each ear before myringotomy. MEE was aspirated, weighed and classified as mucoid or nonmucoid. TEOAE measurements were compared with the quantity and quality of MEE and to the tympanometric findings. RESULTS: Fifty (72%) ears out of the 65 ears containing effusion showed reduced TEOAE. The quantity of effusion was associated significantly (p < 0.001) with the TEOAE responses, and mucoid effusion reduced the emissions more than nonmucoid. The sensitivity of tympanometry in identifying the ears without recordable TEOAE was 73% and the specificity 81%. CONCLUSION: MEE results in a significant reduction in TEOAEs even when the effusion is nonmucoid. This suggests that transmission of acoustic energy to and from the middle ear is altered in children experiencing any form of otitis media with effusion.     

Otoacoustic emissions and extended high-frequency hearing sensitivity in young adults

The relationship between hearing sensitivity in the extended high-frequency region (8-16 kHz) and (1) the presence of synchronized spontaneous otoacoustic emissions (SSOAEs) and (2) the strength of click-evoked and distortion product otoacoustic emissions (CEOAEs and DPOAEs) was investigated in 104 ears of 57 young adults. The age range was confined to 16 to 19 years. All subjects had normal hearing in the conventional audiometric frequency range (0.5-8 kHz). Ears with detected SSOAEs had better hearing sensitivity in the extended high-frequency region and also higher levels of CEOAEs and DPOAEs than ears with undetected SSOAEs. The results support the hypothesis that the presence of SSOAEs is indicative of an ear with highly normal cochlear function over a broad frequency range.     

Otoacoustic emissions in 28 young adults exposed to amplified music.

Popular concern about widespread damage to the hearing from exposure to amplified music continues, although there has been little firm evidence of permanent effects in casual listeners. Measurement of transient evoked otoacoustic emissions (TEOAEs) provides a sensitive technique for testing outer hair cell (OHC) function, and was used in this study of 28 young adults aged 18-25 years, whose only significant source of noise exposure was loud music, to look for evidence of poorer cochlear function in those of greater exposure; they provided 27 right ears and 27 left ears suitable for measurement of TEOAE strength. Estimates of subjects' total noise dose were obtained from self-reports of the duration and intensity of their exposure to music and other sources of noise. Ears with greater exposure to loud music showed significantly weaker TEOAEs than less exposed ears in response to a 4 kHz tone burst, or in response to a saturating (82 dBSPL) click if the response was treated with a high-frequency bandpass filter (2-4 kHz) (p<0.05). Differences between more exposed and less exposed groups of ears were most marked in the 2 kHz half-octave band for right ears, and in the 2.8 kHz half-octave band for left ears. A hypothesis is proposed that weakness in TEOAEs as a result of exposure to loud music is seen first in the 2 kHz region of the emission spectrum, and later at higher frequencies; and that for a given amount of exposure, TEOAE weakness (or OHC damage) is more advanced in left ears than in right.     

Hearing and otitis media with effusion in young adults with cleft lip and palate

Abstract Conclusion: Speech recognition in noise is affected when otitis media with effusion (OME) is present in young adults with unilateral cleft lip and palate. Objective: The objective of this study was to describe the hearing and performance on auditory tasks of young adults with unilateral cleft lip and palate as compared to young adults without cleft lip and palate. Methods: Twenty-six young adults with unilateral cleft lip and palate and 23 young adults without cleft lip and palate participated in the study. Pure tone audiometry, tympanometry, speech recognition in noise at the word and sentence level, and masking level difference were examined. Results: Results revealed elevated hearing thresholds in the young adults with cleft lip and palate as compared with young adults without cleft lip and palate. No differences concerning speech recognition in noise and binaural processing were observed between the young adults with cleft lip and palate and those without. However, there was poorer speech recognition performance in those adults with unilateral cleft lip and palate and OME on the day of testing as compared with young adults with unilateral cleft lip and palate without OME on the day of testing.     

Transient evoked otoacoustic emissions in young children with otitis media with effusion before and after surgery

Objective

Otitis media with effusion (OME) is one of the commonest causes of acquired hearing loss in children with increasing incidence. In young children the diagnosis is restricted to clinical trials and tympanometry whereas evaluation of the auditory function is impossible due to noncompliance during pure tone audiometry. For this purpose, measurement of otoacoustic emissions, especially transient evoked ones (TEOAE), can be applied. The aim of this study is to evaluate the parameters of TEOAE in young children with OME prior and after surgery.

Methods

Prospective study included 50 children with OME, both sexes, aged 2–5 years. Preoperatively tympanometric examination was performed and TEOAE were recorded. Surgery was performed under general anesthesia and included myringotomy with/without ventilation tube insertion. Measurements of TEOAEs (correlation percentage, signal to noise ratio and amplitude) were repeated on the first and six day postoperatively as well as 6 weeks and 6 months postoperatively.

Results

The preoperative TEOAEs were not recorded in 93.5%, with values of all TEOAE parameters being the most affected on highest frequencies. Significant changes of all TEOAE parameters were found 6 weeks postoperatively with further improvement 6 months postoperatively. Statistically highly significant difference of TEOAE between examinees with and without inserted ventilation tubes was established only in regard to preoperative results.

Conclusion

In small children with OME, application of TEOAEs in follow-up of surgical effects is a method of choice for hearing screening due to its objectivity, simplicity and ease of use even after insertion of ventilation tubes. Follow-ups of TEOAE correlation percentage and signal to noise ratio reflect the condition earlier than follow-ups of TEOAE amplitude.     

Cochlear implantation in patients with a history of chronic otitis media

OBJECTIVE: To propose management options for cochlear implantation in chronic otitis media based on our experiences. MATERIAL AND METHODS: A retrospective review of 418 cochlear implantations performed by the 2 senior authors between November 1988 and February 2004 was conducted. Nine patients who had chronic otitis media in the ear to be implanted were included. Of these, three showed active inflammation at presentation; the other six cases had undergone previous tympanomastoidectomy surgery and did not show active inflammation at presentation. RESULTS: Five patients with active inflammation or without an adequate soft tissue layer in the mastoid bowl underwent a two-stage procedure. Four cases who showed inactive inflammation and had an adequate tissue layer to protect the electrode array underwent a single-stage technique, although two of them showed dry tympanic membrane perforation. No local or intracranial inflammation recurred. The electrode was exposed in the mastoid bowl in one case, who was managed with revisional mastoid obliteration with soft tissue. CONCLUSION: Complete eradication of inflammation and the securing of a strong protective soft tissue layer over the electrode are prerequisites for cochlear implantation in ears with chronic otitis media.     

Otoacoustic emissions in normal and hearing-impaired children and normal adults

Although distortion-product otoacoustic emissions (DPOEs) have been studied in adults recently, there is little information regarding them in young children. DPOEs and click-evoked otoacoustic emissions (CEOEs) were measured from a same group of normal and hearing-impaired children (age 4 through 10 years) and normal adults (age 22 through 29 years). Measurements of DPOEs in 13 children's ears with normal hearing showed higher levels of emissions in the 700- to 1400-Hz and 5.7-kHz regions relative to the data obtained in 10 normal adult ears. The 22 ears of children with sensorineural hearing loss demonstrated agreement between pure-tone audiograms and "DPOE audiograms." Measurements of CEOEs revealed that the average level of emission in 15 normal-hearing children's ears was slightly lower than that previously obtained in newborns, but slightly higher than that of adults. In children, the CEOE spectral components in the 4- to 6-kHz region were lower than in newborns, but higher than in adults. These results support the view that the DPOEs and CEOEs comprise a valuable tool in assessment of cochlear function in subjects of all ages.     

Multifrequency tympanometry in adults with otitis media with effusion

We compared the diagnostic values of multifrequency tympanometry (MFT) and conventional 226-Hz tympanometry in adults with otitis media with effusion (OME) and discuss whether the resonant frequency (RF) can be used as a reliable method in adults with OME. Prospective study was designed to compare the normal hearing group and the group with OME. In the OME group (n = 85), conductive or mixed hearing loss was found, air-bone gap was more than 10 dBHL, and acoustic reflex was not elicited. In the normal hearing group (n = 36), pure tone threshold was less than or equal to 15 dBHL and air-bone gap was less than 10 dBHL. Levene's test was used to compare the difference between the OME group and the normal hearing group on day1, day15, day30, day90, respectively. The relationship among multifrequency tympanometry, 226-Hz tympanometry and acoustic reflex test in ears recovering from OME was also investigated. A statistically significant decrease in RF value was found in ears with OME compared to normative data. In follow-up visits, both the RF values and the percentage of type A tympanograms increased while the percentage of type B and C tympanograms decreased. A high agreement between middle ear resonant frequency test and acoustic reflex test in ears recovering from OME was found. The resonant frequency test provides more detailed information than the 226-Hz tympanometry. Multifrequency tympanometry may be a more sensitive and objective diagnostic tool in adults with OME.     

Otoacoustic emissions in patients with hypotension

The aim of this study was to investigate the relation between hypotension and slowly developing hearing impairment, using otoacoustic emissions. A group of 42 patients was examined, with diastolic blood pressure < or = 60 mmHg and systolic blood pressure < or = 105 mmHg. The subjects underwent biochemical, cardiological, ENT and audiological examinations. Distortion product otoacoustic emissions (DPOAE) were recorded in the format of DP-gram. The results were compared to the data of 30 normal persons of similar age and sex, examined at the same laboratory. Audiometric results showed that 18 patients had mild or moderate symmetrical hearing loss in one or more frequencies, mainly in the lower frequency range. DPOAE of the patients had reduced amplitude as compared to controls or were even absent, in one or more frequencies. It may be concluded that a hypotensive condition could be a possible factor in the origin of cochlear damage and DPOAE may be useful in monitoring hypotensive patients.     

Otoacoustic emissions in a song bird

Synchronously evoked otoacoustic emissions (SEOAEs) were found in about two thirds (61%) of 56 ears of the starling Sturnus vulgaris. They appeared with rather broad synchronization widths (about 200 Hz) and predominantly at frequencies in the upper half of the hearing range of this bird. SEOAEs varied in level from below -30 dB to 2 dB SPL and showed typically nonlinear intensity functions. The emissions were present even following extirpation of the middle-ear muscle and could be suppressed by anaesthetics. Using Halothane, it was possible to determine the time course of this suppressive effect. Using second tones, typical iso-suppression tuning curves were obtained. The similarities and differences between the characteristics of these SEOAEs and emissions in other nonmammals and in mammals are discussed with regard to anatomical differences in inner-ear structure.     

The management of otitis media with effusion in adults

The management of 38 patients with idiopathic adult onset otitis media with effusion was evaluated retrospectively. Data from 50 ears were reviewed. The standard treatment consisted of myringotomy and grommet insertion. The patients were followed up for an average period of 27 months. Only 2 ears maintained a significant improvement in the air-bone gap when reviewed approximately 3 months following grommet extrusion. In all of the others, the hearing impairment recurred, and continued to recur despite multiple grommet insertions in several patients. It is concluded that adult onset otitis media with effusion has a low tendency to resolve, and that conventional surgical measures have little to offer in its management.     

Binaural masking level differences in children with a history of otitis media

The binaural hearing of children with and without a history of otitis media (OM) was assessed by determining their binaural masking level differences (BMLDs). The test was also administered to a group of adults. BMLDs for the non-OM children were not significantly different from those of adults. However the mean BMLD of the OM children was significantly lower than that of non-OM children. Some children in the OM group had small (15-25 dB HL) sensitivity deficits in one or both ears. However, no correlation was found between BMLD and hearing level in cases of either symmetric or asymmetric loss. Exclusion of OM children with residual middle ear abnormalities did not abolish the significant difference between the OM and non-OM groups. We suggest that the small BMLDs in the OM group may be associated with these children having difficulties detecting and attending to signals in noisy environments.     

Natural history of untreated otitis media

OBJECTIVE/HYPOTHESIS: Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effusion (OME). STUDY DESIGN: Systematic literature review and meta-analysis. METHOD: Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed. RESULTS: Sixty-three articles met inclusion criteria. AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year. CONCLUSIONS: The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse sequelae from persistent middle ear effusion. Further research is needed to identify prognostic factors that can target children unlikely to improve spontaneously for earlier intervention.     

An unusual prevalence of complications of chronic suppurative otitis media in young adults.

The complications of chronic suppurative otitis media as seen in 117 patients are presented. Fifty per cent of the patients had cholesteatoma, and 28 per cent revealed complications. Two-thirds of these complications, especially the serious intracranial ones, were encountered in young females. This female predominance was attributed to late presentation because of social reasons, or to undue susceptibility to the destructive effect of cholesteatoma. Radical and modified radical operations were recommended to render the ears safe, as most of the patients came from distant rural areas and were judged to have poor compliance to report for regular checks.     

Craniofacial shape in children with and without a positive otitis media history

ObjectivesPast studies using traditional morphometric approaches have reported a handful of differences in craniofacial dimensions between individuals with and without otitis media (OM). In this study, a geometric morphometry (GM) approach was used to determine if craniofacial shape is different among children with no history of OM and a history of recurrent acute OM (RAOM) at two different ages.MethodsNineteen standard landmarks were identified on lateral cephalometric radiographs from 79 children (41 Control, 38 RAOM) at 4 years and 52 children (27 Control, 25 RAOM) at 6 years of age. Following Procrustes superimposition of the landmark coordinate data, comparisons of group differences in overall size and shape were performed. Discriminant function analysis and principal component analysis were used to determine which, if any, aspects of shape variation distinguished RAOM from Control groups.ResultsAt 4 years of age, craniofacial size and shape were significantly different between RAOM and Control groups (p < 0.05). Shape differences were evident in the relative positions of the mandible, cranial base, external acoustic meatus, sphenoid and palate. Those shape differences were not found in the 6-year old group.ConclusionsAt 4 years of age, the RAOM and Control groups have distinct craniofacial morphologies, but by 6 years of age these differences have largely disappeared. This is consistent with the clinical observation that excess RAOM risk resolves around 6 years of age and the hypothesis that this resolution is partially a result of age-related craniofacial changes.     

Acute complications of otitis media in adults

Objectives: To establish the incidence, current treatment and outcome of adult patients with acute intratemporal and intracranial complications of otitis media (OM). Design: A retrospective chart review with a sent questionnaire. Setting: Tertiary referral centre, University hospital. Participants: Adult patients treated for acute intratemporal and intracranial complications of OM over the past 15 years (1990–2004) in the study hospital. Main outcome measures: Incidence, treatment and outcome of patients with intratemporal and intracranial complications of OM. Results: Fifty patients aged 16–75 years were treated. The annual age‐adjusted incidence of acute intratemporal and intracranial complications was 0.32/100 000. Forty‐one (82%) of the complications were intratemporal and nine (18%) were intracranial. The ear disease behind the acute complication was acute otitis media (AOM) in 80% (40/50), chronic otitis media (COM) in 12% (6/50) and COM with cholesteatoma in 8% (4/50). Mastoiditis was complicated by subperiosteal abscess, labyrinthitis and facial paresis in 7% (3/41), 15% (6/41) and 32% (13/41) respectively. Mastoidectomy was performed on 56% (28/50) of the patients. Four (44%) of the intracranial complications were intracranial abscesses, four (44%) were meningitis and one (11%) was sinus thrombosis. Permanent hearing loss occurred in 13 (26%) patients and one patient died due to otogenic meningitis. Conclusions: Severe complications of the OM in adults are rare in Finland. The commonest cause is AOM rather than COM. Operative treatment is predominantly needed for intracranial complications and intratemporal abscesses. Complications of OM are still associated with considerable morbidity, and early recognition is most likely to form the basis for effective treatment.     

Otoacoustic emissions in ears with hearing loss

Fifty ears of 37 patients demonstrating several common types of hearing impairment were examined for the presence of spontaneous and evoked otoacoustic emissions to investigate the relationship of acoustic emissions to hearing pathology. Of the 50 ears, 44 exhibited various degrees of sensorineural hearing loss. Evoked otoacoustic emissions to clicks were detected in 34 of 35 sensorineural hearing loss ears with a subjective click threshold less than 55 dB SPL (25 dB nHL). None of nine ears with sensorineural hearing impairment and a subjective click threshold greater than 55 dB SPL demonstrated click-evoked emissions. Spectral analyses revealed that the constituent frequency components of evoked emissions were always within the frequency range where audiometric thresholds were less than 35 dB HL, and in the majority (94%) of cases, thresholds were less than 25 dB HL. In ears with relatively well-preserved hearing within the frequency range of click or 1.5-kHz toneburst stimuli, the basic features of evoked emissions were similar to those described for normal ears. Similarly, for ears demonstrating spontaneous otoacoustic emissions, estimated audiometric thresholds at the emitted frequencies were always less than 20 dB HL. The influence of the type of otologic pathology on acoustic emissions was studied in a subset of ears exhibiting typical high-frequency hearing losses. Ears with a noise-induced impairment showed a significant reduction in the incidence of both spontaneous emissions and spectral peaks in evoked emissions that was not evident in ears with similar patterns of hearing loss caused by other factors.