The post-winter prevalence rate of middle ear effusion in four-year-old children,judged by tympanometry

Tympanometry and otologic examinations were performed in 373 four-year-old children randomly selected from the Central National Register at the end of February, 1979. A close interaural correlation of the middle ear pressures of a child was found and therefore the tympanometric results represent related as well as independent data. Consequently, the post-winter prevalence rates of type B tympanograms were calculated according to different sampling units: per all ears 13.7%; per right ears 12.9%; per left ears 14.5%; per ears selected at random 13.9%. Additionally, the prevalence rate was estimated per child at 20.4% type B in at least one ear and at 7% type B in both ears. Based upon the literature the validity of the tympanometric method in detecting middle ear effusion is described. The predictive values of positive and negative tests mostly depend on the degree of the cutoff point (pass—fail point) which has been chosen. In this study the cutoff point was the presence of a type B tympanogram. The advantage and disadvantage of applying ‘one ear’ or ‘one child’ as the sampling unit is discussed from a statistical as well as a clinical point of view. When calculating either per ear or per child no sex differences in the prevalence rates could be proved.     

Evaluation of the protective effect of Botulinum toxin type A injection on otitis media with effusion*

Objective: This study makes an analysis of the effect of Botulinum toxin type A on otitis media with effusion in rats.

Method: As part of the study, 24 male Wistar Albino rats were divided into three groups: Group 1: Botulinum toxin Type A and Histam?ne (intratympanic 0.2?ml?=?20 unit BTA); Group 2: Saline and Histamine (intratympanic 0.2?ml 0.9%); Group 3: Histamine (intratympanic 0.2?ml). Histamine (intratympanic 0.2?ml) was administered into the right ear for all groups. DPOAE and ABR tests were carried out on days 5, 10, 15 and 20 from the beginning of the study.

Results: There was no significant difference between DPOAE and ABR scores of the groups. In each group, the DPOAE scores for the right ear significantly decreased on day 5 when compared to the basal scores. In each group, there was no significant difference between days 5, 10 and 15 for the right ear.

Conclusions: Botulinum toxin type A blocked the secretion of glands in the middle ear and showed no effect to prevent the formation of serous otitis. In addition, it was found out that Botulinum toxin did not lead to any morphological change in the cochlea     

Evolution of Meniere’s Disease from MD 1.0, via MD 1.5, to MD 2.0

Abstract

Background: Elder Meniere’s disease (MD) patients ultimately lose their vestibular function.

Objective: This study utilized an inner ear test battery to investigate evolution of MD.

Methods: Total 278 elder MD patients aged >65 years were divided into three groups. Ninety-four patients with bilateral MD (188 ears) were assigned to Group A. The remaining 184 patients with unilateral MD were further divided into two groups. Group B consisted of 20 affected ears with normal vestibular function on the opposite ears, while Group C indicated 184 unaffected ears. All patients underwent an inner ear test battery.

Results: Inner ear deficits in Group B declined from the cochlea via the saccule, utricle to semicircular canals. In contrast, Groups A and C did not significantly differ in the abnormality rates of cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP and caloric tests, indicating that Group C (unaffected ears) may partly share the same mechanism like Group A (affected ears), namely aging and hydropic effects.

Conclusion and significance: Evolution of MD may progress from unilateral MD (MD 1.0), via unilateral MD coupled with asymptomatic hydrops on opposite ear (MD 1.5), toward bilateral MD (MD 2.0), where the number 1.0-2.0 means the number of clinically affected ears.     

Clinical and audiological findings in children with acute otitis media

Conclusion: It is recommended to perform follow-up tympanometry and if necessary tonal audiometry in children who have normal plain otoscopy findings after recovering from acute otitis media (AOM). Children with Type B tympanogram, 3 months following the onset of AOM, are very likely to have a conductive hearing loss. Type B tympanogram is a much better indicator of effusion in the middle ear compared to plain otoscopy. Objective: This study was undertaken to investigate the frequency and duration of middle ear effusion in children following an episode of acute otitis media, to track changes in tonal audiometry and tympanometry findings in the post-AOM period, and recognize the optimal timing for performing both tests. Methods: In this study, 125 children aged 5–7 years with bilateral AOM were randomly selected and separately followed up for 3 months. The children underwent six ear, nose, and throat (ENT 1–6) examinations, six tympanometries (TM 1–6), and three tonal audiometries (TA 1–3). Evaluation of nasopharynx was done at the ENT 1 examination. Children who received ventilation tubes were followed for 21 month altogether. Results: At the first otoscopy, pathological findings were recorded in 250 ears/125 children (100.0%). The number of pathological otoscopy findings decreased at each subsequent examination. At ENT 6 all children had normal otoscopy findings. Type B tympanogram was detected in 49/250 (19.6%) ears at TM 6, performed 3 months following the onset of the disease. At the TA 1 conductive hearing impairment was recorded in 158/250 (63.2%) ears, at TA 2 in 66/250 (26.4%), and at TA 3 in 39/250 (15.6%). Most of them were associated with Type B tympanogram.     

声反射在成人分泌性中耳炎中的诊断价值

目的提高耳科门诊成人分泌性中耳炎中耳积液的检出率,探讨声反射在协助诊断分泌性中耳炎是否伴有中耳积液中的临床价值。方法回顾性分析耳鼻咽喉科门诊169例确诊为分泌性中耳炎伴有中耳积液的成年患者的临床资料,并对听力正常与听力下降患者的鼓室图、同侧声反射及纯音测听等资料进行对比。结果169例(237耳)经鼓膜穿刺证实为中耳积液的患者中,223耳(94.1%)未引出声反射,14耳(5.9%)引出声反射;鼓室图异常200耳(84.4%),正常者37耳(15.6%);216耳(91.1%)有传导性听力下降,21耳(8.9%)听力正常。不论听力是否下降,同侧声反射的未引出率均高于异常鼓室图的概率(P<0.05);在不同听力及不同类型鼓室图中,声反射的未引出率没有差异(P>0.05),具有无创、快捷及客观等优点,能更好的帮助临床工作者评估分泌性中耳炎的疗效及预后。结论声反射能协助提高成人分泌性中耳炎伴中耳积液的检出率,具有无创、快速及客观等优点,能更好地帮助临床工作者评估分泌性中耳炎的疗效及预后。     

Prediction of serous versus purulent otitis media by otoscopy and tympanometry in an animal model

Non-invasive methods for distinguishing different types of otitis media would have clinical value in predicting otologic morbidity. Two such methods, otoscopy and tympanometry, were used in two experimental models of otitis media to determine whether there are unique otoscopic and tympanometric characteristics of serous and purulent otitis media. A flat (type B or B+) tympanogram and yellow tympanic membrane each had a high likelihood of predicting middle ear effusion in these models, and the best prediction was obtained using both parameters simultaneously. A yellow tympanic membrane color predicted purulent otitis media in one model but did not distinguish purulent from serous ears in the other model. In one model, serous otitis media was frequently associated with a type C (negative pressure) tympanogram. Tympanometry provided a valuable adjunct to otoscopy in detecting effusion and in distinguishing serous and purulent disease. These observations may apply to otitis media in humans, although the variable etiologies of otitis media in humans may confound the ability of otoscopy and tympanometry to distinguish middle ear effusion types.     

The predictive value of tympanometry in the diagnosis of middle ear effusion

Over a 12-month period 501 children (age range 11 months to 15 years) underwent surgery for a possible middle ear effusion. All had tympanometry performed within 2 h of surgery. The results of tympanometry were correlated with the surgical findings in 955 ears. A type-B tympanogram has a high sensitivity (0.91) in predicting middle ear effusion with good specificity (0.79). A type-A tympanogram has a very high specificity (0.99) in predicting a dry middle ear but low sensitivity (0.34). Both the positive (0.91) and negative (0.84) predictive values of a type-A tympanogram are high. The addition of a type-C tympanogram increases the sensitivity of predicting a dry middle ear to 0.79. The positive predictive value of a peaked (type-A or -C) tympanogram is 0.71 and should be considered strong evidence that the middle ear is dry. Tympanometry is the best clinical test for the presence or absence of a middle ear effusion, and on the basis of preoperative tympanometry alone the need for surgery should be carefully reassessed.     

Audiological characteristics of the contralateral ear in patients with unilateral physical non-explosive ear trauma

ObjectivesTo document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive (UPN) ear trauma and to compare the audiometric and tympanometric parameters between asymptomatic and symptomatic contralateral ears.DesignProspective analytical clinical study Setting: Specialized (Ear, Nose, and Throat) clinic of a tertiary health institution. Participants: Patients with UPN ear trauma who presented within the first week of the incident. Main outcome measures: Otologic symptoms in the contralateral ear in UPN ear traumaResultsEighteen out of 53 patients (34.0%) experienced symptoms in the contralateral ear. The symptoms were tinnitus in 77.8% (14/18), hearing loss in 66.7% (12/18), and ear blockage in 27.8% (5/18). There was hearing loss in 38/53 (71.7%) of contralateral ears. Hearing loss type and PTAv at the low frequencies were not significantly different (p=0.142), but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears (p<0.05 in all). Type C tympanogram was more prominent in the symptomatic contralateral ear. There was a statistically-significant difference in the type of tympanogram between the two categories of patients (p=0.018). There was no difference in acoustic reflex between the two categories of patients (p=0.095).ConclusionsThe contralateral ear may be affected in up to one-third of patients with UPN ear trauma, and experience otologic symptoms similar to those of the traumatized ears. Audiologic and audiometric parameters were abnormal in most of the contralateral ears. The two ears must be assessed thoroughly in cases of UPN ear trauma.     

Effect of the middle ear status on the recording of vestibular evoked myogenic potential--VEMP

The aim of this study was to assess the effect of the middle ear status on the recording of air- and bone-conducted vestibular evoked myogenic potential. Forty eight children were included in the study, ranging in age from 4 to 10 years. All of the children underwent otoscopy, pure tone audiometry, tympanometry and air- and bone-conducted VEMP in response to click. There were 3 groups according to the condition of the middle ear: group I--52 ears (type A and C1 tympanogram, pure tone average < or = 20 dB), group II--23 ears (type C2 and B tympanogram, pure tone average < or = 20 dB), group III--21 (type B tympanogram, pure tone average > 20 dB). The threshold, presence of correct waveform morphology of the response and latency was evaluated. The condition of the middle ear has no significant effect on the recording of VEMP and mean level of the response threshold with bone stimulation, based on the performed studies. However, with air stimulation it has effect on the recording of VEMP, increase of the mean threshold response and shortening of latency p13 and n23.     

Otitis media with effusion: treatment by autoinflammation using a balloon

Resolution of negative middle ear pressure is important in treating otitis media with effusion (OME). We treated 34 children and 21 adults with OME by autoinflammation using a nose tube and balloon in the 16 months from June 2001 to September 2002. Of these, 7 children and 5 adults had been treated for 3 years or longer, and had had grommets inserted. In 49 ears of 27 early cases of children, 34 ears (69%) improved in tympanometric findings converting to type A from type B, C2 and C5, and 9 ears (18%) of type B converted to type C1. In 23 ears of 16 early cases of adults, 12 ears (52%) improved converting to type A from type B, C2, C5 and C1, and 3 ears (13%) to type C1 from type B. However, 4 ears of 4 children and 5 ears of 5 adults did not recover by autoinflammation. In 7 children with prolonged OME in whom grommets had been inserted, 5 recovered due to autoinflammation, whereas only one of 5 adults recovered. Of 6 patients who had not recovered, 2 were associated with asthma and nasal polyposis and eosinophils infiltrated into the middle ear effusion. In other 2 patients, even when the middle ear effusion disappeared by grommets insertion, they had still dysfunction of the Eustachian tubes confirmed by sonotubometric examination. It seems no beneficial effects of autoinflammation were maintained if patients had tubal dysfunction due to intensive inflammatory changes of the middle ear and tubal mucosa or other unknown origin. Two patients used the device irregularly and rarely. There is a theoretical risk associated with this maneuver of causing baroinjury and forcing infected nasopharyngeal secretions into the middle ear, but we found no complications.     

Tympanometry in the detection of hearing impairments associated with otitis media with effusion

The monitoring of children with otitis media with effusion ties up considerable resources in audiology departments. Impedance audiometry is frequently used when investigating these children. It has been shown to be highly sensitive in detecting middle ear effusion, but its value in identifying those children with a significant hearing impairment secondary to this is in question because of the wide range of hearing impairments possible with a type B tympanogram. This study quantified the sensitivity and specificity of impedance audiometry in detecting a hearing impairment greater than or equal to 25 dB HL due to otitis media with effusion. The subjects were 285 children of whom 20% had hearing thresholds greater than or equal to 25 dB HL. A peaked tympanogram (types A or C) virtually eliminated the possibility (98% confidence) of such a hearing impairment. A flat type B tympanogram was satisfactorily sensitive (93%) in detecting a hearing impairment, but non-specific (76%). The positive predictive value was 49%, i.e. 51% of ears with this type of tympanogram had hearing within acceptable limits. Assuming that a sensorineural impairment has been excluded and a population is being monitored for hearing impairment associated with otitis media with effusion, it is suggested that the presence of a peaked tympanogram indicates normal hearing, whereas those children with a flat tympanogram would require their hearing to be evaluated. Increased use of impedance audiometry to monitor children with otitis media with effusion would reduce the number requiring full pure-tone audiometry with a subsequent reduction in the workload of an audiology department.     

Hearing and ear status of Pacific children aged 11 years living in New Zealand: the Pacific Islands families hearing study

Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems.

Design: A cross-sectional observational study design nested within a birth cohort was employed.

Study sample: Nine-hundred-twenty Pacific children aged 11?years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20?dB hearing loss. Hearing loss was mild (20–39?dB) in most cases; 2% of ears had moderate to moderate-severe (40–69?dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2?years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11?years.

Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.     

Influence of the Gas Exchange Function Through the Middle Ear Mucosa on the Development of Sniff-Induced Middle Ear Diseases

To investigate the influence of gas exchange function through the middle ear mucosa on the development of sniff-induced middle ear diseases, the authors examined the mastoid pneumatization among patients with sniffing habit using computed tomography, and also examined the change of negative middle ear pressure induced by sniffing using tympanogram. In 20 ears with cholesteatoma or adhesive otitis media, the areas of mastoid cavity measured at the level of the lateral semicircular canal were significantly smaller than those in 26 ears with otitis media with effusion (OME) or attic retraction and in eight normal ears with sniffing habit (P < .01 and P < .0001, respectively). In 26 ears with OME or attic retraction, the areas of mastoid cavity were significantly smaller than those in eight normal ears with sniffing habit (P < .0001). By contrast, in the four ears with sniff-induced middle ear disease, the recovery of negative middle ear pressure in 5 minutes without swallowing was less than 10 mm H₂O, whereas in all seven ears with normal eardrum, negative middle ear pressure recovered by more than 20 mm H₂O in 5 minutes. These findings suggested that impairment of gas exchange function through the middle ear mucosa, as well as eustachian tube dysfunction, might be closely related to the development of sniff-induced middle ear diseases.     

279例耳闷胀感的病因分析

目的 探讨产生耳闷胀感的部位和原因。方法 收集耳闷胀感为主诉的279例362耳,对患耳的临床表现、鼓室导抗图、纯音测听和咽鼓管功能进行分析。结果 362耳中鼓室导抗图A型203耳、B型111耳、C型33耳以及鼓膜穿孔15耳。纯音测听表现为传导性聋、感音神经性聋、混合性聋以及正常者分别是83耳、8l耳、105耳和93耳。在362耳中,咽鼓管功能异常208耳,在A型鼓室导抗图203耳中,咽鼓管功能异常67耳。结论 产生耳闷胀感的病变部位包括外、中、内耳和面神经的病变,其中以分泌性中耳炎、各种原因引起的感音神经性聋和“咽鼓管狭窄症”为多。     

Middle Ear Effusions and the Nitrous Oxide Myth

Myringotomies were performed on 75 ears suspected of having chronic or recurrent otitis media with effusion. Preanesthesia and intraoperative tympanograms with halothane, nitrous oxide, and oxygen anesthesia were compared for possible changes in middle ear pressure due to anesthesia. In addition, preanesthesia tympanograms were compared with tympanograms taken 2 weeks before hospital outpatient surgery. Tympanograms of 11 ears were found to shift from a flat type recorded at the office visit to normal range at pre and postinduction anesthesia. Middle ear fluid was not present in any of these 11 ears. The remaining 64 ears were broken down into three abnormal tympanogram configurations; flat, roll-over, and peaked negative pressure types. Comparing the tympanograms done in the office, preanesthesia and intraoperatively, only one of the 64 ears showed a change after induction of anesthesia. Three of the 64 ears revealed an unpredictable result with negative myringotomies. These results tend to support tympanometry as a means in predicting myringotomy findings, and also refute the contention that short-term nitrous oxide anesthesia changes the middle ear effusion during myringotomy.     

Tympanometry as a predictor of middle ear effusion

Tympanometry is often used as a major component of medical referral criteria in both diagnostic audiometry and hearing screening programs. This use is based on an assumption that a relationship exists between the tympanogram type and the presence of middle ear effusion. The present investigation examined this relationship in 142 ears immediately prior to myringotomy. The results suggest that prediction of middle ear effusion on the basis of tympanometric data alone is difficult at best. The only exception is in the case of a flat tympanometric curve (type B), when a 90% occurrence of notable effusion was found. The clinical implications of these data are discussed.     

Long-term observation of ears with reduced middle ear pressure

335 ears from 210 childred in which tympanometry initially indicated middle ear pressure less than or equal to -100 mm H2O or a flat tympanogram have been reinvestigated 3 years later. When the inital investigation was performed all children were 7 years old. The present study reveals that 25% of these ears still have middle ear pressure less than or equal to -100 mm H2O and 16% middle ear pressure less than or equal to -150 mm H2O. In normal material of the same age group 9% have middle ear pressure less than or equal to -100 mm H2O and 4% middle ear pressure less than or equal to -150 mm H2O. The study also reveals effusion in 10% of ears with normal screening audiograms. In ears with normal screening audiograms and middle ear pressure greater than or equal to -145 mm H2O effusion was found in 5% and in ears with abnormal screening audiograms and middle ear pressure less than or equal to -150 mm H2O effusion was found in 81%. As tympanometric criterion for otologist referral, middle ear pressure less than or equal to -150 mm H2O or a flat tympanogram is suggested. The inclusion of tympanometry in routine screening for middle ear pathology in children is recommended.     

Comparison of tympanometry and otomicroscopy during healing of otitis media

One hundred ears in 50 children with acute otitis media during healing were examined with tympanometry and the objective measures were compared with the subjective evaluation of otomicroscopy by four otolaryngologists independently. Tympanometric findings could more often correctly suggest reduced tympanic membrane mobility than did otomicroscopy, but both methods gave an equally good indication of middle ear effusion. However, otomicroscopy was necessary when evaluating the colour and the appearance of the tympanic membrane and revealed middle ear effusion in a few cases with 'normal' tympanometry. As a rule: normal tympanometry (Jerger type A) was closely correlated with a normal tympanic membrane and a normal middle ear without effusion; pathological tympanometry (Jerger type B) was accompanied by middle ear effusion and needed follow-up; ears with tympanometric pressure more negative than -150 mmH2O but more positive than a flat curve needed otomicroscopy to identify middle ear effusion.     

Eustachian tube dysfunction in sleep apnea patients and improvements afforded by continuous positive airway pressure therapy

IntroductionUpper airway resistance may accompany eustachian dysfunction and alter middle ear pressure in patients with obstructive sleep apnea syndrome.ObjectiveTo investigate effects of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on eustachian tube functions.MethodsForty-two mild obstructive sleep apnea syndrome patients, 45 moderate obstructive sleep apnea syndrome patients, 47 severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy, 32 severe obstructive sleep apnea syndrome patients without continuous positive airway pressure therapy, and 88 individuals without sleep apnea (controls) were included. Tympanometric parameters of groups were compared.ResultsRight middle ear pressures in mild and moderate obstructive sleep apnea syndrome groups did not differ significantly from that of control group (p = 0.93 and p = 0.55), as was also true of the left middle ear pressures (p = 0.94 and p = 0.86). Right middle ear pressure was significantly higher in severe obstructive sleep apnea syndrome groups than in the control group, as was the left middle ear pressure (p < 0.001). Middle ear pressure (negative) was significantly lower in severe obstructive sleep apnea syndrome patients with continuous positive airway pressure therapy compared to those without (p < 0.001). Right ear type B and C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (12.4%) than in the controls (0%) (p = 0.02). Left ear type B or C tympanogram frequencies were significantly higher in patients with severe obstructive sleep apnea syndrome without continuous positive airway pressure therapy (21.9%) than in the controls (0%) (p = 0.002).ConclusionMild and moderate obstructive sleep apnea syndrome did not affect middle ear pressure but severe obstructive sleep apnea syndrome may increase the (negative) middle ear pressure. In severe obstructive sleep apnea syndrome patients, long-term continuous positive airway pressure therapy may normalize middle ear pressure.     

Could the presence of a Carhart notch predict the presence of glue at myringotomy?

Could the presence of a Carhart notch predict the presence of glue at myringotomy? The Carhart notch is a dip in the bone conduction at 2000 Hz without a corresponding dip in the air conduction. The main objective of this study was to establish how reliable is the presence of the Carhart notch in a preoperative audiogram in predicting the presence of glue at myringotomy. A prospective study has been carried out in 50 children presenting with glue ear to find out the association between the Carhart notch and the presence of glue at myringotomy. Children were seen before the operation and an audiogram and tympanogram were carried out. Myringotomy was carried out in 95 ears and the presence or absence of glue was recorded. The significance of the air–bone gap and the type of tympanogram in predicting a middle ear effusion were also examined. The audiograms of 37 ears showed a Carhart notch; of these, 36 ears were noted to have glue ear. The correlation between the presence of a Carhart notch in the preoperative audiogram and the presence of glue at myringotomy was found to be significant (P < 0.001) (chi‐square test). Using the decision rule that the presence of a Carhart notch predicts the presence of glue, the following operating characteristics were determined: correct, 83 ears (87.4%); false positive, one ear (1.1%); false negative, 11 ears (11.6%). The presence of a Carhart notch was found to be a strong predictor of the presence of glue at myringotomy.