Different techniques of adenoidectomy and its impact on middle ear pressure: a randomized controlled study.

OBJECTIVES: The aim of this work is to compare between different techniques of adenoidectomy: endoscopic microdebrider-assisted, coblation and conventional adenoidectomy and its effect on middle ear pressure. BACKGROUND: Adenoidectomy, either alone or with tonsillectomy, is considered among the most performed procedures in pediatric otorhinolaryngology. This procedure usually related to the Eustachian tube function and middle ear status. Eustachian tube dysfunction is mainly caused by mechanical obstruction of the tubal orifice, insufficient swallowing and inflammation in the nasopharyngeal mucosa. METHODS: This prospective randomized study was conducted on 90 patients with symptomatic adenoid hypertrophy confirmed by nasopharyngeal X-ray and endoscopic grading preoperatively. Patients were admitted at Otorhinolaryngology department of our institute during the period from January 2022 to January 2023. They were divided into three groups that were operated either by conventional (Group I), endoscopic microdebrider (Group II), or coblation technique (Group III). Each group was assessed through the audiometric parameters plus postoperative bleeding, and VAS results for pain score and postoperative endoscopic grading for adenoid recurrence. RESULTS: Mean age in group A was 9.03 years and in group B was 8.99 years and was 8.99 years in group C with insignificant differences between three groups. There is significant improvement of tympanographic results comparing all groups of the patients at 6 months postoperatively. There is significant relation between the mean VAS comparing preoperative and postoperative results. CONCLUSION: There are better results in tympanographic data at conventional adenoidectomy versus other techniques. However, there are also better postoperative results after either coblation or endoscopic microdebrider adenoidectomy over the conventional technique.

Effect of prosthetic management and its timing on otological and audiological outcomes in infants with cleft lip and palate: A clinical trial.

PURPOSE: To evaluate how prosthetic management affects the otological and audiological state of infants with cleft lip and palate by preventing or treating otitis media (OM). MATERIALS AND METHODS: Thirty infants with cleft lip and palate (L/P) were assigned to three equal groups according to the age of prosthetic intervention; Group I: immediately after birth, Group II: 2 months old, Group III: 5 months old. Assessment of middle ear function by tympanometry and hearing quality by auditory brainstem response (ABR) under natural sleep was conducted before and after prosthetic treatment every month till 10 months of age. Data from the study groups were compared. RESULTS: No statistically significant differences were found between Gp I and Gp II in the 2nd, 3rd, and 4th months for right and left ears (p > 0.05). In the 5th month, statistically significant differences between the three groups were found in tympanometry for right (p = 0.011) and left (p = 0.024) ears also, in ABR for right (p = 0.007) and left (p = 0.011) ears. Tympanometric readings starting from the 6th till the 10th month showed no statistically significant differences between the three groups (p >0.05). The final ABR outcomes of the 10th month indicated statistically significant differences between the three groups for both ears (p = 0.027). CONCLUSIONS: Early prosthetic care could delay the development of OM, so it could potentially improve the otological and audiological state in infants with cleft L/P. However, prosthetic treatment may not be able to completely prevent or eliminate middle ear disorders.

Wideband Tympanometry: Normative Data for Young Iranian Adults.

INTRODUCTION: The middle ear sound transmission features can impact acoustic sounds reaching the inner ear. Wideband tympanometry (WBT) or wideband acoustic immittance is an effective and desirable measurement of conductive conditions in newborns and adults and has appropriate sensitivity to distinguish different pathologies like otosclerosis from other middle ear conflicts. Recently, there has been an increased utilization of WBT, which highlights the importance of collecting population-based normative data as a necessary step in the standardization of this test, as well as for its clinical application. This study aimed to obtain normative data on WBT in the adult Iranian ethnic. METHODS: There were 101 participants (202 ears) consisting of 53 males (57.4%) and 48 females (42.6%) in the age range of 19-29 years. The Titan WBT device (Interacoustics, Assens, Denmark) was used for WBT measurements. The broadband click was utilized as the probe tone between frequencies of 250 Hz and 8,000 Hz. All the participants underwent ear, nose, and throat assessments, pure-tone audiometry, and conventional tympanometry (226 Hz). Features like equivalent ear canal volume (Veq), tympanometric peak pressure, gradient, resonance frequency (RF), energy absorbance (EA), and admittance (Ad) were tested. RESULTS: In this cross-sectional study, 202 ears were tested for WBT. EA increased by frequency enhancement; at 1 kHz and 2 kHz the EA was the most prominent; at 2,519 Hz, it started decreasing, and at 8 kHz, there was a slight increase. There was also a significant difference in the Veq and Ad between males and females. Studies have shown that the Veq may vary between male and female subjects based on body size. CONCLUSION: In this study, normative data for the WBT were obtained from young Iranian adults with normal hearing ranges and middle ear conditions. We hope that this study and the resulting norm will provide a basis for increasing the use of WBT in Iranian diagnostic and clinical practices.

The Diagnostic Value of Multifrequency Tympanometry in Patients with Ménière's Disease: A Prospective Analysis.

INTRODUCTION: Diagnosing Ménière's disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests evaluating the presence of endolymphatic hydrops (EH) are often expensive or time assuming. An in-office quick and simple non-invasive diagnostic test is multifrequency tympanometry (MFT). It can measure conductance at 2 kHz probe tones, which was demonstrated to reflect variations in cochlear pressure. Previous studies investigating MFT as a diagnostic test for MD showed conflicting outcomes possibly biased by their retrospective design. METHODS: We prospectively collected MFT results (Y width) in patients with dizziness and compared MFT test results in affected (group 1) and unaffected (group 2) ears of 37 MD subjects and in control ears of 33 non-MD subjects (group 3). RESULTS: The mean value of the Y width in affected ears was 315.6 ± 70.2 daPa compared to 292.3 ± 98.6 daPa in unaffected ears in MD subjects and 259.4. ± 60.6 daPa in the non-MD group. A positive test result (i.e., a Y width of 235 daPa or more) was found in 35 ears in the MD group, 21 times involving the affected ear and 14 times involving the unaffected ear, compared to 16 in the non-MD group. No significant differences between the three groups could be demonstrated (p > 0.05). We found a sensitivity of 58.3% and specificity of 66.3% for detecting EH in an affected ear in MD subjects. CONCLUSION: There is a trend towards increased conductance tympanometry in affected ears. However, we noticed a high false positive rate of MFT and do not support standardized use of MFT as an additional diagnostic tool for detecting EH in MD patients. A negative test result on the contrary is unlikely related to EH.

Sound energy absorbance changes in the elderly with presbycusis with normal outer and middle ear.

OBJECTIVE: This study aimed to investigate the wideband tympanometry (WBT) findings in the elderly with presbycusis who have normal outer and middle ears according to otoscopic examination and traditional tympanometry, and to determine whether there is a relationship between the middle ear wideband absorbance value and the pure tone air-bone gap (ABG) observed especially at mid-high frequencies in the elderly. METHODS: The study included 30 elderly with presbycusis (> 65 years old, presbycusis group) and 30 healthy individuals (control group) between the ages of 18 and 55. Pure tone air conduction and bone conduction thresholds of all participants were determined and WBT was applied to all participants. Resonance frequency (RF), absorbance ratios at peak pressure (PPAR) and ambient pressure (APAR) values were analyzed. RESULTS: The RF value of the presbycusis group was lower than the control group (p < 0.05). APAR and PPAR values at 2000 and 4000 Hz and mean absorbance values of the presbycusis group were lower than the control group (p < 0.05). APAR was higher at 500 Hz in males than females (p < 0.05), but there was no difference between genders in RFs (p > 0.05). A moderate negative correlation was observed between ABG and both PPAR and APAR at 4000 Hz in presbycusis group (p < 0.05). CONCLUSION: it was determined that there was a decrease in RF and absorbances at 2000 and 4000 Hz in the elderly with presbycusis. Aging affects not only the inner ear but also the conduction mechanism of the middle ear. Our findings may be effective in a more accurate and reliable interpretation of WBT in the elderly with presbycusis.

Evaluation of middle ear and hearing status of ankylosing spondylitis patients with wideband tympanometry and pure tone audiometry tests.

OBJECTIVES: The aim of this study was to evaluate the middle and inner ear function and hearing status of Ankylosing spondylitis (AS) patients. METHODS: One hundred twenty-four ears of 62 patients with AS and 90 ears (control group) of 45 healthy subjects were included in the study. The hearing levels of the participants were assessed with pure tone and high-frequency audiometry at the octave frequency between 250 and 16,000 Hz. The absorbance rates and resonance frequencies of middle ear were measured with the wideband tympanometry (WBT) test. AS group was divided into subgroups based on the disease activity, duration of follow-up, medications used for AS, and the subgroups were compared according to hearing status and absorbance and resonance frequencies of middle ears. RESULTS: A statistically significant difference was found between the AS and control groups in terms of air and bone conduction thresholds at frequencies of 250, 500, 1000, 2000, and 4000 Hz and the mean PTA1, PTA2, and PTA3 values (p < 0.05). In contrast, no statistically significant difference was observed between two groups in terms of high-frequency thresholds (8000-16,000 Hz). Although the middle ear resonance frequency obtained from the WBT test was higher in the AS group compared to the control group, no significant difference was observed (p > 0.05). The severity of disease adversely affected the hearing threshold at 250, and 500 Hz for air conduction, at 500 Hz for bone conduction threshold, and at PTA1 (p < 0.05). The duration and severity of disease did not affect absorbance values of WBT (p > 0.05). CONCLUSION: To our knowledge, this is the first study to demonstrate the effects of AS patients on the middle ear function with WBT and to report middle ear absorbance values and resonance frequency changes in AS patients. The higher resonance frequency values found by WBT in AS patients may be due to the stiffness that develops as a result of middle ear involvement. According to pure tone and high-frequency audiometry findings, it has been seen that AS leads to SNHL especially at low frequencies.

Measuring resonance frequency of the middle ear in school-aged children: potential applications for detecting middle ear dysfunction.

OBJECTIVE: This study established a normative range of resonance frequency (RF) values as estimated using Wideband Tympanometry (WBT) and determined the ability of WBT-estimated RF to predict the presence of middle ear dysfunction in school-aged children. DESIGN: Cross-sectional data were collected using a hearing screening test battery consisting of WBT, Pure Tone Screening (PTS), 226- kHz tympanometry, and ipsilateral Acoustic Stapedial Reflexes (ASR). STUDY SAMPLE: About 1590 children aged 4-13 years. RESULTS: RF significantly decreased from 4 to 13 years of age (4-6 years, 928.95 kHz; 7-9 years, 872.80 kHz; 10-13 years, 863.68 kHz). RF had area under the receiver operating characteristic curve (AROC) values between 0.589 and 0.626 to predict ears that failed PTS or 226- kHz tympanometry. RF below 627 kHz accurately predicted the presence of a Type B tympanogram (AROC 0.945). RF had high test-retest reliability with Intra-Class Coefficient value of 0.817 and good agreement according to Bland-Altman plot analysis. CONCLUSIONS: WBT-estimated RF had fair diagnostic accuracy for predicting PTS and tympanometry results, but had excellent accuracy for predicting the presence of middle ear dysfunction, indicated by a Type B tympanogram. WBT-estimated RF does not require age-, gender-, ear- or ethnicity-specific normative data for clinical use with children.

Effects of earlens lens placement on sound field thresholds, tympanometric measurements and wideband acoustic immittance.

OBJECTIVE: The Earlens is a direct-drive hearing device consisting of a lens which physically displaces the umbo to achieve appropriate gain. The objective is to determine the clinical acceptability of clinical immittance measurements in Earlens wearers. DESIGN: Controlled before-after within-subjects repeated measures study. STUDY SAMPLE: Data is reported for measurements obtained on 15 subjects (average age of 72.2 years) with data from 30 ears. RESULTS: There was a small effect of lens placement on sound field thresholds in most subjects. The largest damping effect of 4 dB was observed at 1000 Hz. An average reduction of 0.17 mL was identified in compliance following lens placement (p < 0.05). An effect of the lens on power absorbance obtained at ambient and peak pressure was found. The lens resulted in an increase in power absorbance at low frequencies (below 500 Hz) and a decrease in the mid to high-frequency range of approximately 500-3500 Hz (p < 0.05). CONCLUSIONS: Lens wear had a small effect on audiometric thresholds and tympanometry for most patients. Clinicians who use compliance and power absorbance should take into consideration lens effects on these measurements. Additional work is required to develop clinical normative ranges of these measures for wearers of the Earlens.

Effects of RME on Hearing in UCLP Patients: A Pilot Study.

OBJECTIVE: To assess the changes in hearing after rapid maxillary expansion (RME) and at the end of 6 months retention period in complete unilateral cleft lip and palate (UCLP) patients using pure tone audiometry and tympanometry test. DESIGN: Prospective pilot study. SETTING: Tertiary health care teaching hospital in New Delhi. PATIENTS: This study was conducted on 6 UCLP patients in the age range of 6-14 years with normal ear anatomy. All 6 patients had undergone primary repair of cleft lip and palate and required no more than 5 mm expansion in the intermolar region. INTERVENTION: RME was done using a Hyrax expander with daily activation of one-quarter turn per day for a period of 15-20 days (0.25 mm per day). MAIN OUTCOME MEASURE: Audiometry and tympanometry readings at the baseline as compared to the post expansion and at the end of 6 months retention period. RESULTS: There were no significant changes in the hearing levels on the audiometry test after RME on the cleft side (p-value -0.51) and the noncleft side ear (p-value -0.26). No significant changes were observed in the middle ear volume on the tympanometry test after RME on the cleft side (p-value -0.09) and the noncleft side ear (p-value -0.28). CONCLUSION: There was no improvement or deterioration in the hearing levels after RME and at the end of 6 months retention period in UCLP patients as evaluated using pure tone audiometry and tympanometry test. Hence RME may be undertaken in UCLP patients safely in terms of hearing is concerned.

Is Topical Nasal Steroid Useful for Treatment of Otitis Media with Effusion in Children?

BACKGROUND: Otitis media with effusion is a common and important pediatric clinical problem; it is the leading cause of hearing impairment in children. Medical treatment remains controversial. AIM: To evaluate the usefulness of using topical nasal steroids in the treatment of otitis media with effusion. PATIENTS AND METHODS: Between November 2019 and October 2022, a prospective controlled clinical study was carried out in the department of otolaryngology at Al-Jerrahat Teaching Hospital in Medical City, Baghdad, Iraq. This study comprised 40 patients with bilateral otitis media with effusion (23 males, 17 females). Two groups were created for the patients. Patients in group A (20 patients) were treated with mometasone furoate nasal spray; 1 puff (50 µg) in each nostril daily for 2 weeks, while the 20 patients in group B were treated with saline nasal spray; 1 puff in each nostril daily for 2 weeks. At the end of the first and second weeks of treatment, otoscopic examination was used to monitor the patients. At the end of the second post-treatment week, pure tone audiometry and tympanometry were performed again. Normal otoscopic results, a type A tympanogram, and enhanced pure tone hearing threshold average to be ≤20 dB HL within 0, 5, 1, and 4 KHz were used to characterize resolution of OME. The association between two means was determined using an independent sample t-test, while the association between categorical variables was determined using an X2-test. RESULTS: At the end of 2nd post-treatment week, there was no significant difference regarding improvement of otitis media with effusion regarding otoscopic, audiometric, and tympanometric results in both groups (P-value >0.05). CONCLUSION: Topical nasal steroid is unuseful for the treatment of otitis media with effusion in the short-term.

Tympanometry and endoscopic diagnosis of eustachian tube dysfunction in patients with chronic rhinosinusitis.

Background: This study assessed the eustachian tube (ET) function in adult patients with chronic rhinosinusitis (CRS) using tympanometry and nasal endoscope. Materials and Methods: This was a hospital-based cross-sectional study conducted for 9 months. All participants underwent endoscopic evaluation of the pharyngeal end of their ETs, and the middle ear function was assessed using tympanometry. Endoscopic findings were graded based on a validated mucosal inflammatory endoscopic grading scale. Statistical analysis was carried out using SPSS version 24. Results: A total of 102 CRS patients and age- and sex-matched controls were recruited. Tympanograms suggestive of eustachian tube dysfunction (ETD) types B and C were found among 7.8% and 12.8% of the right and left ears of the CRS groups, respectively. Mucosal inflammatory endoscopic grade that is diagnostic of ETD Grades 3 and 4 was found among 24.5% and 38.2% of the right and left ET of CRS cases, respectively. Conclusion: CRS predisposes patients to anatomical and functional impairment of ET. The relationship between tympanometry and mucosal inflammatory endoscopic grading scale in detecting ETD among CRS patients showed a strong relationship. However, a combination of the two will improve the diagnosis of ETD by evaluating the ET function directly and indirectly.

Eustachian tube dysfunction in an intensive care unit: A prospective observational study.

Background: Eustachain tube (ET) dysfunction can aggravate the morbidity in ICU patients, but is often ignored. In this prospective observational study we followed a cohort of patients (without pre-existing ET dysfunction) requiring in-patient management, hospitalized either to ICU or to non ICU wards, for any development of ET dysfunction during hospitalization. Methods: Patients requiring hospitalization to ICU or non ICU wards from Dec 2018 to Jun 2019 were included. Those with pre-existing ET dysfunction, disease of ear/nose or sinuses, head neck tumours and history of radiotherapy or glucocorticoid therapy were excluded. All patients were evaluated by serial tympanometry. Type A curve was considered normal while type B, C1 and C2 were considered as ET dysfunction. Results: There were 385 patients, 258 (67.01%) males and 127 (32.99%) females in the ICU group; while non ICU group comprised 129 patients, 86 (66.67%) males and 43 (33.33%) females. ET dysfunction developed in 107 (27.79%) patients in ICU group, but only in 3 (2.3%) in non ICU group (Relative risk 11.95, 95% CI 3.86 to 36.99, P < 0.0001). Within ICU, ET dysfunction showed significant positive association with endotracheal intubation, Ramsay sedation score and number of days on tracheostomy; but not with age, male gender, number of days in ICU, mechanical ventilation or route of feeding. Conclusion: Our study demonstrates high incidence of ET dysfunction in patients admitted to ICU.

Tympanometric findings among adult HIV patients undergoing a short-term treatment with high active antiretroviral therapy (HAART) in port harcourt.

Background: In our practice as ENT specialists, people living with Human immunodeficiency Virus/acquired immunodeficiency syndrome (HIV/AIDS) have presented at the clinics with symptoms suggestive of otitis media with effusion such as the sensation of fluid in the ear, aural fullness and hearing loss. Eustachian tube dysfunction which is often the beginning of middle ear pathology could be caused by nasal allergy, upper respiratory tract infection, or obstruction by a nasal pharyngeal lesion such as lymphoid hyperplasia which is a common feature in people living with HIV/AIDS. Tympanometric findings give a measure of the objective assessment of middle ear function. Aim and Objective: This study was designed to determine tympanometric findings among adult patients undergoing short-term treatment with HAART in Port Harcourt. Patients and Methods: A hospital-based study involving 150 HIV-positive patients that received the same HAART treatment over 6 months and a control group of 150 HIV-negative individuals in Port Harcourt. The data extracted includes; the patient's ear symptoms, otoscopic findings, and tympanogram. Data were analyzed using SPSS version 20 and statistical significance was set at P > 0.05. Results: There was a high proportion of type B-Typanogram at baseline (Rt ear 24[16.0%], left ear 23 [15.3%]) and at repeat (Rt ear 23 (15.3%), Lt ear 21 (14%) evaluations. Also, there was a relatively high proportion of type C- tympanogram at baseline {right ear 18 (12%), left ear 15 (10%)} and at repeat Rt ear 14 (9.3%), Lt ear 10 (6.7%)} evaluations. Conclusion: One out of every eight patients living with HIV infection may likely have Eustachian tube dysfunction while one out of every five may have developed otitis media with effusion already. There was no significant change in tympanometric findings after treatment with HAART.

CHARACTERISTICS OF HEARING RECOVERY IN CHILDREN WITH CHRONIC OTITIS MEDIA WITH EFFUSION AFTER VENTILATION TUBE INSERTION.

The objective was to determine the range of hearing improvement (in dB) post ventilation tube insertion in children with chronic otitis media with effusion (COME), and whether there was a difference in hearing improvement between age groups and genders. This study also investigated whether there was a difference in the mean hearing improvement between the left and right ear, how many months passed before recovery of eustachian tube function, and how long the aeration of the middle ear lasted. The children included in the study were between six and twelve years of age, diagnosed with COME by audiological processing (type B tympanometric recording and conductive hearing loss up to 40 dB on pure tone audiometry) and underwent surgical insertion of ventilation tubes in both ears. Patient data included preoperative tympanometric records, preoperative and postoperative tone audiometry findings, tubometry findings 6 and 10 months after insertion of ventilation tubes, age and gender data, and length of time during which the tubes were in place. The mean hearing improvement of the included patients was 24.2 dB on the right ear and 24.5 dB on the left ear. There was no statistically significant difference between the left and right ear or between the genders. Older age groups had a higher mean hearing improvement compared with the younger age group. Younger age groups had a longer expected period of eustachian tube function recovery, and were expected to have ventilation tubes inserted for a longer period of time. Treatment with ventilation tube insertion resulted in significant improvement in hearing in children where previous conservative therapy failed to recover eustachian tube function and improve hearing. Although children of older age groups had greater preoperative hearing impairment, the recovery of both eustachian tube function and hearing improvement was faster, and the mean length of time that the ventilation tubes had to be inserted was shorter.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part I]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' I.

The clinical protocol of audiological assessment in infants was prepared by the workgroup of Russian pediatric audiologists from different regions. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The protocol has been developed according the evidence based medicine principles, by reviewing current scientific publications on the topic and taking into account the order of providing medical services and other clinical practice guidelines. When direct evidence was not available, both indirect evidence and consensus practice were considered in making recommendations. This guideline is not intended to serve as a standard to dictate precisely how the child should be diagnosed. This guideline is meant to provide the evidence base from which the clinician can make individualized decisions for each patient. The first part of the protocol covers following sections: equipment, staff requirements, timing of the diagnostics, case history and risk factors, preparing the child for the appointment, sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, skin preparing, electrode montage, choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, combined correction factors.

Otoscopy and tympanometry outcomes from the National Health and Nutrition Examination Survey (NHANES).

PURPOSE: The purpose of the study was to estimate the prevalence of conductive pathologies based on tympanometric and otoscopic findings in adults in the U.S. and examine relationships between abnormal findings and audiometrically defined or reported perceived hearing loss and tinnitus. MATERIALS AND METHODS: Data from 3409 individuals aged 20-69 years from the 1999-2000 and 2000-2002 cycles of the National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes included report of ear tubes, self-perceived hearing loss, and tinnitus (yes or no). Otoscopy involved screening for presence of cerumen (ear wax) and physical abnormality for each ear. Ear-specific tympanometry included measures of middle ear pressure, external ear volume, tympanometric width, and admittance/compliance for each ear. Mean and prevalence estimates are provided applying sample weights. A multivariate ordinal regression model adjusting for age, sex, race/ethnicity, and education was used to examine relationships between otoscopy or tympanometry measures with hearing loss and tinnitus. RESULTS: Approximately 12% of the sample showed evidence of abnormal tympanometry and 12% showed evidence of abnormal otoscopy in at least one ear. Measured hearing loss was consistently related to tympanometry outcomes, in both univariate and adjusted models, but perceived hearing loss and tinnitus were not related to abnormal tympanometry or otoscopy. The most common reason for abnormal otoscopy was presence of excessive or impacted cerumen, representing an estimated 10% of the population. CONCLUSIONS: With 1 out of 10 adults having excessive cerumen, adults considering over-the-counter (OTC) hearings aids may benefit from an ear examination prior to purchase.

Wideband tympanometry as a diagnostic tool for Meniere's disease: a retrospective case-control study.

PURPOSE: The main purpose of this study was to investigate the usefulness of wide band tympanometry (WBT) as a diagnostic tool for Ménière's disease (MD) by comparing differences in absorbance measures between normal hearing ears and patient diagnosed with MD. METHODS: We conducted a retrospective case-control study. From a cohort of 116 patients diagnosed with Ménière disease, 52 MD patients and 99 normal hearing adults with no history of otological disease served as subjects. Wideband tympanometry was conducted using at Titan Impedance module and audiometry was performed with a MADSEN Astera2. Mean energy absorbance curves with 95% confidence intervals were computed across cases with MD and controls in the frequency range 226-8000 Hz. An overall test for difference between curves of cases and controls was calculated by multivariate analysis of variance. RESULTS: The MD group and the subpopulations of MD patients who fulfilled the International criteria for MD showed a statistically significant lower absorbance at tympanic peak pressure compared to the control group (p < 0.001). No overlap of confidence intervals between mean curves was found within the frequency range of 2000-4000 Hz. CONCLUSION: Absorbance measures obtained by WBT were able to distinguish between MD ears and normal ears within the frequency range of 2000-4000 Hz. The results indicate that WBT potentially could be a useful and simple non-invasive diagnostic tool for MD. However, more research on the association between absorbance measures and inner ear pathologies is needed.

Functional assessment of military aircrew applicants in a hypobaric chamber.

BACKGROUND: Aircrew are exposed to environmental pressure changes. In the Republic of Singapore Air Force (RSAF), applicants assessed to be at intermediate risk of otic barotrauma undergo a hypobaric chamber assessment ["trial of chamber" (TOC)] to functionally evaluate their suitability for military aircrew vocations. AIMS: To identify factors associated with TOC failure among applicants with otorhinolaryngological conditions. METHODS: All applicants to RSAF aircrew vocations who were assessed to be at intermediate risk of otic barotrauma over a 3-yr period were identified using the RSAF Aeromedical Centre's electronic database. Their medical records, as well as the TOC assessment records of the subset of applicants who underwent TOC, were reviewed for demographic data, clinical findings, and TOC outcomes. RESULTS: Of the 483 identified applicants, 374 (77%) had abnormal otoscopic findings, 103 (21%) had rhinitis symptoms, and 6 (1%) had previous ENT surgery. 123 (25%) underwent TOC, of which 20 (16%) failed. Holding other predictor variables constant, the odds of TOC failure increased by 0.79 per unit decrease in BMI (95% CI 0.63-0.99), and the odds of TOC failure increased by 0.93 per kg decrease in body weight (95% CI 0.87-1.00). An abnormal tympanogram was not a statistically significant predictor of TOC failure (OR 1.96, 95% CI 0.59-6.42). Of the 47 applicants who passed TOC and were eventually recruited, none subsequently developed otic barotrauma (mean follow-up, 3.3 yr ± 1.5 yr). CONCLUSIONS: Applicants with lower weight and BMI are more likely to develop otic barotrauma with environmental pressure change. Tympanometry cannot be reliably used to identify applicants who would more likely pass TOC.

Wideband tympanometry in ears with superior canal dehiscence before and after surgical correction.

OBJECTIVES: Wideband tympanometry (WBT) has been shown to be sensitive to mechanical changes in the ear. This study investigated the effect of surgical correction of superior canal dehiscence (SCD) on WBT (i.e. absorbance and middle ear resonance frequency) compared to those on common surgical outcomes such as symptom resolution, vestibular evoked myogenic potentials (VEMP), and hearing thresholds. STUDY SAMPLE AND STUDY DESIGN: Seven patients (eight ears with SCD) who underwent surgical correction of SCD underwent WBT in addition to pure-tone audiometry and VEMP assessment. RESULTS: Postoperatively, all ears showed normalised/decreased absorbance at low frequencies and slightly enhanced absorbance in the middle frequency range (7/8 ears). The middle ear resonance frequency, which was initially lower than normal in most patients, increased in 6/8 operated ears, and decreased in two ears with no/partial symptom relief. In comparison, complete symptom control was observed in 6/8 operated ears, VEMP amplitudes reduced or normalised in all ears, and hearing thresholds remained stable or improved in 6/8 ears and worsened in two ears. CONCLUSIONS: Surgery seems to change the response to WBT in patients with SCD. The results of WBT may represent mechanical changes induced by SCD, and should be considered when evaluating surgical outcomes.

Allergic rhinitis: An indicator of otitis media with effusion in children seen at aminu kano teaching hospital, Kano.

Background: Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction involving nasal mucosa characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness, and eyes itching. Tympanometry is a simple, rapid, and objective test that can be easily carried out. The use of tympanometry in clinical setting can improve detection of middle ear effusion and other middle ear abnormalities. AR has been found to be one of the predisposing factors to developing Otitis Media with Effusion (OME) in children. Patients and Methods: A case-control study was used to determine the prevalence of OME among children with AR as cases and those without allergy as controls. The study participants were children aged 4-12 years with clinical diagnosis of AR attending ENT clinics of Aminu Kano Teaching Hospital, whereas controls were children age 4-12 years without history of AR, ear diseases, or other respiratory system related ailments attending general outpatient clinics in Aminu Kano Teaching Hospital. An interviewer-administered score for AR (SFAR) questionnaire was filled out for all the participants, those with score of 6 and above were selected as cases. The two groups had complete ENT examination and tympanometry done, findings were recorded, and analyzed using SPSS version 21. Results: The mean age of the cases was 6.8 ± 2.1 years, whereas it was 7.5 ± 2.6 years for the controls. The mean difference was 0.7 and was not statistically significant (t = 2.35, df = 258, P value = 0.20). Type B tympanogram suggesting OME was found in 7.3% of subjects and in 2.8% of controls. Type C tympanogram suggesting negative middle ear pressure was found in 15.5% of subjects and in 4.6% of controls. Type A tympanogram suggesting normal middle ear pressure was found in 75% of subjects and in 90% of controls. Acoustic reflex was found to be absent in 29.6% of subjects and in 15.4% of controls and this found to be statistically significant (χ2 = 7.77, df = 1, P value = 0.001). The difference between type A, B, and C tympanograms of subjects and that of controls was found to be statistically significant (Type A χ2 = 14.62, df = 4, P value = 0.01, Type B χ2 = 14.06, df = 4, P value = 0.01, Type C χ2 = 17.01, df = 6, P value = 0.01). Type B tympanogram was used as an indicator to suggest OME for the purpose of this study. Conclusion: Participants with AR were found to have more abnormalities of tympanometric parameters and higher prevalence of type B tympanogram suggesting OME than controls.