Predictors of Conservative Treatment Outcomes for Adult Otitis Media with Effusion.

OBJECTIVES: Conservative treatments are usually the preferred choices for newly diagnosed adult otitis media with effusion (OME). This study was performed to explore the efficacy of conservative treatments, including medication and eustachian tube auto-inflation (ETA), for treating OME in adults and to analyze its predictors. MATERIALS AND METHODS: A total of 107 adult patients with OME were included. All patients completed two weeks of conservative treatments including medication alone or the combination of medication and ETA. RESULTS: The numbers of patients with only one and both ears affected were 79 and 28, respectively, and therefore, 135 affected ears were included. After treatment, 75 affected ears were classified as responders (55.6%), while 60 ears were classified as nonresponders (44.4%). Four predictive factors, including age, air-bone gap (ABG), tubomanometry value (TMM), and the treatment plan (all p<0.05) were found in treatment outcomes. Patients with age ≤50 years (vs. age>50 years), ABG <17 dB (vs. ABG≥17dB), TMM values of 2-6 (vs. TMM values of 0-1), and patients who received combined treatments, including medication and ETA (vs. patients who received medication only), were more likely to be responders (all p<0.05). CONCLUSION: For OME in adult patients, younger age, smaller ABG, higher TMM value, and combined treatment including medication and ETA are good predictors for treatment success.

Effect of age, electrode array, and time on cochlear implant impedances.

Objectives: To determine the impact of age, electrode array, and time on impedance patterns in cochlear implant (CI) patients. Methods: A retrospective case review was performed on 98 patients implanted with the CI24RE perimodiolar (PM) and CI422 lateral wall (LW) arrays between 2010 and 2014 to assess impedances at the 1 week and 3-6 month visit after initial stimulation (IS). Results: With respect to age, impedances were higher in young patients compared to older patients in the middle and apical turns. With time, there were significant reductions in impedances across most electrodes. Electrode array type also had a significant impact on impedance measurements with PM and LW arrays having higher impedances in the basal turn and apical turns, respectively. Furthermore, PM arrays demonstrated significantly lower impedances in the middle and apical turn with time, when compared to LW arrays. Conclusions: Age, electrode array, and time can independently affect CI impedances. Moreover, we show that PM arrays may be advantageous to LW arrays, due to demonstrated lower impedances in the middle and apical turns long term. Understanding the impact of impedance on speech discrimination and determining the intracochlear processes that contribute to differences in impedance are future research directions.

Tympanostomy tube insertion practice in under-18-year-olds in the South African private healthcare sector insured by Discovery Health.

BACKGROUND: The reported rates of tympanostomy tube insertion (TTI) in children vary significantly internationally. Lack of adherence to evidence-based clinical guidelines may contribute to these differences. OBJECTIVES: To study the rates of TTI in South Africa (SA) in children ≤18 years old in the private healthcare sector, both nationally and regionally, to compare these with international TTI rates, and to determine the use of preoperative audiometry and tympanometry. METHODS: A retrospective analysis was done of data obtained from the Discovery Health database. Rates of TTI were analysed nationally and regionally and in different age groups, as was the use of tympanometry and audiograms. RESULTS: The SA TTI rates were much higher than published international rates except for the 0 - 1-year age group in Canada and Denmark and the 0 - 15-year age group in Denmark. There was a statistically significant regional variation in TTI rates as well as in the use of preoperative audiometry and tympanometry. CONCLUSIONS: SA private sector TTI rates are high by international standards. Significant regional variations may indicate over- or underservicing in certain regions. Further investigation of causes for the high TTI rate and regional variations is recommended. Education of healthcare professionals on recognised indications for TTI may improve patient selection.

Frecuencia de la afección auditiva y los factores asociados en pacientes con artritis idiopática juvenil / Frequency of auditory involvement and of associated factors in patients with juvenile idiopathic arthritis

Introducción: La artritis idiopática juvenil (AIJ) es una enfermedad autoinmune de curso crónico, caracterizada por la presencia de artritis en menores de 16 años, por más de 6 semanas en ausencia de otra causa conocida. La expresión extra articular en el sistema audiovestibular se relaciona con la afección de las articulaciones de la cadena oscicular, como consecuencia del proceso inflamatorio de la membrana sinovial. Estudios previos realizados en población infantil han reportado que la pérdida auditiva puede ser de tipo neurosensorial y/o conductiva. Objetivo: Determinar la frecuencia de la afección auditiva y los factores asociados en los pacientes con AIJ. Metodología: Estudio prospectivo y analítico. Se incluyó a 62 pacientes con AIJ con edades comprendidas entre 5 y 15 años, a partir de agosto del 2013 a enero del 2014. El estudio fue aprobado por el comité de ética local y los padres firmaron el consentimiento bajo información. Se realizó otoscopia microscópica, audiometría tonal, timpanometría, reflejo estapedial y emisiones otoacústicas transitorias (EOT); la evaluación reumatológica incluyó exploración articular y aplicación de cuestionario para la evaluación del estado de salud en la infancia (CHAQ). Se utilizaron medidas de tendencia y de dispersión; asociación χ2 con una p<0,05 para la significación estadística. Resultados: Se incluyó a 62 pacientes; 56 niñas y 6 niños, edad media 11,9 años, duración media de la enfermedad de 3,4 años; el 46% presentó AIJ poliarticular factor reumatoide (FR) positivo; el 40%, AIJ poliarticular FR negativo; el 15% AIJ sistémica y el 3% oligoarticular. Se encontró enfermedad activa en 29 pacientes y 33 en remisión con medicamentos. Se evaluaron en total 124 oídos; en 78 se encontró curva tipo As de la clasificación de Jerger, curva tipo A en 45 y en uno se reportó curva tipo AD. En la audiometría tonal no se encontró hipoacusia en ningún paciente y esta estuvo acorde con la logoaudiometría. Las EOT se encontraron ausentes en el 4% de los evaluados y sin reflejo estapedial en menos del 10%. Los factores que presentaron una asociación con la afección auditiva fueron la variedad poliarticular FR positivo, el tiempo de evolución, el índice de discapacidad y los niveles de VSG (p<0,001). Conclusión: Se encontró en más de la mitad de los pacientes estudiados alteraciones auditivas presentes en el timpanograma, asociadas con la variedad poliarticular FR positivo, tiempo de evolución, actividad de la enfermedad y la elevación de la VSG

Introduction: Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disease characterized by the presence of arthritis in children under 16 years of age for more than 6 weeks in the absence of any other known cause. The extra-articular manifestations, especially in the audiovestibular system, are related to the involvement of the joints of the ossicular chain as a result of the inflammatory process in the synovium. Previous clinical studies in pediatric patients have shown conductive or sensorineural hearing loss. Objective: The aim of this study was to assess the frequency of hearing impairment and of associated factors in patients with JIA. Methodology: A prospective, analytical study was conducted from January 2013 to August 2014 in 62 patients with JIA aged between 5 and 15 years. The study was approved by the local ethics committee and parents signed their informed consent. All subjects underwent audiological examination involving otomicroscopy, audiometry, tympanometry, stapedius reflex and test for transient otoacoustic emissions (TOAE); rheumatologic evaluation included joint examination and the application of a measure of functional ability (disability) using the Childhood Health Assessment Questionnaire (CHAQ). Measures of central tendency and of dispersion were used (chi-square for associations and P<.05 for statistical significance). Results: Sixty-two patients were included: 56 girls and 6 boys, mean age 11.9 years and mean disease duration of 3.4 years; 46% had rheumatoid factor (RF)- positive polyarticular JIA, 40% had RF-negative polyarticular JIA, 15% had disease of systemic onset and 3% had oligoarthritis. Active disease was found in 29 patients and 33 were in remission with medication. Of the total of 124 ears evaluated according to the Jerger classification for tympanometry, abnormal findings were observed in 78 that were type As and in 1 that was type Ad, whereas there were 45 type A ears. Hearing loss was disclosed by speech audiometry, rather than by pure tone audiometry. The TOAE were absent in 4% of those assessed and the stapedius reflex was absent in less than 10%. Factors that had a positive correlation with hearing impairment were RF-positive polyarticular JIA, disease duration, degree of disability and the erythrocyte sedimentation rate level (P<.000). Conclusion: The presence of an abnormal tympanogram suggested early involvement in the structure of the tympanic-ossicular complex; however, 3.4 years later, no hearing loss had been reported

The role of bacteriotherapy in the prevention of adenoidectomy.

OBJECTIVE: Adenoidectomy is a surgical procedure with potential adverse events. Effective nonsurgical therapy could reduce patient risk and harm. The aim of this study was to evaluate the role of bacteriotherapy to reduce the necessity of adenoid surgery. PATIENTS AND METHODS: This experimental study was conducted as an open study in 44 children (30 males and 14 females, mean age 4.9 years) who were candidates for adenoidectomy and tympanocentesis as treatment for adenoidal hypertrophy and otitis media with effusion. Twenty-two children were treated with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray, administered as 2 puffs per nostril twice a day for a week for 3 months (study group). The other half of the children was treated with hypertonic saline nasal lavage on the same schedule (control group). Tympanometry and adenoid size assessment were evaluated throughout the intervention period. RESULTS: In the study group, 6/22 children required surgery, compared to 20/22 children in the study group (p<0.0001). The clinical change in the treated children was a significant reduction of adenoid size (p<0.0001) and improvement of middle ear effusion measured with tympanometry (p<0.0001). CONCLUSIONS: Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray could significantly reduce the need for adenoid surgery.

Wideband tympanometry and absorbance measurements in otosclerotic ears.

OBJECTIVES: This study aimed to assess absorbance using a thorough analysis of individual points of its plot in ears with intraoperatively confirmed otosclerosis. To the best of our knowledge, until recently no analyses have been performed that concerned the shape of an absorbance plot and a detailed analysis of its individual points. This study is the first to undertake such an issue. METHODS: A total of 77 otosclerotic ears were included in the study. Pure tone audiometry, low frequency tympanometry, and wide band tympanometry including absorbance were performed preoperatively. The average patients' age in the group was 43.49 years (standard deviation = 10.44). Individual points of absorbance plot were thoroughly analyzed. Parameters were analyzed, such as resonance frequency; number of peaks; maximum absorbance (Height); and plot Width at the following Heights: 1/3, 1/2, and 2/3 (Width1/3, Width1/2, Width2/3, respectively), as well as associated absorbance parameters and frequencies. RESULTS: Data analysis revealed five different types of absorbance plots. Numerous statistically significant differences regarding the parameters of individual points of the plots were found among the distinguished types. CONCLUSIONS: There are five types of absorbance plots in otosclerotic ears: type I, characterized by two distinct peaks, closely resembling normal ear absorbance plot; type II with a single distinct peak reaching high values of absorbance; type III with reduced absorbance for frequencies <2000 Hz; type IV with reduced absorbance for all frequencies; and type V with reduced absorbance for frequencies >2000 Hz. Absorbance measurements may play an important role in the diagnostics of otosclerosis; however, further research is necessary in this area. LEVELS OF EVIDENCE: 4 Laryngoscope, 129:E365-E376, 2019.

National quality evaluation of peri-surgical hearing care for pediatric otitis media with effusion.

OBJECTIVE: Otitis media with effusion (OME) is a common disease among children that can lead to grave sequelae with respect to hearing. Thus, when treating OME, appropriate hearing care should be provided; ventilation tube insertion (VTI), a standard approach for treating OME, is no exception. This study examined hearing care for VTI and its associated factors, especially at the national level. DESIGN: Retrospective database analysis. SETTING: Taiwan's National Health Insurance Research Database. PARTICIPANTS: One thousand one hundred and fifty-nine patients who received VTI (age ≤12 years; 2011-12). INTERVENTION: No intervention. MAIN OUTCOME MEASURES: Compliance to guidelines: sufficient observation time (OBS), tympanogram before VTI (TYM-B) and hearing tests before and after VTI (HEAR-B and HEAR-A, respectively). RESULTS: The national proportions of completion for each procedure were 30.1% for OBS, 84.4% for TYM-B, 74.3% for HEAR-B and 36.0% for HEAR-A; those of OBS and HEAR-A were extremely low. Age, nasal allergy and even geographic area were associated with differences across completion patterns. Regression revealed some notable patterns. Compared with non-teaching hospitals, teaching hospitals administered HEAR-B most successfully (odds ratio [OR: 3.20, 95% CI: 1.06-9.63) and the smallest hospital group performed HEAR-B most successfully (OR: 2.92, 95% CI: 1.14-7.46). CONCLUSION: Several findings surfaced concerning VTI-related hearing care and its association with many clinical and socioeconomic factors in this national study. These findings could serve as a map for improving hearing care quality among children with OME.

A simple diagnostic scale based on the analysis and screening of clinical parameters in paediatric obstructive sleep apnoea hypopnea syndrome.

OBJECTIVE: This study aimed to develop a simple and accurate method to diagnose paediatric obstructive sleep apnoea hypopnea syndrome. METHODS: A total of 311 children with suspected paediatric obstructive sleep apnoea hypopnea syndrome were included in the study. Multiple clinical parameters, including sex, age, body mass index, history of snoring or gasping, history of nasal obstruction, history of running nose, palatine tonsil size, adenoid to nasopharynx ratio, and tympanogram type, were compared with polysomnography results using relevant correlation and regression analyses. A diagnostic scale was established using the regression equation and the correlation between the polysomnography result and scale result was determined. RESULTS: The apnoea-hypopnea index correlated significantly with a history of snoring or gasping, palatine tonsil size, and tympanogram type. Stepwise logistic regression analysis revealed that the polysomnography result correlated significantly with a history of snoring or gasping, palatine tonsil size, and the adenoid to nasopharynx ratio. The percentage correlation between the scale and polysomnography results was 77.8 per cent. CONCLUSION: The diagnostic scale can be used to diagnose paediatric obstructive sleep apnoea hypopnea syndrome for clinical application when polysomnography cannot be performed. However, it is not suitable for assessing the severity of paediatric obstructive sleep apnoea hypopnea syndrome.

Seasonal differences of tympanogram and middle ear findings in children.

BACKGROUND: It is a known fact that bacterial or viral acute otitis media occurs more frequently in the winter months. Only a few older studies on seasonal differences in middle ear findings are available. These studies are based solely on tympanography, without correlation to intraoperative middle ear findings. This study addresses the question of whether seasonal differences can be found in the preoperative tympanogram and in the corresponding intraoperative findings in children with chronic middle ear problems. PATIENTS AND METHODS: This retrospective study included patients who had undergone myringotomy with or without tympanostomy tube insertion at the Charité-Universitätsmedizin Berlin between January and December 2011. Corresponding to the catarrhal phases, winter months were defined as those from November to April; summer months from May to October. The preoperative tympanogram and the documented intraoperative middle ear finding were statistically analyzed for seasonal differences. RESULTS: A total of 654 ears from 206 male and 127 female patients with mean age 3.7 ± 2.5 years were analyzed. In the majority of cases, a type B tympanogram was found (n = 376; 57.5%), whereas the middle ear was filled with air in 19.1% of cases. No significant seasonal differences were found for either the intraoperative middle ear findings or the preoperative tympanograms (p > 0.05). CONCLUSION: For children with a typical history of chronic otitis media without effusion and chronic tube ventilation dysfunction, myringotomy with or without tympanostomy tube insertion is indicated independently of the season. The results indicate that a wait-and-see approach with hope of improvement during the summer months is not rational.

Detection of modiolar proximity through bipolar impedance measurements.

OBJECTIVES: To test the hypothesis that bipolar electrical impedance measurements in perimodiolar cochlear implants (CIs) may be used to differentiate between perimodiolar insertion technique favoring proximity to the modiolus or lateral wall. STUDY DESIGN AND METHODS: Bipolar impedances are a measure of electrical resistance between pairs of electrode contacts in a CI. Stimulation is through biphasic pulses at fixed frequency. Impedance measurements were made in real time through sequential sampling of electrode pairs. Perimodiolar electrodes were inserted in temporal bones using one of two techniques: 1) In the standard insertion technique (SIT), the electrode array slides along the lateral wall during insertion. 2) In the Advance Off Stylet (Cochlear Ltd. Sydney) technique (AOS), the electrode maintains modiolar contact throughout the insertion process. A set of 22 insertions were performed in temporal bone specimens using perimodiolar electrode arrays with both AOS and SIT. Buffered saline was used as a substitute for natural perilymph based on similar electrical conductivity properties. Impedance with and without stylet removal were recorded with a 30-second sampling window at final insertion depth. RESULTS: There is a significant difference in bipolar impedance measures between AOS and SIT, with impedances rising in measurements with stylet removal. Evaluation was based on two-sided analysis of variance considering technique and electrode with P < 0.025. CONCLUSION: Bipolar electrical impedance can be used to detect relative motion toward the modiolus inside the cochlea. This detection method has the potential to optimize intraoperative placement of perimodiolar electrode arrays during implantation. We anticipate that this will result in lower excitation thresholds and improved hearing outcome. LEVEL OF EVIDENCE: NA. Laryngoscope, 127:1413-1419, 2017.

Wideband Tympanometry Normative Data for Different Age Groups in Turkish Population.

OBJECTIVE: Studies on the use of wideband tympanometry (WBT) for the evaluation of middle ear pathologies have been increasing gradually in recent years. However, studies regarding normative data of WBT are not sufficient. The aim of this study was to determine normative values of WBT for different age groups in Turkish population. MATERIALS AND METHODS: One hundred fifty volunteers from five age-related groups were included in this study. Values of resonance frequency (RF), absorbance percentage according to frequency, maximum absorbance ratio, and maximum absorbance frequency were obtained using WBT. Measurements were recorded at a pressure of 0 decapascal (daPa) using a sound stimulus given at 90±3 decibel sound pressure level (dB SPL). RESULTS: The RF was detected to be significantly lower only in the group of subjects in the age range of 0-1 month. The absorbance value at 250 Hz was detected to be significantly higher in the age groups of 0-1 month and 1 month-2 years than in the other groups. CONCLUSION: We believe that the findings obtained in this study would be helpful in determining normative data regarding WBT; by the determination of this normative data, the clinical use of WBT would become widespread.

Effects of consecutive trials and test-retest reliability of 1000-Hz tympanometry in adults.

OBJECTIVE: To investigate the effect of consecutive 1000-Hz tympanometry testing on admittance measures, and examine test-retest reliability. DESIGN: Repeated measures with eight trials of 1000-Hz Y(a) and B(a)/G(a) tympanometry, respectively, in two ears of each subject, followed by repeated 226-Hz tympanometry. STUDY SAMPLE: Twenty-seven normal-hearing young adults. RESULTS: For single-peak tympanograms, peak Y(tm) and G(tm) systematically increased across trials with a mean change of 8% and 15% at Trial 8, respectively, whereas B(tm) increased marginally. For notched tympanograms, peak Y(tm) and B(tm) decreased by 23% and 162% at Trial 8, and G(tm) in two cases also decreased (10% on average). Trial 2 and 3 contributed 50% to 70% of the total changes. Test-retest differences of subsequently acquired 1000- and 226-Hz tympanograms were smaller than previously reported. CONCLUSIONS: Consecutive testing significantly alters middle-ear admittance in 1000-Hz tympanometry. The outcome is contingent on tympanogram pattern and admittance component: Increase of peak Y(tm) and G(tm) in single-peak tympanograms and decrease of all measures in notched tympanograms. The present results complement previous studies on our understanding of the mechanism underlying this effect: a decrease of middle-ear stiffness. The effect of repetitive tympanometry should be accounted for in research involving sequential testing.

[Wide band tympanometry energy reflectance in Chinese infants and children with normal outer and middle ears].

OBJECTIVE: To explore the law of wide band tympanometry energy reflectance (WBTER) in Chinese infants of Han nationality with normal outer and middle ears, and to provide the normal values for the clinical application of WBTER. METHODS: Ninety four infants (170 ears) of Han nationality with normal outer and middle ears evidenced by temporal bone CT, and 226 Hz and 1 000 Hz tympanometry at the ages between three and 48 months (median age: 14 months) were selected and divided into four groups: 3-6 months (32 ears), 7-12 months (53 ears), 13-24 months (46 ears) and 25-48 months (39 ears). WBTER was conducted on these infants, and the basic law of energy reflectance under different frequencies, as well as the influence of age on energy reflectance were analyzed using SPSS 15.0. RESULTS: The normal value of energy reflectance was higher at low frequency, gradually decreased with the increase of frequency, reached the minimum near 4 000 Hz , followed by constantly increased till 8 000 Hz. In the scope of frequency below 1 000 Hz and above 6 350 Hz, the energy reflectance values of infants in the group of 3-6 months were significantly lower than those of infants in other age groups (P < 0.05). In comparison to the group below six months, the groups over six months generally had higher energy reflectance and lower fluctuation. CONCLUSIONS: The pattern of energy reflectance across frequency range for Chinese infants and children was consistent with that of other races reported in foreign countries. The WBTER changes with the growing of age, which tends to be stable after the first six months of birth.

Use of tympanometry in general practice in Denmark.

OBJECTIVES: Otitis media has been a serious disease and can be that even today. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indication of fluid in the middle ear and thereby improve the quality of treatment. The aim of this ongoing study is to analyze the use of tympanometry in Denmark after reimbursement for doing tympanometry (November 2006) when clinically indicated. Our research questions were: How many clinics were using tympanometry? How frequent was it used? Is the use increasing? Has the number of GPs in the clinic any relation to the use of tympanometry? METHOD: We used information in The Danish National Health Service in three Regions to analyze the use of tympanometry in general practice during the years 2007-2009. The coverage of the GPs is 100% in the regions. RESULTS: The three regions counted about half of Danish population. In 2009 the material was 902 different clinics with more than 1700 GPs. In 2007 55% of the clinics did tympanometry, in 2009 the figure was 60%. In the clinics doing tympanometry the median value was 28 tympanometries per year (inter-quartile range 13-53) per GP. The variation in the use of tympanometry was surprisingly high, from none or a few per GP per year to a maximum of more than 500 tympanometric examinations per GP a year. This huge variation has to be discussed. DISCUSSION: Many answers can be given. Some of the explanation was problems in doing correct tympanometry, and problems understand the clinical implications of curves and the figures.

Factors that introduce intrasubject variability into ear-canal absorbance measurements.

Wideband immittance measures can be useful in analyzing acoustic sound flow through the ear and also have diagnostic potential for the identification of conductive hearing loss as well as causes of conductive hearing loss. To interpret individual measurements, the variability in test­retest data must be described and quantified. Contributors to variability in ear-canal absorbance­based measurements are described in this article. These include assumptions related to methodologies and issues related to the probe fit within the ear and potential acoustic leaks. Evidence suggests that variations in ear-canal cross-sectional area or measurement location are small relative to variability within a population. Data are shown to suggest that the determination of the Thévenin equivalent of the ER-10C probe introduces minimal variability and is independent of the foam ear tip itself. It is suggested that acoustic leaks in the coupling of the ear tip to the ear canal lead to substantial variations and that this issue needs further work in terms of potential criteria to identify an acoustic leak. In addition, test­retest data from the literature are reviewed.

Unexpected relationship between tympanometry and mortality in children with nontraumatic coma.

OBJECTIVE: We sought to further examine the relationship between tympanometry and mortality after noting an unexpected association on assessment of baseline data of a study whose primary aim was to investigate the utility of noninvasive tympanic membrane displacement measurement for monitoring intracranial pressure in childhood coma. METHODS: We recruited children who presented with acute nontraumatic coma to the high-dependency unit of Kilifi District Hospital on the rural coast of Kenya. We excluded children with sickle cell disease, epilepsy, and neurodevelopmental delay. We performed tympanometry on the right ear before tympanic membrane displacement analyzer measurements. All children were managed according to standard World Health Organization guidelines. RESULTS: We recruited 72 children with a median age of 3.2 years (interquartile range [IQR]: 2.0-4.3 years); 31 (43%) were female. Thirty-eight (53%) had cerebral malaria, 8 (11%) acute bacterial meningitis, 4 (6%) sepsis, and 22 (30%) encephalopathy of unknown etiology. Twenty (28%) children died. Tympanometry was normal in 25 (35%) children. Adjusting for diagnosis and clinical features of increased intracranial pressure, both associated with death on univariable analysis, children with abnormal tympanometry had greater odds of dying than did those with normal tympanometry (adjusted odds ratio: 17.0; 95% confidence interval: 1.9-152.4; P = .01). Children who died had a lower compliance (0.29 mL; IQR: 0.09-0.33 mL) compared with those who survived (0.48 mL; IQR: 0.29-0.70 mL) (P < .01). CONCLUSIONS: Abnormal tympanometry appears to be significantly associated with death in children with acute nontraumatic coma. This finding needs to be explored further through a prospective study that incorporates imaging and intensive physiologic monitoring.

[Comparative analysis of 226 Hz and 1 000 Hz probe tone tympanometry in infants].

OBJECTIVE: To analyze the judgement standard and evaluate the diagnostic value of the low frequency and high frequency tympanometry in infants with otitis media. METHOD: Tympanograms for admittance with 226 Hz and 1 000 Hz probe tones and resonant frequency were obtained from normal infants (195 cases, 321 ears) and infants with otitis media(122 cases, 171 ears). The mean, standard deviation, median, 5% quantile, 95% quantile and 95% confidence interval of peak admittance, gradient and resonant frequency were measured and calculated in different age groups. The significant differences of 1000 Hz peak admittance, 226 Hz peak admittance and gradient between normal infants and infants with otitis median were analyzed using SPSS 11.0. The false positive rate and the false negative rate of different age groups in infants with otitis media were evaluated according to such judgement standards as 1000 Hz peak admittance, 226Hz peak admittance or gradient. RESULT: The false positive rate and the false negative rate of the 1000 Hz probe tone tympanometry in infants with otitis media unter one year of age were 3.07% and 1.84% as the normal range of positive peak was more than 0.2 mmho. The false positive rate and the false negative rate of the 1000 Hz probe tone tympanometry in infants with otitis media aged 1-2 years and aged 2-3 years were 3.26%, 5.26% and 1.52%, 0.00% respectively,as the normal range of positive peak was more than 0.3 mmho. These was no significant difference in the gradient with 226 Hz probe tone between normal infants and infants with otitis median under one year of age. The false positive rate and the false negative rate of the 226 Hz probe tone tympanometry in infants with otitis media aged 1-2 years and aged 2-3 years were 44.57%, 31.58% and 16.67%, 6.67% respectively, as the gradient with 226 Hz probe tone was a judgement standard. CONCLUSION: (1) The diagnostic accuracy of tympanometry with 1000 Hz probe tone for otitis media in infants younger than 3 years of age exceeded 226 Hz probe tone tympanometry, the 1000 Hz probe tone tympanometry is suggested to the evaluation of middle ear function in infants before 3 years. (2) It is reasonable that the normal range of positive peak is more than 0.2 mmho in infants unter one year of age and the normal range of positive peak is more than 0.3 mmho in infants aged 1-3 years.

Estudo das medidas de imitância acústica com tom sonda de 226 e 1000 Hz em neonatos / Study of acoustic immittance measures with probe tone of 226 and 1000 Hz in neonates

OBJETIVO: Estudar as medidas de volume, pressão do pico e complacência obtidas nas curvas timpanométricas de neonatos, na comparação entre gêneros e orelhas, utilizando tom sonda de 226 e 1000 Hz, e analisar as respostas obtidas na pesquisa dos reflexos acústicos com os dois tons de sonda testados. MÉTODOS: Foram avaliados 73 neonatos, com integridade de células ciliadas externas verificadas pelas emissões otoacústicas evocadas transientes. Foi realizada a avaliação das medidas de imitância acústica nas crianças, tendo como desfecho clínico a observação das respostas obtidas nas timpanometrias e na pesquisa dos reflexos acústicos com tom sonda de 226 e 1000 Hz. RESULTADOS: Observamos diferença entre as curvas de pico único e pico duplo, com maior ocorrência de pico único com tom sonda de 1000 Hz. Verificamos diferença entre os gêneros, na medida complacência em 226 Hz e entre as orelhas, nas medidas complacência e pressão do pico em 226 e 1000 Hz, respectivamente. Encontramos, também, diferença nas médias dos reflexos acústicos ipsilaterais e contralaterais com tom sonda de 1000 Hz, em relação a variável gênero, e entre os reflexos ipsilaterais e contralaterais nas frequências de 1000 e 2000 Hz com tom sonda de 226 e 1000 Hz. CONCLUSÃO: Houve diferença entre as variáveis analisadas com tom sonda de 226 e 1000 Hz. Os valores de compliância e de reflexos foram mais elevados no gênero feminino. Todos os neonatos apresentaram reflexos acústicos, sendo os contralaterais mais elevados que os ipsilaterais.

PURPOSE: Study the measures of volume, peak pressure and complacency in tympanometric curves of neonates with gender, ears and tone probe of 226 and 1000 Hz and analyze the responses obtained in the survey of the acoustic reflections with the two tone probe tested. METHODS: transversal study, observational and contemporary. We evaluated 73 neonatal with integrity of outer hair cells observed by transient evoked otoacoustic emissions. The children performed the evaluation of measures of acoustic immittance clinical outcome, observation of the answers obtained in tympanometries and research of acoustic reflexes with tone probe 226 and 1000 Hz. RESULTS: We observed statistically significant difference between the curves of single and double peak, with a higher occurrence of single peak with tone probe of 1000 Hz. There was statistically significant difference between the genders as complacency in 226 Hz and between the ears in compliance measures and peak pressure in 226 and 1000 Hz, respectively. In addition, we found statistically significant difference in the average of the ipsilateral and contralateral acoustic reflexes with tone probe of 1000 Hz against the variable gender and ipsilateral and contralateral reflexes between the frequencies of 1000 and 2000 Hz with tone probe of 226 and 1000 Hz. CONCLUSION: The results obtained in this study showed statistically significant difference between analyzed variables with tone probe of 226 and 1000 Hz tone. The compliance values and reflexes were higher in females. All neonates had acoustic reflexes, and reflexes contralateral higher than the ipsilateral.

Desarrollo de una hoja de cálculo del impedimento auditivo usando Microsoft EXCEL / Developement of a spreadsheet for hearing impairment using Microsoft Excel

En nuestra actividad profesional diaria es habitual que necesitemos calcular el impedimento auditivo, para realizar informes médicos o para informar a nuestros pacientes. Hasta ahora hemos utilizado tablas y sistemas de cálculo manual que lo facilitan. Para simplificar y hacer más preciso este cálculo hemos desarrollado un sistema utilizando el programa Microsoft Excel y las fórmulas de cálculo de la American Academy of Otolaryngology. Respecto a otros sistemas, el programa de cálculo que describimos aporta 2 ventajas. La primera es su capacidad para corregir el error asociado a la aplicación directa de la fórmula de cálculo del impedimento monoaural, que con valores audiométricos normales (<25dB)da resultados negativos y en caso de hipoacusia profunda (>90dB), resultados superiores al 100%. La segunda ventaja es que no se tiene que indicar cuál es el oído mejor antes de realizar el cálculo binaural hecho que evita la introducción de los valores de «oído mejor» «oído peor» en 2 celdas y supone el ahorro de alrededor de un 20% de tiempo total de cálculo. En conclusión, consideramos que en nuestras especialidades, la hoja de cálculo de Excel adaptada para la valoración del impedimento auditivo, resulta muy adecuada, reproduce los resultados de cualquier sistema de cálculo manual y minimiza la posibilidad de error, por lo que puede aportar un ahorro de tiempo y una mayor seguridad (AU)

In daily clinical practice, the results of audiometric tests often need to be converted into the percentage of hearing impairment in order to prepare health reports or to provide information requested by patients. Until now, manual systems have been used to calculate this percentage. To simplify and add precision to this calculation, we developed a spreadsheet using Microsoft Excel software and the American Academy of Otolaryngology's formula to determine hearing handicap. Compared with other systems, our spreadsheet provides two main advantages. First, it corrects the intrinsic problem of the original formula, which gives negative results in the presence of normal audiometries (values under 25dB) or results over 100 in the case of severe hypoacusis (values over 90dB). The second advantage is that there is no need to specify the best ear in order to calculate the global hearing handicap, thus avoiding the introduction of two values and saving 20% of the overall calculation time. In conclusion, we consider that the Excel spreadsheet, adapted for the evaluation of hearing handicap, could save time and be more accurate than manual methods, thus reducing the possibility of making mistakes (AU)

Índice de perturbación, de precisión vocal y de grado de aprovechamiento de energía para la evaluación del riesgo vocal / Perturbation, precision and extra energy gain indexes for the evaluation of vocal risk

Este trabajo presenta la aplicación de un método adecuado para el análisis del riesgo vocal debido a las alteraciones de voz. Se obtienen 3 índices: a) un índice de perturbación que agrupa 4 parámetros clásicos como el Jitter, el Shimmer, la relación armónico ruido y la amplitud del cepstrum; b) un índice de precisión vocal vinculado con la estabilidad articulatoria y medido como la inversa de la desviación estándar de los primeros 5 formantes, y c) un índice asociado al grado de aprovechamiento de energía que evalúa tanto la coincidencia entre los armónicos con los formantes como las pérdidas de energía que se producen en el tracto vocal, medidas como la inversa de los anchos de banda. Para esta presentación, los índices mencionados se evalúan en 84 voces de docentes con distintos grados de alteración de voz, durante la emisión de la vocal /a/. El índice de perturbación se calcula a partir de las contribuciones parciales sobre una diagonal que va desde valores normales en un extremo hasta valores patológicos en el otro. El índice de precisión vocal se presenta con un gráfico de las áreas de formantes normalizadas respecto de la frecuencia fundamental. El índice de aprovechamiento de energía muestra una gráfica inversa de los anchos de banda a lo largo de un continuo. La agrupación de las voces de docentes en normales, con riesgo vocal y alteradas se presenta en relación a los respectivos diagnósticos laringológicos verificando su utilidad en la evaluación masiva de los profesionales con riesgo vocal (AU)

This study describes the application of an acoustic analysis method that can be used for vocal risk evaluation. Three indexes are calculated: (i) a perturbation index, with classical perturbation parameters, such as jitter, shimmer, harmonic-to-noise ratio, and cepstrum amplitude; (ii) a precision index related to articulatory stability, measured by the inverse of the standard deviation of the first five formants, and (iii) an extra energy gain index due to both optimal harmonic/formant alignment and losses at the vocal tract, measured by the inverse of the first five formant bandwidths. The above indexes were evaluated in 84 school teachers with distinct grades of voice alterations during emission of the vowel /a/. The perturbation index is calculated on the basis of the partial scores along a diagonal line ranging from normal at one end to altered measurements at the other. The precision index is represented as a formant plot - normalized to fundamental frequency - which shows the contributions of both formant one and formant two to the precision index. To verify energy management at the vocal tract, formant bandwidths are measured and their inverse is drawn as points along a non-contribution/contribution line. The teachers’ voices were automatically classified in three groups: normal, at risk and altered, all of which were successfully compared with their laryngologist's diagnosis. The method employed is a promising application for vocal risk evaluation (AU)