Wideband absorbance tympanometry: a novel method in identifying otosclerosis

Advancements in Pediatric Audiological Assessments Using Wideband Acoustic Immittance: A Review

OBJECTIVES

This study's objectives were to explore the potential of wideband acoustic immittance (WAI) as a diagnostic tool, examining its accuracy and efficiency in pediatric audiology.

METHODS

A narrative review of the contemporary literature was conducted, focusing on studies that assessed the use of WAI in diagnosing pediatric auditory conditions. Key variables such as diagnostic accuracy, efficiency, and clinical outcomes were considered.

RESULTS

This review highlighted that WAI offers a broader range of test frequencies and more comprehensive diagnostic information compared with traditional tympanometry. The studies indicated that WAI has the potential to improve diagnostic accuracy and efficiency in pediatric audiology. Distinct patterns of wideband absorbance were identified, enabling more detailed and accurate diagnostic evaluations.

CONCLUSIONS

WAI shows substantial potential as a diagnostic tool in pediatric audiology, offering improvements in diagnostic accuracy and efficiency over traditional methods. While the initial findings are promising, further research is needed to fully understand its applicability and benefits across different pediatric populations. Future studies should aim to validate the clinical utility of WAI to ensure its widespread adoption in pediatric audiological assessments.

Predictive accuracy of wideband absorbance in children with large vestibular aqueduct syndrome: A single-center retrospective study

Objectives

This study aimed to assess the clinical significance of Wideband Absorbance (WBA) in children with Large Vestibular Aqueduct Syndrome (LVAS), which could potentially serve as diagnostic and predictive markers for LVAS in children.

Design

This was a single-center retrospective case-control study. Audiological measurements and Wideband Acoustic Immittance (WAI) were performed. Propensity score matching (PSM) was considered to treat group imbalance. The Receiver Operating Characteristic (ROC) curves and area under the ROC curve (AUC) were used to evaluate the sensitivity and specificity of WBA.

Study sample

Participants included 42 children with LVAS and 163 normal children aged 6 months -11 years recruited from clinical audiology settings between 2019 and 2021.

Results

The WBA at Tympanometric Peak Pressure (WBATPP) and Ambient Pressure (WBAA) in the LVAS group were significantly lower than those of the control group at 1259-2000 Hz but higher at 4000-6349 Hz (p < 0.05, power >0.8). The WBAA (1587 Hz) AUC value was 0.805, identifying a score ≤0.565 as indicative of a LVAS risk.

Conclusions

WBA holds promise in distinguishing LVAS from the normal condition and warrants further exploration as a tool to examine the influence of inner ear pressure on acoustic energy transmission in the middle ear.

Material characterization of human middle ear using machine-learning-based surrogate models

This study aims to introduce a novel non-invasive method for rapid material characterization of middle-ear structures, taking into consideration the invaluable insights provided by the mechanical properties of ear tissues. Valuable insights into various ear pathologies can be gleaned from the mechanical properties of ear tissues, yet conventional techniques for assessing these properties often entail invasive procedures that preclude their use on living patients. In this study, in the first step, we developed machine-learning models of the middle ear to predict its responses with a significantly lower computational cost in comparison to finite-element models. Leveraging findings from prior research, we focused on the most influential model parameters: the Young's modulus and thickness of the tympanic membrane and the Young's modulus of the stapedial annular ligament. The eXtreme Gradient Boosting (XGBoost) method was implemented for creating the machine-learning models. Subsequently, we combined the created machine-learning models with Bayesian optimization (BoTorch) for fast and efficient estimation of the Young's moduli of the tympanic membrane and the stapedial annular ligament. We demonstrate that the resultant surrogate models can fairly represent the vibrational responses of the umbo, stapes footplate, and vibration patterns of the tympanic membrane at most frequencies. Also, our proposed material characterization approach successfully estimated the Young's moduli of the tympanic membrane and stapedial annular ligament (separately and simultaneously) with values of mean absolute percentage error of less than 7%. The remarkable accuracy achieved through the proposed material characterization method underscores its potential for eventual clinical applications of estimating mechanical properties of the middle-ear structures for diagnostic purposes.

Study on characteristics of wideband acoustic immittance in patients with Inner Ear Malformations

OBJECTIVE

To compare the differences in wideband absorbance and the resonance frequency (RF) between patients with inner ear malformations and normal control, and to explore the auditory diagnostic value of wideband acoustic immittance (WAI).

METHODS

A total of 38 patients (59 ears) with enlarged vestibular aqueduct (EVA), 13 patients (14 ears) with incomplete partition type I (IP-I) and 13 patients (26 ears) with incomplete partition type II (IP-II) were included. 50 normal control (100 ears). All subjects underwent WAI tests to compare the absorbance configuration and resonance frequency.

RESULTS

All the group showed lower absorbance at ambient pressure than at peak pressure in certain frequencies under 2000Hz. Under 1000Hz, the absorbance of EVA was higher than that of other groups. The average absorbance and highest absorbance of IP-I were the lowest(P＜0.05). However, IP-II and normal group had similarity on some characteristics. The three IEM groups mainly different at low and high frequencies, but not at medium frequencies. The highest absorbance of all the groups were appeared around 3000Hz. The RF of all the groups from low to high were EVA＜IP-II＜normal control＜IP-I, and the lowest was EVA(P＜0.05).

CONCLUSION

Inner ear malformations can affect energy absorbance and RF. WAI is sensitive and non-invasive to provide useful information about inner ear status and facilitate detection of ear pathology.

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.

Wideband Acoustic Absorbance in Otosclerosis: Does Stapedotomy Restore Normal Tympanic Cavity Function?*

Introduction Otosclerosis is characterized by the fixation of the stapes to the oval window, thereby impairing acoustic signal absorbance. A commonly used surgical technique for improving hearing in cases of otosclerosis is stapedotomy. However, it is unclear whether this surgery restores all the physical characteristics of the tympano-ossicular system.

Objective To evaluate the tympano-ossicular system in individuals with fenestral otosclerosis pre and poststapedotomy using wideband tympanometry.

Method A total of 47 individuals and 71 ears were assessed. The subjects were divided into three groups: presurgery otosclerosis; postsurgery; and a control group of normal-hearing adults. A handheld tympanometer with a wideband module (226–8,000 Hz) was used to take measurements at ambient pressure and under pressurized conditions. The level of statistical significance adopted was p ≤ 0.05.

Results Acoustic absorbance at 226 Hz was low for all groups. At frequencies in the range 630 to 5,040 Hz, each group had a characteristic absorbance curve, allowing them to be distinguished from one another. In the presurgery group, absorbance values were below normal levels, with energy absorbance below 10%. Low energy absorbance was most evident at 1,000 Hz in the presurgery group, but this was not observed in the postsurgery group. Although there was an improvement in hearing, the surgery failed to restore the tympano-ossicular system to normal.

Conclusion Wideband acoustic absorbance proved able to differentiate normal ears and otosclerotic ears pre and postsurgery, under both ambient pressure and pressurized conditions.

The Role of Wideband Tympanometry in the Diagnosis of Meniere's Disease

Meniere's disease (MD) is a clinical syndrome characterized by spontaneous recurrent vertigo, usually accompanied by hearing loss, tinnitus, and aural fullness. The cause of MD remains unclear and is generally considered to be associated with endolymphatic hydrops. Studies showed that patients with MD could have eustachian tube dysfunction (ETD). ETD can disrupt the pressure balance between the middle and inner ear and impair the inner ear's function. In recent years, several studies have attempted to identify MD by using wideband tympanometry (WBT). However, there are limited studies in this area. There is no consensus on how to use WBT to diagnose Meniere's disease. Therefore, we endeavored to conduct a narrative review in this aspect based on the latest research findings. Reduction in resonance frequency and absorbance are characteristic of MD and can identify Meniere's disease. The use of an increase in the integrated area of absorbance as an indicator for identifying MD is controversial. WBT seems to be ineffective as a diagnostic tool during the acute episodes of Meniere's disease. Patients with MD may benefit from WBT. WBT has excellent potential for future use in Meniere's disease. However, further large sample sizes, multicenter studies are needed.