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

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.

Investigation of Age and Gender Effects on the Middle Ear With Wideband Tympanometry in Adults

OBJECTIVES

Several studies have reported the effects of age and gender on the middle ear of adults using wideband acoustic immittance (WAI) that measures middle ear function over a range of frequencies rather than the traditional measures with a single probe tone. Although these results are often based on WAI measurements under ambient pressure, using WAI under varying ear-canal pressures (wideband tympanometry [WBT]) may be able to provide more information about age and gender effects on the middle ear. The aim of this study is to examine the effects of age and gender on the middle ear with WBT in three different age groups consisting of young, middle-aged, and older adults.

DESIGN

A total of 95 adults with normal middle ear function were assessed, including 32 young adults (16 men, 16 women, aged 20 to 39 years), 31 middle-aged adults (15 men, 16 women, aged 41 to 60 years), and 32 older adults (16 men, 16 women, aged 65 to 82 years). WBT measurements were performed from 226 to 8000 Hz using Interacoustics Titan. Energy absorbance data at tympanometric peak pressure (EA TPP ) and ambient pressure (EA AP ) at 1/3 octave frequencies, and resonance frequency (RF) data were analyzed according to age and gender variables.

RESULTS

Analysis results showed that the mean EA TPP was significantly higher from 500 to 794 Hz and at 5040 and 6350 Hz, and significantly lower from 1587 to 3175 Hz in older adults compared with young adults. The mean EA AP was significantly lower from 1587 to 3175 Hz, and significantly higher at 5040 and 6350 Hz in older adults compared with young adults. There was no significant difference in the mean EA TPP and mean EA AP at any frequency between young and middle-aged adults, and middle-aged and older adults. RF was significantly lower in older adults compared with young adults. In all age groups, men had higher mean EA TPP and mean EA AP at lower frequencies and lower mean EA TPP and mean EA AP at higher frequencies than women. Men had slightly lower RF than women in young and older adults, while men had significantly lower RF than women in middle-aged adults.

CONCLUSIONS

This study demonstrated that there are possible age and gender effects on the middle ear that may affect the mechanical transmission of sound. It may be useful to consider this finding in clinical evaluation in adults of different ages and genders, and to establish age- and gender-specific WBT norms in the adult population.

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.

Characteristics of large vestibular aqueduct syndrome in wideband acoustic immittance

Objective

To describe the characteristics of large vestibular aqueduct syndrome (LVAS) in wideband acoustic immittance (WAI) and to explore whether inner ear deformity has an impact on WAI results.

Methods

Subjects with typical LVAS (LVAS group) and control subjects with a normal anatomical structure of the inner ear (control group) were screened from pediatric patients with cochlear implants using thin-slice computed tomography (CT) images of the temporal bone. With inflammation of the auditory canal and middle ear excluded by routine ear examination and 226 Hz acoustic immittance, WAI data were acquired. Then, the maximum absorbance as the major observation indicator on the mean tympanogram was compared between the LVAS group and control group, and a descriptive comparison of the mean tympanogram and frequency-absorbance curve at peak pressure was performed between the two groups.

Results

The LVAS group included 21 cases (38 ears), and the control group included 27 cases (45 ears). All LVAS subjects met the Valvassori criteria, and the VA at the horizontal semicircular canal displayed flared expansion. On the mean tympanogram, the maximum absorbance in the LVAS group (0.542 ± 0.087) was significantly higher than that in the control group (0.455 ± 0.087) (p < 0.001). The tympanogram in the LVAS group showed an overall elevation, and the absorbance at all pressure sampling points was significantly higher than that in the control group (p < 0.001). The frequency-absorbance curve at peak pressure first increased and then decreased in both groups, and the LVAS group showed higher absorbance than the control group in the frequency range below 2,828 Hz. The absorbance at 343-1,124 Hz was significantly different between the two groups (p < 0.001), and 343-1,124 Hz was the major frequency range at which the maximum absorbance on the mean tympanogram increased in the LVAS group.

Conclusion

Large vestibular aqueduct syndrome (LVAS) shows increased absorbance in low and medium frequency ranges in WAI. The maximum absorbance on the mean tympanogram can serve as a reliable evaluation indicator. Inner ear factors must be considered when middle ear lesions are analyzed by WAI.

Oral splint therapy in patients with Menière's disease and temporomandibular disorder: a long-term, controlled study

PURPOSE

To assess the effect of oral splint therapy on audio-vestibular symptoms in patients with Menière's disease (MD) and temporomandibular disorder (TMD).

METHODS

Retrospective case-control study. Treatment group: 37 patients with MD and TMD who received gnatological treatment.

CONTROL GROUP

26 patients with MD and TMD who had never received gnatological treatment. The number of vertigo spells in 6 months (primary endpoint), pure-tone audiometry average (PTA), MD stage, functional level, Dizziness handicap Index (DHI), Tinnitus handicap Index (THI) and Aural Fullness Scale (AFS) were compared at baseline and after 24 months according to groups. Analysis of Covariance was used to determine the treatment effect.

RESULTS

Groups were comparable for demographic, clinical data, baseline PTAs and the number of vertigo spells. Analysis of covariance showed a significant effect of gnathological treatment on number of vertigo spells ([Formula: see text] = 0.258, p < 0.001), PTA ([Formula: see text] = 0.201, p < 0.001), MD stage ([Formula: see text] = 0.224, p < 0.001), functional level ([Formula: see text] = 0.424, p < 0.001), DHI ([Formula: see text] = 0.421, p < 0.001), THI ([Formula: see text] = 0.183, p < 0.001), but not for AFS ([Formula: see text] = 0.005, p = 0.582). The treatment group showed vertigo control of class A in 86.5% and class B in 13.5% of patients. In the control group, vertigo control was of class A in 19.2% of patients and class B in 11.5%, class C in 30.8%, class D in 11.5%, class E in 19.2% and class F in 7.7%. Classes of vertigo control differed significantly (X² test, p < 0.001).

CONCLUSIONS

Oral splint therapy could represent a viable treatment in patients with TMD and uncontrolled MD disease. The effects are maintained at least after 2 years.

[Characteristics of wideband tympanometry in patients with Ménière's disease based on neutral network]

Objective:To construct a prediction model for Ménière's disease based on neural network and evaluate its prediction ability. Methods:Sixty-four patients with Ménière's disease underwent gadolinium enhanced magnetic resonance imaging of inner ear which showed endolymphatic hydrops. Meanwhile, 40 healthy adults were enrolled as controls. The database of wideband tympanometry of patients and control subjects was analyzed, and the neural network model was established by MATLAB 2021a software. The prediction ability of the model was evaluated by accuracy, positive predictive value, negative predictive value, the Youden index, sensitivity, specificity, receiver operating characteristic curve and area under curve （AUC）. Results:A feedforward network model was built with a single hidden layer to predict Ménière's disease with wideband tympanometry. There were 104 features in the input layer, 13 neuron nodes in the hidden layer and 1 output neuron in the output layer. The accuracy of the model was 83.2%, the positive predictive value was 80.7%, the negative predictive value was 84.3%, the sensitivity was 76.5%, the specificity was 83.7%, the Youden index was 0.602, and the AUC was 0.855. Conclusion:Based on neural network, the prediction model of Ménière's disease with high accuracy was constructed according to the results of wideband tympanometry, which provided reference for the diagnose of Ménière's disease.

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.

[Characteristics and differential diagnosis of middle ear cholesteatoma and chronic suppurative otitis media with wideband acoustic immittance]

Objective:Through analysis of the sound energy absorbance of wideband acoustic immittance to provide a basis for differential diagnosis of adult acquired secondary cholesteatoma of the middle ear and patients with chronic suppurative otitis media（CSOM）. Methods:38 cases of cholesteatoma and 40 cases of CSOM admitted to the Department of Otolaryngology, Affiliated Hospital of Xuzhou Medical University from September 2020 to December 2021 were selected as the research group, and 30 cases （60 ears） of normal adults were selected as the control group. A total of 16 frequency points were selected, and the energy absorbance of wideband acoustic immittance was taken as the research parameter. The characteristics of energy absorbance under ambient pressure among the three are compared. Then the ROC in the cholesteatoma group was drawn, and by calculating the AUC, the Cut-off values and the corresponding sensitivity and specificity were found. Results:The energy absorbance in CSOM group at 1100-5700 Hz and the cholesteatoma group at 560-5700 Hz was lower than that in the control group, and the difference in some frequency bands was statistically significant. The energy absorbance in the cholesteatoma group at 226-7100 Hz was lower than that in the CSOM group, and the difference between the two groups in many frequency points was statistically significant. The ROC in the research group was drawn and it was found that the AUC in the 560, 710, 890, and 4500 bands was > 0.5, and in the other bands was > 0.7（P<0.05）. The AUC in the 2800 Hz was the largest （0.78）, the Cut-off value was 0.31, the corresponding sensitivity was 78.38%, specificity was 73.33%. Conclusion:Wideband acoustic immittance can be used as an auxiliary method for the differential diagnosis of adult-acquired secondary cholesteatoma of the middle ear and chronic suppurative otitis media in adults.

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.