Wideband Tympanometry in Meniere's Disease

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.

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.

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.

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.

[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.

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.

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.