1
|
Lewis JD, Rutherford A, Stanford KE. Differential effects of mass-loading the eardrum and stiffening the middle ear on wideband absorbance. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:3615-3626. [PMID: 38833283 DOI: 10.1121/10.0026224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
The current work investigated the effects of mass-loading the eardrum on wideband absorbance in humans. A non-invasive approach to mass-loading the eardrum was utilized in which water was placed on the eardrum via ear canal access. The mass-loaded absorbance was compared to absorbance measured for two alternative middle ear states: normal and stiffened. To stiffen the ear, subjects pressurized the middle ear through either exsufflation or insufflation concurrent with Eustachian tube opening. Mass-loading the eardrum was hypothesized to reduce high-frequency absorbance, whereas pressurizing the middle ear was hypothesized to reduce low- to mid-frequency absorbance. Discriminant linear analysis classification was performed to evaluate the utility of absorbance in differentiating between conditions. Water on the eardrum reduced absorbance over the 0.7- to 6-kHz frequency range and increased absorbance at frequencies below approximately 0.5 kHz; these changes approximated the pattern of changes reported in both hearing thresholds and stapes motion upon mass-loading the eardrum. Pressurizing the middle ear reduced the absorbance over the 0.125- to 4-kHz frequency range. Several classification models based on the absorbance in two- or three-frequency bands had accuracy exceeding 88%.
Collapse
Affiliation(s)
- James D Lewis
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
| | - Alicia Rutherford
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
- Knoxville Veterans Affairs, Audiology, Knoxville, Tennessee 37919, USA
| | - Kathleen E Stanford
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, USA
- Greater Knoxville Ear, Nose, and Throat, Powell, Tennessee 37849, USA
| |
Collapse
|
2
|
Eberhard KE, Merchant GR, Nakajima HH, Neely ST. Toward Automating Diagnosis of Middle- and Inner-ear Mechanical Pathologies With a Wideband Absorbance Regression Model. Ear Hear 2024:00003446-990000000-00283. [PMID: 38797886 DOI: 10.1097/aud.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES During an initial diagnostic assessment of an ear with normal otoscopic exam, it can be difficult to determine the specific pathology if there is a mechanical lesion. The audiogram can inform of a conductive hearing loss but not the underlying cause. For example, audiograms can be similar between the inner-ear condition superior canal dehiscence (SCD) and the middle-ear lesion stapes fixation (SF), despite differences in pathologies and sites of lesion. To gain mechanical information, wideband tympanometry (WBT) can be easily performed noninvasively. Absorbance , the most common WBT metric, is related to the absorbed sound energy and can provide information about specific mechanical pathologies. However, absorbance measurements are challenging to analyze and interpret. This study develops a prototype classification method to automate diagnostic estimates. Three predictive models are considered: one to identify ears with SCD versus SF, another to identify SCD versus normal, and finally, a three-way classification model to differentiate among SCD, SF, and normal ears. DESIGN Absorbance was measured in ears with SCD and SF as well as normal ears at both tympanometric peak pressure (TPP) and 0 daPa. Characteristic impedance was estimated by two methods: the conventional method (based on a constant ear-canal area) and the surge method, which estimates ear-canal area acoustically.Classification models using multivariate logistic regression predicted the probability of each condition. To quantify expected performance, the condition with the highest probability was selected as the likely diagnosis. Model features included: absorbance-only, air-bone gap (ABG)-only, and absorbance+ABG. Absorbance was transformed into principal components of absorbance to reduce the dimensionality of the data and avoid collinearity. To minimize overfitting, regularization, controlled by a parameter lambda, was introduced into the regression. Average ABG across multiple frequencies was a single feature.Model performance was optimized by adjusting the number of principal components, the magnitude of lambda, and the frequencies included in the ABG average. Finally, model performances using absorbance at TPP versus 0 daPa, and using the surge method versus constant ear-canal area were compared. To estimate model performance on a population unknown by the model, the regression model was repeatedly trained on 70% of the data and validated on the remaining 30%. Cross-validation with randomized training/validation splits was repeated 1000 times. RESULTS The model differentiating between SCD and SF based on absorbance-only feature resulted in sensitivities of 77% for SCD and 82% for SF. Combining absorbance+ABG improved sensitivities to 96% and 97%. Differentiating between SCD and normal using absorbance-only provided SCD sensitivity of 40%, which improved to 89% by absorbance+ABG. A three-way model using absorbance-only correctly classified 31% of SCD, 20% of SF and 81% of normal ears. Absorbance+ABG improved sensitivities to 82% for SCD, 97% for SF and 98% for normal. In general, classification performance was better using absorbance at TPP than at 0 daPa. CONCLUSION The combination of wideband absorbance and ABG as features for a multivariate logistic regression model can provide good diagnostic estimates for mechanical ear pathologies at initial assessment. Such diagnostic automation can enable faster workup and increase efficiency of resources.
Collapse
Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Copenhagen Hearing and Balance Centre, Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | | |
Collapse
|
3
|
Aithal S, Aithal V, Kei J. Wideband Absorbance Predicts the Severity of Conductive Hearing Loss in Children With Otitis Media With Effusion. Ear Hear 2024; 45:636-647. [PMID: 38082489 DOI: 10.1097/aud.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES The objectives of the present study were to investigate the relationship between wideband absorbance (WBA) and air-bone gap (ABG) in children with a conductive hearing loss (CHL) due to otitis media with effusion (OME) and determine the accuracy of WBA to predict the magnitude of ABGs. DESIGN This was a prospective, cross-sectional study involving a control group of 170 healthy ears from 130 children (mean age 7.7 years) and a CHL cohort of 181 ears from 176 children (mean age 5.9 years) with OME. The CHL cohort was divided into three groups: CHL1, CHL2, and CHL3 defined by mean ABG (averaged across 0.5 to 4 kHz) of 16 to 25 dB, 26 to 35 dB, and 36 to 45 dB, respectively. WBA was measured at frequencies from 0.25 to 8 kHz at ambient pressure. RESULTS WBA was significantly reduced between 0.25 and 5 kHz for all CHL groups. The difference in WBA at 1 to 4 kHz between the control and CHL groups increased with increasing ABG. The predictive accuracy, as indicated by area under the receiver operating characteristic curve (AUROC) of WBA, increased with increasing ABG. The AUROC for WBA at 1.5 kHz was 0.86 for the CHL1, 0.91 for the CHL2, and 0.93 for the CHL3 group. The AUROCs for WBA averaged across 0.5 to 4 kHz were 0.88, 0.93, and 0.94 for the CHL1, CHL2, and CHL3 groups, respectively. Linear regression analyses showed significant negative correlations between WBA 0.5-4 k and ABG 0.5-4 k . The regression model (ABG 0.5-4 k = 31.83 - 24.08 × WBA 0.5-4 k ) showed that WBA 0.5-4 k predicted ABG 0.5-4 k with high accuracy. Comparison of predicted and actual WBA on a different group of subjects revealed that at an individual level, the model predicted ABG between 16 and 35 with greater precision. CONCLUSIONS There were significant strong correlations between WBA and ABG such that WBA decreased with increasing ABG. WBA demonstrated good discrimination accuracy with AUROC exceeding 0.88 for the 0.5 to 4 kHz and 1 to 4 kHz frequency bands. The WBA test holds promise for determining the severity of CHL in children with OME.
Collapse
Affiliation(s)
- Sreedevi Aithal
- Department of Audiology, Townsville University Hospital, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
- Department of Speech Pathology, School of Rehabilitation Sciences, James Cook University, Queensland, Australia
| | - Venkatesh Aithal
- Department of Audiology, Townsville University Hospital, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
| |
Collapse
|
4
|
Zhao Z, Ren C, Fan X, Zha D, Lin Y. Study on characteristics of wideband acoustic immittance in patients with Inner Ear Malformations. Int J Pediatr Otorhinolaryngol 2024; 176:111802. [PMID: 38041987 DOI: 10.1016/j.ijporl.2023.111802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/07/2023] [Accepted: 11/19/2023] [Indexed: 12/04/2023]
Abstract
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.
Collapse
Affiliation(s)
- Zhemaiwei Zhao
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
| | - Cuncun Ren
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
| | - Xiaoqin Fan
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
| | - Dingjun Zha
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
| | - Ying Lin
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
| |
Collapse
|
5
|
AlMakadma HA, Reed BF, Sanford CA. An Absorbance Peak Template for Clinical Assessment of Sound Conduction in Newborn Ears. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:5152-5168. [PMID: 37971558 DOI: 10.1044/2023_jslhr-23-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE Power absorbance measures recorded over a wide range of frequencies allow for clinical inferences about the outer/middle ears' acoustic mechanics. A frequency-dependent feature in the newborn wideband absorbance response, the prominent mid-frequency absorbance peak, has been linked to middle-ear resonance. However, current normative methods were not designed to assess subtle changes in such features. This work aims to develop and validate an absorbance peak template (APT) for assessment of absorbance peaks in newborns. Additional objectives are to compare test performance of absorbance peaks and APTs to existing normative methods, to demonstrate APT-based methods for categorization of abnormal absorbance peaks, and to describe absorbance peak test-retest variability. METHOD Peak absorbance and peak frequency were analyzed in a training data set (490 measurements in 84 newborn ears who passed transient evoked otoacoustic emissions [TEOAEs] screenings), and an APT was developed by computing normal limits on these two absorbance peak variables. Split-set analysis evaluated the reproducibility of APT, and test-retest analysis was performed. Test performance analysis, conveyed by area under the receiver operating characteristic curve (AROC) and 95% confidence intervals (CIs), compared absorbance peak variables to absorbance area indices (AAIs) in a validation data set (359 ears that passed distortion-product OAE [DPOAE] screening and 64 ears that failed). APT-based assessment paradigms for normal and abnormal ears were compared to the common absorbance normative range paradigm. RESULTS Split-set analysis demonstrated a good reproducibility of APT, and test-retest of absorbance peak variables showed that they were stable measures for clinical assessment. Test performance of peak absorbance (AROC = 0.83; 95% CI [0.77, 0.88]) was comparable to the top-performing AAI variables (AROC = 0.85; 95% CI [0.80, 0.90]). APT-based assessment categorized measurements based on their peak absorbance and peak frequency and enhanced the detection of subtle frequency changes that were missed by the normative range method. CONCLUSION Analysis of absorbance peaks guided by APT has the potential to simplify and improve assessments of sound conduction pathways in newborn ears and can be used together with or in-place of current methods for analysis of wideband absorbance data.
Collapse
Affiliation(s)
- Hammam A AlMakadma
- Department of Otolaryngology-HNS and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY
| | - Beth F Reed
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Chris A Sanford
- Department of Communication Sciences and Disorders, College of Health, Idaho State University, Pocatello
| |
Collapse
|
6
|
Humes L. Development and Application of a Reference Interval Approach to Wideband Absorbance Norms Using U.S. Population Data for Ages 6 to 80+ Years. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4590-4617. [PMID: 37793612 DOI: 10.1044/2023_jslhr-23-00313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE U.S. national wideband absorbance (WBA) data for 17,446 ears included in the National Health and Nutrition Examination Surveys for 2015-2016 and 2017-2020 were analyzed to develop and apply normative reference intervals (RIs). METHOD Analyses used distribution-free medians and cumulative distribution functions (CDFs). Notable differences between medians were defined as those with non-overlapping 95% confidence intervals, and differences between CDFs were evaluated using Cohen's h effect size. Strict inclusion criteria identified "healthy ears" with 1,240 ears meeting all the inclusion criteria for the reference group. RIs, WBA values corresponding to the 2.5th and 97.5th percentiles for the reference group, were established. The established RIs were then applied to the full unscreened data set to determine the prevalence of WBA values outside the RIs. RESULTS WBA RIs were established for all 6- to 19-year-olds and for 20- to 69-year-olds separated into three groups: females, males, and non-Hispanic Asians. The differences among the CDFs underlying these RIs corresponded to small effect sizes. When a single RI, 0.40 < average WBA < 0.75, was applied to the full data set, about 6%-13% of ears fell outside the derived RIs. Logistic regression analyses found abnormal tympanometric results to be responsible for the extreme WBA values among the general population. Abnormal tympanometric results increased the odds of having WBA values outside the RI by ≥ 300%. CONCLUSIONS U.S. population data for healthy ears were used to establish RIs for WBA of about 0.40-0.75. About 6%-13% of Americans, 6-80+ years of age, had WBA values outside these RI limits. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24185745.
Collapse
Affiliation(s)
- Larry Humes
- Department of Speech, Language and Hearing Sciences, Indiana University Bloomington
| |
Collapse
|
7
|
Abstract
As wideband absorbance (WBA) gains popularity, it is essential to understand the impact of different middle ear pathologies on the absorbance patterns as a function of frequency in children with various middle ear pathologies. More recently, the use of wideband tympanometry has enabled clinicians to conduct WBA at ambient pressure (WBA amb ) as well as the pressurized mode (WBA TPP ). This article reviews evidence for the ability of WBA measurements to accurately characterize the normal middle ear function across a wide range of frequencies and to aid in differential diagnosis of common middle ear disorders in children. Absorbance results in cases of otitis media with effusion, negative middle ear pressure, Eustachian tube malfunction, middle ear tumors, and pressure equalization tubes will be compared to age-appropriate normative data. Where applicable, WBA amb as well as WBA TPP will be reviewed in these conditions. The main objectives of this article are to identify, assess, and interpret WBA amb and WBA TPP outcomes from various middle ear conditions in children between the ages of 3 and 12 years.
Collapse
Affiliation(s)
- Navid Shahnaz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Sreedevi Aithal
- Department of Audiology, Townsville University Hospital, Townsville, Australia.,School of Rehabilitation Sciences, University of Queensland, Queensland, Australia.,School of Rehabilitation, James Cook University, Queensland, Australia
| | - Gabriel A Bargen
- Department of Communication Sciences and Disorders, Idaho State University, Meridian, Idaho
| |
Collapse
|
8
|
Sanford CA, Brockett JE, Aithal V, AlMakadma H. Implementation of Wideband Acoustic Immittance in Clinical Practice: Relationships among Audiologic and Otologic Findings. Semin Hear 2023; 44:65-83. [PMID: 36925656 PMCID: PMC10014207 DOI: 10.1055/s-0043-1763295] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
A number of studies have produced normative and developmental data and examples of wideband acoustic immittance (WAI) obtained in ears with pathologies and or dysfunction. However, incorporation of this tool into clinical audiology and otolaryngology practice has been slower than expected, potentially due to challenges with interpretation, integration into existing test batteries, and confidence in practical application. This article presents information aimed at helping clinicians increase their confidence in using this new tool by becoming more familiar and making connections with the ways that WAI outcomes both align with and add to standard immittance, audiometric and otologic diagnostic test outcomes. This article presents several case studies to demonstrate the use of WAI in realistic clinical settings. Each case presents a brief background, case history, audiologic/otologic findings, and initial recommendations, followed by a discussion on how the inclusion of WAI test outcomes aids in diagnostic decisions. The overall aim of this work is to identify the relationships among different diagnostic test outcomes, to demonstrate basic WAI interpretation principles, and encourage the reader to engage with this diagnostic tool in clinical practice.
Collapse
Affiliation(s)
- Chris A Sanford
- Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
| | - Jeff E Brockett
- Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
| | - Venkatesh Aithal
- Audiology Department, Townsville University Hospital and Hearing Research Unit for Children, University of Queensland, Queensland, Australia
| | - Hammam AlMakadma
- Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
9
|
Shahnaz N, AlMakadma H, Sanford CA. The Rise and Fall of Aural Acoustic Immittance Assessment Tools. Semin Hear 2023; 44:5-16. [PMID: 36925655 PMCID: PMC10014212 DOI: 10.1055/s-0043-1764139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Clinical assessment of middle ear function has undergone multiple transformations and developments since the first acoustic impedance measurements were made in human ears nearly a century ago. The decades following the development of the first acoustic impedance bridge by Metz in 1946 witnessed a series of technological advancements leading to the widespread use of single-frequency admittance tympanometry in the 1960s. In the 1970s, multi-frequency and multi-component tympanometry (MFT) emerged for clinical use, allowing for a better understanding of the middle ear acoustic-mechanical response at frequencies between 200 and 2,000 Hz. MFT has not gained widespread clinical adoption despite its advantages over single-frequency tympanometry. More recent technological developments enabled assessment for frequencies greater than 2,000 Hz, leading to the advent of wideband acoustic immittance measures with capabilities for comprehensive assessment of middle ear acoustic mechanics, and a great potential for use of acoustic immittance testing in various diagnostic practices. This article reviews important historical markers in the development and operation of middle ear assessment tools and analysis methods. Technical and clinical factors underlying the emergence and adoption of different acoustic immittance tests as a standard of clinical practice are described. In addition, we discuss the likelihood for widespread adoption of wideband acoustic immittance and wideband tympanometry in future clinical practice.
Collapse
Affiliation(s)
- Navid Shahnaz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Address for correspondence Navid Shahnaz, Ph.D. School of Audiology and Speech Sciences, Faculty of Medicine, University of British Columbia2177 Wesbrook Mall, Friedman Building, Vancouver, British Columbia V6T 1Z3Canada
| | - Hammam AlMakadma
- Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Chris A. Sanford
- Department of Communication Sciences and Disorders, College of Health, Idaho State University, Pocatello, Idaho
| |
Collapse
|
10
|
Zhang L, Wang J, Grais EM, Li Y, Zhao F. Three-dimensional wideband absorbance immittance findings in young adults with large vestibular aqueduct syndrome. Laryngoscope Investig Otolaryngol 2022; 8:236-244. [PMID: 36846429 PMCID: PMC9948593 DOI: 10.1002/lio2.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the effect of large vestibular aqueduct syndrome (LVAS) on middle ear sound transmission using wideband absorbance immittance (WAI). Methods WAI results from young adult LVAS patients and normal adults were compared. Results Averaged energy absorbance (EA) at ambient and peak pressure in the LVAS group showed differences to the normal group. Under ambient pressure, the average EA of the LVAS group was significantly higher than the normal group at frequencies 472-866 Hz and 6169-8000 Hz (p < .05) and lower at frequencies 1122-2520 Hz (p < .05). Under peak pressure, absorbance was increased at frequencies 515-728, 841, and 6169-8000 Hz (p < .05) and decreased at 1122-1374 Hz and 1587-2448 Hz (p < .05). An investigation into the effect of external auditory canal pressure on EA across frequencies in the pressure-frequency domain, showed that EA differed significantly in the low-frequency region of 707and 1000 Hz from 0 to 200 daPa and 500 Hz at 50 daPa (p < .05). There was also a significant difference in EA between the two groups at 8000 Hz (p < .05) in the pressure range -200-300 daPa. Conclusion WAI is a valuable tool to measure the effect of LVAS on middle ear sound transmission. LVAS has a significant effect on EA at low and mid frequencies under ambient pressure, while the frequencies affected are mainly at low frequencies when positive pressure is presented. Level of Evidence Level 3a.
Collapse
Affiliation(s)
- Lifang Zhang
- Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijing Tongren Hospital, Capital Medical UniversityBeijingChina,Beijing Engineering Research Center of Audiological TechnologyBeijingChina
| | - Emad M. Grais
- Department of Automatic Control and Systems EngineeringUniversity of SheffieldSheffieldUK,Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUnited Kingdom
| | - Yongxin Li
- Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of EducationBeijing Tongren Hospital, Capital Medical UniversityBeijingChina
| | - Fei Zhao
- Centre for Speech and Language Therapy and Hearing Science, Cardiff School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUnited Kingdom
| |
Collapse
|
11
|
Böck K, Böhnke F, Rahne T, Strenger T. Optical measurements of eardrum vibrations and sound propagation in the ear canal for the fitting of active middle ear implants. Acta Otolaryngol 2022; 142:140-153. [PMID: 35209792 DOI: 10.1080/00016489.2022.2038388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Middle ear implants (MEI) are for the medical rehabilitation of the hearing function in case of sound conduction hearing losses as well as cochlear hearing losses and their combinations. OBJECTIVES An objective tool to reach the best fitting of the external worn sound processors is essential for patients who do not want or cannot participate in the fitting process. METHODS In addition to Laser-Doppler-Vibrometry (LDV) measurement, the sound pressure was measured distant to the eardrum to attain additional information for comparison. Three groups of patients with different middle ear characteristics were examined. RESULTS Because of the large spreading of measuring results even within a patient group with similar eardrum and middle ear conditions it is difficult to develop characteristic diagrams which represent the mean values of eardrum displacements with different sound processor adjustments being the base for normative data courses. CONCLUSIONS AND SIGNIFICANCE The LDV measurements can be used as a tool for fitting sound processors by finding individual maximum eardrum velocities in the frequency range 125 Hz to 8 kHz. In comparison to acoustical measurements the optical measurements have advantages concerning lower variations of measurement values, higher spectral resolution, and robustness against disturbing acoustic noise, especially at low frequencies.
Collapse
Affiliation(s)
- Katja Böck
- Department of Otorhinolaryngology, Technical University Munich, Munich, Germany
| | - Frank Böhnke
- Department of Otorhinolaryngology, Technical University Munich, Munich, Germany
| | - Torsten Rahne
- Department of Otorhinolaryngology, University Hospital Halle (Saale), Halle, Germany
| | - Tobias Strenger
- Department of Otorhinolaryngology, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
12
|
Preserving Wideband Tympanometry Information With Artifact Mitigation. Ear Hear 2022; 43:563-576. [PMID: 34387582 PMCID: PMC8855961 DOI: 10.1097/aud.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Absorbance measured using wideband tympanometry (WBT) has been shown to be sensitive to changes in middle and inner ear mechanics, with potential to diagnose various mechanical ear pathologies. However, artifacts in absorbance due to measurement noise can obscure information related to pathologies and increase intermeasurement variability. Published reports frequently present absorbance that has undergone smoothing to minimize artifact; however, smoothing changes the true absorbance and can destroy important narrow-band characteristics such as peaks and notches at different frequencies. Because these characteristics can be unique to specific pathologies, preserving them is important for diagnostic purposes. Here, we identify the cause of artifacts in absorbance and develop a technique to mitigate artifacts while preserving the underlying WBT information. DESIGN A newly developed Research Platform for the Interacoustics Titan device allowed us to study raw microphone recordings and corresponding absorbances obtained by WBT measurements. We investigated WBT measurements from normal hearing ears and ears with middle and inner ear pathologies for the presence of artifact and noise. Furthermore, it was used to develop an artifact mitigation procedure and to evaluate its effectiveness in mitigating artifacts without distorting the true WBT information. RESULTS We observed various types of noise that can plague WBT measurements and that contribute to artifacts in computed absorbances, particularly intermittent low-frequency noise. We developed an artifact mitigation procedure that incorporates a high-pass filter and a Tukey window. This artifact mitigation resolved the artifacts from low-frequency noise while preserving characteristics in absorbance in both normal hearing ears and ears with pathology. Furthermore, the artifact mitigation reduced intermeasurement variability. CONCLUSIONS Unlike smoothing algorithms used in the past, our artifact mitigation specifically removes artifacts caused by noise. It does not change frequency response characteristics, such as narrow-band peaks and notches in absorbance at different frequencies that can be important for diagnosis. Also, by reducing intermeasurement variability, the artifact mitigation can improve the test-retest reliability of these measurements.
Collapse
|
13
|
Velikoselskii A, Papatziamos G, Smeds H, Verrecchia L. Wideband tympanometry in ears with superior canal dehiscence before and after surgical correction. Int J Audiol 2021; 61:692-697. [PMID: 34420430 DOI: 10.1080/14992027.2021.1964041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
Collapse
Affiliation(s)
- Aleksandr Velikoselskii
- Division of Ear, Nose and Throat Diseases, Audiology and Neurotology Section, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Papatziamos
- Division of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
| | - Henrik Smeds
- Division of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
| | - Luca Verrecchia
- Division of Ear, Nose and Throat Diseases, Audiology and Neurotology Section, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Otolaryngology Unit, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
14
|
Merchant GR, Neely ST. The influence of otitis media with effusion on middle-ear impedance estimated from wideband acoustic immittance measurements. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:969. [PMID: 34470321 PMCID: PMC8349246 DOI: 10.1121/10.0005822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
The goal of this work was to estimate the middle-ear input impedance ( Zme) from wideband acoustic immittance (WAI) measures and determine whether Zme improves the clinical utility of WAI. The data used in this study were from a previously reported set of WAI measurements in ears with otitis media with effusion [OME; Merchant, Al-Salim, Tempero, Fitzpatrick, and Neely (2021). Ear Hear., published online]. Ears with OME were grouped based on effusion volume, which was confirmed during tube surgery. Zme was estimated from the measured ear-canal impedance. An electrical-analog model of ear-canal acoustics and middle-ear mechanics was used to model the ear canal and Zme. The model results fit the measured responses well for all conditions. A regression approach was used to classify the responses of different variable types to effusion volume groups and determine the specificity and sensitivity of the binary classifications. The Zme magnitude increased with increasing effusion volume. The area under the receiver operating characteristic curve (AUC) was compared for binary decisions of the OME categories. The Zme estimate resulted in a clinically meaningful improvement in the AUC for distinguishing healthy ears from ears with OME. Overall, these results suggest that Zme estimation may provide useful information of potential clinical value to improve the diagnostic utility of WAI measurements for OME.
Collapse
Affiliation(s)
- Gabrielle R Merchant
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
| | - Stephen T Neely
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
| |
Collapse
|
15
|
Torrecilla SG, Avan P. Wideband tympanometry patterns in relation to intracranial pressure. Hear Res 2021; 408:108312. [PMID: 34298416 DOI: 10.1016/j.heares.2021.108312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/19/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Wideband tympanometry performs a more thorough analysis of middle-ear mechanics than the conventional single-frequency method with a 226-Hz probe tone. The present work examines the sensitivity of wideband tympanometry to the stiffness of the stapes-annular ligament system in relation to intracranial pressure (ICP) and labyrinthine fluid pressure. Here, body tilt allowed ICP to be set at different values. Sixty-eight ears of volunteers were tested sequentially in upright, supine, head-down (-30°) and upright postures. Energy absorbance of the ear was measured in these postures with a commercially available wideband-tympanometry device between 0.25 and 3 kHz, at ear-canal pressures between -600 and 300 daPa. In each posture, it was possible to find a single (posture-dependent) pressure in the ear canal at which a tympanometric peak occurred at all frequencies below about 1.1 kHz. The average across ears of tympanometric-peak pressure (TPP), close to 0 in upright posture, got increasingly positive, +19 daPa in supine and +27 daPa in head-down positions. The three-dimensional plot of energy absorbance against frequency and pressure displayed an invariant shape, merely shifting with TPP along the pressure axis. Thus, a properly adjusted ear-canal pressure neutralized the effects of ICP on the ear's energy absorbance. Comparisons to published invasive assessments of ICP in the different tested body positions led to the proposed relationship ICP ≈ 15 TPP, likely describing the transformer effect between tympanic membrane and stapes-annular ligament system at quasi-static pressures. With wideband tympanometry, the middle ear may serve as a precision scales for noninvasive ICP measurements.
Collapse
Affiliation(s)
| | - Paul Avan
- Neurosensory Biophysics Laboratory, University Clermont Auvergne, France; Institut de l'Audition, Paris, France; Centre Jean Perrin, Clermont-Ferrand, France.
| |
Collapse
|
16
|
Merchant GR, Schulz KM, Patterson JN, Fitzpatrick D, Janky KL. Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance. Ear Hear 2021; 41:1111-1124. [PMID: 32032225 PMCID: PMC7392788 DOI: 10.1097/aud.0000000000000831] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. DESIGN Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. RESULTS All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. CONCLUSIONS Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.
Collapse
Affiliation(s)
| | - Kyli M. Schulz
- Boys Town National Research Hospital, Omaha, NE 68131
- The University of Texas at Austin, TX 78712
| | | | | | | |
Collapse
|
17
|
Song Cheng Y, Raufer S, Guan X, Halpin CF, Lee DJ, Nakajima HH. Superior Canal Dehiscence Similarly Affects Cochlear Pressures in Temporal Bones and Audiograms in Patients. Ear Hear 2021; 41:804-810. [PMID: 31688316 PMCID: PMC7190445 DOI: 10.1097/aud.0000000000000799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The diagnosis of superior canal dehiscence (SCD) is challenging and audiograms play an important role in raising clinical suspicion of SCD. The typical audiometric finding in SCD is the combination of increased air conduction (AC) thresholds and decreased bone conduction thresholds at low frequencies. However, this pattern is not always apparent in audiograms of patients with SCD, and some have hearing thresholds that are within the normal reference range despite subjective reports of hearing impairment. In this study, we used a human temporal bone model to measure the differential pressure across the cochlear partition (PDiff) before and after introduction of an SCD. PDiff estimates the cochlear input drive and provides a mechanical audiogram of the temporal bone. We measured PDiff across a wider frequency range than in previous studies and investigated whether the changes in PDiff in the temporal bone model and changes of audiometric thresholds in patients with SCD were similar, as both are thought to reflect the same physical phenomenon. DESIGN We measured PDiff across the cochlear partition in fresh human cadaveric temporal bones before and after creating an SCD. Measurements were made for a wide frequency range (20 Hz to 10 kHz), which extends down to lower frequencies than in previous studies and audiograms. PDiff = PSV- PST is calculated from pressures measured simultaneously at the base of the cochlea in scala vestibuli (PSV) and scala tympani (PST) during sound stimulation. The change in PDiff after an SCD is created quantifies the effect of SCD on hearing. We further included an important experimental control-by patching the SCD, to confirm that PDiff was reversed back to the initial state. To provide a comparison of temporal bone data to clinical data, we analyzed AC audiograms (250 Hz to 8kHz) of patients with symptomatic unilateral SCD (radiographically confirmed). To achieve this, we used the unaffected ear to estimate the baseline hearing function for each patient, and determined the influence of SCD by referencing AC hearing thresholds of the SCD-affected ear with the unaffected contralateral ear. RESULTS PDiff measured in temporal bones (n = 6) and AC thresholds in patients (n = 53) exhibited a similar pattern of SCD-related change. With decreasing frequency, SCD caused a progressive decrease in PDiff at low frequencies for all temporal bones and a progressive increase in AC thresholds at low frequencies. SCD decreases the cochlear input drive by approximately 6 dB per octave at frequencies below ~1 kHz for both PDiff and AC thresholds. Individual data varied in frequency and magnitude of this SCD effect, where some temporal-bone ears had noticeable effects only below 250 Hz. CONCLUSIONS We found that with decrease in frequency the progressive decrease in low-frequency PDiff in our temporal bone experiments mirrors the progressive elevation in AC hearing thresholds observed in patients. This hypothesis remains to be tested in the clinical setting, but our findings suggest that that measuring AC thresholds at frequencies below 250 Hz would detect a larger change, thus improving audiograms as a diagnostic tool for SCD.
Collapse
Affiliation(s)
- Y. Song Cheng
- New York University Medical Center, New York, NY, 10016, USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Stefan Raufer
- Speech and Hearing Bioscience and Technology Program, Harvard Medical School, 260 Longwood Ave., Boston, MA, 02115, USA
| | - Xiying Guan
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | | | - Daniel J. Lee
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| | - Hideko Heidi Nakajima
- Speech and Hearing Bioscience and Technology Program, Harvard Medical School, 260 Longwood Ave., Boston, MA, 02115, USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, 02114, USA
| |
Collapse
|
18
|
Wideband Acoustic Immittance in Cochlear Implant Recipients: Reflectance and Stapedial Reflexes. Ear Hear 2021; 41:883-895. [PMID: 31688195 DOI: 10.1097/aud.0000000000000810] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES to characterize differences in wideband power reflectance for ears with and without cochlear implants (CIs), to describe electrically evoked stapedial reflex (eSR)-induced changes in reflectance, and to evaluate the benefit of a broadband probe for reflex threshold determination for CI recipients. It was hypothesized that reflectance patterns in ears with CIs would be consistent with increased middle ear stiffness and that reflex thresholds measured with a broadband probe would be lower compared with thresholds obtained with a single-frequency probe. DESIGN Eleven CI recipients participated in both wideband reflectance and eSR testing. Ipsilateral reflexes were measured with three probes: a broadband chirp (swept from 200 to 8000 Hz), a 226 Hz tone, and a 678 Hz tone. Wideband reflectance measures acquired from 28 adults without CIs and with normal middle ear function served as a normative data set for comparison. RESULTS Considering the group data, average reflectance was significantly greater for ears with CIs across 250 to 891 Hz and 4238 to 4490 Hz compared with the normative data set, although individual reflectance curves were variable. Some CI recipients also had low 226 Hz admittance, which contributed to the group finding, considering the control group had clinically normal 226 Hz admittance by design. Electrically evoked stapedial reflexes were measurable in nine of 14 ears (64.3%) and in 24 of 46 electrodes (52.5%) tested. Reflex-induced changes in reflectance patterns were unique to the participant/ear, but similar across activators (electrodes) within a given ear. In addition, reflectance values at or above 1000 Hz were affected most by activating the stapedial reflex, even in ears with clinically normal 226 Hz admittance. This is a higher-frequency range than has been reported for acoustically evoked reflex-induced reflectance changes and is consistent with increased middle ear stiffness at rest. Electrically evoked reflexes could be measured more often with the 678 Hz or the broadband probe compared with the 226 Hz probe tone. Although reflex thresholds were lower with the broadband probe compared with the 678 Hz probe in 16 of 24 conditions, this was not a statistically significant finding (Wilcoxon signed-rank test; p = 0.072). CONCLUSIONS The applications of wideband acoustic immittance measurements (reflectance and reflexes) should also be considered for ears with CIs. Further work is needed to describe changes across time in ears with CIs to more fully understand the reflectance pattern indicating increased middle ear stiffness and to optimize measuring eSRs with a broadband probe.
Collapse
|
19
|
Wideband tympanometry as a diagnostic tool for Meniere's disease: a retrospective case-control study. Eur Arch Otorhinolaryngol 2021; 279:1831-1841. [PMID: 34009459 DOI: 10.1007/s00405-021-06882-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
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.
Collapse
|
20
|
Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance. Ear Hear 2021; 42:1183-1194. [PMID: 33928915 DOI: 10.1097/aud.0000000000001037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this work is to determine whether there is a systematic effect of middle ear effusion volume on wideband acoustic immittance in children with surgically confirmed otitis media with effusion. DESIGN Wideband acoustic immittance was measured in 49 ears from children (9 months to 11 years) who had a diagnosis of otitis media with effusion and compared to 14 ears from children (10 months to 10 years) without a recent history of otitis media. For children with otitis media with effusion, wideband acoustic immittance testing took place in the child's preoperative waiting room before surgical placement of tympanostomy tubes. Testing was completed in a pressurized condition (wideband tympanometry) for all ears as well as in an ambient condition in a subset of ears. Intraoperative findings regarding effusion volume were reported by the surgeons immediately before tube placement and confirmed following myringotomy. This classified the volume of effusion as compared to middle ear volume categorically as either full, partial, or clear of effusion. The type of wideband acoustic immittance explored in this work was absorbance. Absorbance responses were grouped based on effusion volume into one of four groups: full effusions, partial effusions, ears clear of effusion at the time of surgery, and normal control ears. Standard tympanometry was also completed on all ears. RESULTS Absorbance is systematically reduced as the volume of the middle ear effusion increases. This reduction is present at most frequencies but is greatest in the frequency range from 1 to 5 kHz. A multivariate logistic regression approach was utilized to classify ears based on effusion volume. The regression approach classified ears as effusion present (full and partial ears) or absent (clear ears and normal control ears) with 100% accuracy, ears with effusion present as either partial or full with 100% accuracy, and ears without effusion as either normal control ears or ears clear of effusion with 75% accuracy. Regression performance was also explored when the dataset was split into a training set (70% of the data) and a validation test set (30% of the data) to simulate how this approach would perform on unseen data in a clinical setting. Accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve are reported. Overall, this approach demonstrates high sensitivity and specificity for classifying ears as effusion being present or absent and as present effusions being full or partial with areas under the curve ranging from 1 to 0.944. Despite the lack of effusion present in both clear ears and normal control ears, this approach was able to distinguish between these ears, but with a more moderate sensitivity and specificity. No systematic effect of effusion volume was found on standard tympanometry. CONCLUSIONS Wideband acoustic immittance, and more specifically, absorbance, is a strong and sensitive indicator of the volume of a middle ear effusion in children with otitis media with effusion.
Collapse
|
21
|
Eberhard KE, Chari DA, Nakajima HH, Klokker M, Cayé-Thomasen P, Lee DJ. Current Trends, Controversies, and Future Directions in the Evaluation and Management of Superior Canal Dehiscence Syndrome. Front Neurol 2021; 12:638574. [PMID: 33889125 PMCID: PMC8055857 DOI: 10.3389/fneur.2021.638574] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Patients with superior canal dehiscence syndrome (SCDS) can present with a range of auditory and/or vestibular signs and symptoms that are associated with a bony defect of the superior semicircular canal (SSC). Over the past two decades, advances in diagnostic techniques have raised the awareness of SCDS and treatment approaches have been refined to improve patient outcomes. However, a number of challenges remain. First, there is currently no standardized clinical testing algorithm for quantifying the effects of superior canal dehiscence (SCD). SCDS mimics a number of common otologic disorders and established metrics such as supranormal bone conduction thresholds and vestibular evoked myogenic potential (VEMP) measurements; although useful in certain cases, have diagnostic limitations. Second, while high-resolution computed tomography (CT) is the gold standard for the detection of SCD, a bony defect does not always result in signs and symptoms. Third, even when SCD repair is indicated, there is a lack of consensus about nomenclature to describe the SCD, ideal surgical approach, specific repair techniques, and type of materials used. Finally, there is no established algorithm in evaluation of SCDS patients who fail primary repair and may be candidates for revision surgery. Herein, we will discuss both contemporary and emerging diagnostic approaches for patients with SCDS and highlight challenges and controversies in the management of this unique patient cohort.
Collapse
Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Divya A. Chari
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Hideko Heidi Nakajima
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Mads Klokker
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel J. Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
22
|
Aithal S, Aithal V, Kei J, Anderson S. Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study. J Am Acad Audiol 2021; 31:708-718. [PMID: 33588510 DOI: 10.1055/s-0040-1719130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of this study was to describe wideband absorbance (WBA) findings in patients with cholesteatomas and retraction pockets (RPs). DESIGN In this prospective study, tympanometry, audiometry, and wideband tympanometry (WBT) were performed on 27 ears with an RP (eight with epitympanic RP and 19 ears with mesotympanic RP), 39 ears with a cholesteatoma (23 ears with epitympanic and 16 ears with mesotympanic cholesteatomas [MCs]), and 49 healthy ears serving as controls. RESULTS Mean WBA at ambient pressure (WBAamb) of both experimental groups was reduced significantly between 0.8 and 5 kHz relative to the control group. The difference between mean WBAamb and mean WBA at tympanometric peak pressure (WBATPP) was greater for the RP (0.12-0.16 between 0.5 and 1.5 kHz) than for the cholesteatoma group (0.03-0.11 between 0.6 and 3 kHz). Mean WBAamb of both epitympanic RP (ERP) and epitympanic cholesteatoma (EC) subgroups was significantly lower than that of the control group. Mean WBATPP of the ERP subgroup attained normal levels as per the control group, while mean WBATPP of EC subgroup was significantly lower than that of the control group at 0.8 to 1.5 kHz and 4 to 5 kHz. In contrast, both mesotympanic RP and MC subgroups demonstrated similar mean WBAamb and WBATPP values. No significant differences in WBAamb and WBATPP results between the RP and cholesteatomas groups were observed. Receiver operating characteristic (ROC) analyses indicated that the area under the ROC curve for distinguishing between the RP and cholesteatomas groups ranged from 0.44 to 0.60, indicating low accuracy in separating the two groups. CONCLUSION While it is not possible to distinguish between the RP and cholesteatomas groups based on the WBAamb and WBATPP results, it is potentially feasible to differentiate between the EC and ERP conditions. Further study using a large clinical sample is recommended to determine the sensitivity and specificity of the WBA test to identify the EC and ERP conditions.
Collapse
Affiliation(s)
- Sreedevi Aithal
- Department of Audiology, Townsville Hospital, Queensland, Australia.,Department of Audiology, School of Health and Rehabilitation Sciences, University of Queensland, Australia.,Department of Speech Pathology, School of Rehabilitation Sciences, James Cook University, Townsville, Australia
| | - Venkatesh Aithal
- Department of Audiology, Townsville Hospital, Queensland, Australia.,Department of Audiology, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Joseph Kei
- Department of Audiology, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Shane Anderson
- Department of ENT, Townsville Hospital, Queensland, Australia
| |
Collapse
|
23
|
Karuppannan A, Barman A. Wideband absorbance tympanometry: a novel method in identifying otosclerosis. Eur Arch Otorhinolaryngol 2021; 278:4305-4314. [PMID: 33388979 DOI: 10.1007/s00405-020-06571-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the study was to know whether the wideband absorbance measurements can be a useful tool to identify ears with otosclerosis. The present study analyzed WBA measurements and highlighted its effectiveness in identifying ears with otosclerosis and differentiating from healthy normal ears. METHODS The study included 42 ears with otosclerosis which were compared with an equal sample size of healthy normal ears. WBA across frequencies and wideband average absorbance (375-2000 Hz) at the peak and ambient pressure, and resonance frequency were measured and analyzed. RESULTS Results showed that WBA levels increased with an increase in frequencies up to 2000 Hz and decreased thereafter, both in the otosclerosis and healthy normal ears. The mean WBA in the otosclerosis group was significantly lower in the 250-2000 Hz frequency range than in the healthy normal ear group. The WBA values at ambient pressure reduced significantly up to 500 Hz for the healthy normal ear group and 1500 Hz for otosclerosis group, compared with peak pressure. Further, the analysis of wideband average absorbance at ambient pressure showed reduced absorbance (0.35) and higher resonance frequency (1350.33 Hz) in the otosclerosis group compared with the healthy normal ear group (0.60 and 930.14 Hz, respectively). ROC analysis indicated that WBA is suitable for identifying otosclerotic ears and also in differentiating from healthy normal ears based on WBA values from 250 to 1500 Hz. High diagnostic values of WBA (> 90% sensitivity and specificity) were observed at a frequency of 1000 Hz. CONCLUSIONS The inclusion of WBA into clinical routine test procedures could be a useful tool for detecting otosclerosis. Further research is required to validate its clinical use in combination with other middle ear measures.
Collapse
Affiliation(s)
- Arunraj Karuppannan
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India.
| | - Animesh Barman
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India
| |
Collapse
|
24
|
Effects of Otosclerosis on Middle Ear Function Assessed With Wideband Absorbance and Absorbed Power. Ear Hear 2020; 42:547-557. [PMID: 33156125 DOI: 10.1097/aud.0000000000000968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Wideband absorbance and absorbed power were evaluated in a group of subjects with surgically confirmed otosclerosis (Oto group), mean age 51.6 years. This is the first use of absorbed power in the assessment of middle ear disorders. Results were compared with control data from two groups of adults, one with normal hearing (NH group) mean age of 31 years, and one that was age- and sex-matched with the Oto group and had sensorineural hearing loss (SNHL group). The goal was to assess group differences using absorbance and absorbed power, to determine test performance in detecting otosclerosis, and to evaluate preoperative and postoperative test results. DESIGN Audiometric and wideband tests were performed over frequencies up to 8 kHz. The three groups were compared on wideband tests using analysis of variance to assess group mean differences. Receiver operating characteristic (ROC) curve analysis was also used to assess test accuracy at classifying ears as belonging to the Oto or control groups using the area under the ROC curve (AUC). A longitudinal design was used to compare preoperative and postoperative results at 3 and 6 months. RESULTS There were significant mean differences in the wideband parameters between the Oto and control groups with generally lower absorbance and absorbed power for the Oto group at ambient and tympanometric peak pressure (TPP) depending on frequency. The SNHL group had more significant differences with the Oto group than did the NH group in the high frequencies for absorbed power at ambient pressure and tympanometric absorbed power at TPP, as well as for the tympanometric tails. The greatest accuracy for classifying ears as being in the Oto group or a control group was for absorbed power at ambient pressure at 0.71 kHz with an AUC of 0.81 comparing the Oto and NH groups. The greatest accuracy for an absorbance measure was for the comparison between the Oto and NH groups for the peak-to-negative tail condition with an AUC of 0.78. In contrast, the accuracy for classifying ears into the control or Oto groups for static acoustic admittance at 226 Hz was near chance performance, which is consistent with previous findings. There were significant mean differences between preoperative and postoperative tests for absorbance and absorbed power. CONCLUSIONS Consistent with previous studies, wideband absorbance showed better sensitivity for detecting the effects of otosclerosis on middle ear function than static acoustic admittance at 226 Hz. This study showed that wideband absorbed power is similarly sensitive and may perform even better in some instances than absorbance at classifying ears as having otosclerosis. The use of a group that was age- and sex-matched to the Oto group generally resulted in greater differences between groups in the high frequencies for absorbed power, suggesting that age-related norms in adults may be useful for the wideband clinical applications. Absorbance and absorbed power appear useful for monitoring changes in middle ear function following surgery for otosclerosis.
Collapse
|
25
|
Measurement of Wideband Absorbance as a Test for Otosclerosis. J Clin Med 2020; 9:jcm9061908. [PMID: 32570989 PMCID: PMC7355593 DOI: 10.3390/jcm9061908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/26/2023] Open
Abstract
The purpose of this study was to investigate the effectiveness of wideband energy absorbance in diagnosing otosclerosis by comparing the differences in acoustic absorbance between otosclerotic and normal ears. Exactly 90 surgically confirmed otosclerotic ears were included in the test group. The control group consisted of 126 matched normal-hearing subjects. The Titan hearing test platform (Interacoustics) was used for absorbance and acoustic immittance tests. Energy absorbance, measured at tympanometric peak pressure, was analyzed in the range 226–8000 Hz. Differences between normal and otosclerotic ears were analyzed in quarter-octave bands. Wideband absorbance, i.e., absorbance averaged over the 226–2000 Hz band, and resonance frequency were calculated and compared between normal and otosclerotic ears. Significant differences between the absorbance of normal and otosclerotic ears were found, especially at low and middle frequencies. No significant effect of ear side or gender was observed. For average wideband absorbance and resonance frequency, less pronounced (although significant) differences were found between normal and otosclerotic ears. Measurement of peak-pressure energy absorbance, averaged over a frequency band around 650 Hz, provides a valid criterion in testing for otosclerosis. The test is highly effective, with a sensitivity and specificity of over 85% and area under receiver operating characteristic curve above 0.9. Average wideband absorbance can also be used, but its effectiveness is lower. Other immittance-related measures are considerably less effective.
Collapse
|
26
|
Niemczyk E, Lachowska M, Tataj E, Kurczak K, Niemczyk K. Wideband acoustic immitance - Absorbance measurements in ears after stapes surgery. Auris Nasus Larynx 2020; 47:909-923. [PMID: 32505608 DOI: 10.1016/j.anl.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/15/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aimed to thoroughly assess absorbance in ears after stapes surgery (stapedotomy/stapedectomy) and how stapes surgery affects wideband acoustic immittance (WAI) metrics. METHODS Eighty-three otosclerotic ears were analyzed pre- and postoperatively. The analysis comprised: air-bone gap (ABG) and WAI which included absorbance measurements, resonance frequency assessment, low frequency tympanometry and metrics derived from these measures. RESULTS Absorbance after stapes surgery changed considerably compared to otosclerotic ears before surgery and also differed from normal ears. Absorbance after stapes surgery revealed two significantly different plot types: single-low-frequency-peak absorbance and two-peaks absorbance. Stapes surgery reduced resonance frequency in majority of operated ears and increased static compliance in low frequency tympanometry. Static compliance difference was directly proportional to ABG improvement at low frequencies. Postoperative ABG at 250 Hz and 500 Hz was most commonly correlated with postoperative WAI parameters. ABG improvement at 3000 Hz and 4000 Hz was directly proportional to absorbance difference at ~3000 Hz and 4000 Hz. It influenced the width of the postoperative absorbance by shifting both sides of the plot (negative values shift the points of the plot toward lower frequencies) with the correlation being more pronounced in postoperative two-peaks absorbance type ears. CONCLUSIONS Absorbance by itself is not sufficient for assessment of changes to middle function following stapes surgery, and should be complemented with other measures. WAI measurements including absorbance, resonance frequency assessment, low frequency tympanometry, and metrics derived from these measures combined with air-bone gap provide insight into mechano-acoustic changes in the middle-ear system as a result of stapes surgery.
Collapse
Affiliation(s)
- Elżbieta Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa, Poland
| | - Magdalena Lachowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa, Poland.
| | - Emanuel Tataj
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland
| | | | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097 Warszawa, Poland
| |
Collapse
|
27
|
Abstract
OBJECTIVE Determine if changes in middle ear absorbance measured with wide-band tympanometry (WBT) occur following hearing-preservation cochlear implantation (CI). Such measures may provide insight into the mechanisms of acoustic hearing loss postimplantation. STUDY DESIGN Clinical capsule report. SETTING Tertiary academic referral center. DESIGN WBT absorbance was measured bilaterally during pre- and postoperative clinical office visits in five unilaterally-implanted cochlear implant recipients. Pre- and postoperative WBT measures were compared within each subject in the implanted and contralateral, unimplanted ears. RESULTS In general, WBT absorbance measurements show a broad spectral pattern including two or three distinct peaks measured over a frequency range of 226 to 8000 Hz. Grand average and linear mixed model comparisons between the pre- and postoperative WBT patterns show significantly reduced (p < 0.05) low-frequency absorbance in the implanted ears in the frequency region over 0.6 to 1.1 kHz, but not in the unimplanted ears. The maximum effect occurred at 1 kHz with absorbance decreasing from ∼0.8 to ∼0.5 after implantation. The limited data are consistent with expected relationships between WBT absorbance and air- and bone-conduction thresholds, assuming an increased air-bone gap reflects conductive hearing loss. CONCLUSION Cochlear implantation can result in reduction of low-frequency acoustic absorbance as measured by WBT. WBT may be a useful and sensitive tool for monitoring the mechanical status of the middle and inner ears following cochlear implantation.
Collapse
|
28
|
Merchant GR, Siegel JH, Neely ST, Rosowski JJ, Nakajima HH. Effect of Middle-Ear Pathology on High-Frequency Ear Canal Reflectance Measurements in the Frequency and Time Domains. J Assoc Res Otolaryngol 2019; 20:529-552. [PMID: 31673928 PMCID: PMC6889121 DOI: 10.1007/s10162-019-00735-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/20/2019] [Indexed: 10/25/2022] Open
Abstract
The effects of middle-ear pathology on wideband acoustic immittance and reflectance at frequencies above 6-8 kHz have not been documented, nor has the effect of such pathologies on the time-domain reflectance. We describe an approach that utilizes sound frequencies as high as 20 kHz and quantifies reflectance in both the frequency and time domains. Experiments were performed with fresh normal human temporal bones before and after simulating various middle-ear pathologies, including malleus fixation, stapes fixation, and disarticulation. In addition to experimental data, computational modeling was used to obtain fitted parameter values of middle-ear elements that vary systematically due to the simulated pathologies and thus may have diagnostic implications. Our results demonstrate that the time-domain reflectance, which requires acoustic measurements at high frequencies, varies with middle-ear condition. Furthermore, the extended bandwidth frequency-domain reflectance data was used to estimate parameters in a simple model of the ear canal and middle ear that separates three major conductive pathologies from each other and from the normal state.
Collapse
Affiliation(s)
- Gabrielle R. Merchant
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Boys Town National Research Hospital, Omaha, NE USA
| | | | | | - John J. Rosowski
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
| | - Hideko H. Nakajima
- Speech and Hearing Bioscience and Technology, Harvard Division of Medical Sciences (formerly the Harvard-MIT Division of Health Sciences and Technology), Cambridge, MA USA
- Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA USA
| |
Collapse
|
29
|
Aithal S, Aithal V, Kei J, Manuel A. Effect of Negative Middle Ear Pressure and Compensated Pressure on Wideband Absorbance and Otoacoustic Emissions in Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:3516-3530. [PMID: 31437100 DOI: 10.1044/2019_jslhr-h-18-0426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective This study investigated pressurized transient evoked otoacoustic emission (TEOAE) responses and wideband absorbance (WBA) in healthy ears and ears with negative middle ear pressure (NMEP). Method In this cross-sectional study, TEOAE amplitude, signal-to-noise ratio, and WBA were measured at ambient and tympanometric peak pressure (TPP) in 36 ears from 25 subjects with healthy ears (age range: 3.1-13.0 years) and 88 ears from 76 patients with NMEP (age range: 2.0-13.1 years), divided into 3 groups based on NMEP (Group 1 with TPP between -101 and -200 daPa, Group 2 with TPP between -201 and -300 daPa, and Group 3 with TPP between -301 and -400 daPa). Results Mean TEOAE amplitude, signal-to-noise ratio, and WBA were increased at TPP relative to that measured at ambient pressure between 0.8 and 1.5 kHz. Further decrease in TPP beyond -300 daPa did not result in further increases in the mean TEOAE or WBA at TPP. The correlation between TEOAE and WBA was dependent on the frequency, pressure conditions, and subject group. There was no difference in pass rates between the 2 pressure conditions for the control group, while the 3 NMEP groups demonstrated an improvement in pass rates at TPP. With pressurization, the false alarm rate for TEOAE due to NMEP was reduced by 17.8% for NMEP Group 1, 29.2% for NMEP Group 2, and 15.8% for NMEP Group 3. Conclusion Results demonstrated the feasibility and clinical benefits of measuring TEOAE and WBA under pressurized conditions. Pressurized TEOAE and WBA should be used for assessment of ears with NMEP in hearing screening programs to reduce false alarm rates.
Collapse
Affiliation(s)
- Sreedevi Aithal
- Department of Audiology, The Townsville Hospital, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Venkatesh Aithal
- Department of Audiology, The Townsville Hospital, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Alehandrea Manuel
- Department of Audiology, The Townsville Hospital, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| |
Collapse
|
30
|
Model-based hearing diagnostics based on wideband tympanometry measurements utilizing fuzzy arithmetic. Hear Res 2019; 378:126-138. [DOI: 10.1016/j.heares.2019.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 11/20/2022]
|
31
|
Yigit O, Tokgoz-Yilmaz S, Tahir E, Bajin MD, Kar I, Sennaroglu L. Wideband Tympanmetry Results of Bone Cement Ossiculoplasty. Am J Otolaryngol 2019; 40:512-519. [PMID: 31006501 DOI: 10.1016/j.amjoto.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study. STUDY DESIGN A prospective study. SETTING Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed. RESULTS A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups. CONCLUSION Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.
Collapse
Affiliation(s)
- O Yigit
- Audiology Department, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - S Tokgoz-Yilmaz
- Audiology Department, Faculty of Health Sciences, Ankara University, Ankara, Turkey.
| | - E Tahir
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| | - M D Bajin
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| | - I Kar
- Department of Biostatistics, Ankara University, Ankara, Turkey
| | - L Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
| |
Collapse
|
32
|
Aithal V, Aithal S, Kei J, Manuel A. Normative Wideband Acoustic Immittance Measurements in Caucasian and Aboriginal Children. Am J Audiol 2019; 28:48-61. [PMID: 30938562 DOI: 10.1044/2018_aja-18-0065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The aims of this study were to develop normative data for wideband acoustic immittance (WAI) measures in Caucasian and Australian Aboriginal children and compare absorbance measured at 0 daPa (WBA0) and tympanometric peak pressure (TPP; WBATPP) between the 2 groups of children. Additional WAI measures included resonance frequency, equivalent ear canal volume, TPP, admittance magnitude (YM), and phase angle (YA). Method A total of 171 ears from 171 Caucasian children and 87 ears from 87 Aboriginal children who passed a test battery consisting of 226-Hz tympanometry, transient evoked otoacoustic emissions, and pure tone audiometry were included in the study. WAI measures were obtained under pressurized conditions using wideband tympanometry. Data for WBA0, WBATPP, YM, and YA were averaged in one-third octave frequencies from 0.25 to 8 kHz. Results There was no significant ear effect on all of the 7 measures for both groups of children. Similarly, there was no significant gender effect on all measures except for WBATPP in Aboriginal children. Aboriginal boys had significantly higher WBATPP than girls at 1.5 and 2 kHz. A significant effect of ethnicity was also noted for WBATPP at 3, 4, and 8 kHz, with Caucasian children demonstrating higher WBATPP than Aboriginal children. However, the effect size and observed power of the analyses were small for both effects. Conclusion This study developed normative data for 7 WAI measures, namely, WBA0, WBATPP, TPP, Veq, RF, YM, and YA, for Caucasian and Aboriginal children. In view of the high similarity of the normative data between Caucasian and Aboriginal children, it was concluded that separate ethnic-specific norms are not required for diagnostic purposes.
Collapse
Affiliation(s)
- Venkatesh Aithal
- Audiology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Sreedevi Aithal
- Audiology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Alehandrea Manuel
- Audiology Department, Townsville Hospital and Health Service, Douglas, Queensland, Australia
| |
Collapse
|
33
|
Fracture of the Incus Caused by Digital Manipulation of the Ear Canal and its Diagnosis Using Wideband Acoustic Immittance. Otol Neurotol 2019; 40:e115-e118. [DOI: 10.1097/mao.0000000000002103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Niemczyk E, Lachowska M, Tataj E, Kurczak K, Niemczyk K. Wideband tympanometry and absorbance measurements in otosclerotic ears. Laryngoscope 2018; 129:E365-E376. [PMID: 30592049 DOI: 10.1002/lary.27747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/07/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elżbieta Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
| | | | - Emanuel Tataj
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kurczak
- Centre for Foreign Languages, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
35
|
Marcrum SC, Steffens T, Zeman F, Kummer P. Wideband Absorbance and 226-Hz Tympanometry in the Prediction of Optimal Distortion Product Otoacoustic Emission Primary Tone Levels. Am J Audiol 2018; 27:614-622. [PMID: 30383179 DOI: 10.1044/2018_aja-18-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Distortion product otoacoustic emission (DPOAE) amplitude is sensitive to the primary tone level separation effective within the cochlea. Despite potential for middle ear sound transmission characteristics to affect this separation, no primary tone level optimization formula accounts for its influence. This study was conducted to determine if inclusion of ear- and frequency-specific immittance features improves primary tone level optimization formula performance beyond that achieved using a univariate, L2-based formula. METHOD For 30 adults with normal hearing, DPOAE, wideband absorbance, and 226-Hz tympanometry measures were completed. A mixed linear modeling technique, incorporating both primary tone and acoustic immittance features, was used to generate a multivariable formula for the middle ear-specific recommendation of primary tone level separations for f2 = 1-6 kHz. The accuracy with which L1OPT, or the L1 observed to maximize DPOAE level for each given L2, could be predicted using the multivariable formula was then compared with that of a traditional, L2-based univariate formula for each individual ear. RESULTS Use of the multivariable formula L1 = 0.47L2 + 2.40A + f2param + 38 [dB SPL] resulted in significantly more accurate L1OPT predictions than did the univariate formula L1 = 0.49L2 + 41 [dB SPL]. Although average improvement was small, meaningful improvements were identified within individual ears, especially for f2 = 1 and 6 kHz. CONCLUSION Incorporation of a wideband absorbance measure into a primary tone level optimization formula resulted in a minor average improvement in L1OPT prediction accuracy when compared with a traditional univariate optimization formula. Further research is needed to identify characteristics of ears that might disproportionately benefit from the additional measure.
Collapse
Affiliation(s)
- Steven C. Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Germany
| | - Thomas Steffens
- Department of Otolaryngology, University Hospital Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Germany
| | - Peter Kummer
- Department of Otolaryngology, University Hospital Regensburg, Germany
| |
Collapse
|
36
|
Tympanogram Findings in Hemodialysis Patients. J Craniofac Surg 2018; 30:e49-e52. [PMID: 30480629 DOI: 10.1097/scs.0000000000004960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study is to investigate whether changes in cerebrospinal fluid (CSF) pressure during the hemodialysis (HD) treatment are reflected on tympanometric measurements. METHODS The study was performed on 24 HD patients. The static compliance and absorbance values of the patients before and after HD were measured using a wideband tympanometry. The tympanogram tests were performed immediately before and at the end of the HD session. RESULTS The static compliance values of the patients after HD were significantly lower than those before HD. This decrease significantly correlated with the adequacy of dialysis determined by urea reduction rate and Kt/V. The absorbance values showed a decrease in the band 343 and 727 Hz, but no significant difference was found in other frequencies. The static admittance and absorbance values were influenced by the HD process. DISCUSSION This influence might be due to the increase in CSF pressure as a result of the removal of urea from blood during HD session.
Collapse
|
37
|
Kim SY, Han JJ, Oh SH, Lee JH, Suh MW, Kim MH, Park MK. Differentiating among conductive hearing loss conditions with wideband tympanometry. Auris Nasus Larynx 2018; 46:43-49. [PMID: 29885747 DOI: 10.1016/j.anl.2018.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information. METHODS We recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups. RESULTS The normal subjects showed an average peak pressure of -19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (-124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P<0.022). Mastoid problems subjects showed decreased absorbance at all frequencies. CONCLUSION WBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.
Collapse
Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA University College of Medicine, Seoul, South Korea
| | - Jae Joon Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Me Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| |
Collapse
|
38
|
Matsumura E, Matas CG, Sanches SGG, Magliaro FCL, Pedreño RM, Genta PR, Lorenzi-Filho G, Carvallo RMM. Severe obstructive sleep apnea is associated with cochlear function impairment. Sleep Breath 2017; 22:71-77. [PMID: 28681146 DOI: 10.1007/s11325-017-1530-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/19/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study is to investigate the association between obstructive sleep apnea (OSA) with middle ear acoustic transference and cochlear function. METHODS Male individuals with and without mild, moderate, and severe OSA according to standard criteria of full polysomnography and no co-morbidities were studied. Subjects with BMI ≥40 kg/m2, present or past treatment for OSA, with heart failure, diabetes, hypertension, dyslipidemia, stroke, use of chronic medications, and previous history of risk for hearing loss were excluded. All subjects were submitted to full polysomnography, evaluation of wideband acoustic immittance by energy of absorbance (EA), and distortion product otoacoustic emissions (DPOAE). RESULTS We studied 38 subjects (age 35.8 ± 7.2 years, BMI 28.8 ± 3.8 kg/m2) divided into no OSA (n = 10, age 33.6 ± 6.4 years, BMI 26.9 ± 4.1 kg/m2), mild (n = 11, age 32.8 ± 2.9 years, BMI 28.5 ± 3.5 kg/m2), moderate (n = 8, age 34.1 ± 6.8 years, BMI 29.6 ± 3.3 kg/m2), and severe OSA (n = 9, age 41.2 ± 9.2 years, BMI 30.5 ± 3.8 kg/m2). EA was similar between groups. In contrast, patients with severe OSA presented significantly lower DPOAE amplitudes when compared to the control, mild, and moderate OSA groups (p ≤ 0.03, for all comparisons). CONCLUSIONS Acoustic transference function of middle ear is similar in adults with and without OSA. Severe OSA is independently associated with cochlear function impairment in patients with no significant co-morbidities.
Collapse
Affiliation(s)
- Erika Matsumura
- Speech and Hearing Sciences Investigation on Human Hearing Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Carla G Matas
- Speech and Hearing Sciences Investigation on Hearing Electrophysiology Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Seisse G G Sanches
- Speech and Hearing Sciences Investigation on Human Hearing Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernanda C L Magliaro
- Speech and Hearing Sciences Investigation on Hearing Electrophysiology Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Raquel M Pedreño
- Speech and Hearing Sciences Investigation on Hearing Electrophysiology Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pedro R Genta
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata M M Carvallo
- Speech and Hearing Sciences Investigation on Human Hearing Laboratory, Physical Therapy, Speech, Language and Hearing Sciences and Occupational Therapy Department, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
39
|
Abstract
OBJECTIVES Ossicular discontinuity may be complete, with no contact between the disconnected ends, or partial, where normal contact at an ossicular joint or along a continuous bony segment of an ossicle is replaced by soft tissue or simply by contact of opposing bones. Complete ossicular discontinuity typically results in an audiometric pattern of a large, flat conductive hearing loss. In contrast, in cases where otomicroscopy reveals a normal external ear canal and tympanic membrane, high-frequency conductive hearing loss has been proposed as an indicator of partial ossicular discontinuity. Nevertheless, the diagnostic utility of high-frequency conductive hearing loss has been limited due to gaps in previous research on the subject, and clinicians often assume that an audiogram showing high-frequency conductive hearing loss is flawed. This study aims to improve the diagnostic utility of high-frequency conductive hearing loss in cases of partial ossicular discontinuity by (1) making use of a control population against which to compare the audiometry of partial ossicular discontinuity patients and (2) examining the correlation between high-frequency conductive hearing loss and partial ossicular discontinuity under controlled experimental conditions on fresh cadaveric temporal bones. Furthermore, ear-canal measurements of umbo velocity and wideband acoustic immittance measurements were investigated to determine the usefulness regarding diagnosis of ossicular discontinuity. DESIGN The authors analyzed audiograms from 66 patients with either form of surgically confirmed ossicular discontinuity and no confounding pathologies. The authors also analyzed umbo velocity (n = 29) and power reflectance (n = 12) measurements from a subset of these patients. Finally, the authors performed experiments on six fresh temporal bone specimens to study the differing mechanical effects of complete and partial discontinuity. The mechanical effects of these lesions were assessed via laser Doppler measurements of stapes velocity. In a subset of the specimen (n = 4), wideband acoustic immittance measurements were also collected. RESULTS (1) Calculations comparing the air-bone gap (ABG) at high and low frequencies show that when high-frequency ABGs are larger than low-frequency ABGs, the surgeon usually reported soft-tissue bands at the point of discontinuity. However, in cases with larger low-frequency ABGs and flat ABGs across frequencies, some partial discontinuities as well as complete discontinuities were reported. (2) Analysis of umbo velocity and power reflectance (calculated from wideband acoustic immittance) in patients reveal no significant difference across frequencies between the two types of ossicular discontinuities. (3) Temporal bone experiments reveal that partial discontinuity results in a greater loss in stapes velocity at high frequencies when compared with low frequencies, whereas with complete discontinuity, large losses in stapes velocity occur at all frequencies. CONCLUSION The clinical and experimental findings suggest that when encountering larger ABGs at high frequencies when compared with low frequencies, partial ossicular discontinuity should be considered in the differential diagnosis.
Collapse
|
40
|
Wegner I, Shahnaz N, Grolman W, Bance ML. Wideband acoustic immittance measurements in assessing crimping status following stapedotomy: A temporal bone study. Int J Audiol 2016; 56:1-7. [PMID: 27534272 DOI: 10.1080/14992027.2016.1214759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To ascertain if wideband acoustic immitance (WAI) measurements are useful in assessing crimping status following stapedotomy. DESIGN WAI measurements were obtained using the Mimosa Acoustics HearID system. Wideband chirp sound stimuli and a set of tone stimuli for nine frequencies between 0.2 and 6 kHz were used at 60 dB SPL. Five sets of measurements were performed on each temporal bone: mobile stapes, stapes fixation and stapedotomy followed by insertion of a tightly crimped, a loosely crimped and an uncrimped prosthesis. STUDY SAMPLE Eight fresh-frozen temporal bones were harvested from human cadaveric donors. RESULTS At lower frequencies, up to 1 kHz, stapes fixation decreased absorbance. Compared to the baseline absorbance, absorbance with stapes fixation dropped by 6 to 17% in absolute terms from the baseline value (p = 0.027). Absorbance was not affected in higher frequencies (p = 0.725). Stapedotomy changed the absorbance curve significantly compared to the normal condition with an increase of absolute absorbance values by 6 to 36% around 0.25-1 kHz (p-value <0.01). The crimping conditions did not differ from one another (p = 0.555). CONCLUSION WAI is not useful in distinguishing between tightly crimped, loosely crimped and uncrimped stapes prostheses following stapedotomy.
Collapse
Affiliation(s)
- Inge Wegner
- a Department of Otorhinolaryngology - Head and Neck Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.,b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands.,c Division of Otolaryngology, Department of Surgery , Dalhousie University , Halifax , NS , Canada , and
| | - Navid Shahnaz
- d School of Audiology & Speech Sciences, Faculty of Medicine, University of British Columbia , Vancouver , Canada
| | - Wilko Grolman
- a Department of Otorhinolaryngology - Head and Neck Surgery , University Medical Center Utrecht , Utrecht , The Netherlands.,b Brain Center Rudolf Magnus, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Manohar L Bance
- c Division of Otolaryngology, Department of Surgery , Dalhousie University , Halifax , NS , Canada , and
| |
Collapse
|
41
|
Controlled exploration of the effects of conductive hearing loss on wideband acoustic immittance in human cadaveric preparations. Hear Res 2016; 341:19-30. [PMID: 27496538 DOI: 10.1016/j.heares.2016.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/26/2016] [Accepted: 07/30/2016] [Indexed: 11/24/2022]
Abstract
Current clinical practice cannot distinguish, with any degree of certainty, the multiple pathologies that produce conductive hearing loss in patients with an intact tympanic membrane and a well-aerated middle ear without exploratory surgery. The lack of an effective non-surgical diagnostic procedure leads to unnecessary surgery and limits the accuracy of information available during pre-surgical consultations with the patient. A non-invasive measurement to determine the pathology responsible for a conductive hearing loss prior to surgery would be of great value. This work investigates the utility of wideband acoustic immittance (WAI), a non-invasive measure of middle-ear mobility, in the differential diagnosis of pathologies responsible for conductive hearing loss. We focus on determining whether power reflectance (PR), a derivative of WAI, is a possible solution to this problem. PR is a measure of the fraction of sound power reflected from the middle ear when a sound stimulus is presented to the ear canal. PR and other metrics of middle-ear performance (such as ossicular motion via laser Doppler vibrometry) were measured in well-controlled human temporal bone preparations with simulated pathologies. We report measurements before and after simulation of stapes fixation (n = 8), malleus fixation (n = 10), ossicular disarticulation (n = 10), and superior canal dehiscence (n = 8). Our results are consistent with the small set of previously published reflectance measurements made in temporal bones and patients. In this present study, these temporal bone experiments with different middle- and inner-ear pathologies were compared to the initial normal state by analyzing both WAI and ossicular motion, demonstrating that WAI can be a valuable tool in the diagnosis of conductive hearing loss.
Collapse
|
42
|
Sun XM. Wideband Acoustic Immittance: Normative Study and Test-Retest Reliability of Tympanometric Measurements in Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:819-834. [PMID: 27517667 DOI: 10.1044/2016_jslhr-h-14-0322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/14/2015] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to present normative data of tympanometric measurements of wideband acoustic immittance and to characterize wideband tympanograms. METHOD Data were collected in 84 young adults with strictly defined normal hearing and middle ear status. Energy absorbance (EA) was measured using clicks for 1/12-octave frequencies (0.236 to 8 kHz), with the ear canal air pressure systematically varied (+200 to -300 daPa). In 40 ears, 7 consecutive trials and a trial of clinical 226-Hz acoustic admittance (Ya) tympanometry followed. A cavity test was also conducted. RESULTS From the wideband EA tympanogram, several EA spectrums and EA tympanograms were derived. Descriptive statistics were performed, and population parameters were estimated. The immediate test-retest reliability was excellent. Effects of ear canal air pressure on EA were examined comprehensively. Differences in EA between tympanometric and ambient-pressure measurements were significant. Single-frequency EA tympanograms exemplified for half-octave frequencies were contrasted. The bandpass EA tympanogram, 0.236- and 1-kHz EA and Ya tympanograms, and 226-Hz Ya tympanogram were compared in 9 variables. CONCLUSIONS This study established a database of wideband tympanograms in healthy adults. The data analyses will promote our understanding of the middle ear transfer function. These data will serve as a reference for further studies in clinical populations.
Collapse
|
43
|
Pal'chun VT, Levina YV, Guseva AL, Efimova SP, Doronina OM. [Acoustic impedanceometry: the evolution of diagnostic possibilities]. Vestn Otorinolaringol 2015; 80:59-64. [PMID: 27006982 DOI: 10.17116/otorino201580659-64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present review of the literature reports the materials concerning the application of the acoustic impedance measurements of normal ears and pathologically charged organs of hearing that are important for the differential diagnostics and monitoring of the hearing system condition during the conservative and surgical treatment.
Collapse
Affiliation(s)
- V T Pal'chun
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - Yu V Levina
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - S P Efimova
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| | - O M Doronina
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia, 117997
| |
Collapse
|