Diagnostic accuracy of the video otoscope in tympanic membrane perforation

OBJECTIVE

The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation.

METHODS

This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard.

RESULTS

176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p< 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them.

CONCLUSIONS

The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis.

LEVEL OF EVIDENCE

Is this diagnostic or monitoring test accurate? (Diagnosis)-Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).

Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta-Analysis

OBJECTIVES/HYPOTHESIS

The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs).

STUDY DESIGN

Systematic review with meta analysis.

METHODS

Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed.

RESULTS

Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21).

CONCLUSIONS

TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:2091-2097, 2021.

Audiological characteristics of the contralateral ear in patients with unilateral physical non-explosive ear trauma

Objectives

To document the frequency of occurrence and types of symptoms experienced in the contralateral ear in patients with unilateral physical non-explosive (UPN) ear trauma and to compare the audiometric and tympanometric parameters between asymptomatic and symptomatic contralateral ears.

Design

Prospective analytical clinical study Setting: Specialized (Ear, Nose, and Throat) clinic of a tertiary health institution. Participants: Patients with UPN ear trauma who presented within the first week of the incident. Main outcome measures: Otologic symptoms in the contralateral ear in UPN ear trauma.

Results

Eighteen out of 53 patients (34.0%) experienced symptoms in the contralateral ear. The symptoms were tinnitus in 77.8% (14/18), hearing loss in 66.7% (12/18), and ear blockage in 27.8% (5/18). There was hearing loss in 38/53 (71.7%) of contralateral ears. Hearing loss type and PTAv at the low frequencies were not significantly different (p=0.142), but other audiometric parameters were significantly different between asymptomatic and symptomatic contralateral ears (p<0.05 in all). Type C tympanogram was more prominent in the symptomatic contralateral ear. There was a statistically-significant difference in the type of tympanogram between the two categories of patients (p=0.018). There was no difference in acoustic reflex between the two categories of patients (p=0.095).

Conclusions

The contralateral ear may be affected in up to one-third of patients with UPN ear trauma, and experience otologic symptoms similar to those of the traumatized ears. Audiologic and audiometric parameters were abnormal in most of the contralateral ears. The two ears must be assessed thoroughly in cases of UPN ear trauma.

Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test

Objectives:

To compare the diagnostic performance of the Hum Test against the Weber Test using pure tone audiometry (PTA) as the “gold standard” comparator.

Methods:

29 participants with normal hearing of ages 18 to 35 without any history of hearing abnormalities or otologic conditions were enrolled. Subjects underwent three tests (Hum Test, Weber Test, and PTA) across two conditions: with an ear plug in one ear (side randomized) and without ear plugs.

Results:

When examining the ability of the Hum Test to detect simulated conductive hearing loss (CHL), the test had a sensitivity of 89.7% and specificity of 100% with high pitched humming and 93.1% and 100%, respectively, with low pitched humming. The Weber Test had a sensitivity and specificity of 96.6% and 100%, respectively. McNemar’s test demonstrated agreement between the Hum Test, performed with either high pitched ( P = .32) or low pitched ( P = .56) humming, and the Weber Test. Receiver operating characteristic (ROC) curves for the Hum Test (both high and low pitched) and Weber test were compared and demonstrated no statistically significant difference.

Conclusion:

The Hum Test is comparable to the Weber Test with regards to its sensitivity, specificity, and diagnostic accuracy in assessing new onset unilateral CHL in previously normal hearing subjects.

Management of traumatic tympanic membrane perforation: a comparative study

This prospective study was conducted to evaluate the efficacy of sea buckthorn oil patches in treating traumatic tympanic membrane (TM) perforations. We enrolled 370 patients with traumatic TM perforations of different sizes. These patients were randomly assigned to control group and treatment group. In the treatment group, a sterile cotton patch with sea buckthorn oil was used to cover the TM perforations. In the control group, patients were treated with a sterile cotton patch. The healing rate and time were compared between the two groups. We found that the overall healing rate was significantly higher in the treatment group than in the control group. For middle and large TM perforations, sea buckthorn oil treatment led to a significant increase in the healing rate. At 2 months after injury, the duration of healing was, generally, shorter in the treatment group than in the control group (P<0.05). In conclusion, sea buckthorn oil patches are effective in treating middle and large TM perforations, which results in increased healing rates and decreased healing time.