-
Otolaryngology--head and Neck Surgery :... Oct 2021Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric... (Review)
Review
Interpretation of tympanometry commonly relies on the historical convention of classifying findings according to large and arbitrary threshold shifts of tympanometric peak pressure (TPP). This convention had value for prior generations of otolaryngologists in diagnosing severe, chronic middle ear disease requiring surgical intervention but may not be well suited for the present-day evaluation of less severe disease. The existing definition of a type C curve (less than -100 daPa) is likely insensitive to detect subtle abnormalities, including some presentations of obstructive eustachian tube dysfunction. The accuracy of clinical diagnosis may be improved by reporting the absolute values of TPP and moving beyond classification according to arbitrary thresholds.
Topics: Acoustic Impedance Tests; Ear Diseases; Ear, Middle; Humans
PubMed: 33687296
DOI: 10.1177/0194599821995828 -
Ugeskrift For Laeger Mar 2000A flat tympanogram predicts a middle ear effusion in about 90% of cases. This paper describes how to perform tympanometry, some common problems when doing it and how to... (Review)
Review
A flat tympanogram predicts a middle ear effusion in about 90% of cases. This paper describes how to perform tympanometry, some common problems when doing it and how to classify the curves in normal (type A), middle ear effusion (type B) or negative pressure (type C). The theoretical background of impedance audiometry is outlined. The stapedius reflex, pneumatic otoscopy, reflexometry and otomicroscopy are described as supplements or alternatives in diagnosing fluid in the middle ear. Tympanometry is recommended as a diagnostic modality for general practitioners.
Topics: Acoustic Impedance Tests; Humans; Otitis Media with Effusion
PubMed: 10765708
DOI: No ID Found -
American Family Physician Dec 1991The tympanogram is an objective measure of middle ear effusion or eustachian tube dysfunction. It provides information about the compliance or mobility of the tympanic... (Review)
Review
The tympanogram is an objective measure of middle ear effusion or eustachian tube dysfunction. It provides information about the compliance or mobility of the tympanic membrane, the pressure within the middle ear and the volume of the external ear canal. Tympanograms are classified as type A (normal), type B (indicating fluid behind the tympanic membrane) or type C (indicating eustachian tube dysfunction). The objective data obtained by tympanometry are a useful adjunct in the diagnosis and follow-up of middle ear disease.
Topics: Acoustic Impedance Tests; Child; Ear Diseases; Eustachian Tube; Humans; Otitis Media with Effusion
PubMed: 1746392
DOI: No ID Found -
The New England Journal of Medicine Mar 1983
Topics: Acoustic Impedance Tests; Child; Humans; Otitis Media with Effusion
PubMed: 6681650
DOI: 10.1056/NEJM198303033080917 -
Ear and Hearing 2022Absorbance measured using wideband tympanometry (WBT) has been shown to be sensitive to changes in middle and inner ear mechanics, with potential to diagnose various...
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.
Topics: Acoustic Impedance Tests; Artifacts; Ear, Inner; Hearing; Humans; Reproducibility of Results
PubMed: 34387582
DOI: 10.1097/AUD.0000000000001117 -
Brazilian Journal of Otorhinolaryngology 2022Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the...
INTRODUCTION
Endolymphatic hydrops is the pathophysiological substrate of Ménière's disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease.
OBJECTIVE
To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease.
METHODS
We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9).
RESULTS
Different peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (-11 daPa) and the symptomatic group (-192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction.
CONCLUSIONS
The Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.
Topics: Acoustic Impedance Tests; Cross-Sectional Studies; Ear, Inner; Endolymphatic Hydrops; Humans; Meniere Disease
PubMed: 32782123
DOI: 10.1016/j.bjorl.2020.05.029 -
Minnesota Medicine Jun 1990
Topics: Acoustic Impedance Tests; Audiometry; Audiometry, Pure-Tone; Child; Hearing Disorders; Humans; Mass Screening
PubMed: 2366714
DOI: No ID Found -
Audiology & Neuro-otology 2023The middle ear sound transmission features can impact acoustic sounds reaching the inner ear. Wideband tympanometry (WBT) or wideband acoustic immittance is an effective...
INTRODUCTION
The middle ear sound transmission features can impact acoustic sounds reaching the inner ear. Wideband tympanometry (WBT) or wideband acoustic immittance is an effective and desirable measurement of conductive conditions in newborns and adults and has appropriate sensitivity to distinguish different pathologies like otosclerosis from other middle ear conflicts. Recently, there has been an increased utilization of WBT, which highlights the importance of collecting population-based normative data as a necessary step in the standardization of this test, as well as for its clinical application. This study aimed to obtain normative data on WBT in the adult Iranian ethnic.
METHODS
There were 101 participants (202 ears) consisting of 53 males (57.4%) and 48 females (42.6%) in the age range of 19-29 years. The Titan WBT device (Interacoustics, Assens, Denmark) was used for WBT measurements. The broadband click was utilized as the probe tone between frequencies of 250 Hz and 8,000 Hz. All the participants underwent ear, nose, and throat assessments, pure-tone audiometry, and conventional tympanometry (226 Hz). Features like equivalent ear canal volume (Veq), tympanometric peak pressure, gradient, resonance frequency (RF), energy absorbance (EA), and admittance (Ad) were tested.
RESULTS
In this cross-sectional study, 202 ears were tested for WBT. EA increased by frequency enhancement; at 1 kHz and 2 kHz the EA was the most prominent; at 2,519 Hz, it started decreasing, and at 8 kHz, there was a slight increase. There was also a significant difference in the Veq and Ad between males and females. Studies have shown that the Veq may vary between male and female subjects based on body size.
CONCLUSION
In this study, normative data for the WBT were obtained from young Iranian adults with normal hearing ranges and middle ear conditions. We hope that this study and the resulting norm will provide a basis for increasing the use of WBT in Iranian diagnostic and clinical practices.
Topics: Adult; Humans; Male; Infant, Newborn; Female; Young Adult; Acoustic Impedance Tests; Iran; Cross-Sectional Studies; Ear, Middle; Hearing
PubMed: 36137525
DOI: 10.1159/000526380 -
Ear, Nose, & Throat Journal Nov 2007
Topics: Acoustic Impedance Tests; Hearing Loss, Conductive; Humans; Male; Middle Aged; Reflex, Acoustic; Severity of Illness Index; Temporal Bone; Tomography, X-Ray Computed
PubMed: 18225624
DOI: No ID Found -
The Journal of Laryngology and Otology Sep 2022This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was...
OBJECTIVE
This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry.
METHOD
A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined.
RESULTS
Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions.
CONCLUSION
The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol.
Topics: Acoustic Impedance Tests; Adult; Audiometry; Deafness; Hearing Loss; Humans; Otoscopy; Prevalence
PubMed: 35606901
DOI: 10.1017/S0022215122001190