Audiologic Profiles of Children With Otitis Media With Effusion

Al-Salim, Sarah; Tempero, Richard M.; Johnson, Hannah; Merchant, Gabrielle R.

doi:10.1097/aud.0000000000001038

Cited by 14 publications

(20 citation statements)

References 51 publications

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“…However, as described above, the commonly used physiologic test to detect OME (tympanometry) only has an overall accuracy of 84% and is not sensitive to small changes in middle ear mechanics. This is consistent with what was observed by Al-Salim et al 2021, as there was no systematic effect of effusion volume on outcomes for standard 226 Hz tympanometry. Thus, there exists a need for a diagnostic measure that can provide information on effusion characteristics, specifically effusion volume.…”

Section: Introductionsupporting

confidence: 91%

“…Recent work from our laboratory demonstrated that the volume of an effusion present in the middle ear space directly impacts how much hearing loss occurs as a result of a given episode of OME (Al-Salim et al, 2021). Children that had ears with full effusions, or middle ear effusions that filled the entire middle ear cavity, generally had a flat moderate CHL with a mean 4 frequency pure-tone average of 43 dB HL in those ears.…”

Section: Introductionmentioning

confidence: 99%

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Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance

et al. 2021

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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.

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Section: Introductionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance

et al. 2021

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“…Unlike that with OAEs, the validity of ABR results is not affected by the presence of OME, beyond the impact of any conductive hearing loss that the OME may be causing. 105 Although some have advocated for performing ABR testing under general anesthesia concurrent with tympanostomy tube insertion, some children with OME have worse ABR thresholds following tube insertion, and results must be interpreted with caution. 106,107 Further discussion of ABR in hearing assessment related to tympanostomy tubes is beyond the scope of this guideline and should be based on shared decisions with the clinician, family, and audiologist.…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…Auditory brainstem response (ABR) testing is another physiologic measure of hearing that might be useful when behavioral audiometry is not feasible. Unlike that with OAEs, the validity of ABR results is not affected by the presence of OME, beyond the impact of any conductive hearing loss that the OME may be causing 105 . Although some have advocated for performing ABR testing under general anesthesia concurrent with tympanostomy tube insertion, some children with OME have worse ABR thresholds following tube insertion, and results must be interpreted with caution 106 , 107 .…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Rosenfeld

Tunkel

Schwartz

et al. 2022

Otolaryngol.--head neck surg.

164

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Objective Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. All these conditions are encompassed by the term otitis media (middle ear inflammation). This guideline update provides evidence-based recommendations for patient selection and surgical indications for managing tympanostomy tubes in children. The guideline is intended for any clinician involved in managing children aged 6 months to 12 years with tympanostomy tubes or children being considered for tympanostomy tubes in any care setting as an intervention for otitis media of any type. The target audience includes specialists, primary care clinicians, and allied health professionals. Purpose The purpose of this clinical practice guideline update is to reassess and update recommendations in the prior guideline from 2013 and to provide clinicians with trustworthy, evidence-based recommendations on patient selection and surgical indications for managing tympanostomy tubes in children. In planning the content of the updated guideline, the guideline update group (GUG) affirmed and included all the original key action statements (KASs), based on external review and GUG assessment of the original recommendations. The guideline update was supplemented with new research evidence and expanded profiles that addressed quality improvement and implementation issues. The group also discussed and prioritized the need for new recommendations based on gaps in the initial guideline or new evidence that would warrant and support KASs. The GUG further sought to bring greater coherence to the guideline recommendations by displaying relationships in a new flowchart to facilitate clinical decision making. Last, knowledge gaps were identified to guide future research. Methods In developing this update, the methods outlined in the American Academy of Otolaryngology–Head and Neck Surgery Foundation’s “Clinical Practice Guideline Development Manual, Third Edition: A Quality-Driven Approach for Translating Evidence Into Action” were followed explicitly. The GUG was convened with representation from the disciplines of otolaryngology–head and neck surgery, otology, pediatrics, audiology, anesthesiology, family medicine, advanced practice nursing, speech-language pathology, and consumer advocacy. Action Statements The GUG made strong recommendations for the following KASs: (14) clinicians should prescribe topical antibiotic ear drops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea; (16) the surgeon or designee should examine the ears of a child within 3 months of tympanostomy tube insertion AND should educate families regarding the need for routine, periodic follow-up to examine the ears until the tubes extrude. The GUG made recommendations for the following KASs: (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months’ duration, from the date of onset (if known) or from the date of diagnosis (if onset is unknown); (2) clinicians should obtain a hearing evaluation if OME persists for 3 months or longer OR prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer AND documented hearing difficulties; (5) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who do not receive tympanostomy tubes, until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (6) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (7) clinicians should offer bilateral tympanostomy tube insertion in children with recurrent acute otitis media who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (8) clinicians should determine if a child with recurrent acute otitis media or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (10) the clinician should not place long-term tubes as initial surgery for children who meet criteria for tube insertion unless there is a specific reason based on an anticipated need for prolonged middle ear ventilation beyond that of a short-term tube; (12) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (13) clinicians should not routinely prescribe postoperative antibiotic ear drops after tympanostomy tube placement; (15) clinicians should not encourage routine, prophylactic water precautions (use of earplugs or headbands, avoidance of swimming or water sports) for children with tympanostomy tubes. The GUG offered the following KASs as options: (4) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) AND symptoms that are likely attributable, all or in part, to OME that include, but are not limited to, balance (vestibular) problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life; (9) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is likely to persist as reflected by a type B (flat) tympanogram or a documented effusion for 3 months or longer; (11) clinicians may perform adenoidectomy as an adjunct to tympanostomy tube insertion for children with symptoms directly related to the adenoids (adenoid infection or nasal obstruction) OR in children aged 4 years or older to potentially reduce future incidence of recurrent otitis media or the need for repeat tube insertion.

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“…Moreover, 226-Hz tympanometry has a poor correlation to the severity of the conductive hearing loss in OM. 42 Additionally, Al-Salim et al 43 have shown that effusion volume, which was determined surgically, was correlated with outcomes from several audiological tests, including the degree of the conductive hearing loss as determined by ABGs, the presence of the otoacoustic emission, and ABR wave V latency, but noted no correlation with 226-Hz tympanometry. For the detection and determination of MEE volume, and the type of effusion in the middle ears of children, the American Academy of Otolaryngology has recommended the use of pneumatic otoscopy.…”

Section: Otitis Media and Middle Ear Effusionmentioning

confidence: 99%

Wideband Acoustic Immittance in Children

2023

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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 (WBAamb) as well as the pressurized mode (WBATPP). 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, WBAamb as well as WBATPP will be reviewed in these conditions. The main objectives of this article are to identify, assess, and interpret WBAamb and WBATPP outcomes from various middle ear conditions in children between the ages of 3 and 12 years.

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Audiologic Profiles of Children With Otitis Media With Effusion

Cited by 14 publications

References 51 publications

Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance

Improving the Differential Diagnosis of Otitis Media With Effusion Using Wideband Acoustic Immittance

Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)

Wideband Acoustic Immittance in Children

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