Diagnosing Middle Ear Pathology in 6- to 9-Month-Old Infants Using Wideband Absorbance: A Risk Prediction Model

Myers, Joshua C.; Kei, Joseph; Aithal, Sreedevi; Aithal, Venkatesh; Driscoll, Carlie; Khan, Asaduzzaman; Manuel, Alehandrea; Joseph, Anjali; Malicka, Alicja N.

doi:10.1044/2018_jslhr-h-18-0004

Cited by 6 publications

(38 citation statements)

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“…Early onset of otitis media in infancy increases risk of frequent and persistent infections through childhood (Howie, Ploussard, & Sloyer, 1975;MacIntyre et al, 2010;Marchant et al, 1986;Shurin, Pelton, Donner, & Klein, 1979). Quick and accurate tools for assessing middle ear function in infants could help provide timely diagnosis and appropriate management for affected children (Hunter et al, 2008b;Myers et al, 2018b). Wideband acoustic immittance (WAI) is an emerging test of middle ear function that is quick to administer and has several advantages over current routine clinical tests such as tympanometry.…”

Section: Introductionmentioning

confidence: 99%

“…Although preliminary studies in infants have reported strong performance Myers et al, 2018b;Prieve et al, 2013b), more diagnostic research in this age group is necessary, as WAI could be a valuable tool for identifying middle ear pathology early in childhood. Furthermore, research is needed on different age groups through infancy, as there are large developmental effects on the WAI response that are not yet complete by 24 months of age (Keefe et al, 1993;Kei et al, 2013;Myers et al, 2019c).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There is growing evidence that WAI can detect mild pathology such as Eustachian tube dysfunction, as well as more severe conditions such as otitis media with effusion (Aithal et al, 2018;Beers et al, 2010;Ellison et al, 2012;Hunter et al, 2008b;Myers et al, 2018aMyers et al, , 2018bRobinson et al, 2016;Shaver & Sun, 2013;Voss et al, 2012;Werner et al, 2010). Studies of infants and children have found average absorbance or reflectance for mild cases falls between results for healthy ears and ears with severe middle ear dysfunction from 1000 to 6000 Hz Ellison et al, 2012;Hunter et al, 2008b;Myers et al, 2018b). Beers et al (2010) Previous quantitative diagnostic WAI studies in infants and children have used a binary (pass/fail) outcome to assess test performance (Aithal et al, 2015;Beers et al, 2010;Ellison et al, 2012;Hunter et al, 2010;Keefe et al, 2003a;Keefe et al, 2012;Myers et al, 2018aMyers et al, , 2018bPiskorski et al, 1999;Prieve et al, 2013b;Sanford et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…Studies of infants and children have found average absorbance or reflectance for mild cases falls between results for healthy ears and ears with severe middle ear dysfunction from 1000 to 6000 Hz Ellison et al, 2012;Hunter et al, 2008b;Myers et al, 2018b). Beers et al (2010) Previous quantitative diagnostic WAI studies in infants and children have used a binary (pass/fail) outcome to assess test performance (Aithal et al, 2015;Beers et al, 2010;Ellison et al, 2012;Hunter et al, 2010;Keefe et al, 2003a;Keefe et al, 2012;Myers et al, 2018aMyers et al, , 2018bPiskorski et al, 1999;Prieve et al, 2013b;Sanford et al, 2009). However, when using a binary outcome, it can be difficult to know how to treat ears with mild dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Myers¹

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Background. Infants with early onset of otitis media have greater risk of recurrent and chronic infections that can affect language and development. Diagnostic tools able to quickly and accurately identify middle ear pathology early in infancy could help to facilitate timely intervention for these children.Wideband acoustic immittance (WAI) is an emerging technology for assessing middle ear function with significant advantages over established clinical tests such as tympanometry. WAI does not require pressurization of the ear canal, and is a high-resolution test, measuring middle ear function over a wider frequency range than is possible with tympanometry. Preliminary studies in infants have shown promising results, but further research assessing the diagnostic performance of WAI is needed. Also, the large amount of data generated by WAI can make results difficult to interpret. Research into suitable quantitative techniques to analyse results is still in its infancy. Prediction models are an attractive method for analysis of multivariate data as they can provide individualized probabilities that an infant has middle ear dysfunction. A clinically useful prediction model must be able to accurately discriminate between normal ears and those with middle ear dysfunction, and be well calibrated (i.e., give accurate predictions). However, the number of variables generated by WAI can cause issues with overfitting when developing multivariate models. An overfitted model will accurately describe the data it was developed on, but is likely to perform poorly when applied to new samples. Some form of data reduction or penalization is therefore necessary when modelling WAI. Another issue with developing WAI models is that there are substantial maturational effects on WAI through infancy that need to be controlled for. This can be achieved by either developing models for specific age groups (e.g., a model specifically for neonates), or by controlling for the effect of age by including interactions between age and WAI variables in a model, or by only using developmentally stable regions as predictor variables.Objective. The aim of this work was to investigate the diagnostic performance of WAI in infants by developing predictive models. Data reduction strategies such as selecting predictors based on prior research and principal component analysis were used to increase the likelihood that models would generalize to new samples. The effect of age was initially accounted for by developing age-specific models for neonates, 6-month infants, and 12-month infants (Chapters 2, 3 and 4, respectively). Longitudinal developmental effects on WAI through infancy were then investigated in Chapter 5, and this knowledge was used to develop a model controlling for the effect of age through infancy (6 to 18 months) (Chapter 6, Study 1). The neonate model was assessed for generalizability by applying the model to results from a new sample of infants (Chapter 6, Study 2)ii Methods. Tympanometry, distortion product otoacoustic emissions (DPOAEs) and ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Myers¹

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Longitudinal Development of Wideband Absorbance and Admittance Through Infancy

Myers

Kei

Aithal

et al. 2019

J Speech Lang Hear Res

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Purpose The aim of this article was to study the normal longitudinal development of wideband absorbance and admittance measures through infancy. Method Two hundred one infants who passed the newborn hearing screen (automated auditory brainstem response) were tested at birth and then followed up at approximately 6, 12, and 18 months of age. Most infants were of either White (86%) or Asian (11%) descent. At each test session, infants passed tympanometry and distortion product otoacoustic emission tests. High-frequency (1000-Hz) tympanometry was used at birth and 6 months of age, and low-frequency (226-Hz) tympanometry was used at 12 and 18 months of age. Wideband pressure reflectance was also measured at each session and analyzed in terms of absorbance, admittance at the probe tip, and admittance normalized for differences in ear canal area. Multilevel hierarchical models were fitted to the absorbance and admittance data to investigate for effects of age, ear side, gender, ethnicity, and frequency. Results There were considerable age effects on wideband absorbance and admittance measurements over the first 18 months of life. The most dramatic changes occurred between birth and 6 months of age, and there were significant differences between all age groups in the 3000- to 4000-Hz region. There were significant ethnicity effects that were substantial for certain combinations of ethnicity, age, and frequency (e.g., absorbance at 6000 Hz at 12 months of age). Conclusion There are large developmental effects on wideband absorbance and admittance measures through infancy. For absorbance, we recommend separate reference data be used at birth, 6 months of age, and 12–18 months of age. For admittance (both normalized and at the probe tip), we advise using separate normative regions for each age group (neonates and 6, 12, and 18 months).

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Diagnosing Middle Ear Dysfunction in 10- to 16-Month-Old Infants Using Wideband Absorbance: An Ordinal Prediction Model

Myers

Kei

Aithal

et al. 2019

J Speech Lang Hear Res

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Purpose The aim of this study was to develop an ordinal prediction model for diagnosing middle ear dysfunction in 10- to 16-month-old infants using wideband absorbance. Method Wideband absorbance, tympanometry, and distortion product otoacoustic emissions were measured in 358 ears of 186 infants aged 10–16 months ( M age = 12 months). An ordinal reference standard (normal, mild, and severe middle ear dysfunction) was created from the tympanometry and distortion product otoacoustic emission results. Absorbance from 1000 to 5657 Hz was used to model the probability of middle ear dysfunction with ordinal logistic regression. Model performance was evaluated using measures of discrimination ( c -index) and calibration (calibration curves). Performance measures were adjusted for overfitting (bias) using bootstrap resampling. Probabilistic and simplified methods for interpreting the model are presented. The probabilistic method displays the probability of ≥ mild and ≥ severe middle ear dysfunction, and the simplified method presents the condition with the highest probability as the most likely diagnosis (normal, mild, or severe middle ear dysfunction). Results The c -index of the fitted model was 0.919 (0.914 after correction for bias), and calibration was satisfactory for both the mild and severe middle ear conditions. The model performed well for the probabilistic method of interpretation, and the simplified (most likely diagnosis) method was accurate for normal and severe cases but diagnosed some cases with mild middle ear dysfunction as normal. Conclusions The model may be clinically useful, and either the probabilistic or simplified paradigm of interpretation could be applied, depending on the context. In situations where the main goal is to identify severe middle ear dysfunction and ease of interpretation is highly valued, the simplified interpretation may be preferable (e.g., in a screening clinic that may not be concerned about missing some mild cases). In a diagnostic clinical environment, however, it may be beneficial to use the probabilistic method of interpretation.

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Diagnosing Middle Ear Pathology in 6- to 9-Month-Old Infants Using Wideband Absorbance: A Risk Prediction Model

Cited by 6 publications

References 64 publications

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Diagnosing conductive dysfunction in infants using wideband acoustic immittance: development and validation of predictive models

Longitudinal Development of Wideband Absorbance and Admittance Through Infancy

Diagnosing Middle Ear Dysfunction in 10- to 16-Month-Old Infants Using Wideband Absorbance: An Ordinal Prediction Model

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