Eustachian Tube Dysfunction and Wideband Absorbance Measurements at Tympanometric Peak Pressure and 0 daPa

Aithal, Sreedevi; Aithal, Venkatesh; Kei, Joseph; Anderson, Shane; Liebenberg, Simon

doi:10.3766/jaaa.18002

Cited by 12 publications

(20 citation statements)

References 38 publications

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“…40 Absorbance results of the present study are in agreement with other studies that reported absorbance being reduced at ambient pressure and returning to normal levels at TPP in ears with negative middle ear pressure. 19,41 Using an experimental model, Pau et al 18 reported that tympanometry in ears with RPs or atelectasis does not measure middle ear pressure correctly. The TPP depends on the size of the RP and the remaining gas volume in the middle ear.…”

Section: Discussionmentioning

confidence: 99%

“…WBA, measured at ambient pressure (WBA) or under pressurized conditions (wideband tympanometry, WBT) performs better than the single frequency tympanometry in identifying middle ear pathologies such as otosclerosis, otitis media with effusion (OME), and eustachian tube dysfunction. 12,[19][20][21][22] To date, there are no studies that have systematically investigated WBA or WBT in ears with RPs or cholesteatomas. As a sensitive measure of middle ear function, WBA may shed light on specific pathological changes of RPs and cholesteatomas.…”

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confidence: 99%

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Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study

Aithal

Kei

et al. 2020

J Am Acad Audiol

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study

Aithal

Kei

et al. 2020

J Am Acad Audiol

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“…WBT performed under pressurised conditions has the potential to improve the accuracy of detecting middle ear disorders [7]. Aithal et al (2018) measured WBA 0 and WBA TPP in 43 ears with Eustachian tube dysfunction and 102 ears with normal middle ear function. They reported that ears with Eustachian tube dysfunction had reduced WBA 0 between 0.6 and 1.5 kHz compared to WBA TPP .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Wideband Tympanometry Findings in Healthy Neonates

Aithal

Kei

et al. 2022

J Am Acad Audiol

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Objectives The objective of the present study was to describe pressurised wideband absorbance at tympanometric peak pressure (WBATPP) and 0 daPa (WBA0) in healthy Caucasian neonates. Subjects: A total of 249 ears from 249 neonates who passed a test battery of 1000-Hz tympanometry, distortion product otoacoustic emissions and automated auditory brainstem response were included in the study. Method: WBATPP and WBA0 were averaged in one-third octave frequencies from 0.25 to 8 kHz. Data were statistically analysed for effects of frequency, ear and gender. Results Normative WBATPP and WBA0 data obtained from healthy neonates are presented. There was no significant difference between WBATPP and WBA0 at all frequencies. Both WBATPP and WBA0 demonstrated a multi-peaked pattern with maxima of 0.80 and 0.72 at 1.25-1.5 and 6 kHz, respectively, and two minima of 0.45 and 0.49 at 0.4-0.5 kHz and 4 kHz, respectively. The effects of ear and gender were not significant for both WBA measures. Conclusion Pressurised WBATPP and WBA0 data were provided for healthy Caucasian neonates. They will be useful for assessment of middle ear function and assist in differentiating between conductive and sensorineural hearing losses in neonates.

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“…However, creating a dichotomous outcome from a disease that lies on a spectrum can lead to loss of information. Furthermore, 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, Aithal, Kei, Anderson, & Liebenberg, 2018;Beers et al, 2010;Ellison et al, 2012;Hunter et al, 2008b;Robinson, Thompson, & Allen, 2016;Shaver & Sun, 2013;Voss, Merchant, & Horton, 2012;Werner et al, 2010). Studies of infants and children have found a systematic decrease in A as the severity of middle ear disease increases Ellison et al, 2012;Hunter et al, 2008b).…”

Section: Predictive Modellingmentioning

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).…”

Section: Introductionmentioning

confidence: 99%

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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Eustachian Tube Dysfunction and Wideband Absorbance Measurements at Tympanometric Peak Pressure and 0 daPa

Cited by 12 publications

References 38 publications

Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study

Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary Study

Wideband Tympanometry Findings in Healthy Neonates

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

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