Abstract:Assessment of middle ear impedance using noninvasive electroacoustic measurements has undergone successive developments since its first clinical application in the 1940s, and gained widespread adoption since the 1970s in the form of 226-Hz tympanometry, and applications in multifrequency tympanometry. More recently, wideband acoustic immittance (WAI) is allowing unprecedented assessments of the middle ear acoustic mechanics thanks to the ability to record responses over a wide range of frequencies. The purpose… Show more
Purpose:
Power absorbance measures recorded over a wide range of frequencies allow for clinical inferences about the outer/middle ears' acoustic mechanics. A frequency-dependent feature in the newborn wideband absorbance response, the prominent mid-frequency absorbance peak, has been linked to middle-ear resonance. However, current normative methods were not designed to assess subtle changes in such features. This work aims to develop and validate an absorbance peak template (APT) for assessment of absorbance peaks in newborns. Additional objectives are to compare test performance of absorbance peaks and APTs to existing normative methods, to demonstrate APT-based methods for categorization of abnormal absorbance peaks, and to describe absorbance peak test–retest variability.
Method:
Peak absorbance and peak frequency were analyzed in a training data set (490 measurements in 84 newborn ears who passed transient evoked otoacoustic emissions [TEOAEs] screenings), and an APT was developed by computing normal limits on these two absorbance peak variables. Split-set analysis evaluated the reproducibility of APT, and test–retest analysis was performed. Test performance analysis, conveyed by area under the receiver operating characteristic curve (AROC) and 95% confidence intervals (CIs), compared absorbance peak variables to absorbance area indices (AAIs) in a validation data set (359 ears that passed distortion-product OAE [DPOAE] screening and 64 ears that failed). APT-based assessment paradigms for normal and abnormal ears were compared to the common absorbance normative range paradigm.
Results:
Split-set analysis demonstrated a good reproducibility of APT, and test–retest of absorbance peak variables showed that they were stable measures for clinical assessment. Test performance of peak absorbance (AROC = 0.83; 95% CI [0.77, 0.88]) was comparable to the top-performing AAI variables (AROC = 0.85; 95% CI [0.80, 0.90]). APT-based assessment categorized measurements based on their peak absorbance and peak frequency and enhanced the detection of subtle frequency changes that were missed by the normative range method.
Conclusion:
Analysis of absorbance peaks guided by APT has the potential to simplify and improve assessments of sound conduction pathways in newborn ears and can be used together with or in-place of current methods for analysis of wideband absorbance data.
Purpose:
Power absorbance measures recorded over a wide range of frequencies allow for clinical inferences about the outer/middle ears' acoustic mechanics. A frequency-dependent feature in the newborn wideband absorbance response, the prominent mid-frequency absorbance peak, has been linked to middle-ear resonance. However, current normative methods were not designed to assess subtle changes in such features. This work aims to develop and validate an absorbance peak template (APT) for assessment of absorbance peaks in newborns. Additional objectives are to compare test performance of absorbance peaks and APTs to existing normative methods, to demonstrate APT-based methods for categorization of abnormal absorbance peaks, and to describe absorbance peak test–retest variability.
Method:
Peak absorbance and peak frequency were analyzed in a training data set (490 measurements in 84 newborn ears who passed transient evoked otoacoustic emissions [TEOAEs] screenings), and an APT was developed by computing normal limits on these two absorbance peak variables. Split-set analysis evaluated the reproducibility of APT, and test–retest analysis was performed. Test performance analysis, conveyed by area under the receiver operating characteristic curve (AROC) and 95% confidence intervals (CIs), compared absorbance peak variables to absorbance area indices (AAIs) in a validation data set (359 ears that passed distortion-product OAE [DPOAE] screening and 64 ears that failed). APT-based assessment paradigms for normal and abnormal ears were compared to the common absorbance normative range paradigm.
Results:
Split-set analysis demonstrated a good reproducibility of APT, and test–retest of absorbance peak variables showed that they were stable measures for clinical assessment. Test performance of peak absorbance (AROC = 0.83; 95% CI [0.77, 0.88]) was comparable to the top-performing AAI variables (AROC = 0.85; 95% CI [0.80, 0.90]). APT-based assessment categorized measurements based on their peak absorbance and peak frequency and enhanced the detection of subtle frequency changes that were missed by the normative range method.
Conclusion:
Analysis of absorbance peaks guided by APT has the potential to simplify and improve assessments of sound conduction pathways in newborn ears and can be used together with or in-place of current methods for analysis of wideband absorbance data.
Purpose:
U.S. national wideband absorbance (WBA) data for 17,446 ears included in the National Health and Nutrition Examination Surveys for 2015–2016 and 2017–2020 were analyzed to develop and apply normative reference intervals (RIs).
Method:
Analyses used distribution-free medians and cumulative distribution functions (CDFs). Notable differences between medians were defined as those with non-overlapping 95% confidence intervals, and differences between CDFs were evaluated using Cohen's
h
effect size. Strict inclusion criteria identified “healthy ears” with 1,240 ears meeting all the inclusion criteria for the reference group. RIs, WBA values corresponding to the 2.5th and 97.5th percentiles for the reference group, were established. The established RIs were then applied to the full unscreened data set to determine the prevalence of WBA values outside the RIs.
Results:
WBA RIs were established for all 6- to 19-year-olds and for 20- to 69-year-olds separated into three groups: females, males, and non-Hispanic Asians. The differences among the CDFs underlying these RIs corresponded to small effect sizes. When a single RI, 0.40 < average WBA < 0.75, was applied to the full data set, about 6%–13% of ears fell outside the derived RIs. Logistic regression analyses found abnormal tympanometric results to be responsible for the extreme WBA values among the general population. Abnormal tympanometric results increased the odds of having WBA values outside the RI by ≥ 300%.
Conclusions:
U.S. population data for healthy ears were used to establish RIs for WBA of about 0.40–0.75. About 6%–13% of Americans, 6–80+ years of age, had WBA values outside these RI limits.
Supplemental Material:
https://doi.org/10.23641/asha.24185745
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