Rhythmic Wave Patterns on Ambient Pressure Tympanometry in Patients With Objective Tinnitus-associated Pathologies

Abstract

Objective: To introduce the concept of ambient pressure tympanometry (APT) and its association with pathologies that may present with objective tinnitus. Study Design: Retrospective case series. Setting: Tertiary referral center. Subjects and Methods: Audiologists performed APT on adult patients as part of routine audiological testing. Ears with myoclonus and patulous Eustachian tube (PET) were identified via review of patient history and physical examination. All other conditions were verified via computed tomography (CT) temporal bone imaging. Ears with conditions that could impair tympanic membrane compliance, such as otosclerosis or tympanic membrane perforation, were excluded. APT findings were analyzed via a novel algorithm. Results: A radiographic finding associated with objective tinnitus was confirmed in 67 ears that underwent CT imaging; 45 (67%) of these ears displayed rhythmic APT wave patterns. These included 28 ears with superior semicircular canal dehiscence, 4 ears with sigmoid sinus dehiscence, 6 ears with internal carotid artery dehiscence, 4 ears with glomus tumor, and 3 ears with encephalocele. In addition, we identified three ears with myoclonus and one ear with PET. In a subset of 30 ears with objective tinnitus symptoms that underwent CT imaging, 22 displayed rhythmic waves; of these 22 ears, 20 (91%) had a radiographic finding associated with objective tinnitus. Conclusions: Rhythmic APT wave patterns are common and may be associated with numerous temporal bone pathologies that may present with objective tinnitus. APT is a simple, rapid, and widely available tool that warrants further study to determine its value in screening of these otologic conditions.

Ambient pressure tympanometry in the workup of patulous eustachian tube and neurotologic disorders

“…However, a significant portion of our cohort displayed pulse‐synchronous patterns at rest, and the majority of CT‐imaged ears displayed radiographic findings suggestive of neurotological diagnoses. APT is not clinically applied for these conditions, despite associations with pulse‐synchronous patterns 6,7 . As these conditions can present similarly to PET, pulse‐synchronous waveforms should prompt consideration for temporal bone CT imaging.…”

“…APT is not clinically applied for these conditions, despite associations with pulse-synchronous patterns. 6,7 As these conditions can present similarly to PET, pulse-synchronous waveforms should prompt consideration for temporal bone CT imaging. Further neurotology workup may also be indicated, as radiographic findings can be incidental.…”

“…Ambient pressure tympanometry (APT), an established but infrequently employed test for PET, measures TM compliance over 20 seconds without external pressure changes and can be performed on most versions of standard tympanometry equipment. APT may demonstrate pulse-synchronous waveforms associated with SSCD and other neurotological conditions 6,7 or respiration-synchronous waveforms during respiratory manoeuvres, which are associated with PET. 3,5,8 In this study, we measure the sensitivity and specificity of APT for PET and compare the sensitivity of various respiratory manoeuvres.…”

Ambient Pressure Tympanometry Wave Patterns in Patients With Superior Semicircular Canal Dehiscence

“…The 43 SSCD ears in this study (27 ears with SSCD only and 16 SSCD ears with comorbid pathology) were briefly described in a case series, which did not include a control group or associated data on symptoms, audiometry and vestibular testing (30). To our knowledge, these two studies are the only systematic studies in the English literature that evaluate APT in the workup of conditions other than PET.…”

“…Clinically, APT is solely employed in the workup of Patulous Eustachian Tube (PET); respiration-synchronous compliance changes have been reported in up to 75% of these patients (23)(24)(25). Compliance changes on APT have also been associated in small case series with glomus tumor, myoclonus, jugular bulb dehiscence, carotid artery dehiscence, and SSCD (26)(27)(28)(29)(30). Here, we present the first systematic analysis of the association between rhythmic APT wave patterns and SSCD, motivating further study of the utility of APT in the diagnostic workup of SSCD.…”