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Sensitivity, specificity and predictive value of tympanometry in predicting a hearing impairment in otitis media with
Insights
Tympanometry can help identify children with otitis media with effusion (OME) and hearing loss. Using specific tympanogram types (B or C2) can reduce audiology testing while still detecting most cases of hearing impairment.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Diagnostic Imaging
Background:
- Otitis media with effusion (OME) requires ongoing monitoring for disease persistence and hearing assessment.
- Tympanometry is a potential tool to predict hearing impairment in children with OME.
Purpose of the Study:
- To evaluate the effectiveness of tympanometry in predicting hearing impairment in children with OME.
- To determine optimal strategies for audiometric monitoring in children with OME.
Main Methods:
- Study included 1153 children aged 3.25-6.75 years with suspected OME.
- Analyzed tympanogram types (B and C2) and their correlation with hearing thresholds.
- Assessed impact of extended pressure range and exclusion of inattentive children on test accuracy.
Main Results:
- Including type C2 tympanograms with type B improved sensitivity but lowered specificity for detecting hearing loss.
- Extended pressure range and excluding inattentive children did not alter sensitivity or specificity.
- Limiting audiometry to children with type B or C2 tympanograms reduced workload by 31% while identifying 95% of impaired children.
Conclusions:
- Tympanometry, specifically types B and C2, can aid in resource allocation for audiometric monitoring in OME.
- Targeted audiometry based on tympanogram results offers an efficient approach to identify hearing impairment in children with OME.
Abstract:
Children with otitis media with effusion (OME) need monitoring over time to identify persistence of disease and to assess their hearing thresholds as a surrogate of auditory disability. It would be useful if tympanometry could be used to predict those with an impairment. This study looked at 1153 children, aged between 3.25 and 6.75 years, referred for suspected OME. The inclusion of type C2 tympanograms with type B tympanograms versus all other tympanogram types increased the sensitivity of detecting air-conduction thresholds and air-bone gaps of various magnitudes in the better hearing ear but lowered the specificity and the positive predictive value. Extending the pressure range to -600 daPa and excluding the 30% of children with poor concentration on audiometry made no difference to the sensitivity and specificity. The results were the same for the poorer hearing ear. These findings are of practical help in monitoring children with OME. Thus taking an air-conduction average of 25 dB HL in the better ear as the level needing detection, if all children are audiometrically assessed then 100% of those with an impairment will be identified. Limiting audiometry to those with a bilateral type B tympanogram reduces the workload by 50%, but 90% of impaired children will still be detected. Limiting audiometry to those with type B or C2 tympanograms reduces the workload to 69% of the sample, and 95% of impaired children will be identified. With such data, decisions as to how to allocate limited audiometric resources for monitoring children with OME are made easier.