The aging ear: an otomicroscopic and tympanometric study

To analyze changes in tympanometric measures with age and to study some otitis-related issues in the elderly (> or = 60 years) population.

The study was designed as a combination of a cross-sectional survey and a controlled study. We studied a random sample of 232 elderly subjects using an extended battery of audiological tests, including pure-tone audiometry. tympanometry with a probe frequency of 226 Hz, otomicroscopy and a standardized questionnaire. A sample of 60 otologically normal subjects were selected for comparative analysis with young healthy controls, and for description of age-related changes and gender differences.

Using linear regression analyses of ear canal volume, middle ear pressure and tympanic membrane compliance on age, no consistently significant change in these parameters with age was found. When these measures were compared between the elderly and the controls, using parametric and non-parametric statistical tests, no significant differences were found for either gender. The only significant gender difference was found for ear canal volume, which was greater for elderly males than for elderly females In the unscreened elderly sample, the adjusted prevalence for reported previous or current otitis media was 15-27% of the population (95% CI). The adjusted prevalence for reported previous or current chronic otitis media (COM) or sequelae thereof was 1-7% (95% CI). With the exception of cerumen obstruction, the prevalence of outer ear canal-related complaints was 1-7% (95% CI). There were some discrepancies between these reported complaints and the findings at otomicroscopy. Although elderly subjects with COM were found to have poorer hearing at speech frequencies than normal elderly subjects. no such effect was found in subjects with scarring or atrophy of the tympanic membrane. The effect of pathological findings at otomicroscopy on tympanometric measures in the elderly sample was highly variable and no consistent association was found.

No change in middle ear sound transmission, as assessed by tympanometry, occurs with normal aging. Ear canal volume is smaller in elderly females than elderly males, which is potentially relevant to the study of otoacoustic emissions in the elderly. The estimated prevalence of ear canal-related problems, excluding cerumen obstruction, is of such a magnitude that the introduction of partially implanted hearing aids may be warranted in our elderly population.