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Tympanometry in the detection of hearing impairments associated with otitis media with effusion
1Department of Otolaryngology, Royal Infirmary, Glasgow, UK.
Insights
Impedance audiometry effectively identifies children with normal hearing using peaked tympanograms. However, flat tympanograms require further audiological evaluation for potential hearing loss due to otitis media with effusion.
Area of Science:
- Pediatric Audiology
- Otolaryngology
- Diagnostic Imaging
Background:
- Otitis media with effusion (OME) is a common childhood condition requiring significant audiology resources.
- Impedance audiometry is a sensitive tool for detecting middle ear effusion but its specificity for identifying associated hearing impairment is debated.
- Type B tympanograms, indicative of effusion, can be associated with a wide range of hearing thresholds.
Purpose of the Study:
- To quantify the sensitivity and specificity of impedance audiometry in detecting hearing impairment (≥25 dB HL) in children with OME.
- To evaluate the diagnostic accuracy of different tympanogram types for identifying hearing loss in OME.
- To inform audiology department protocols for monitoring children with OME.
Main Methods:
- A study involving 285 children with OME was conducted.
- Impedance audiometry results (tympanogram types A, C, and B) were correlated with hearing thresholds.
- Sensitivity, specificity, and predictive values were calculated for detecting hearing impairment ≥25 dB HL.
Main Results:
- Peaked tympanograms (Types A or C) demonstrated high negative predictive value, virtually ruling out significant hearing impairment (98% confidence).
- Flat tympanograms (Type B) showed good sensitivity (93%) but lower specificity (76%) for detecting hearing impairment.
- The positive predictive value for Type B tympanograms was 49%, indicating that over half of ears with this result had acceptable hearing.
Conclusions:
- Peaked tympanograms in children with OME can reliably indicate normal hearing, reducing the need for further audiological testing.
- Children with flat tympanograms require formal hearing evaluation to assess for significant hearing impairment.
- Implementing these findings can optimize audiology resource allocation and reduce departmental workload.
Abstract:
The monitoring of children with otitis media with effusion ties up considerable resources in audiology departments. Impedance audiometry is frequently used when investigating these children. It has been shown to be highly sensitive in detecting middle ear effusion, but its value in identifying those children with a significant hearing impairment secondary to this is in question because of the wide range of hearing impairments possible with a type B tympanogram. This study quantified the sensitivity and specificity of impedance audiometry in detecting a hearing impairment greater than or equal to 25 dB HL due to otitis media with effusion. The subjects were 285 children of whom 20% had hearing thresholds greater than or equal to 25 dB HL. A peaked tympanogram (types A or C) virtually eliminated the possibility (98% confidence) of such a hearing impairment. A flat type B tympanogram was satisfactorily sensitive (93%) in detecting a hearing impairment, but non-specific (76%). The positive predictive value was 49%, i.e. 51% of ears with this type of tympanogram had hearing within acceptable limits. Assuming that a sensorineural impairment has been excluded and a population is being monitored for hearing impairment associated with otitis media with effusion, it is suggested that the presence of a peaked tympanogram indicates normal hearing, whereas those children with a flat tympanogram would require their hearing to be evaluated. Increased use of impedance audiometry to monitor children with otitis media with effusion would reduce the number requiring full pure-tone audiometry with a subsequent reduction in the workload of an audiology department.