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Identification of conductive hearing loss in young infants using tympanometry and wideband reflectance
Beth A Prieve1, Kathy R Vander Werff, Jonathan L Preston
1Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, Syracuse, NY 13244, USA. baprieve@syr.edu
Insights
Wideband reflectance (WBR) and tympanometry using 678- and 1000 Hz probe tones effectively detect conductive hearing loss (CHL) in infants. These methods show significant differences between normal hearing and CHL ears in young children.
Area of Science:
- Audiology
- Pediatric Medicine
- Otoacoustic Emissions
Background:
- Conductive hearing loss (CHL) in infants can impede auditory development.
- Early detection of CHL is crucial for timely intervention.
- Accurate diagnostic tools are needed for infant hearing screening.
Purpose of the Study:
- To evaluate the diagnostic efficacy of tympanometry and wideband reflectance (WBR) for identifying CHL in infants.
- To compare the performance of different tympanometry probe frequencies (226, 678, 1000 Hz) and WBR in detecting CHL.
- To determine the sensitivity and specificity of these methods in a young infant population.
Main Methods:
- Auditory brainstem response (ABR) was used to classify hearing in 60 infant ears (43 normal hearing, 17 CHL).
- Tympanometry was performed using 226, 678, and 1000 Hz probe tones, analyzing acoustic middle ear admittance (Ya) and two-category classifications.
- Wideband reflectance (WBR) was measured using a chirp stimulus and analyzed across 13 frequency bands.
Main Results:
- Tympanometry with 678- and 1000 Hz probe tones showed significant differences in Ya and classification between CHL and normal hearing ears.
- A 226 Hz probe tone for tympanometry did not yield significant differences.
- WBR demonstrated significantly higher reflectance in CHL ears at frequencies of 800-2500 Hz and 6300 Hz, with large effect sizes and high positive likelihood ratios.
Conclusions:
- Wideband reflectance (WBR) and tympanometry utilizing 678- and 1000 Hz probe frequencies are effective tools for detecting CHL in young infants.
- These methods offer reliable diagnostic capabilities for identifying conductive hearing impairments in the pediatric population.
Objective:
The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants.
Methods:
Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen's d and likelihood ratios were computed for comparison with statistically significant differences.
Results:
Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen's d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32.
Conclusions:
CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz.
