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Diagnosing Middle Ear Dysfunction in 10- to 16-Month-Old Infants Using Wideband Absorbance: An Ordinal Prediction
Joshua Myers1,2, Joseph Kei1, Sreedevi Aithal1,2
1Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Insights
This study developed a wideband absorbance model to diagnose middle ear dysfunction in infants. The model accurately predicts middle ear conditions, offering flexible interpretation for clinical use.
Area of Science:
- Audiology
- Pediatric Medicine
- Biomedical Engineering
Background:
- Middle ear dysfunction is common in infants, impacting hearing and development.
- Accurate and early diagnosis is crucial for timely intervention.
- Current diagnostic methods may have limitations in infant populations.
Purpose of the Study:
- To develop an ordinal prediction model for diagnosing middle ear dysfunction in infants (10-16 months) using wideband absorbance.
- To evaluate the model's performance in discriminating between normal, mild, and severe middle ear dysfunction.
- To present probabilistic and simplified interpretation methods for clinical application.
Main Methods:
- Wideband absorbance, tympanometry, and distortion product otoacoustic emissions were measured in 186 infants.
- An ordinal reference standard was established using tympanometry and otoacoustic emissions.
- Ordinal logistic regression modeled middle ear dysfunction probability using absorbance (1000-5657 Hz).
- Model performance was assessed using c-index and calibration, with bias correction via bootstrap resampling.
Main Results:
- The ordinal prediction model demonstrated strong discrimination (c-index=0.919, 0.914 after bias correction).
- Calibration was satisfactory for both mild and severe middle ear conditions.
- The probabilistic interpretation method performed well; the simplified method was accurate for normal and severe cases but occasionally misdiagnosed mild cases as normal.
Conclusions:
- The developed wideband absorbance model shows clinical utility for diagnosing middle ear dysfunction in infants.
- Both probabilistic and simplified interpretation methods are viable, with selection dependent on clinical context.
- The simplified method may be preferred for screening to identify severe cases, while the probabilistic method offers greater detail for diagnostic settings.
Abstract:
Purpose The aim of this study was to develop an ordinal prediction model for diagnosing middle ear dysfunction in 10- to 16-month-old infants using wideband absorbance. Method Wideband absorbance, tympanometry, and distortion product otoacoustic emissions were measured in 358 ears of 186 infants aged 10-16 months (M age = 12 months). An ordinal reference standard (normal, mild, and severe middle ear dysfunction) was created from the tympanometry and distortion product otoacoustic emission results. Absorbance from 1000 to 5657 Hz was used to model the probability of middle ear dysfunction with ordinal logistic regression. Model performance was evaluated using measures of discrimination (c-index) and calibration (calibration curves). Performance measures were adjusted for overfitting (bias) using bootstrap resampling. Probabilistic and simplified methods for interpreting the model are presented. The probabilistic method displays the probability of ≥ mild and ≥ severe middle ear dysfunction, and the simplified method presents the condition with the highest probability as the most likely diagnosis (normal, mild, or severe middle ear dysfunction). Results The c-index of the fitted model was 0.919 (0.914 after correction for bias), and calibration was satisfactory for both the mild and severe middle ear conditions. The model performed well for the probabilistic method of interpretation, and the simplified (most likely diagnosis) method was accurate for normal and severe cases but diagnosed some cases with mild middle ear dysfunction as normal. Conclusions The model may be clinically useful, and either the probabilistic or simplified paradigm of interpretation could be applied, depending on the context. In situations where the main goal is to identify severe middle ear dysfunction and ease of interpretation is highly valued, the simplified interpretation may be preferable (e.g., in a screening clinic that may not be concerned about missing some mild cases). In a diagnostic clinical environment, however, it may be beneficial to use the probabilistic method of interpretation.
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