Screening procedure for detection of middle ear and cochlear disease

Experiences from a six-year study in which 11,772 seven-year-olds have been tested with a combination of the pure tone sweep check test and impedance audiometry (tympanometry and stapedius reflex test) are presented. During the study there has been a gradual change in the screening level. The goal has been to find an ideal screening level in which the results from the screening procedure correspond as much as possible to the findings of the otologist. Analysis of the results from the stapedius reflex test demonstrated that in ears in which the middle ear pressure was within +/- 50 mm H2O the stapedius reflex test could not be elicited in 1.9% of the ears when the maximum output of the audiometer was used (110 dB SPL ipsilateral stimulation); in the ears with middle ear pressure within +/- 150 mm H2O the stapedius reflex could not be elicited in 6.1% using the maximum output of the audiometer. Based on the experiences from our studies it is therefore recommended that the stapedius reflex test be excluded from the test battery and that pure tone screening supplemented by tympanometry be used. A middle ear pressure of less than or equal to -150 mm H2O or a flat tympanogram and/or tone screening levels > 20 dB HTL at 0.5 kHz and/or 4 kHz are considered as indicative of ear pathology.