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Negative middle ear pressure. Variations by season and sex
Insights
Negative middle ear pressures are common in children and vary seasonally, challenging their use as indicators of pathology. This variability risks over-referral for nonexistent middle ear problems.
Area of Science:
- Pediatric Otolaryngology
- Audiology
- Public Health
Background:
- Negative middle ear pressure is often considered pathological.
- Understanding its prevalence in children is crucial for accurate diagnosis.
Purpose of the Study:
- To investigate the variations in negative middle ear pressure over a 12-month period in seven-year-old children.
- To assess the relationship between middle ear pressure, seasonal changes, sex, and hearing loss.
Main Methods:
- A 12-month longitudinal study of 352 unselected seven-year-old children.
- Repeated field screenings for middle ear pressure and hearing loss (>20 dB).
- Audiological evaluation at a hospital clinic for children failing field screenings.
Main Results:
- Negative middle ear pressure (-150 to -250 mm H2O) occurred in 25%-55% of children, varying by season.
- Bilateral negative pressures were more frequent in boys.
- Mild conductive hearing loss (10-20 dB) affected 7%-44% of children, unrelated to sex.
Conclusions:
- The high prevalence and variability of negative middle ear pressure challenge its definition as solely pathological.
- Seasonal variations and sex differences in occurrence are noted.
- Relying solely on middle ear pressure can lead to over-referral for unnecessary investigations and treatments.
Abstract:
This study describes variations in the occurrence of negative middle ear pressures during a 12-month period in an unselected group of 352 children, all about seven years old. During the year-long study, the children were screened several times in the field to measure middle ear pressure and hearing losses greater than 20 dB. The children that failed this field screening were transported to the Hearing Clinic of Vejle Hospital and their auditory acuity was measured by audiological procedures. Calculation of the cumulated incidence of negative middle ear pressure showed that a pressure of -150 to -250 mm H2O, otherwise purported to reflect pathology, occurred in 25% to 55% of the children at different times during the year. The prevalence of these negative middle ear pressures was such as to negate the term "pathology," which is usually applied to such findings. Various negative pressures were found to occur as characteristics of the season of the year and were also found to occur more frequently bilaterally in boys. Conductive hearing losses of 10 to 20 dB were found in 7% to 44% of the children but were not found to be related to sex. The variability of middle ear pressure limits its value in predicting middle ear pathology and leads to a risk that children will be over-referred for further investigation and treatment of nonexistent middle ear problems if middle ear pressure is used as the sole prognosticator of middle ear pathology.