Validity and Reliability of Tympanometric Measures for Pediatric Patients

1991 ◽  
Vol 34 (2) ◽  
pp. 386-390 ◽  
Author(s):  
Roanne G. Karzon
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Peak Pressure ◽  
Clinical Situation ◽  
Validity And Reliability ◽  
Ear Canal ◽  
Acoustic Admittance ◽  
Validation Criterion ◽  
Significant Change

Sensitivity and specificity of static acoustic admittance (SAA) and tympanometric width (TW) were assessed for 116 pediatric patients. Otologic examination was the validation criterion. Reliability of immediate repeat tympanometric measures (SAA, TW, peak pressure, and estimate of ear canal volume) was also evaluated. A statistically significant change in SAA, with a larger SAA on measure two than measure one, was observed. No significant change across the two sequential measures was observed for TW, peak pressure, or the estimate of ear canal volume. The sensitivity and specificity data collected are discussed with respect to assisting clinicians in selecting tympanometric criteria suitable to their own clinical situation.

scholarly journals Multifrequency tympanometry in infants

2012 ◽  
Vol 16 (02) ◽  
pp. 186-194 ◽  
Author(s):  
Camila Macedo ◽  
Mariza Feniman ◽  
Tamyne de Moraes
Keyword(s):  
Otoacoustic Emissions ◽  
Visual Inspection ◽  
Peak Pressure ◽  
Respiratory Infections ◽  
Risk Indicators ◽  
Inclusion Criteria ◽  
Ear Canal ◽  
Acoustic Admittance ◽  
A Prospective Study ◽  
Occlusion Effect

Summary Introduction: The use of conventional tympanometry is not sufficiently sensitive to detect all cases of middle ear changes, and this hinders accurate diagnosis. Objective: To characterize acoustic immittance measures of infants from 0 to 3 months of age using multifrequency tympanometry in a prospective study. Method: 54 infants from 0 to 3 months of age were evaluated. The inclusion criteria included absence of respiratory infections during the evaluation, presence of transient evoked otoacoustic emissions, and absence of risk indicators for hearing loss. The subjects were evaluated by an audiologic interview, a visual inspection of the ear canal, and measures of acoustic immittance at the frequencies of 226 Hz, 678 Hz, and 1,000 Hz. Tympanometric records of the occlusion effect, tympanometric curve type, tympanometric peak pressure, equivalent ear canal volume, and peak compensated static acoustic admittance were collected. Results: The results indicated the presence of an occlusion effect (2.88% at 226 Hz, 4.81% at 678 Hz and 3.85% at 1,000 Hz), predominance of a tympanometric curve with a single peak (65.35% at 226 Hz, 81.82% at 678 Hz, and 77.00% at 1,000 Hz), and tympanometric peak pressure ranging from -155 to 180 daPa. Further, the equivalent ear canal volume increased with the frequency of the probe (0.64 mL at 226 Hz, 1.63 mho at 678 Hz, and 2.59 mmho at 1,000 Hz) and the peak compensated static acoustic admittance values increased with an increase in frequency (0.51 mL at 226 Hz, 0.55 mmho at 678 Hz and 1.20 mmho at 1,000 Hz). 93.06% of the tympanograms were classified as normal at 226 Hz, 81.82% at 678 Hz, and 77.00 % at 1,000 Hz, respectively. Conclusion: Taken together, these results demonstrated that utilizing these evaluations made it possible to characterize the acoustic immittance measures of infants.

Tympanometric Changes at 226 Hz and 678 Hz Across 10 Trials and for Two Directions of Ear Canal Pressure Change

1984 ◽  
Vol 27 (2) ◽  
pp. 257-266 ◽  
Author(s):  
Richard H. Wilson ◽  
Janet E. Shanks ◽  
Susan K. Kaplan
Keyword(s):  
Young Adults ◽  
Middle Ear ◽  
Peak Pressure ◽  
Pressure Change ◽  
Transmission System ◽  
Ear Canal ◽  
Acoustic Admittance ◽  
Pressure Peak ◽  
The Mean

The influence that repeated tympanometric trials have on the aural-acoustic admittance characteristics of the middle-ear transmission system was studied in 24 young adults. The 226-Hz and 678-Hz data were generated by concurrently digitizing the conductance and admittance tympanograms at 25 daPa/s for both ascending and descending pressure directions. Ten successive trials for each frequency and direction of pressure change were made. Changes in admittance corrected for ear canal volume across the 10 tympanometrie trials were computed. The results demonstrated that generally admittance increases as the number of trials increases. For many subjects, the complexity of the tympanometric configuration also increases across trials. The results from eight subjects with single-peaked 678-Hz tympanograms were compared with the results from eight subjects with notched 678-Hz tympanograms to explain the mean decrease in susceptance across tympanometric trials. Finally, the pressure peak locations of the conductance, susceptance, and admittance tympanograms were evaluated and are discussed. The effects that differences in peak pressure location have on the computed static admittance values are presented.

An Examination of Asymmetry in Adult Tympanometric Measures

2021 ◽  
Author(s):  
Andrew Stuart ◽  
Emma K. Tomaszewski ◽  
Baylee M. Engelhardt
Keyword(s):  
Standard Deviation ◽  
Peak Pressure ◽  
Ear Canal ◽  
Probe Tone ◽  
Confidence Levels ◽  
Statistical Confidence ◽  
Acoustic Admittance ◽  
Interaural Differences ◽  
The Right ◽  
Normal Adults

Abstract Background During audiologic evaluations, an examination of interaural asymmetry is commonly evaluated. To date, however, interaural differences for tympanometric indices have not been reported for adults. Without documented tympanometric right-left differences, one cannot determine if asymmetries are normal or are indicative of significant clinical asymmetries. Purpose The purpose of this study was to investigate interaural asymmetries in peak compensated static acoustic admittance (Ytm), equivalent ear canal volume (Vea), tympanometric peak pressure (TPP), and tympanometric width (TW) in normal adults. Research Design Descriptive, correlational, and inferential measures designs were employed. Study Sample Participants were 188 otologically normal Caucasian young adults (i.e., 77 females and 111 males; M = 23.0 years, standard deviation [SD] = 2.7, range = 18–30 years). Data Collection and Analyses Ytm, Vea, TPP, and TW measures were obtained bilaterally from an admittance tympanogram using a 226 Hz probe tone. Separate two-factor mixed measures analysis of variance examined the effect of ear and sex for each tympanometric index. Correlation analyses examined the association between right and left ear indices. Interaural differences in tympanometric indices were examined with independent t-tests. Critical differences, for deciding if two tympanometric indices are different between ears, were computed from the standard deviations of the right–left ear difference for statistical confidence levels of 85, 90, 95, and 99%. Results The effect of ear was not statistically significant (p > 0.05) on any tympanometric index. Females had significantly lower Ytm and smaller Vea measures than males (p < 0.05). Correlations between all right and left tympanometric indices were positive and statistically significant (p < 0.05). There were no statistically significant differences in interaural differences for any of the tympanometric indices as a function of sex (p > 0.05). Critical differences, for confidence levels for 85% to 99% confidence ranged from ± 0.20–0.36 mmhos for Ytm, ± 0.23–0.41 cm3 for Vea, ± 11.1–19.8 daPa for TPP, and ± 27.2–48.7 daPa for TW. Conclusion A clinician can use these critical differences to determine if tympanometric index interaural differences in ears of young normal Caucasian adults are statistically significant.

scholarly journals Deep learning for accurately recognizing common causes of shoulder pain on radiographs

2021 ◽  
Author(s):  
Nils F. Grauhan ◽  
Stefan M. Niehues ◽  
Robert A. Gaudin ◽  
Sarah Keller ◽  
Janis L. Vahldiek ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Clinical Situation ◽  
Assistive Device ◽  
Test Dataset ◽  
Joint Dislocation ◽  
Independent Expert ◽  
Common Causes

Abstract Objective Training a convolutional neural network (CNN) to detect the most common causes of shoulder pain on plain radiographs and to assess its potential value in serving as an assistive device to physicians. Materials and methods We used a CNN of the ResNet-50 architecture which was trained on 2700 shoulder radiographs from clinical practice of multiple institutions. All radiographs were reviewed and labeled for six findings: proximal humeral fractures, joint dislocation, periarticular calcification, osteoarthritis, osteosynthesis, and joint endoprosthesis. The trained model was then evaluated on a separate test dataset, which was previously annotated by three independent expert radiologists. Both the training and the test datasets included radiographs of highly variable image quality to reflect the clinical situation and to foster robustness of the CNN. Performance of the model was evaluated using receiver operating characteristic (ROC) curves, the thereof derived AUC as well as sensitivity and specificity. Results The developed CNN demonstrated a high accuracy with an area under the curve (AUC) of 0.871 for detecting fractures, 0.896 for joint dislocation, 0.945 for osteoarthritis, and 0.800 for periarticular calcifications. It also detected osteosynthesis and endoprosthesis with near perfect accuracy (AUC 0.998 and 1.0, respectively). Sensitivity and specificity were 0.75 and 0.86 for fractures, 0.95 and 0.65 for joint dislocation, 0.90 and 0.86 for osteoarthrosis, and 0.60 and 0.89 for calcification. Conclusion CNNs have the potential to serve as an assistive device by providing clinicians a means to prioritize worklists or providing additional safety in situations of increased workload.

Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

2021 ◽  
pp. 109352662199148
Author(s):  
M. Cristina Pacheco ◽  
Nicole Green ◽  
Jane Dickerson ◽  
Dale Lee
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
High Specificity ◽  
Visual Assessment ◽  
Pathology Report ◽  
Low Sensitivity ◽  
Endoscopic Assessment

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

scholarly journals Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation

2018 ◽  
Vol 13 ◽  
pp. 117727191775190 ◽  
Author(s):  
Sara Bobillo ◽  
Javier Rodríguez-Fanjul ◽  
Anna Solé ◽  
Julio Moreno ◽  
Mònica Balaguer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Prospective Observational Study ◽  
Pediatric Patients ◽  
Clinical Situation ◽  
Multiple Organ ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Membrane Oxygenation ◽  
Neurologic Sequelae ◽  
Kinetics Of

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.

Multiple Frequency Tympanometry

1993 ◽  
Vol 36 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Janet E. Shanks ◽  
Richard H. Wilson ◽  
Nancy K. Cambron
Keyword(s):  
Phase Angle ◽  
Phase Difference ◽  
Middle Ear ◽  
Multiple Frequency ◽  
Ear Canal ◽  
Sweep Frequency ◽  
Difference Curve ◽  
Angle Measurements ◽  
Rectangular Form ◽  
Acoustic Admittance

Three methods for compensating multiple frequency acoustic admittance measurements for ear canal volume were studied in 26 men with normal middle ear transmission systems. Peak compensated static acoustic admittance (| y |) and phase angle (ø) were calculated from sweep frequency tympanograms (226–1243 Hz in 113 Hz increments). Of the procedures used to compensate for volume in rectangular form, the ear canal pressure used to estimate volume had the largest effect on the estimate of middle ear resonance. Median resonance was 800 Hz for admittance measurements compensated at 200 daPa versus 1100 Hz for measurements compensated at –350 daPa. The remaining two methods, compensation of susceptance only versus both susceptance and conductance and compensation using the minimum volume versus separate volumes at each frequency, did not affect estimates of middle ear resonance. Estimates of middle ear resonance from compensated phase angle measurements also were compared with estimates of resonance from admittance and phase difference curves. although resonance could not be estimated from the phase difference curve, resonance estimated from the admittance difference curve agreed with the estimate from compensated phase angle.

Criterion and Construct Validity and Reliability of the Pediatric IV Difficulty Score

2020 ◽  
Author(s):  
Jane H. Hartman ◽  
James F. Bena ◽  
Shannon L. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Construct Validity ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Peripheral Vascular ◽  
Validity And Reliability ◽  
User Groups ◽  
Validity Criteria ◽  
Placement Success ◽  
Difficulty Score ◽  
Different Levels

Highlights Abstract Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score. Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients’ age, race, and medical diagnosis (construct validity), and reliability of difficulty levels. Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups. Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access.

scholarly journals A comparison between threshold criterion and amplitude criterion in transcranial motor evoked potentials during surgery for supratentorial lesions

2019 ◽  
Vol 131 (3) ◽  
pp. 740-749 ◽  
Author(s):  
Tammam Abboud ◽  
Cindy Schwarz ◽  
Manfred Westphal ◽  
Tobias Martens
Keyword(s):  
Evoked Potentials ◽  
Sensitivity And Specificity ◽  
Motor Function ◽  
Stimulus Intensity ◽  
Motor Evoked Potentials ◽  
Threshold Level ◽  
Percentage Increase ◽  
Threshold Criterion ◽  
Amplitude Criterion ◽  
Significant Change

OBJECTIVEThe aim of this study was to compare sensitivity and specificity between the novel threshold and amplitude criteria for motor evoked potentials (MEPs) monitoring after transcranial electrical stimulation (TES) during surgery for supratentorial lesions in the same patient cohort.METHODSOne hundred twenty-six patients were included. All procedures were performed under general anesthesia. Craniotomies did not expose motor cortex, so that direct mapping was less suitable. After TES, MEPs were recorded bilaterally from abductor pollicis brevis (APB), from orbicularis oris (OO), and/or from tibialis anterior (TA). The percentage increase in the threshold level was assessed and considered significant if it exceeded by more than 20% on the affected side the percentage increase on the unaffected side. Amplitude on the affected side was measured with a stimulus intensity of 150% of the threshold level set for each muscle.RESULTSEighteen of 126 patients showed a significant change in the threshold level as well as an amplitude reduction of more than 50% in MEPs recorded from APB, and 15 of the patients had postoperative deterioration of motor function of the arm (temporary in 8 cases and permanent in 7 [true-positive and false-negative results]). Recording from TA was performed in 66 patients; 4 developed postoperative deterioration of motor function of the leg (temporary in 3 cases and permanent in 1), and showed a significant change in the threshold level, and an amplitude reduction of more than 50% occurred in 1 patient. An amplitude reduction of more than 50% occurred in another 10 patients, without a significant change in the threshold level or postoperative deterioration. Recording from OO was performed in 61 patients; 3 developed postoperative deterioration of motor function of facial muscles (temporary in 2 cases and permanent in 1) and had a significant change in the threshold level, and 2 of the patients had an amplitude reduction of more than 50%. Another 6 patients had an amplitude reduction of more than 50% but no significant change in the threshold level or postoperative deterioration.Sensitivity of the threshold criterion was 100% when MEPs were recorded from APB, OO, or TA, and its specificity was 97%, 100%, and 100%, respectively. Sensitivity of the amplitude criterion was 100%, 67%, and 25%, with a specificity of 97%, 90%, and 84%, respectively.CONCLUSIONSThe threshold criterion was comparable to the amplitude criterion with a stimulus intensity set at 150% of the threshold level regarding sensitivity and specificity when recording MEPs from APB, and superior to it when recording from TA or OO.

Considerations for neonatal and pediatric pain management

2019 ◽  
Vol 76 (19) ◽  
pp. 1511-1520 ◽  
Author(s):  
Pooja Shah ◽  
Anita Siu
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Pediatric Patients ◽  
Safety Data ◽  
Clinical Situation ◽  
Assessment Tools ◽  
Patient Specific ◽  
Pediatric Pain ◽  
Unique Challenge

Abstract Purpose Current literature and clinical practice guidelines on pediatric pain management are reviewed. Summary Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child’s age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients. Conclusion The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.

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