Impedance Tympanometry and Acoustic Reflectometry at Myringotomy

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 475-480
Author(s):  
Thomas R. Babonis ◽  
Michael R. Weir ◽  
Patrick C. Kelly
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Type A ◽  
Tube Placement ◽  
Clinical Impression ◽  
Type B ◽  
Middle Ear Effusion ◽  
Experienced Clinician ◽  
Ear Effusion ◽  
Higher Sensitivity

A total of 220 ears undergoing myringotomy and pressure-equalizing tube placement were studied with impedance tympanometry and acoustic reflectometry in a direct comparison for detection of middle-ear effusion. Impedance tympanometry and acoustic reflectometry were equally accurate, detecting the presence or absence of middle-ear effusion in 73% and 72% of ears, respectively. The presence of effusion in ears with tympanographic patterns other than type A and type B was not consistently and reliably predicted. The higher sensitivity of impedance tympanometry (90%) compared with that for acoustic reflectometry (58%) contrasted with the opposite findings for specificities (54% vs 88%). It is concluded that impedance tympanometry and acoustic reflectometry measure different events at the tympanic membrane and their utility lies in the fact that they complement each other. These instruments can aid the experienced otoscopist in confirming a clinical impression and assist the less experienced clinician in validating or improving otoscopic skills.

scholarly journals Influence of middle ear alterations on children's balance

2021 ◽  
Vol 31 (Supplement_2) ◽  
Author(s):  
Joana Ferreira ◽  
Carla Matos Silva ◽  
Inês Araújo
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Middle Ear ◽  
Postural Balance ◽  
Sensory Integration ◽  
Type A ◽  
Clinical Test ◽  
Type B ◽  
Balance Performance ◽  
Balance Disorders

Abstract Background Postural instability is a possible symptom in children with otitis media, which often occurs in this population. The child with balance disorders usually has intolerance to sudden movements, difficulties in moving in the dark, nausea, vomiting and numerous fall events. To verify whether changes in the middle ear can influence the balance postural in children from 3 to 5 years. Methods The sample consisted of 31 children of both sexes, aged between 3 and 5 years. To collect data, a tympanogram was used to analyze the integrity of the tympanic membrane and the Modifid Clinical Test of Sensory Integration and Balance (MCTSIB), with four different sensory conditions, to assess static postural balance. Results Regarding the tympanogram, it was verified that the majority of the sample showed no changes, 45.2% of which were type A and 32.3% of type C1. Regarding the type B and C2 tympanogram, it was found that 12.9% of the sample had type B tympanogram and 9.7% type C2. When comparing these values with the MCTSIB results, there were no significant differences between the tympanogram with changes (B and C2) and the tympanogram without changes (A and C1), regarding the child's balance performance. Conclusions In this study, it was concluded that the alterations of the middle ear, proved through the tympanogram, did not influence the postural balance. However, it was found that the unilateral changes reported by the tympanogram, suggest higher values of postural oscillation, compared to bilateral changes.

Experimental Otitis Media with Effusion following Middle Ear Inoculation of Nonviable H Influenzae

1984 ◽  
Vol 93 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Thomas F. DeMaria ◽  
David J. Lim ◽  
Bruce R. Briggs ◽  
Nobuhiro Okazaki
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Animal Experiment ◽  
Otitis Media With Effusion ◽  
Type B ◽  
Negative Bacterium ◽  
Middle Ear Effusion ◽  
Sterile Saline ◽  
Inflammatory Changes ◽  
Ear Effusion

In order to test the hypothesis that nonviable bacteria can induce middle ear inflammation leading to persistent middle ear effusion (MEE), we conducted an animal experiment using formalin-killed Hemophilus influenzae, the bacterium reported to be the most common pathogen isolated from chronic MEEs. Over 70% of the chinchillas injected with formalin-killed H influenzae type b or a nontypeable isolate developed sterile, straw-colored serous MEEs, and exhibited histological evidence of extensive inflammatory changes of the middle ear mucosal connective tissue and epithelium. Control animals injected with pyrogen-free sterile saline did not exhibit any inflammatory changes or effusions in the middle ears. Our data suggest that endotoxin on the surface of H influenzae, a gram-negative bacterium, may be responsible for the induction of the otitis media with effusion. It is suggested that endotoxin (even when the organisms are no longer viable) may be responsible for the production of serous MEE and inflammatory changes in the middle ear.

scholarly journals Tympanostomy Tube Selection: A Review of the Evidence

2016 ◽  
Vol 7 (1) ◽  
pp. 17-22
Author(s):  
Ho Sandra ◽  
David J Kay
Keyword(s):  
Otitis Media ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
The United States ◽  
Tube Placement ◽  
Tympanostomy Tube ◽  
Middle Ear Effusion ◽  
Surgeon Experience ◽  
Ear Effusion

ABSTRACT Tympanostomy tube (TT) insertion for ventilation of the middle ear is one of most commonly performed procedures in the United States. Indications for tube insertion include otitis media with effusion, recurrent acute otitis media, hearing loss caused by middle ear effusion and persistent acute otitis media. In general, TTs are divided into two categories, short-term tubes and long-term tubes. Depending on the indications for tube placement and surgeon experience with the TT, different tubes can be used. A myriad of tubes have been created since their first documented use in 1845 in attempts to provide better middle ear ventilation, improve ease of placement and prevent complications, such as post-tube otorrhea, persistent perforation and tube occlusion. In order for a tube to be effective, it should be biocompatible with the middle ear to minimize a foreign body reaction. Teflon and silicone remain two of the most commonly used materials in TTs. In addition, the tube design also plays a role for insertion and retention times of TTs. Lastly, TTs can also be coated with various substances, such as silver-oxide, phosphorylcholine and more recently, antibiotics and albumin, in order to prevent biofilm formation and decrease the rate of post-TT otorrhea. Persistent middle ear effusion affects many children each year and can impact their quality of life as well as hearing and language development. With nearly 1 out of every 15 children by the age of 3 years receiving TTs, it is imperative that the right tube be chosen to facilitate optimal ventilation of the middle ear while minimizing complications. How to cite this article Ho S, Kay DJ. Tympanostomy Tube Selection: A Review of the Evidence. Int J Head Neck Surg 2016;7(1):17-22.

Evidence in Infants With Cleft Palate That Breast Milk Protects Against Otitis Media

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 853-860 ◽  
Author(s):  
Jack L. Paradise ◽  
Barbara A. Elster ◽  
Lingshi Tan
Keyword(s):  
Breast Milk ◽  
Cleft Palate ◽  
Otitis Media ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Tube Placement ◽  
Middle Ear Effusion ◽  
Feeding Mode ◽  
Initial Development ◽  
Ear Effusion

Objective. Most infants with cleft palate suckle unproductively and require feeding by artificial means. Most also have unremitting otitis media accompanied by (usually) nonpurulent middle-ear effusion, a complication generally attributed to impaired eustachian tube ventilatory function. We observed two infants with cleft palate in whom one or both ears appeared effusionfree on more than one occasion, and who also were receiving or previously had received breast milk feedings. This prompted us to analyze the relation between middle-ear status and feeding mode in a large series of infants with cleft palate. Our objective was to determine whether in these infants the receipt of breast milk mitigated the otherwise virtually invariable development and continued presence of otitis media. Methods. We reviewed and analyzed data concerning both feeding mode and the presence or absence of middle-ear effusion in 315 infants with cleft palate, as recorded systematically in the course of prospective studies at our Cleft Palate-Craniofacial Center. Analysis was limited to periods preceding the infants' receipt of tympanostomy-tube placement or palate repair, or their second birthday, whichever occurred first. Results. Freedom from effusion in one or both ears was found at one or more visits in only seven (2.7%) of 261 infants fed cow's milk or soy formula exclusively, but in 17 (32%) of 54 infants fed breast milk exclusively or in part for varying periods (P < .0001). In virtually all instances, the breast milk had been harvested by the mother and fed to the infant via an artificial feeder. Baseline clinical and sociodemographic characteristics and surveillance in the two groups of infants were comparable. Conclusions. Artificially fed breast milk provides variable protection against the development of otitis media in infants with cleft palate. This finding supports the likelihood of a similarly protective effect of breast milk in noncleft infants. The finding also suggests strongly that in infants with cleft palate, impaired eustachian tube function is not the only pathogenetic factor in the infants' initial development of middle-ear effusion.

Efficacy of Acoustic Reflectometry in Detecting Middle Ear Effusion

1986 ◽  
Vol 95 (5) ◽  
pp. 472-476 ◽  
Author(s):  
Christine A. Avery ◽  
George A. Gates ◽  
Thomas J. Prihoda
Keyword(s):  
Tympanic Membrane ◽  
Otitis Media ◽  
Sensitivity And Specificity ◽  
Middle Ear ◽  
Otitis Media With Effusion ◽  
Chronic Otitis Media ◽  
Lower Sensitivity ◽  
Middle Ear Effusion ◽  
Receiver Operator Characteristics ◽  
Ear Effusion

The acoustic otoscope measures the amount of sound reflected from the tympanic membrane. Since the amount of reflected sound is increased by fluid in the middle ear, it seemed likely that the acoustic otoscope could be used for detection of otitis media. We compared acoustic reflectometry with over 4,000 tympanometric and otoscopic examinations in 451 children who were examined at regular intervals following surgery for chronic otitis media with effusion. The data indicate a lower sensitivity and specificity of acoustic reflectometry than had been reported previously. The receiver-operator characteristics of this device are discussed.

Ultrasound Characterization of Middle Ear Effusion

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P70-P70
Author(s):  
Rahul Seth ◽  
Christopher Discolo ◽  
Paul R Krakovitz
Keyword(s):  
Middle Ear ◽  
Ease Of Use ◽  
Tube Placement ◽  
Oral Antibiotic ◽  
Middle Ear Effusion ◽  
Exact Test ◽  
Pressure Equalization ◽  
Middle Ear Fluid ◽  
Specificity And Sensitivity ◽  
Ear Effusion

Objective To further 1) enhance and assess the ability to detect and characterize middle ear effusion using A-mode ultrasonography with miniature curved array transducers, and 2) identify bacterial presence in relation to effusion viscosity. Methods A prospective unblinded comparison study was performed to determine ultrasound efficacy in detecting effusion characteristics. Ultrasonographic examination using an ultrasound probe was performed on 107 patients (197 ears) scheduled to undergo bilateral myringotomy with pressure equalization tube placement. With the child anesthetized, the probe was placed into the external ear canal after sterile water was inserted. Ultrasound recordings from the tympanic membrane and middle ear space were recorded and analyzed for viscosity. Middle ear aspirate was sent for bacterial culture. Myringotomy was then performed. Results Computer-based algorithms analyzed the waveforms and were able to detect the presence of thick, thin, and lack of fluid with a sensitivity and specificity of greater than 90%. Thin effusions had a significantly higher infection rate (64% versus 12%, p<0.01, Fisher's exact test) when cultured from ears of children not taking oral antibiotic therapy. Similar results were obtained from cultures taken of middle ear fluid in children taking antibiotics (69% versus 12%, p<0.002). Conclusions The specificity and sensitivity of ultrasound middle ear fluid detection is greater than 90%, exceeding the accuracy of tympanometry and other devices. Moreover, it can accurately predict the viscosity of an effusion, which can give insight into its likelihood of infection. Further technologies to promote ease of use will be needed.

Persistent Effusions of the Middle Ear

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 102-103 ◽  
Author(s):  
David W. Teele ◽  
Gerald B. Healy ◽  
Francis P. Tally
Keyword(s):  
Bacterial Infection ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Anaerobic Bacteria ◽  
Anaerobic Infection ◽  
Middle Ear Effusion ◽  
Asymptomatic Children ◽  
Ear Effusion

Recent reports of isolation of bacteria from effusions of the middle ear taken from asymptomatic children have suggested a possible role for persistent bacterial infection in the etiology of prolonged effusions. To investigate the significance of anaerobic bacteria in such effusions, we obtained 51 samples of middle ear effusion (MEE) from 30 children. After careful cleansing of the tympanic membrane with 70% alcohol, we performed tympanocentesis prior to performing a myringotomy. Fastidious bacteriologic methods failed to yield a single anaerobic isolate from any of these specimens. We conclude that anaerobic infection of MEE is exceedingly uncommon.

A Comparison of Retention and Complication Rates of Large-Bore (Paparella II) and Small-Bore Middle Ear Ventilating Tubes

1985 ◽  
Vol 93 (3) ◽  
pp. 322-330 ◽  
Author(s):  
Mark R. Klingensmith ◽  
Melvin Strauss ◽  
George H. Conner
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Complication Rate ◽  
Type I ◽  
Complication Rates ◽  
Type Ii ◽  
Intubation Time ◽  
Middle Ear Effusion ◽  
Ventilating Tubes ◽  
Ear Effusion

Large-bore myringotomy tubes are usually reserved for the treatment of refractory middle ear effusion. Theoretically, they have an extended intubation time and a higher complication rate. There is, however, scant support of this in the literature. The duration of intubation, efficacy, and complication rates of the large-bore Paparella type II tube were compared with Paparella type I, Shepard, and Armstrong tubes. The study included 242 patients with 600 intubations. In addition, a subpopulation of patients receiving their initial intubation during this study was reviewed. Findings were similar for both groups. Paparella type II tubes had a prolonged period of intubation and a decreased reintubation rate when compared with the smaller bore tubes. Larger bore tubes had an increased complication rate when compared with the smaller bore tubes. Complications included occasional or frequent otorrhea and an increased rate of permanent perforation of the tympanic membrane. There was no instance of cholesteatoma formation secondary to intubation. Guidelines are presented for the use of the Paparella type II tube.

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