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.

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.

Normative Wideband Acoustic Immittance Measurements in Caucasian and Aboriginal Children

2019 ◽  
Vol 28 (1) ◽  
pp. 48-61 ◽  
Author(s):  
Venkatesh Aithal ◽  
Sreedevi Aithal ◽  
Joseph Kei ◽  
Alehandrea Manuel
Keyword(s):  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Normative Data ◽  
Peak Pressure ◽  
Pure Tone Audiometry ◽  
Gender Effect ◽  
High Similarity ◽  
Ear Canal ◽  
Australian Aboriginal ◽  
Aboriginal Children

PurposeThe aims of this study were to develop normative data for wideband acoustic immittance (WAI) measures in Caucasian and Australian Aboriginal children and compare absorbance measured at 0 daPa (WBA0) and tympanometric peak pressure (TPP; WBATPP) between the 2 groups of children. Additional WAI measures included resonance frequency, equivalent ear canal volume, TPP, admittance magnitude (YM), and phase angle (YA).MethodA total of 171 ears from 171 Caucasian children and 87 ears from 87 Aboriginal children who passed a test battery consisting of 226-Hz tympanometry, transient evoked otoacoustic emissions, and pure tone audiometry were included in the study. WAI measures were obtained under pressurized conditions using wideband tympanometry. Data for WBA0, WBATPP, YM, and YA were averaged in one-third octave frequencies from 0.25 to 8 kHz.ResultsThere was no significant ear effect on all of the 7 measures for both groups of children. Similarly, there was no significant gender effect on all measures except for WBATPPin Aboriginal children. Aboriginal boys had significantly higher WBATPPthan girls at 1.5 and 2 kHz. A significant effect of ethnicity was also noted for WBATPPat 3, 4, and 8 kHz, with Caucasian children demonstrating higher WBATPPthan Aboriginal children. However, the effect size and observed power of the analyses were small for both effects.ConclusionThis study developed normative data for 7 WAI measures, namely, WBA0, WBATPP, TPP, Veq, RF, YM, and YA, for Caucasian and Aboriginal children. In view of the high similarity of the normative data between Caucasian and Aboriginal children, it was concluded that separate ethnic-specific norms are not required for diagnostic purposes.

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 143. Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Zahra Kassamali Escobar ◽  
Todd Bouchard ◽  
Jose Mari Lansang ◽  
Scott Thomassen ◽  
Joanne Huang ◽  
...  
Keyword(s):  
Primary Care ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Specific Rate ◽  
Inclusion Criteria ◽  
Diagnosis Codes ◽  
Control And Prevention ◽  
Viral Respiratory Infections

Abstract Background Between 15–50% of patients seen in ambulatory settings are prescribed an antibiotic. At least one third of this usage is considered unnecessary. In 2019, our institution implemented the MITIGATE Toolkit, endorsed by the Centers for Disease Control and Prevention to reduce inappropriate antibiotic prescribing for viral respiratory infections in emergency and urgent care settings. In February 2020 we identified our first hospitalized patient with SARS-CoV(2). In March, efforts to limit person-to-person contact led to shelter in place orders and substantial reorganization of our healthcare system. During this time we continued to track rates of unnecessary antibiotic prescribing. Methods This was a single center observational study. Electronic medical record data were accessed to determine antibiotic prescribing and diagnosis codes. We provided monthly individual feedback to urgent care prescribers, (Sep 2019-Mar 2020), primary care, and ED providers (Jan 2020 – Mar 2020) notifying them of their specific rate of unnecessary antibiotic prescribing and labeling them as a top performer or not a top performer compared to their peers. The primary outcome was rate of inappropriate antibiotic prescribing. Results Pre toolkit intervention, 14,398 patient visits met MITIGATE inclusion criteria and 12% received an antibiotic unnecessarily in Jan-April 2019. Post-toolkit intervention, 12,328 patient visits met inclusion criteria and 7% received an antibiotic unnecessarily in Jan-April 2020. In April 2020, patient visits dropped to 10–50% of what they were in March 2020 and April 2019. During this time the unnecessary antibiotic prescribing rate doubled in urgent care to 7.8% from 3.6% the previous month and stayed stable in primary care and the ED at 3.2% and 11.8% respectively in April compared to 4.6% and 10.4% in the previous month. Conclusion Rates of inappropriate antibiotic prescribing were reduced nearly in half from 2019 to 2020 across 3 ambulatory care settings. The increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning. Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV(2) pandemic. Disclosures All Authors: No reported disclosures

Distortion product otoacoustic emissions upon ear canal pressurization

2013 ◽  
Vol 133 (4) ◽  
pp. EL331-EL337 ◽  
Author(s):  
Makram Zebian ◽  
Volker Schirkonyer ◽  
Johannes Hensel ◽  
Sven Vollbort ◽  
Thomas Fedtke ◽  
...  
Keyword(s):  
Otoacoustic Emissions ◽  
Distortion Product Otoacoustic Emissions ◽  
Ear Canal ◽  
Distortion Product

scholarly journals Reducing reflected contributions to ear-canal distortion product otoacoustic emissions in humans

2006 ◽  
Vol 119 (6) ◽  
pp. 3896-3907 ◽  
Author(s):  
Tiffany A. Johnson ◽  
Stephen T. Neely ◽  
Judy G. Kopun ◽  
Michael P. Gorga
Keyword(s):  
Otoacoustic Emissions ◽  
Distortion Product Otoacoustic Emissions ◽  
Ear Canal ◽  
Distortion Product

The Occlusion Effect in Bone Conduction Hearing

1965 ◽  
Vol 8 (2) ◽  
pp. 137-148 ◽  
Author(s):  
David P. Goldstein ◽  
Claude S. Hayes
Keyword(s):  
Sound Pressure Level ◽  
Sound Pressure ◽  
Bone Conduction ◽  
Pressure Level ◽  
Ear Canal ◽  
Significant Difference ◽  
Threshold Measure ◽  
Level Shifts ◽  
Positive Correlations ◽  
Occlusion Effect

This experiment tested the hypothesis that the occlusion effect is accompanied by an increase in sound pressure level in the external auditory canal. Pure tone bone conduction thresholds and sound pressure levels were measured, first with the ear canal open, then with the ear canal closed, at two positions of the bone vibrator and at five frequencies in 28 normal listeners. Statistical analyses revealed a significant difference between measures at 250, 500, and 1 000 cps but not at 2 000 and 4 000 cps. Average sound pressure level shifts tended to be larger than their threshold measure counterparts. The two measures, nevertheless, yielded positive correlations.

scholarly journals Fecal calprotectin is an early predictor of endoscopic response and histologic remission after the start of vedolizumab in inflammatory bowel disease

2020 ◽  
Vol 13 ◽  
pp. 175628482097976
Author(s):  
Renske W. M. Pauwels ◽  
Christien J. van der Woude ◽  
Nicole S. Erler ◽  
Annemarie C. de Vries
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Predictive Value ◽  
Fecal Calprotectin ◽  
Clinical Decisions ◽  
Inclusion Criteria ◽  
Inflammatory Bowel ◽  
A Prospective Study ◽  
Colonic Biopsies ◽  
Study Inclusion

Background and aims: Early prediction of the effect of vedolizumab (VDZ) in inflammatory bowel disease (IBD) is of paramount importance to guide clinical decisions. This study assessed whether early fecal calprotectin (FC) can predict endoscopic response and histologic remission after VDZ initiation. Methods: This was a prospective study. Inclusion criteria were endoscopic inflammation and FC >100 µg/g. FC was determined at baseline and weeks 2, 4, 8 and 16. At week 16, endoscopies with ileal and colonic biopsies were performed. FC changes were assessed with Wilcoxon Rank Sum tests. ROC statistics were used to assess the diagnostic accuracy of FC. Results: In total, 45 patients [27 Crohn’s disease (CD), 16/2 ulcerative colitis (UC)/IBD-unclassified] [40% males, median age 39 (28–51) years] were included. Week 16 endoscopic response and histologic remission rates were 58% and 33%. A median 37% decline in FC at week 2 was observed only in endoscopic responders, p = 0.025. FC <250 µg/g at week 8 predicted endoscopic response in both UC and CD (positive predictive value 100%), whereas absence of FC decline at week 8 corresponded with absence of endoscopic response in CD [negative predictive value (NPV) 82%] and absence of histologic remission in both UC and CD (NPV 90%). Conclusion: The onset of a decline in FC as early as week 2 is associated with endoscopic response to VDZ induction. FC <250 µg/g at week 8 is associated with endoscopic response, whereas absence of FC decline at week 8 is associated with absence of both endoscopic response and histologic remission. FC levels 8 weeks after the start of VDZ could be used to guide clinical decisions and might substitute for endoscopic response evaluation.

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