Tympanometry Comparison of Diabetic Type I and Diabetic Type II Rats

Hearing impairment affects over two-thirds of adults with diabetes. We investigated whether rat models of type 1 and type 11 diabetes display impaired auditory function. Tympanometry measurements were conducted in Sprague-Dawley rats (control, n = 20), streptozotocin-induced type I diabetic Sprague-Dawley rats (n = 20) at 42 - 56 days old;Zucker rats (Hos: ZFDM-Lean (fa/+, n = 20) and Zucker Type 2 Diabetic rats (ZFDM (Hos: ZFDM-fa/fa);n = 20)), 90 days old. All rats were male. Control animals had normal type A tympanograms. Tweny one (75%) of the tympanic membranes in the diabetic type I group produced abnormal tympanograms: 46% were type B, 28% had no peak found, and 1% were type C. The ear canal measurements were lower in the left ear in type I mice (0.19 ± 0.07) and higher in the left ear for type II mice (0.23 ± 0.15 ml) compared to the controls of 0.39 ± 0.14 ml) and (0.2 ± 0.12 ml) respectively (P < 0.0001). The compliances for the right ear and left ear were lower for the type II diabetic group (0.18 ± 0.05 ml) and (0.18 ± 0.05 ml) compared to the control group (0.28 ± 0.19 ml) and (0.28 ± 0.49 ml) (P < 0.0001) respectively. In conclusion, control rats exhibited type A tympanograms with a highly functional middle ear system. Diabetic type I rats (n = 20) mostly exhibited type B tympanograms with a less compliant middle ear system. Compliance was reduced in the diabetic type I and II animals compared to the control. Future studies should utilise histological methods alongside tympanometry. Sections of the middle ear could be used to analyze ossicle size and confirm size differences. This information would be useful in avenues for treatment options for hearing loss in diabetes.

Disagreement in middle ear volume estimation between tympanometry and three-dimensional volume reconstruction in the context of tympanic membrane perforation

Introduction: Middle ear volume(MEV) is a clinically relevant parameter across middle ear diseases. MEV values between these techniques have never before been tested for agreement in ears with perforated tympanic membranes(TMs).Methods: Middle ears were identified from 36 patients ranging 18-89 years of age with TM perforations who underwent tympanometry and temporal bone computed tomography(CT) between 2005 and 2015. MEVs calculated by both tympanometry and three-dimensional volume reconstruction(3DVR) were analyzed for agreement using Bland Altman plots. The differences between tympanometric and 3DVR MEV values for each given middle ear were characterized across MEV quartiles(1= smallest; 4= largest) and across increasing states of middle ear disease using Kruskale Wallis and Wilcoxon testing with Bonferroni correction.Results: Bland Altman plots demonstrated significant disagreement between MEV measurement techniques. Differences between tympanometric(T) and 3DVR MEV values were significantly greater with increasing average(i.e.(Tt3DVR)/2)) MEV per linear regression(p < 0.0001). Significance was demonstrated between fourth and first average MEV quartiles(p= 0.0024), fourth and second quartiles(p= 0.0024), third and first quartiles(p= 0.0048), and third and second quartiles(p= 0.048). Absolute MEV difference was not significantly different across varying states of middle ear disease(p= 0.44).Conclusion: Statistically and clinically significant disagreement was demonstrated between tympanometric and 3DVR MEV values. Studies that vary in MEV estimation techniques may be expected to demonstrate significantly different results. These preliminary results suggest that clinicians should endeavor to seek further confirmation when interpreting high tympanometric MEV values.

High-and Low-Frequency Probe Tone Tympanometry in Chinese Infants

Objective To assess the utility of low- and high-frequency tympanometry in the diagnosis of middle ear dysfunction in Chinese infants. Methods Tympanograms were obtained with 226 Hz, 678 Hz and 1000 Hz probe tones from infants aged 5-25 weeks with normal auditory brainstem responses(ABRs)(15 infants, 30 ears) and with prolonged wave I latencies(17 infants, 20 ears), suggesting middle ear dysfunction, using a GSI Tympstar middle ear analyzer Version II. Results The single-peaked tympanogram was the most characteristic type in both groups and seen in 25 ears (83.3%) in the normal ABR group and in 18 ears (90%) in the delayed wave I group, respectively. The peak pressure, peak compensated static acoustic admittance and gradient of 226 Hz tympanometry were of no significant differences between the two groups. The 678 Hz tympanograms of admittance, susceptance and conductance demonstrated non-peak, single-, double- and tri-peaked patterns in both groups. The agreement between ABRs and 678 Hz tympanograms of admittance,susceptance and conductance were 70.0%, 58.0% and 64.0%(kappa=0.324, 0.234 and 0.118) respectively. For 1000 Hz probe tone, admittance, susceptance and conductance tympanograms showed single peaked patterns in 28(93.3%), 25 (83.3%) and 26(86.7%) of the 30 normal ears. Admittance, susceptance and conductance tympanograms using the 1000 Hz probe tone were flat in 15 (75%), 17(85%) and 13 (65%) of the ears in infants with prolonged wave I latencies. For 1000 Hz admittance, susceptance and conductance Tympanograms, the agreement between tympanometry and ABR results were 90.0%, 92.0% and 86.0% with kappa at 0.783, 0.831 and 0.690, respectively. Conclusion 1000 Hz probe tone tympanometry is a promising middle ear function test for infants of 1-6 months age, while 226 Hz and 678 Hz probe tones are less efficient in detecting middle ear dysfunction in infants.

Why use tympanometry in general practice: A review

Otitis media is a frequent problem in preschool children and one of the most common reasons for treatment with antibiotics in children. The exact diagnosis is important for proper management. The diagnosis of otitis media is often difficult. Pneumatic otoscopy, otomicroscopy, and tympanometry can improve the diagnostic quality by indicating fluid or no fluid in the middle ear and thus improve the quality of treatment. The aim of this review is to explain why and how tympanometry can improve the diagnostic quality in otitis media, and to identify some barriers and difficulties encountered when using tympanometry in daily practice. The current literature on tympanometry and own experiences during 38 years are used to elucidate the aim. Tympanometry is difficult to understand and use, when the procedure is not properly trained. The problems are both of a technical nature, and it is difficult to understand and use the information from the curve and the figures on the display. If the use of tympanometry in general practice is increased, the diagnostic quality will improve and hopefully antibiotics will be prescribed on more appropriate indications and less frequently. More demand on tympanometry will hopefully reduce the price of the tympanometer, making it more accessible for GPs. First in that situation the use will be nearly as common as the use of the otoscope.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

婴儿分泌性中耳炎的听力学结果分析

目的 探讨226、1 000 Hz鼓室声导抗测试和气-骨导听性脑干反应(ABR)以及畸变产物耳声发射(DPOAE)在诊断低月龄婴儿分泌性中耳炎(OME)中的作用。方法 回顾性分析年龄为1~6个月的119例(192耳)中耳积液患儿(异常组)和66例(132耳)正常婴儿(正常组)的226、1 000 Hz鼓室声导抗测试和气-骨导ABR,以及DPOAE检测结果。结果 (1)OME婴儿,1 000 Hz鼓室声导抗异常图形(As型、B型、C型)有189耳(98.44%),226 Hz鼓室声导抗异常图形(As型、B型、C型)有135耳(70.31%);(2)OME婴儿ABR波Ⅰ潜伏期延长179耳(93.23%),ABR波Ⅴ反应阈中度异常69耳(35.94%)、轻度异常97耳(50.52%)、阈值正常26耳(13.54%),骨导ABR阈值正常164耳(85.42%),阈值轻度异常28耳(14.58%),气-骨导ABR阈值差值变大162耳(84.37%);(3)OME婴儿DPOAE未引出151耳(78.65%)。结论 1 000 Hz声导抗异常、气-骨导ABR阈值差变大、ABR波I潜伏期延长和气导ABR阈值异常对低月龄婴儿中耳积液的诊断有重要参考价值,226 Hz声导抗对部分低月龄婴儿中耳积液的诊断不能提供准确信息。

Hearing Assessment among Sudanese Rheumatoid Arthritis Patients versus Non-Rheumatoid Arthritis Individuals

Background: Rheumatoid arthritis (RA) disease is one of the most common chronic autoimmune diseases that affect many body systems including the auditory system. Objectives: To assess hearing thresholds and to ascertain types of hearing loss among Sudanese rheumatoid arthritis patients attending rheumatology clinic in Omdurman military hospital and matching them with non-rheumatoid arthritis subjects. Methodology: This descriptive and analytic (comparative) hospital based cross sectional study conducted from October 2020 to April 2021 which include 66 RA patients with age range (21 - 60 years) matched with 41 non-rheumatoid arthritis group sharing same characteristics (nation, gender and age). Pure tone audiometry, tympanometry and acoustic reflexes were done for all RA patients and matched groups. Statistical analysis of the data was carried out using the association and correlation tests for associations and t-test for independent samples. Results: Thirty-six (54.5%) of RA patients had hearing impairment versus 9 (22%) non-RA in PTA test. Twenty-four RA cases (36.3%) showed asymmetrical hearing threshold and graph in PTA between right and left ears. Thirty-four (51.5%) right and 36 (54.5%) left ears were normal degree followed by 23 (34.8%) in the right and 24 (36.4%) in the left ears were mild degree hearing loss. Among hearing impaired RA patients;20 right ears (62.5%) and 19 left ears (65.5%) had sensorineural hearing loss (SNHL), conductive hearing loss 11 (34.4%) right ears and 9 (31%) left ears. Mixed HL was in 1 right ear (3.1%) and 1 left ear (3.5%). The most common degree of SNHL type was mild in (75%) and (78.9%) in right and left ears respectively, moderate and moderate severe were (20%) in the right and (15.7%) in the left ears. Fifty-eight right ears (87.9%) and 56 left ears (84.8%) had type A tympanogram while 7 (10.6%) right ears and 9 left ears (13.6%) were type As tympanogram, one right and one left ears had type Ad tympanogram. Acoustic reflex was impaired in 17 right ears and 17 left ears (25.8% for both). There were significant statistical differences in most of the specific frequency means between the study group and non-rheumatoid group in the right and left ears p-value 0.05). Also there was no significant statistical association between anti-rheumatic drugs used and hearing threshold of RA patients (p-value > 0.05). Conclusion: Hearing impairment especially sensorineural type is common in Sudanese rheumatoid arthritis patients. Conductive hearing loss is less common and most likely due to ossicles diarthrodial joint stiffness. No influence of the disease activity or used anti-rheumatic drugs on hearing threshold of the RA patients was detected in this study.

Comparison of Allergic Rhinitis and Bronchial Asthma Impacts on Tympanometric Parameters in Children at Kano, Nigeria

Background: Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction that affects sino-nasal mucosa and is characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness and eyes itching. Bronchial asthma (BA) is one of the common childhood diseases that affects the respiratory system characterized by recurrent cough, wheezing, chest tightness and difficulty with breathing. The two conditions are different manifestations of allergic disease of the airway;the composition of the inflammatory substrate in the mucosa of allergic patients is similar to the late-phase allergic response seen elsewhere in the respiratory tract, such as in bronchial asthma. Aim: The aim was to compare the impacts of allergic rhinitis and bronchial asthma on tympanometric parameters in children. Patients & Methods: This is a hospital based comparative cross-sectional study. Two groups of participants aged 4 - 12 years, one group with documented clinical diagnosis of allergic rhinitis and the other group with documented clinical diagnosis of bronchial asthma were consecutively selected from ear, nose and throat (ENT) and pediatrics cardiopulmonary outpatient clinics of Aminu Kano Teaching Hospital Kano respectively. Equal number of children aged 4 - 12 years with no history of ENT diseases or bronchial asthma that were selected from elementary schools within the same community served as a control group. An interviewer-administered questionnaire was filled out for all the participants, complete ENT and chest examinations were carried out and subsequently all the selected participants had tympanometry done, findings were recorded and analyzed. Results: The mean age of participants with bronchial asthma was found to be 7.5 ± 2.6 years while participants with allergic rhinitis had the mean age of 6.8 ± 2.1 years. The mean middle ear pressure (MEP) of participants with bronchial asthma was found to be -15.22 dapa and -40.32 dapa in those with allergic rhinitis. Acoustic reflex was found to be absent in 15.4% of the participants with bronchial asthma and 29.6% of allergic rhinitis participants. Type B tympanogram was found in 2.8% of bronchial asthma participants and 7.3% in participants with allergic rhinitis. Type C tympanogram was found in 4.6% of participants with bronchial asthma and 15.5% of participants with allergic rhinitis. Type A tympanogram was found in 90% of participants with bronchial asthma and 75% of participants with allergic rhinitis. The difference between type A, B and C tympanograms of participants with bronchial asthma and those with allergic rhinitis was found to be statistically significant (Type A χ2 = 14.62, df = 4, p value = 0.01, Type B χ2 = 14.06, df = 4, p value = 0.01, Type C χ2 = 17.01, df = 6, p value = 0.01). Conclusion: Participants with allergic rhinitis were found to have more abnormalities of tympanometric parameters compared to participants with bronchial asthma which signifies allergic rhinitis conferred an increased risk of having middle ear diseases and otitis media with effusion compared to bronchial asthma.

Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy

Background Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods. Methods Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy, tympanometry, air-conduction auditory steady-state responses （AC-ASSR）, and computerized tomography （CT） before adenoidectomy. Results About 73.4% （304/414） of ears were confirmed to have middle ear effusion （MEE） by otoscopy; 75.4% （312/414） of ears revealed M EE by CT. CT scan correctly predicted all the myringotomy results, giving 100% accuracy on the diagnosis of MEE. Additionally, CT revealed two children with inner ear malformations. Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%. Type C tympanogram with peak pressure 〈-200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE. We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% （223/410） of ears were confirmed of hearing loss. Furthermore, 5.2% （16/310） of the ears with MEE suffered from severe to profound hearing loss. The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz （P 〈0.001） frequencies; 29.7% （92/310） of ears with MEE were regarded as normal hearing level. About 55.8% （173/310） of ears with MEE were classified as having slight-mild hearing loss. Conclusions The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy. CT scan is good for the assessment of MEE before ventilation tube insertion.

婴儿分泌性中耳炎评估方法

婴儿分泌性中耳炎在临床上较为常见，持续性中耳炎可导致听觉及言语发育障碍，因此应引起足够重视。近年来国内外报道226Hz探测音鼓室声导抗测试对6月龄以内婴儿中耳功能评估不敏感，1000Hz鼓室导抗图测试是婴儿中耳功能有效及可靠的方法。此外，在各种听力学检查方法中，有的参数也能很好反映婴儿的中耳功能。本文重点就婴儿分泌性中耳炎评估方法的研究现状做一综述，以便为早期发现、早期评估和早期治疗提供帮助。

Frequency of otitis media with effusion among children aged 1-5 years presenting to immunization center of tertiary care hospitals,Rawalpindi

Objective:We conducted this study to assess the etiopathogenic relation of otitis media with effusion(OME)in a group of children aged 1-5 years among the local population of Rawalpindi.Methods:This was a cross-sectional retrospective study.Study was conducted among the children presenting to the immunization center of three tertiary care hospitals of Rawalpindi.Otitis media was assessed by clinical examination and tympanometry from August 2019 to January 2020.Multi-factor regression analysis was then applied to recognize the statistical significance and association of various risk factors to OME.Results:Out of 400 children enrolled in this study,108(27.0%)had OME,out of which 65(60.2%)were males and 30(27.8%)were of age group 2-3 years.Multivariable regression analysis of risk factors associated with OME showed it was strongly associated with snoring(P<0.001),last year symptoms(attack of ear aches with hearing loss[P=0.002]),drugs(URTI antibiotics[P=0.026],All 3 drugs[P=0.013]).Conclusions:We found out that OME is a common disease which if not identified or treated timely can lead to other hard to cure health problems.Control of its etiopathogenic factors can play a major role in its prevention.