Infant tympanometry: differential results by race

A Preliminary Attempt to Profile Tympanometric Measures in Infants Using High Frequency Probe Tones

There is dearth of published data on high frequency tympanometric measures for infants in Indian context. Aim of present study was to profile Peak compensated static acoustic admittance (Ytm), Tympanometric peak pressure (TPP), Tympanometric width (TW) and Equivalent ear canal volume (Vea) in infants. Cross-sectional study on 50 infants with present TEOAEs and with risk indicators for hearing loss. Tympanometry was performed using GSI-Tympstar for 678 and 1000 Hz probe tones. Descriptive statistics were used to determine mean, SD and minimum and maximum for both genders. Using 678 Hz, Ytm ranged from 0.09 to 1. 48 mmho (males) and 0.11 to 1.14 mmho (females), while with 1000 Hz ranged from 0.15 to 1.49 (males) and 0.13-1.61 mmho (females). Using 678 Hz, TPP ranged from -95 to 70 daPa (males) and -155 to 80 daPa (females), while with 1000 Hz ranged from -75 to 95 daPa (males) and -145 to 50 daPa (females). Using 678 Hz, TW ranged from 30 to 190 daPa (males) and 40-23 daPa (females), while with 1000 Hz ranged from 60 to 210 daPa (males) and 40-183 daPa (females). Using 678 Hz, Vea ranged from 0.11 to 1.7 mmho (males) and 0.14-2.5 mmho (females), while with 1000 Hz ranged from 0.14 to 2.0 mmho (males) and 0.14-3.6 mmho (males). This study was a preliminary attempt to profile the tympanic measures. Ytm values were lesser or similar to other studies, TPP and Vea values had lower and narrow range, while TW were more than previous studies.

Chinese children with nonsyndromic cleft lip/palate: Factors associated with hearing disorder

OBJECTIVES

This study examined the auditory status of Chinese children with nonsyndromic cleft lip/palate (NSCL/P), investigated factors associated with peripheral hearing loss and compared results with earlier studies in western countries.

METHODS

Case history profiles and audiological data from 148 Chinese children with NSCL/P, aged between 6 and 15 years, who attended the Cleft Lip and Palate Clinic Center in a major Chinese urban hospital from July 2012 to September 2013 were acquired. The audiological status of the participants was reviewed, based on the results of their pure tone audiometry, tympanometry and acoustic reflex thresholds assessments. Factors including age, gender, cleft type, residential locality and school achievement were examined in relation to auditory status.

RESULTS

Findings revealed that 17% of the Chinese children with NSCL/P had hearing impairment at the time of assessment. Unilateral hearing loss was noted in 12% of children and in 5% of cases bilateral hearing loss was noted. In the majority of cases the hearing loss was slight and conductive in nature. Age, gender, residential locality and school achievement were found to have no relationship with severity of hearing loss. Children with cleft lip showed a lower degree of hearing impairment than children with cleft palate or cleft lip and palate.

CONCLUSION

Similar to studies for western children, Chinese children with CL/P associated with no known syndrome are at risk of peripheral hearing loss, generally of conductive type. However, the prevalence of peripheral hearing loss appears to be less than in western children with NSCL/P. Ethnic/racial factors may be a major contributing factor accounting for the discrepancies between the current results and western studies.

Natural history of untreated otitis media

OBJECTIVE/HYPOTHESIS

Data from cohort studies and untreated groups in randomized controlled trials can be identified through systematic literature review and synthesized with meta-analysis to estimate natural history of acute otitis media (AOM) and otitis media with effusion (OME).

STUDY DESIGN

Systematic literature review and meta-analysis.

METHOD

Source articles were identified by MEDLINE search through August 2002 plus manual crosschecks of bibliographies and published meta-analyses. Data were abstracted independently by two investigators and combined with random effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI), and heterogeneity. Sensitivity analysis was performed.

RESULTS

Sixty-three articles met inclusion criteria. AOM symptoms improved within 24 hours without antibiotics in 61% of children (95% CI, 50-72%), rising to 80% by 2 to 3 days (95% CI, 69-90%). Suppurative complications were comparable if antibiotics were withheld (0.12%) or provided (0.24%). Children entered recurrent AOM trials with a mean rate of 5.5 or more annual episodes but averaged only 2.8 annual episodes while on placebo (95% CI, 2.2-3.4). No AOM episodes occurred in 41%, and only 17% remained otitis prone (3 or more episodes). OME after untreated AOM had 59% resolution by 1 month (95% CI, 50-68%) and 74% resolution by 3 months (95% CI, 68-80%). OME of unknown duration had 28% spontaneous resolution by 3 months (95%, CI 14-41%), rising to 42% by 6 months (95% CI, 35-49%). In contrast, chronic OME had only 26% resolution by 6 months and 33% resolution by 1 year.

CONCLUSIONS

The natural history of otitis media is very favorable. Combined estimates of spontaneous resolution provide a benchmark against which to judge new or established interventions. The need for surgery in children with recurrent AOM or chronic OME should be balanced against the likelihood of timely spontaneous resolution and the potential risk of learning, language, or other adverse sequelae from persistent middle ear effusion. Further research is needed to identify prognostic factors that can target children unlikely to improve spontaneously for earlier intervention.

Racial and gender effects on pure-tone thresholds and distortion-product otoacoustic emissions (DPOAEs) in normal-hearing young adults

This study examined racial and gender effects on behavioral thresholds and distortion-product otoacoustic emissions (DPOAEs) in the same subjects. Pure-tone behavioral thresholds and DPOAEs were measured in 60 young normal-hearing adult subjects (20 Caucasian, 20 Asian, 20 African-American, with ten females and ten males in each group). Behavioral thresholds were measured from 1000 through 16,000 Hz using Békèsy tracking. A DPOAE frequency sweep was measured with primary stimulus levels of L(1)/L(2)=60/45 dB SPL, and an f(2)/f(1) of 1.2 at discrete f(2) frequencies between 2000 through 12,000 Hz for each subject. Significant racial and gender differences in behavioral thresholds were found at 14,000 and 16,000 Hz, with the African Americans and females having the best hearing sensitivity. Based on the current results, similar findings for DPOAE frequency sweeps can be expected amongst different racial groups given that no significant differences were identified between the groups. To further define the effects of race and gender on auditory measures, future studies should include larger numbers of subjects, measurement of body size and middle ear reflectance, and examine emission generators.

Tympanometry of a diverse group of preschool aged children

OBJECTIVE

Ethnicity has been previously described as a risk factor for middle ear disease. Little data exist on the presence of middle ear disease based on tympanometry screening comparing Asian children and children of other races.

METHODS

Two hundred and seventy children aged 3-5 were screened with tympanometry at six Head Start sites in St. Paul, Minnesota during the months of September and October of 2004. Gender, age, and race/ethnicity was recorded and entered into a database, along with values for canal volume, static admittance, peak pressure, and tympanometric width.

RESULTS

Criteria for abnormal tympanometry were based on American Speech-Language Hearing Association (ASHA) recommendations for a failed tympanogram for 1-5 year olds (admittance <0.3 mmho or width >200 daPa). There were no statistically significant differences in failure rates between males and females. There were, however, more failures for Asian (predominantly Hmong) children compared to children of other races/ethnicities after adjusting for age and gender differences (OR=6.39, CI 3.65-11.2, p<0.001) and for children <4-years-old compared to children 4-5-years-old after adjusting for race and gender differences (OR=1.99, CI 1.03-3.84, p<0.05).

CONCLUSIONS

Asian children were more than six times as likely to fail tympanometry as children of other races/ethnicities. The explanation for this difference is likely to be multifactorial, and further research is needed to characterize this difference.

Tympanometry measures in native and non-native Hawaiian children

BACKGROUND

Ethnicity has been readily accepted as a variable affecting the incidence of otitis media, with certain indigenous groups having an increased risk of middle ear dysfunction. Tympanometry provides objective information on middle ear status, and findings obtained from this procedure have often served as a criterion for medical referral.

OBJECTIVE

To extend previous research and to facilitate use of normative tympanometry measures obtained from children with native Hawaiian ancestry.

METHODS

Data were collected from 718 ears of 359 children in academic levels ranging from preschool to third grade. Subjects were matched across groups (182 native Hawaiian; 177 non-native Hawaiian) for academic level and gender. Variables included physical ear-canal volume (Vec), tympanometric peak compliance (peak Y, also known as static admittance), tympanometric width (TW), and tympanometric peak pressure (TPP).

RESULTS

Significantly higher TW (F1,714=8.82, P=0.008) and TPP (F1,714=9.98, P=0.002) values occurred in ears of native Hawaiian children. Statistical interaction between gender and age was not significant.

CONCLUSION

Differences in tympanometric findings between groups suggest differences in middle ear function, and these findings continue to underscore the importance of including tympanometry within a hearing screening protocol for early identification of possible hearing impairment.

Lack of association of race/ethnicity and otitis media in the first 2 years of life

Race has been identified as a risk factor for otitis media (OM) in several studies. To further explore this, a database of visits with age at visit < 24 months was constructed from data captured electronically at a public health clinic in North Carolina between July 1994 and December 1996. Among 3,108 children with at least 1 visit, 45% were African-American, 26% were Latino, and 29% were White. There were no differences among the groups in episodes of OM per child or ratio of OM episodes to total visits per child. A cohort of 166 children with follow-up throughout their first 2 years of life was identified. In this group, being uninsured or having exposure to out-of-home child care was associated with an increased risk of OM. Race/ethnicity had no association with frequency of OM as measured by episodes per child, proportion with > or = 1 episode, or proportion with > or = 3 episodes.

Tympanometric norms for Chinese young adults

OBJECTIVE

To obtain tympanometric norms in Southern Chinese young adult population and compare the results with data obtained for a Caucasian population.

DESIGN

Ear canal volume (Vea), tympanometric compensated static acoustic admittance (Peak Ytm), tympanometric width (TW) and tympanometric peak pressure (TPP) were obtained on 100 Southern Chinese young adults. Results were compared with findings from Roup et al. (1998). Inter-tester reliability was established.

RESULTS

Compared with the results obtained by Roup et al. (1998) on non-Hispanic Caucasian population, Southern Chinese subjects were found to have lower Peak Ytm, wider TW and more positive TPP values. No gender difference was noted for Peak Ytm, TW and TPP values in Chinese subjects. Inter-tester reliability was good.

CONCLUSION

The tympanometric norms obtained in this study are recommended when evaluating middle ear function among Southern Chinese young adults.

Relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion in the first two years of life

The relation of infant feeding practices, cigarette smoke exposure, and group child care to the onset and duration of otitis media with effusion (OME) was evaluated in a cohort of 698 healthy infants prospectively monitored by tympanometry in the home every 2 to 4 weeks until 2 years of age. Except for an experimental group of children who were offered early tube placement, the study children received conventional care from their personal physician or clinic. We used LISREL, a structural equation modeling procedure (computer software), to explore associations between environmental variables and OME onset and duration while controlling for interrelations among the variables. Supine feeding position and early initiation of group child care were associated with earlier onset of OME. Shorter duration of breast-feeding, increased packs of cigarettes smoked per day in the home, and increased hours per week in group child care were associated with an increase in the amount of time with OME during one or more of the age blocks studied (birth to 6, 6 to 12, 12 to 18, and 12 to 24 months). For a decrease in the amount of time with OME during the first 2 years of life, prolonged breast-feeding and upright feeding position should be encouraged, and cigarette smoke exposure should be minimized. Limiting early child care in large groups might also be advisable.