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Yilmaz N, Soylemez E, Sanuc MB, Bayrak MH, Sener V. Sound energy absorbance changes in the elderly with presbycusis with normal outer and middle ear. Eur Arch Otorhinolaryngol 2022; 280:2265-2271. [PMID: 36350367 DOI: 10.1007/s00405-022-07742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to investigate the wideband tympanometry (WBT) findings in the elderly with presbycusis who have normal outer and middle ears according to otoscopic examination and traditional tympanometry, and to determine whether there is a relationship between the middle ear wideband absorbance value and the pure tone air-bone gap (ABG) observed especially at mid-high frequencies in the elderly. METHODS The study included 30 elderly with presbycusis (> 65 years old, presbycusis group) and 30 healthy individuals (control group) between the ages of 18 and 55. Pure tone air conduction and bone conduction thresholds of all participants were determined and WBT was applied to all participants. Resonance frequency (RF), absorbance ratios at peak pressure (PPAR) and ambient pressure (APAR) values were analyzed. RESULTS The RF value of the presbycusis group was lower than the control group (p < 0.05). APAR and PPAR values at 2000 and 4000 Hz and mean absorbance values of the presbycusis group were lower than the control group (p < 0.05). APAR was higher at 500 Hz in males than females (p < 0.05), but there was no difference between genders in RFs (p > 0.05). A moderate negative correlation was observed between ABG and both PPAR and APAR at 4000 Hz in presbycusis group (p < 0.05). CONCLUSION it was determined that there was a decrease in RF and absorbances at 2000 and 4000 Hz in the elderly with presbycusis. Aging affects not only the inner ear but also the conduction mechanism of the middle ear. Our findings may be effective in a more accurate and reliable interpretation of WBT in the elderly with presbycusis.
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Durante AS, Nascimento PC, Almeida KD, Servilha TR, Marçal GJ, Neto OMDS. Wideband Acoustic Absorbance in Otosclerosis: Does Stapedotomy Restore Normal Tympanic Cavity Function?*. Int Arch Otorhinolaryngol 2022; 26:e730-e737. [DOI: 10.1055/s-0042-1748533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Otosclerosis is characterized by the fixation of the stapes to the oval window, thereby impairing acoustic signal absorbance. A commonly used surgical technique for improving hearing in cases of otosclerosis is stapedotomy. However, it is unclear whether this surgery restores all the physical characteristics of the tympano-ossicular system.
Objective To evaluate the tympano-ossicular system in individuals with fenestral otosclerosis pre and poststapedotomy using wideband tympanometry.
Method A total of 47 individuals and 71 ears were assessed. The subjects were divided into three groups: presurgery otosclerosis; postsurgery; and a control group of normal-hearing adults. A handheld tympanometer with a wideband module (226–8,000 Hz) was used to take measurements at ambient pressure and under pressurized conditions. The level of statistical significance adopted was p ≤ 0.05.
Results Acoustic absorbance at 226 Hz was low for all groups. At frequencies in the range 630 to 5,040 Hz, each group had a characteristic absorbance curve, allowing them to be distinguished from one another. In the presurgery group, absorbance values were below normal levels, with energy absorbance below 10%. Low energy absorbance was most evident at 1,000 Hz in the presurgery group, but this was not observed in the postsurgery group. Although there was an improvement in hearing, the surgery failed to restore the tympano-ossicular system to normal.
Conclusion Wideband acoustic absorbance proved able to differentiate normal ears and otosclerotic ears pre and postsurgery, under both ambient pressure and pressurized conditions.
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Affiliation(s)
- Alessandra Spada Durante
- Faculty of Speech-Language Pathology and Audiology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Polyana Cristiane Nascimento
- Faculty of Speech-Language Pathology and Audiology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Katia de Almeida
- Faculty of Speech-Language Pathology and Audiology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Thamyris Rosati Servilha
- Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Gil Junqueira Marçal
- Department of Otorhinolaryngology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Osmar Mesquita de Sousa Neto
- Department of Otorhinolaryngology, Escola de Ciências Médicas da Santa Casa de São Paulo. R. Dr. Cesário Mota Júnior, São Paulo, SP, Brazil
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Nie L, Li C, Marzani F, Wang H, Thibouw F, Grayeli AB. Classification of Wideband Tympanometry by Deep Transfer Learning with Data Augmentation for Automatic Diagnosis of Otosclerosis. IEEE J Biomed Health Inform 2021; 26:888-897. [PMID: 34181561 DOI: 10.1109/jbhi.2021.3093007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Otosclerosis is a common disease of the middle ear leading to stapedial fixation. Its rapid and non-invasive diagnosis could be achieved through wideband tympanometry (WBT), but the interpretation of the raw data provided by this tool is complex and time-consuming. Convolutional neural networks (CNN) could potentially be applied to this situation to help the clinicians categorize WBT data. A dataset containing 135 samples from 80 patients with otosclerosis and 55 controls was obtained. We designed a lightweight CNN to categorize samples into the otosclerosis and control. Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.95 0.011, and the F1-score was 0.89 0.031 (r=10). The performance was further improved by data augmentation schemes and transfer learning strategies (AUC: 0.97 0.010, F1-score: 0.94 0.016, p<0.05, ANOVA). Finally, the most relevant diagnostic features employed by the CNN were assessed via the activation pattern heatmaps. These results are crucial for the visual interpretation of WBT graphic outputs which clinicians use in routine, and for a better understanding of the WBT signal in relation to the ossicular mechanics.
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Karuppannan A, Barman A. Wideband absorbance tympanometry: a novel method in identifying otosclerosis. Eur Arch Otorhinolaryngol 2021; 278:4305-4314. [PMID: 33388979 DOI: 10.1007/s00405-020-06571-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/12/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the study was to know whether the wideband absorbance measurements can be a useful tool to identify ears with otosclerosis. The present study analyzed WBA measurements and highlighted its effectiveness in identifying ears with otosclerosis and differentiating from healthy normal ears. METHODS The study included 42 ears with otosclerosis which were compared with an equal sample size of healthy normal ears. WBA across frequencies and wideband average absorbance (375-2000 Hz) at the peak and ambient pressure, and resonance frequency were measured and analyzed. RESULTS Results showed that WBA levels increased with an increase in frequencies up to 2000 Hz and decreased thereafter, both in the otosclerosis and healthy normal ears. The mean WBA in the otosclerosis group was significantly lower in the 250-2000 Hz frequency range than in the healthy normal ear group. The WBA values at ambient pressure reduced significantly up to 500 Hz for the healthy normal ear group and 1500 Hz for otosclerosis group, compared with peak pressure. Further, the analysis of wideband average absorbance at ambient pressure showed reduced absorbance (0.35) and higher resonance frequency (1350.33 Hz) in the otosclerosis group compared with the healthy normal ear group (0.60 and 930.14 Hz, respectively). ROC analysis indicated that WBA is suitable for identifying otosclerotic ears and also in differentiating from healthy normal ears based on WBA values from 250 to 1500 Hz. High diagnostic values of WBA (> 90% sensitivity and specificity) were observed at a frequency of 1000 Hz. CONCLUSIONS The inclusion of WBA into clinical routine test procedures could be a useful tool for detecting otosclerosis. Further research is required to validate its clinical use in combination with other middle ear measures.
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Affiliation(s)
- Arunraj Karuppannan
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India.
| | - Animesh Barman
- Department of Audiology, All India Institute of Speech and Hearing, Manasagangothri, Mysuru, Karnataka, India
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Singh NK, Raul A, Malik G, Sao T. Intersession Variations in Frequency Tuning of Ocular Vestibular Evoked Myogenic Potentials in Healthy Individuals. Am J Audiol 2019; 28:407-413. [PMID: 31461334 DOI: 10.1044/2019_aja-ind50-18-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective Frequency tuning of ocular vestibular evoked myogenic potential (oVEMP), which is the stimulus frequency corresponding to the largest oVEMP amplitude, has been used to diagnose cases with Ménière's disease and differentiate them from cases with benign paroxysmal positional vertigo with a high degree of sensitivity and specificity. However, this measure of oVEMP is carved out of the peak-to-peak amplitude of oVEMP, and studies on test-retest reliability of amplitude of oVEMP have shown moderate-to-excellent reliability of amplitude. This would theoretically render the frequency tuning of oVEMP susceptible to variations across multiple recordings. This being the case, erroneous conclusions regarding the presence of Ménière's disease could be made if the frequency tuning varies between recordings. However, there is no published report regarding the test-retest reliability of frequency tuning measure of oVEMP even in healthy individuals, to the best of our knowledge. Therefore, this study aimed to study the test-retest reliability of frequency tuning of oVEMP in healthy individuals. Method The study included 20 healthy adults in the age range of 18-25 years. All participants underwent oVEMP recording in 4 different sessions, with each session consisting of oVEMP recording for octave and midoctave tone-burst frequencies from 250 to 2000 Hz. Results The results revealed no significant difference in frequency tuning of oVEMP among the sessions (p > .05). The intraclass correlation coefficient for frequency tuning data was found to be .857. Conclusion The frequency tuning of oVEMP has excellent test-retest reliability and therefore lends itself to applications requiring multiple sessions of recording.
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Affiliation(s)
- Niraj Kumar Singh
- Department of audiology, All India Institute of Speech and Hearing, Mysuru.,BASLP Unit, ENT Department, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Aradhana Raul
- BASLP Unit, ENT Department, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Garima Malik
- BASLP Unit, ENT Department, Netaji Subhash Chandra Bose Medical College, Jabalpur, India
| | - Tulsi Sao
- BASLP Unit, ENT Department, Netaji Subhash Chandra Bose Medical College, Jabalpur, India.,Department of ENT, BASLP Course, Pandit Jawahar Lal Nehru Memorial Medical College and Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur, India
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Effect of Probe-Tone Frequency on Ipsilateral and Contralateral Electrical Stapedius Reflex Measurement in Children With Cochlear Implants. Ear Hear 2019; 40:732-740. [DOI: 10.1097/aud.0000000000000656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mantzari E, Maragoudakis P, Kandiloros D, Ferekidis E, Korres SG. The profile of otoacoustic emissions and multifrequency tympanometry in otosclerotic patients undergoing two types of stapes surgery: small fenestra and microtraumatic stapedotomy. Med Sci Monit 2014; 20:1613-20. [PMID: 25205087 PMCID: PMC4167506 DOI: 10.12659/msm.890755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/01/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Otoacoustic emissions (OAEs) are influenced in otosclerosis. The aim of the current study was to investigate the profile of transient evoked (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) in association with multifrequency tympanometry measures in otosclerotic patients undergoing 2 types of stapes surgery: small fenestra and microtraumatic stapedotomy. MATERIAL AND METHODS A retrospective analysis of prospectively collected data was conducted evaluating 51 otosclerotic patients and 50 normal hearing subjects. Small fenestra and microtraumatic stapedotomy were performed in 27 and 24 patients, respectively. Pure tone audiometry (PTA) was always measured. Detection of TEOAEs and DPOAEs at 5 frequency steps (1, 1.4, 2, 2.8, and 4 kHz) preoperatively and at 2 and 5 months postoperatively, stratified by the type of surgery, represented the main goal of the study. Resonant frequency derived by multifrequency tympanometry was also evaluated. RESULTS All patients demonstrated improvement in hearing level postoperatively, with significant closure of air-bone gap on PTA. Resonant frequency values returned to normal after microtraumatic stapedotomy but were exceedingly decreased following the small fenestra technique. The detection of both TEOAEs and DPOAEs was improved, but when the detection was stratified by the tested frequencies, significant increase in the number of patients with detectable OAEs was observed, mainly during testing at 1 and 1.4 kHz. CONCLUSIONS Otosclerotic patients exhibited improvement in the detection of OAEs, particularly at low frequencies, after both procedures. Resonant frequency was normalized following the microtraumatic stapedotomy, whereas it is over-decreased after the small fenestra technique.
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Affiliation(s)
| | - Pavlos Maragoudakis
- Department of Otolaryngology, Athens National University, Attikon Hospital, Athens, Greece
| | - Dimitrios Kandiloros
- Department of Otolaryngology, Athens National University, Attikon Hospital, Athens, Greece
| | - Eleftherios Ferekidis
- Department of Otolaryngology, Athens National University, Hippokration Hospital, Athens, Greece
| | - Stavros G. Korres
- Department of Otolaryngology, Athens National University, Hippokration Hospital, Athens, Greece
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Sugasawa K, Iwasaki S, Fujimoto C, Kinoshita M, Inoue A, Egami N, Ushio M, Chihara Y, Yamasoba T. Diagnostic usefulness of multifrequency tympanometry for Ménière's disease. Audiol Neurootol 2013; 18:152-60. [PMID: 23392344 DOI: 10.1159/000346343] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 12/06/2012] [Indexed: 11/19/2022] Open
Abstract
Multifrequency tympanometry (MFT) is the measurement of the impedance of the middle ear transmission system at a wide range of frequencies from 200 Hz to 2 kHz. A potential use of MFT as a new diagnostic tool for detecting endolymphatic hydrops has recently been reported. However, its clinical usefulness for diagnosing Ménière's disease (MD) remains unclear. To evaluate the clinical usefulness of MFT as a new qualitative and diagnostic test for MD, we performed MFT in 70 patients with unilateral or bilateral MD and in 29 normal control subjects. The width of double peaks in the admittance tympanograms (Y width) at 2 kHz and the resonance frequency (RF) were analyzed, and receiver operating characteristic (ROC) curves were constructed. The Y width in MD-affected ears was significantly greater than that in control ears (p < 0.001). The RF in MD-affected ears was significantly lower than that in control ears (p < 0.01). Neither the Y width nor RF had a significant relationship with hearing levels or the results of caloric and vestibular myogenic potential testings. The area under the ROC curve was 0.71 for the Y width and 0.66 for the RF. At the optimal cutoff points, the sensitivity and specificity of the Y width were 47.3 and 86.8%, respectively, and those of the RF were 41.3 and 84.2%, respectively. These results indicated that MFT is significantly associated with the presence of MD, but its diagnostic accuracy is only modest. MFT is a simple, noninvasive test, which should be considered as a complementary test in the diagnosis of MD.
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Affiliation(s)
- Keiko Sugasawa
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Yasui T, Iwasaki S, Sugasawa K, Sakamoto T, Kashio A, Suzuki M, Kakigi A, Yamasoba T. Admittance tympanometry with 2-kHz probe tones in patients with low-frequency hearing loss. Laryngoscope 2012; 122:2252-5. [PMID: 22777819 DOI: 10.1002/lary.23439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 04/21/2012] [Accepted: 04/25/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the reliability of admittance tympanometry with 2-kHz probe tones in diagnosing ears with endolymphatic hydrops in patients with low-frequency hearing loss. STUDY DESIGN Case-control study. METHODS Thirty-six Japanese patients with low-frequency hearing loss (including 21 with Mènière disease, three with delayed endolymphatic hydrops, and 12 with acute or repetitious low-frequency sensorineural hearing loss), 18 patients with other types of hearing loss, and 16 subjects with normal hearing were enrolled at University of Tokyo Hospital. We measured the width of the splitting peaks in the admittance tymapnometry with 2-kHz probe tones. RESULTS Widths of the probe pressure corresponding to splitting peaks of admittance (Y) tympanometry were significantly greater in the ears with endolymphatic hydrops than in the ears without endolymphatic hydrops in patients with low-frequency hearing loss. Furthermore, the widths in the ears with endolymphatic hydrops were greater than those in ears with other types of hearing loss. Widths of >255 daPa were observed in 38% of ears with endolymphatic hydrops and low-frequency hearing loss and in 21% of ears with other types of hearing loss. CONCLUSIONS The current study demonstrated that wide splitting peaks of Y tympanometry are more frequently observed in ears showing low-frequency hearing loss than in those with other types of hearing loss, indicating that Y tympanometry can be used to diagnose endolymphatic hydrops in daily practice.
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Affiliation(s)
- Takuya Yasui
- Department of Otolaryngology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Sanford CA, Schooling T, Frymark T. Determining the presence or absence of middle ear disorders: an evidence-based systematic review on the diagnostic accuracy of selected assessment instruments. Am J Audiol 2012; 21:251-68. [PMID: 22585938 DOI: 10.1044/1059-0889(2012/11-0029)] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To conduct an evidence-based systematic review on the state of the evidence and the diagnostic accuracy of multifrequency tympanometry (MFT), 1000 Hz tympanometry, and wideband acoustic transfer functions in determining the presence or absence of middle ear disorders. METHOD A systematic search of the literature published between 1975 and 2011 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality. RESULTS Ten studies were included and focused on participants with otosclerosis or otitis media. Two studies investigated 1000 Hz tympanometry, 7 examined MFT, and 2 addressed wideband reflectance (WBR). Methodological quality varied. Positive likelihood ratios (LR+) were predominantly uninformative for MFT and were mixed for 1000 Hz tympanometry. LR+ values for WBR ranged from diagnostically suggestive to informative. Negative likelihood ratios (LR-) for 1000 Hz tympanometry and WBR were at least diagnostically suggestive. LR- values for MFT were mixed, with half considered clinically uninformative and half considered diagnostically suggestive. CONCLUSIONS Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of these technologies. Additional investigations are needed to determine which tools can most accurately predict middle ear status.
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Affiliation(s)
| | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
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Multi-frequency tympanometry: clinical applications for the assessment of the middle ear status. Indian J Otolaryngol Head Neck Surg 2012; 65:283-7. [PMID: 24427583 DOI: 10.1007/s12070-011-0470-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 12/26/2011] [Indexed: 10/14/2022] Open
Abstract
The aim of the present paper was to review the current knowledge on multi-frequency tympanometry and explore its role as a diagnostic tool in various otologic conditions. Literature review in Medline and other database sources. Prospective controlled, prospective comparative, and prospective cohort studies, animal studies, retrospective studies and systematic reviews. Multi-frequency tympanometry provides more accurate and detailed information about the middle ear dynamics than standard tympanometry. Otosclerosis and rheumatoid arthritis characteristically increase the resonant frequency (RF) of the middle ear. Ossicular chain discontinuity, atelectatic tympanic membrane, and otitis media with effusion typically decrease the RF of the middle ear. Multifrequency tympanometry can also assess the stage of rheumatoid arthritis in the presence of middle ear involvement. The RF can be affected by the mechanical impedance of the cochlea, and multi-frequency tympanometry can be helpful in the diagnostic workup of LVAS. Multi-frequency tympanometry can be a useful tool to predict the diagnosis of various middle ear pathologies preoperatively, due to the ensuing changes in the RF of the mechano-acoustic system of the middle ear, which can be accurately determined when this methodology is applied.
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Aural symptoms in patients with temporomandibular joint disorders: multiple frequency tympanometry provides objective evidence of changes in middle ear impedance. Otol Neurotol 2011; 31:1359-64. [PMID: 20679956 DOI: 10.1097/mao.0b013e3181edb703] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The association of temporomandibular joint (TMJ) disorders with aural symptoms, such as tinnitus, otic fullness, and subjective decrease of hearing acuity, is a well-established clinical observation. Although several hypotheses have been made about the otic-conductive origin of these complaints, conventional 226-Hz tympanometry has failed to demonstrate any middle ear abnormalities. The aim of this study was to evaluate patients with TMJ disorders with multiple frequency tympanometry (MFT). STUDY DESIGN Prospective clinical study. SETTING Outpatient clinic. PATIENTS The population of this study consisted of 40 patients with unilateral TMJ disorders diagnosed for longer than 1 month. INTERVENTIONS After verifying that there were no abnormal otoscopic findings, 226-Hz tympanometry, conventional pure-tone audiometry, brainstem auditory evoked potentials, and MFT were performed. MAIN OUTCOME MEASURE Resonant frequency (RF) values. RESULTS With the exception of MFT, no abnormal audiologic findings were revealed. The ear ipsilateral to the lesion demonstrated significantly higher (p = 0.002) RF values in comparison to the contralateral ear. The difference in RF values was more obvious in patients aged 45 years or younger. CONCLUSION The results of this study imply an increase in the stiffness of the middle ear, which has not been detected by conventional tympanometry. This represents the first concrete documentation of minor alterations in the conductive properties of the middle ear and seems to support the various hypotheses on the middle-ear origin of aural complaints in patients with TMJ disorders. Further studies are needed before a clear insight on the presumably multifactorial pathophysiology of these complaints can finally be reached.
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