scholarly journals Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

2017 ◽  
Vol 28 (09) ◽  
pp. 838-860 ◽  
Author(s):  
Douglas H. Keefe ◽  
Kelly L. Archer ◽  
Kendra K. Schmid ◽  
Denis F. Fitzpatrick ◽  
M. Patrick Feeney ◽  
...  
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Group Delay ◽  
Surgical Intervention ◽  
Broadband Noise ◽  
Positive Pressure ◽  
Control Group ◽  
Corrective Surgery ◽  
Ear Canal ◽  
Reflex Threshold

AbstractOtosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis.To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis.A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group.The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female).Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25–8 kHz), reflectance tests (0.25–8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1–8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears.Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7–1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35–0.7 kHz, and at 2.8–4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic.Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.

Factors Influencing the Acoustic-Immittance Characteristics of the Acoustic Reflex

1979 ◽  
Vol 22 (3) ◽  
pp. 480-499 ◽  
Author(s):  
Richard H. Wilson
Keyword(s):  
Middle Ear ◽  
Sound Pressure ◽  
Broadband Noise ◽  
Intensity Level ◽  
Ear Canal ◽  
Acoustic Reflex ◽  
Impedance Characteristics ◽  
Reflex Threshold ◽  
Acoustic Reflex Threshold ◽  
Tonal Stimuli

Measurements of the aural acoustic-immittance (admittance and impedance) characteristics of the middle-ear transmission system in humans during the quiescent (static) and reflexive states were made (N = 36) utilizing a signal-averaging technique. Three pure tones (750, 1000, and 2000 Hz) and broadband noise stimuli elicited the acoustic reflex in 2-dB steps at sound-pressure levels from 84–116 dB (tones) and 66–116 dB (noise) during ascending- and descending-intensity level runs. The contralateral middle-ear activity was monitored with a 220-Hz probe by digitizing the conductance and susceptance outputs of an admittance meter. A computer corrected for the ear-canal volume utilizing measurements made at ear-canal pressures of 0 and −350 daPa and then converted the conductance and susceptance values into admittance and impedance units. The results were reported in absolute and relative immittance units, including components, as a function of both stimulus sound-pressure level and intensity level above the acoustic-reflex threshold. The static immittance of the middle ear changed nonlinearly over time to lower admittance or higher impedance values. The influence of this static-immittance shift on the reflex magnitude was discussed. The largest mean reflex magnitude and the slowest rate of growth were observed with broadband noise, although eight of the 36 subjects demonstrated the largest reflex magnitude in response to one or more of the tonal stimuli. Although static-immittance values and acoustic-reflex thresholds were poorly correlated, the reflex magnitudes were proportional to static immittance. The variability of the reflex measures was similar to the variability of the static-immittance values. Finally, bi-directional changes in resistance during the reflexive state were observed and discussed.

Squamous Epithelium in the Middle Ear and Sinus

1994 ◽  
Vol 73 (1) ◽  
pp. 47-48
Author(s):  
Alper Tutkun ◽  
Caglar Batman ◽  
Cüneyt Üneri ◽  
Mehmet Ali Sehitoglu
Keyword(s):  
Middle Ear ◽  
Statistical Difference ◽  
Squamous Epithelium ◽  
Normal Skin ◽  
University Hospital ◽  
Control Group ◽  
Study Group ◽  
External Ear ◽  
Ear Canal ◽  
Superior Part

This study has been performed between December 1990—March 1991 in the Microsurgery laboratory of the Marmara University Hospital. Twelve healthy albino guinea pigs were used as a study group while the control group consists of three animals. The potentials for cholesteatoma formation of the squamous epithelium, namely the squamous epithelium of the posterior superior part of the external ear canal skin and normal skin, were investigated. Among 24 subjects who were implanted by canal skin, cholesteatoma was fanned in 21 of them. Likewise, 19 of 24 animals implanted by normal skin came out with cholesteatoma formation. Between these two types of epithelium, there is no statistical difference in cholesteatoma formation (p >0.5).

Normative Sweep Frequency Impedance Measures in Healthy Neonates

2014 ◽  
Vol 25 (04) ◽  
pp. 343-354 ◽  
Author(s):  
Venkatesh Aithal ◽  
Joseph Kei ◽  
Carlie Driscoll ◽  
Andrew Swanston ◽  
Katrina Roberts ◽  
...  
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Static Pressure ◽  
Auditory Brainstem ◽  
Ear Canal ◽  
Sweep Frequency ◽  
Tone Frequency ◽  
Automated Auditory Brainstem Response ◽  
Brainstem Response ◽  
Stapedial Reflex

Background: Diagnosing middle ear disorders in neonates is a challenging task for both audiologists and otolaryngologists. Although high-frequency (1000 Hz) tympanometry and acoustic stapedial reflex tests are useful in diagnosing middle ear problems in this age group, they do not provide information about the dynamics of the middle ear in terms of its resonance frequency (RF) and mobility. The sweep frequency impedance (SFI) test can provide this information, which may assist in the diagnosis of middle ear dysfunction in neonates. Purpose: This study aimed to investigate the feasibility of testing neonates using the SFI technique, establish normative SFI data for RF and mobility of the middle ear in terms of changes in sound pressure level (ΔSPL in dB), and describe the dynamics of the middle ear in healthy Australian neonates. Study Sample: A prospective sample of 100 neonates (58 males, 42 females) with a mean gestational age of 39.3 wk (SD = 1.3 wk; range = 38–42 wk), who passed all three tests, namely, automated auditory brainstem response, transient evoked otoacoustic emissions, and 1000 Hz tympanometry, were included in this study. Data Collection and Analysis: A SFI research prototype was used to collect the data. First, the SPL in the ear canal was measured as a probe-tone frequency was swept from 100–2000 Hz with the ear canal static pressure held constant at 200 daPa. Then, this measurement was repeated with the static pressure reduced in 50 daPa steps to –200 daPa. Additional measurement was also performed at the static pressure, where the peak of the 1000 Hz tympanogram occurred. A graph showing the variation of SPL against frequency at all static pressures was plotted. From this graph, the RF and ΔSPL at tympanometric peak pressure (TPP) were determined. Descriptive statistics and an analysis of variance (ANOVA) were applied to the RF and ΔSPL data with gender and ear as independent variables. Results: The results showed two resonance regions of the outer/middle ear with the high RF (mean = 1236 Hz; 90% range: 830–1518 Hz) being approximately equal to four times that of the low RF (mean = 287 Hz; 90% range = 209–420 Hz). The low RF was more easily identifiable than the high RF. The ΔSPL at the low RF (mean = 8.2 dB; 90% range = 3.4–13 dB) was greater than that at the high RF (mean = 5.0 dB; 90% range = 1.5–8.1 dB). There were no significant differences or interactions between genders and ears. Conclusion: The study showed that the SFI is a feasible test of middle ear function in neonates. The SFI results revealed two regions of resonance with the lower resonance (287 Hz) possibly related to the movements of the outer ear canal wall and higher resonance (1236 Hz) related to the resonance of the middle ear. The normative data developed in this study will be useful in evaluating outer and middle ear function in neonates.

Reverse Cochlear Propagation in the Intact Cochlea of the Gerbil: Evidence for Slow Traveling Waves

2010 ◽  
Vol 103 (3) ◽  
pp. 1448-1455 ◽  
Author(s):  
Sebastiaan W. F. Meenderink ◽  
Marcel van der Heijden
Keyword(s):  
Traveling Waves ◽  
Otoacoustic Emissions ◽  
Group Delay ◽  
Basilar Membrane ◽  
Pressure Waves ◽  
Travel Times ◽  
Acoustic Measurements ◽  
Ear Canal ◽  
Direct Pressure ◽  
Cochlear Microphonic Potential

The inner ear can produce sounds, but how these otoacoustic emissions back-propagate through the cochlea is currently debated. Two opposing views exist: fast pressure waves in the cochlear fluids and slow traveling waves involving the basilar membrane. Resolving this issue requires measuring the travel times of emissions from their cochlear origin to the ear canal. This is problematic because the exact intracochlear location of emission generation is unknown and because the cochlea is vulnerable to invasive measurements. We employed a multi-tone stimulus optimized to measure reverse travel times. By exploiting the dispersive nature of the cochlea and by combining acoustic measurements in the ear canal with recordings of the cochlear-microphonic potential, we were able to determine the group delay between intracochlear emission-generation and their recording in the ear canal. These delays remained significant after compensating for middle-ear delay. The results contradict the hypothesis that the reverse propagation of emissions is exclusively by direct pressure waves.

Injectable Form of Cross-Linked Hyaluronan is Effective for Middle Ear Wound Healing

2007 ◽  
Vol 116 (9) ◽  
pp. 667-673 ◽  
Author(s):  
Simon Angeli ◽  
Sarah Connell ◽  
Brian Gibson ◽  
Ali Ozdek ◽  
John T. McElveen ◽  
...  
Keyword(s):  
Wound Healing ◽  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Inflammatory Cells ◽  
Control Group ◽  
Term Study ◽  
Distortion Product ◽  
Long Term Study ◽  
Group 2 ◽  
Group 1

Objectives: Two studies were designed to investigate a hyaluronan (HA) gel for middle ear (ME) wound healing. Methods: We used a guinea pig model of ME wound healing. In a long-term study, we performed a comparison of hearing and ME inflammation in 3 groups. Group 1 (n = 8) underwent bilateral wounding of ME mucosa and unilateral packing of the ME with HA gel (Sepragel). Group 2 (n = 6) was the same as group 1 except that the packing was absorbable bovine collagen sponges (Gelfoam). Group 3, the control group (n = 14), had operated, unpacked ears. In a short-term study, we investigated ME retention of HA gel at 1 and 2 weeks (n = 16). Results: At 1 week, all ears showed decreased distortion product otoacoustic emissions (DPOAEs) and auditory brain stem responses (ABRs) secondary to ME packing and postsurgical inflammation. The controls recovered preoperative DPOAEs and ABRs by week 2. Group 1 had decreased low-frequency DPOAEs at weeks 2 and 6, but their high-frequency DPOAEs and ABRs recovered to preoperative values by week 6. Group 2 had hearing losses that persisted throughout the study. Group 1 showed normal ME and inner ear histologic characteristics. Group 2 showed inflammatory cells within the ME and cochleas. Group 1 showed less packing retention than did group 2 at week 6 (p = 016). Eighty-five percent of the HA packing remained at 1 week, and 73% at 2 weeks. Conclusions: Hyaluronan gel was a relatively safe and effective ME packing material in our animal model.

Identifying otosclerosis with battery of aural acoustical tests of absorbance, group delay, reflex threshold, and chirp-evoked otoacoustic emissions

2014 ◽  
Vol 135 (4) ◽  
pp. 2277-2277
Author(s):  
Douglas H. Keefe ◽  
Kelly L. Archer ◽  
Kendra K. Schmid ◽  
Denis F. Fitzpatrick ◽  
M. Patrick Feeney ◽  
...  
Keyword(s):  
Otoacoustic Emissions ◽  
Group Delay ◽  
Reflex Threshold

Otoacoustic Emissions

1991 ◽  
Vol 1 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Theodore J. Glattke ◽  
Sharon G. Kujawa
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Great Promise ◽  
Ear Canal ◽  
Auditory Periphery ◽  
Screening Programs ◽  
The Status ◽  
Cochlear Partition ◽  
Tonal Stimuli

Otoacoustic emissions are low-intensity sounds that are produced in the cochlea and transmitted through the middle ear apparatus to the ear canal. They can be detected and extracted from the background noise in the ear canal through the use of a sensitive microphone and selective filtering or averaging techniques. The technical aspects of emission recording are very similar to those associated with the detection and capture of auditory evoked potentials. Emissions provide an acoustic link to a physiological window through which we can view the auditory periphery using frequency-specific stimuli that are presented at low and moderate intensities. The window provides an opportunity to examine cochlear activity that occurs prior to stimulation of the nervous system. Tonal emissions occur spontaneously in approximately 40% of people who have normal thresholds for pure-tone stimuli. SOAE and other types of emissions may be influenced by both ipsilateral and contralateral stimuli. One form of interaction results in suppression of the emission, and the tuning patterns associated with suppression of emissions by ipsilateral stimuli have characteristics that are similar to tuning patterns associated with single cochlear hair cells and individual neurons of the auditory nerve. These findings and other lines of evidence support the conclusion that an emission having tonal characteristics is produced from a very restricted region of the cochlear partition. Emissions may be evoked by brief click or tonal stimuli, and by continuous tonal stimuli, in virtually all individuals who have normal pure-tone thresholds and uncompromised middle ear systems. The EOAE are compromised by conditions that compromise the function of the cochlea, and they hold promise as tools that might be employed in screening for hearing loss. Preliminary findings suggest that screening employing TEOAE produces a yield that is similar to that produced by screening programs based on auditory brainstem responses. Emissions may offer advantages over current screening methods because of the ease with which they can be recorded and their apparent independence from neurological influence. Many questions regarding the origin and nature of emissions remain unanswered, but they appear to offer great sensitivity to the status of the auditory periphery. DPOAE provide an opportunity to scan the cochlear partition from base to apex with frequency-specific stimuli, and give the examiner a detailed view of the status of the end organ. The study of DPOAE holds great promise in refinement of site of lesion identification. It is exciting to witness the development of a tool to help clinical examiners probe the function of the previously inaccessible cochlea.

Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up

2011 ◽  
Vol 7 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Maggie Bellew ◽  
Mark Liddington ◽  
Paul Chumas ◽  
John Russell
Keyword(s):  
Developmental Delay ◽  
Surgical Intervention ◽  
Surgical Correction ◽  
Control Group ◽  
Corrective Surgery ◽  
Developmental Assessment ◽  
Sagittal Synostosis ◽  
Locomotor Function ◽  
Locomotor Control

Object The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age. Methods The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8–39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age). Results The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients. Conclusions The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.

Effects of External Ear Canal Pressure on the Middle-Ear Muscle Reflex Threshold

1974 ◽  
Vol 17 (3) ◽  
pp. 526-530 ◽  
Author(s):  
Frederick N. Martin ◽  
Sherry Coombes
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
External Auditory Canal ◽  
Acoustic Impedance ◽  
Normal Hearing ◽  
Air Pressure ◽  
External Ear ◽  
Ear Canal ◽  
Acoustic Reflex ◽  
Reflex Threshold

Twenty normal-hearing individuals served as subjects in an experiment designed to determine the relationships between positive and negative air pressure in the external auditory canal and the intensity required to elicit the acoustic reflex. Pressure was varied from +240 to −240 mm H 2 O. Changes in the magnitude of acoustic impedance were measured on an acoustic impedance meter and displayed graphically on a Y-T recorder. As air pressure was varied in the canal and the tympanic membrane was displaced from its position of greatest compliance, systematic increases in the intensity required to elicit the reflexes were noted. The magnitude of the differences was smaller than might have been anticipated, not exceeding a mean of 5.1 dB at −240 mm H 2 O.

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