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Identification of Conductive Hearing Loss in Young Infants Using Tympanometry and Wideband Reflectance

Prieve, Beth A.1; Vander Werff, Kathy R.1; Preston, Jonathan L.2; Georgantas, Lea3

doi: 10.1097/AUD.0b013e31826fe611
Research Articles
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Objective: The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants.

Methods: Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen’s d and likelihood ratios were computed for comparison with statistically significant differences.

Results: Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen’s d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32.

Conclusions: CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz.

Middle ear measures are a critical and recommended part of the test battery for diagnosis of hearing loss in early infancy. This study aimed to determine the effectiveness of tympanometry and wideband reflectance for identifying conductive hearing loss in infants aged approximately 2 months. Tympanometry was measured using probe tones of 226, 678, and 1000 Hz, and admittance of the middle ear was calculated in various ways. Tympanometry using a 1000 Hz probe tone and wideband reflectance were both found to be effective in identifying conductive hearing loss in young infants.

1Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, Syracuse, New York, USA; 2Department of Communication Disorders, Southern Connecticut State University, New Haven, Connecticut, USA; 3Department of Audiology, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA.

ACKNOWLEDGMENTS: The authors are grateful to Lisa Lamson and Nicole Anzalone for expert data management, assistance with measurements and statistics, and article preparation.

This study was funded by the March of Dimes Birth Defects Foundation.

The authors declare no conflicts of interest.

Address for correspondence: Beth A. Prieve, Department of Communication Sciences & Disorders, 805 S. Crouse Avenue, Syracuse, NY 13244, USA. E-mail: baprieve@syr.edu

Received December 22, 2011

Accepted August 6, 2012

© 2013 by Lippincott Williams & Wilkins