Comparison of the tympanogram and otoscopic findings in effusions of middle ear

Öz

Objective: The aim of this study was to investigate the role of tympanogram test in routine use comparing the tympanogram findings and otoscopic examination find­ings in patients with suspicious otitis media with effusion. Materials and methods: 64 outpatients with suspicious otitis media with effusion presented at our Otorhinolar­yngology clinic and first otoscopic examination and then tympanometric examination was performed for their 128 ears. Predictions of the physicians who performed oto­scopic examination for outcomes from tympanogram and actual tympanogram outcomes were compared. Results: Predictions of the physician for otoscopic ex­amination were different from tympanogram outcomes in 22.6 percent (n=29) of 128 otoscopic examinations in total. However, the physician predicted Type A tym­panogram suggesting no effusion in only four of these otoscopic examinations yet Type B or Type C outcomes suggesting existence of effusion were obtained from tym­panogram. Conclusion: Application of tympanogram test routinely as part of otologic examination to each patient is a cause of material loss. Our first choice should be otoscopic ex­amination.

Anahtar Kelimeler

• Otitis media with effusion, tympanogram, otoscope

Orta kulak efüzyonlarında timpanogram ile otoskopik bulguların karşılaştırılması

Öz

Amaç: Efüzyonlu otitis media şüpheli olgularda timpa­nogram bulgularının otoskopik muayene bulguları ile karşılaştırılarak timpanogram testinin rutin kullanımdaki yerinin sorgulanması. Gereç ve yöntem: Efüzyonlu otitis media şüphesi ile Ku­lak Burun Boğaz (KBB) polikliniğimize ayaktan başvuran 64 olgunun 128 kulağına otoskopik muayene ve sonra­sında timpanometrik inceleme yapıldı. Otoskopik mua­yeneyi yapan hekimlerin timpanogramda çıkacak sonuç hakkında tahminleri ile gerçek timpanogram sonuçları karşılaştırıldı. Bulgular: İncelemeye dahil edilen toplam 128 otoskopik muayenenin 29\'unda (%22,6) hekimin otoskopik muaye­ne tahmini ile timpanogram sonucu aynı çıkmadı. Ancak bu otoskopik muayenelerin sadece dördünde hekim ta­rafından efüzyon olmadığını düşündüren Tip A timpanog­ram tahmini yapılırken, timpanogram işleminde efüzyon varlığını düşündüren Tip B veya Tip C sonuçları elde edil­miştir. Sonuç: Timpanogram testinin otolojik muayenenin bir parçası olarak rutin olarak her hastaya uygulanması za­man ve maddi kayıp sebebidir. Bu nedenle öncelikli seçe­neğimiz otoskopik muayene olmalıdır.

Anahtar Kelimeler

• Efüzyonlu otitis media, timpanogram, otoskop

Kaynakça

1. Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol 1970;92:311-24.
2. Zielhuis GA, Rach GH, Van Den Broek P. Screening for otitis media with effusion in preschool children. Lancet 1989;11;1(8633):311-4.
3. Casselbrant ML, Brostoff LM, Cantekin EI, et al. Otitis me- dia with effusion in preschool children. Laryngoscope 1985;95:428-36.
4. Vergison A, Dagan R, Arguedas A, et al. Otitis media and its consequences: beyond the earache. Lancet Infect Dis 2010;10:195-203.
5. Brake MK, Jewer K, Flowerdew G, et al. Tympanocentesis re- sults of a canadian pediatric myringotomy population, 2008 to 2010. J Otolaryngol Head Neck Surg 2012;41:282-7.
6. Birch L, Elbrond O. Prospective epidemiological study of se- cretory otitis media in children not attending kindergarten: an incidence study. Int J Pediatr Otorhinolaryngol 1986;11:191-7
7. Watters GN, Jones JE, Freeland AP. The predictive value of tympanometry in the diagnosis of middle ear effusion. Clin Otolaryngol 1997;22:343-5.
8. Preston K. Pneumatic otoscopy: a review of the literature Issues Compr Pediatr Nurs 1998;21:117-28.

9. Helenius KK, Laine MK, Tahtinen PA, et al. Tympanometry in discrimination of otoscopic diagnoses in young ambulatory children. Pediatr Infect Dis J 2012;31:1003-6.
10. Kumral TL, Veyseller B, Ulusan M, et al. Value of otoacoustic emission tests in the diagnosis and follow-up of the otitis media with effusion. Kulak Burun Boğaz İhtis Derg 2010;20:123-8.
11. Ren DD, Wang WQ. Assessment of middle ear effusion and audiological characteristics in young children with adenoid hypertrophy. Chin Med J (Engl) 2012;125:1276-8.