Çocuklarda Orta Kulak Patolojisini Belirlemede Geniş Bant Absorbans Ölçümünün Etkinliğinin Araştırılması

Yıl 2021, , 385 - 402, 31.08.2021

Emrah Yıldız Hande Evin Eskicioğlu , Aslı Çakır Selhan Gürkan Taner Kemal Erdağ Günay Kırkım

https://doi.org/10.21020/husbfd.839780

Öz

Amaç: Bu çalışmanın amacı çocuklarda iletim tipi işitme kaybı (İTİK)’in öngörülmesinde ve efüzyonlu otitis media (EOM)’nın belirlenmesinde geniş bant absorbans (GBA) ölçümünün etkinliğini değerlendirmektir.
Gereç ve Yöntem: GBA ve saf ses odyometri eşikleri normal orta kulak durumu ile 34 çocuktan (56 kulak) (yaş aralığı 3.58 ile 10.83 yıl, ortalama 7.01 yıl) ve İTİK’li 40 çocuktan (73 kulak) (yaş aralığı 3.42 ile 9.67 yıl, ortalama 6.04 yıl) ölçüldü. Katılımcılar aşağıdaki kriterlere dayalı olarak CHL grubuna dahil edildi: Hava-kemik aralığı (HKA) en az bir frekansta 20 dB ya da en az iki frekansta 15 dB, ve İTİK’in muhtemel nedeni olarak EOM ya da tuba Eustachii disfonksiyonu değerlendirildi. Bu iki ölçüm verisi GBA ve İTİK’in derecesi arasındaki ilişkiyi açıklamak amacıyla incelendi. Pearson korelasyonu ve regresyon analizi GBA’nın öngörü yeteneğini değerlendirmek için kullanıldı. ROC analizi duyarlılık ve özgüllük oranlarını belirlemek için uygulandı.
Bulgular: Absorbans İTİK grubunda tüm frekanslarda kontrol grubundan daha düşük gözlendi. Pearson korelasyon analizinde HKA ile ortam basıncındaki GBA arasında güçlü, anlamlı ve negatif korelasyon (R>0,69, p<0,000) bulundu. Regresyon analizinde HKA ile ortam basıncındaki GBA arasında, lineer modelde R-kare=0,779, kübik modelde R-kare=0,810, logaritmik modelde R-kare=0,783 bulundu.
Sonuç: ROC eğrisi altında kalan alan (AUC)’ye göre, ortam basıncındaki GBA, 226 Hz komplians ve timpanometrik genişliğe göre İTİK için daha iyi bir öngörü faktörü olarak düşünülebilir. GBA testi orta kulağın mekanik özelliklerini ölçmek için klinik bir tanı aracı olarak kullanılabilir ve aynı zamanda EOM hakkında daha ayrıntılı bilgi verebilir.

Anahtar Kelimeler

Geniş Band Timpanometri, Geniş Band Absorbans, Otitis Media, İletim Tipi İşitme Kaybı

Destekleyen Kurum

Dokuz Eylül Üniversitesi Bilimsel Araştırmalar Koordinasyon Birimi

Proje Numarası

2016.KB.SAG.006

Teşekkür

Çalışma Dokuz Eylül Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi tarafından 2016.KB.SAG.006 proje numarası ile desteklenmiştir.

Researching of the Efficiency of Wideband Absorbance Measurement in Determining Middle Ear Pathology in Children

Öz

Objective: The aim of the present study was to evaluate the efficiency of wideband absorbance (WBA) measurement in identifying Otitis media with effusion (OME) and in predicting conductive hearing loss (CHL) in children.
Methods: WBA and pure tone audiometry thresholds were measured from 34 children (56 ears) with normal middle ear status (age range 3.58 to 10.83 years, mean 7.01 years) and 40 children (73 ears) with CHL (age range 3.42 to 9.67 years, mean 6.04 years). Participants were included the CHL group based on the following criteria: Air-bone gap (ABG) 20 dB for at least one frequency or 15 dB for at least two frequencies, and otitis media or tuba Eustachii disfunction judged to be the possible cause of CHL. Two measurements data were analyzed to explain the relationship between WBA and the degree of CHL. Pearson correlation, and the regression analysis were used to evaluate the predicting ability of WBA. ROC analysis was performed to determine the sensitivity and the specificity rates.
Results: Absorbance at all frequencies in the CHL group was smaller than the control group. The pearson correlation analysis was found strong, significant and negative correlation (R>0,69, p<0,000) between ABG and WBA at ambient pressure. The regression analysis was found at linear model R-squared=0,779, at cubic model R-squared=0,810, at logarithmic model R-squared=0,783 between ABG and WBA at ambient pressure.
Conclusion: Based on the area under the ROC (AUC), WBA in ambient pressure was better predictors of CHL than 226 Hz compliance and tympanometric width. WBA testing may be used as a clinical diagnostic tool to measure the mechanic properties of the middle ear and also may give more detailed information about OME.

Anahtar Kelimeler

Wideband Tympanometry, Wideband Absorbance, Otitis Media, Conductive Hearing Loss

Proje Numarası

2016.KB.SAG.006

Kaynakça

• Beers, A. N., Shahnaz, N., Westerberg, B. D., & Kozak, F. K. (2010). Wideband reflectance in normal Caucasian and Chinese school-aged children and in children with otitis media with effusion. Ear and hearing, 31(2), 221-233. doi: 10.1097/AUD.0b013e3181c00eae Cetin, A. C., Gurkan, S., Kirkim, G., & Guneri, E. A. (2019). Wide-Band Tympanometry Results during an Acute Episode of Ménière’s Disease. Audiology and Neurotology, 24(5), 231-236.doi:10.1159/000502768.
• Cranford, J. L. (2007). Basics of Audiology: Vibrations to Sounds. Plural Publishing.
• Dempster, J. H., & MacKenzie, K. (1991). Tympanometry in the detection of hearing impairments associated with otitis media with effusion. Clinical Otolaryngology & Allied Sciences, 16(2), 157-159. doi:10.1111/j.1365-2273.1991.tb01967.x
• Feeney, M. P., Keefe, D. H., Hunter, L. L., Fitzpatrick, D. F., Garinis, A. C., Putterman, D. B., & McMillan, G. P. (2017). Normative Wideband Reflectance, Equivalent Admittance at the Tympanic Membrane, and Acoustic Stapedius Reflex Threshold in Adults. Ear and Hearing, 38(3), e142–e160. doi:10.1097/aud.0000000000000399.
• Hunter LL, Tubaugh L, Jackson A, Propes S. (2008). Wideband middle ear power measurement in infants and children. J Am Acad Audiol.,19: 309 - 324. doı: 10.3766/jaaa.19.4.4
• Hunter, L. L., & Shahnaz, N. (2013). Acoustic immittance measures: Basic and advanced practice. Plural Publishing.
• Hunter, L. L., & Sanford, C. A. (2015). Tympanometry and wideband acoustic immittance. Handbook of clinical audiology. 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 137-163.
• Keefe, D. H., Bulen, J. C., Arehart, K. H., & Burns, E. M. (1993). Ear‐canal impedance and reflection coefficient in human infants and adults. The Journal of the Acoustical Society of America, 94(5), 2617-2638. doi:10.1121/1.407347
• Keefe, D. H., & Simmons, J. L. (2003). Energy transmittance predicts conductive hearing loss in older children and adults. The Journal of the Acoustical Society of America, 114(6), 3217-3238.doi:10.1121/1.1625931
• Kefee DH, Sanford CA, Ellison JC. (2012). Wideband aural acoustic absorbance predicts conductive hearing loss in children. Int J Audiol.,51: 880 - 891. doi: 10.3109/14992027.2012.721936
• Liu, Y. W., Sanford, C. A., Ellison, J. C., Fitzpatrick, D. F., Gorga, M. P., & Keefe, D. H. (2008). Wideband absorbance tympanometry using pressure sweeps: System development and results on adults with normal hearing. The Journal of the Acoustical Society of America, 124(6), 3708-3719.. doi: 10.1121/1.3001712
• Mazlan, R., Kei, J., Ya, C. L., Yusof, W. N. H. M., Saim, L., & Zhao, F. (2015). Age and gender effects on wideband absorbance in adults with normal outer and middle ear function. Journal of Speech, Language, and Hearing Research, 58(4), 1377-1386.
• MRC Multi-centre Otitis Media Study Group. (2009). Air-conduction estimated from tympanometry (ACET) 1: Relationship to measured hearing in OME. Int J Pediatr Otorhinolaryngol.,73: 21 - 42. doi: 10.1016/j.ijporl.2008.09.014
• Niemczyk, E., Lachowska, M., Tataj, E., Kurczak, K., & Niemczyk, K. (2018). Wideband tympanometry and absorbance measurements in otosclerotic ears. The Laryngoscope. 129(10), 365-376 doi:10.1002/lary.27747
• Nozza, R. J., Bluestone, C. D., Kardatzke, D., & Bachman, R. (1994). Identification of middle ear effusion by aural acoustic admittance and otoscopy. Foundations of pediatric audiology, 195-209. doi: 10.1097/00003446-199408000-00005
• Piskorski, P., Keefe, D. H., Simmons, J. L., & Gorga, M. P. (1999). Prediction of conductive hearing loss based on acoustic ear-canal response using a multivariate clinical decision theory. The Journal of the Acoustical Society of America, 105(3), 1749-1764. doi: 10.1121/1.426713
• Prieve, B. A., Feeney, M. P., Stenfelt, S., & Shahnaz, N. (2013). Prediction of conductive hearing loss using wideband acoustic immittance. Ear and Hearing, 34, 54s-59s. doi: 10.1097/AUD.0b013e31829c9670
• Teele, D. W., & Teele, J. (1984). Detection of middle ear effusion by acoustic reflectometry. The Journal of pediatrics, 104(6), 832-838. doi: 10.1016/S0022-3476(84)80476-X