Diagnostic value of the wideband acoustic absorbance test in middle-ear effusion S TERZI, A ÖZGÜR, Ö Ç ERDIVANLI, Z Ö COS¸KUN, M OGURLU, M DEMIRCI, E DURSUN Department of Otorhinolaryngology, Medical Faculty, Recep Tayyip Erdog˘ an University, Rize, Turkey Abstract Objectives: This study aimed to investigate the diagnostic value of wideband acoustic absorbance testing in otitis media with effusion. Methods: This prospective study compared middle-ear wideband acoustic absorbance rates in three paediatric patient groups: a healthy group of 34 volunteers; 48 patients diagnosed with otitis media with effusion; and 28 patients with chronic effusion but no sign of effusion during myringotomy. The diagnostic value of absorbance testing was analysed with the receiver operating characteristic test. Results: The wideband acoustic absorbance rate was significantly lower in the otitis media with effusion group than in both the otitis media and healthy groups at the 0.375 –2 kHz averaged mean absorbance ( p < 0.017 and p < 0.001, respectively). Receiver operating characteristic analysis showed the highest diagnostic value for the 0.375–2 kHz averaged mean (area under the curve 0.984), followed by those at 1 and 1.5 kHz (area under the curve: 0.973 and 0.967, respectively). Conclusion: The wideband acoustic absorbance test is more accurate for detecting middle-ear effusion compared with conventional 226-Hz tympanometry. Its practicality and objectivity suggest that the wideband acoustic absorbance test may be a better alternative for diagnosing otitis media with effusion. Key words: Acoustic Impedance Tests; Tympanometry; Middle Ear Effusion Introduction Otitis media with effusion (OME) is defined as fluid accumulation in the middle-ear mucosa due to inflamma- tion, but without signs or symptoms of acute infection. 1 However, OME remains an important health issue and one of the leading causes of hearing loss in children. Between 35 per cent and 70 per cent of pre-school children experience at least one episode of OME. 1,2 Otitis media with effusion is distinct from acute otitis media. Acute otitis media is characterised by the acute onset of signs and symptoms of middle-ear inflammation, such as ear pain and fever. In contrast, OME is frequently associated with recurrent acute otitis media and often follows an episode of acute otitis media. 3 From a medical perspective, OME is a severe disease that can cause hearing loss. From a socio-economic perspective, hearing loss may lead to difficulties in the child’s education and social life, in addition to costing the family in both time and financial resources. 4 Long-lasting middle-ear effusion decreases both tympanic membrane mobility and sound conduction. This can lead to a hearing loss of 15–40 dB. Hearing loss caused by recurrent middle-ear effusion may result in speech and language impairment, which may conse- quently decrease the quality of the child’s social life. 5 Any decrease in tympanic membrane mobility should be confirmed by pneumatic otoscopy and tym- panography. Pneumatic otoscopy has a sensitivity of 94 per cent and a specificity of 74– 78 per cent in experi- enced hands. 6,7 For equivocal physical examination findings, current clinical guidelines recommend either 226-Hz tympanometry or acoustic reflectometry as an adjunct to pneumatic otoscopy. Tympanometry with a standard 226-Hz probe tone is reliable in infants aged 4 months or older and shows good inter-observer agree- ment in routine clinical practice. Younger infants require specialised equipment with a higher probe tone frequency. 8,9 Wideband immittance testing was developed to evaluate the external ear-canal and middle-ear function using wideband frequencies. Wideband immittance (which includes absorbance and acoustic admittance) is measured at the external ear canal and enables Presented as an oral presentation at the 3rd National Otology and Neurootology Congress, 1–4 May 2014, Antalya, Turkey Accepted for publication 13 March 2015 First published online 22 September 2015 The Journal of Laryngology & Otology (2015), 129, 1078–1084. MAIN ARTICLE © JLO (1984) Limited, 2015 doi:10.1017/S0022215115002339 https://doi.org/10.1017/S0022215115002339 Downloaded from https:/www.cambridge.org/core. University of Pretoria, on 12 Jan 2017 at 13:02:08, subject to the Cambridge Core terms of use, available at https:/www.cambridge.org/core/terms.