Pure‐tone Audiometry in Otosclerosis: Insufficient Evidence for the Diagnostic Value of the Carhart Notch

Wegner, Inge; Bittermann, Arnold J. N.; Hentschel, Mayke A.; Heijden, Geert J. M. van der; Grolman, Wilko

doi:10.1177/0194599813495661

Cited by 19 publications

(13 citation statements)

References 14 publications

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“…using predefined criteria (see Table 2 for assessment criteria). A similar version of this system was previously used in other diagnostic systematic reviews (8)(9)(10). The criteria were classified as ''satisfactory'' (*), or ''unsatisfactory or unclear'' (*).…”

Section: Study Assessmentmentioning

confidence: 99%

A Systematic Review of the Diagnostic Value of CT Imaging in Diagnosing Otosclerosis

Wegner

Waes

Bittermann

et al. 2016

Otology &Amp; Neurotology

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Section: Study Assessmentmentioning

confidence: 99%

A Systematic Review of the Diagnostic Value of CT Imaging in Diagnosing Otosclerosis

Wegner

Waes

Bittermann

et al. 2016

Otology &Amp; Neurotology

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“…This compares to a three-frequency PTA for AC for the Oto group of 56 dB HL with a mean three-frequency ABG of 28 dB. The mean BC thresholds for the ears with otosclerosis were borderline normal at around 25 dB HL or better from 0.5 to 4.0 kHz except at 2 kHz where the mean BC threshold was 36.5 dB HL demonstrating a BC “Carhart notch” often associated with otosclerosis (Wegner et al 2013). These BC thresholds were within 5 dB of the mean BC thresholds at each frequency from 0.5 to 4.0 kHz in preoperative audiograms from 83 patients with otosclerosis aged 50–60 years reported by Vartiainen and Karjalainen (1992).…”

Section: Resultsmentioning

confidence: 85%

Effects of Otosclerosis on Middle Ear Function Assessed With Wideband Absorbance and Absorbed Power

et al. 2020

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Objective-Wideband absorbance and absorbed power were evaluated in a group of subjects with surgically confirmed otosclerosis (Oto group), mean age 51.6 years. This is the first use of absorbed power in the assessment of middle ear disorders. Results were compared with control data from two groups of adults, one with normal hearing, (NH group) mean age of 31 years, and one that was age-and sex-matched with the Oto group and had sensorineural hearing loss (SNHL group). The goal was to assess group differences using absorbance and absorbed power, to determine test performance in detecting otosclerosis, and to evaluate pre-operative and postoperative test results.Design-Audiometric and wideband tests were performed over frequencies up to 8 kHz. The three groups were compared on wideband tests using analysis of variance to assess group mean differences. Receiver operating characteristic (ROC) curve analysis was also used to assess test accuracy at classifying ears as belonging to the Oto or control groups using the area under the ROC curve (AUC). A longitudinal design was used to compare pre-and post-operative results at 3 and 6 months.Results-There were significant mean differences in the wideband parameters between the Oto and control groups with generally lower absorbance and absorbed power for the Oto group at ambient and tympanometric peak pressure (TPP) depending on frequency. The SNHL group had more significant differences with the Oto group than did the NH group in the high frequencies for absorbed power at ambient pressure and tympanometric absorbed power at TPP, as well as for the tympanometric tails. The greatest accuracy for classifying ears as being in the Oto group or a control group was for absorbed power at ambient pressure at 0.71 kHz with an AUC of 0.81 comparing the Oto and NH groups. The greatest accuracy for an absorbance measure was for the

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“…The Carhart effect was commonplace in preoperative bone conduction in patients with osteosclerosis, where an artificial exaggeration in BC thresholds can falsely be considered sensorineural hearing loss, underestimates the patients' cochlear reserve (19,23), and also puzzles doctors making choice of whether to proceed with surgery. So, previously, the proportion and extent to which the preoperative elevated BC threshold implies poor cochlear function, and which artificial exaggeration could be resolved by surgery had not been clearly studied.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Frequency-Specific Preoperative Sensorineural Hearing Loss to Postoperative Overclosure of Bone Conduction in Stapedotomy

Fang

Zhang

Ersbo

et al. 2021

Otology &Amp; Neurotology

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Objective:To evaluate the frequency-specific relationships between the preoperative sensorineural hearing loss and postoperative overclosure of bone conduction (BC) threshold after stapedotomy.Methods:We conducted a retrospective analysis of 207 otosclerosis patients who underwent stapedotomy in our hospital. Pre- and postoperative audiometry were collected between patients with or without preoperative sensorineural hearing loss (SNHL) component (i.e., SNHL group and non-SNHL group, respectively). Overclosure rate (OR), deterioration rate (DR), and their significant values (i.e., SOR or SDR) were compared between the sub-groups at each frequency to access the frequency-specific outcomes.Results:There were 69 patients in non-SNHL group and 138 patients in SNHL group. Postoperative success rate was similar in non-SNHL group and SNHL group. For frequency-specific outcomes, both the OR and SOR were significantly obvious in all SNHL subgroups than those in non-SNHL subgroups (p < 0.001), except at 4 kHz for SOR. Extent of overclosure and significant overclosure were more obvious in SNHL subgroups than those in non-SNHL subgroups (p < 0.01). The DR and SDR of BC were significantly obvious at 1k to 4 kHz in non-SNHL subgroups than those in SNHL subgroups (p < 0.01), however, not so for the extent of deterioration (p > 0.05). Frequency-specific success rate was similar at each frequency.Conclusion:Stapedotomy was efficient and safe in patients with or without SNHL component preoperatively. Frequency-specific overclosure effect was more obvious in all tone frequencies in SNHL subgroups than those in non-SNHL subgroups. For frequency-specific outcomes, about 50% BC with preoperative SNHL component at tone frequency meet postoperative significant overclosure effect, which was most obvious at low frequencies.

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Pure‐tone Audiometry in Otosclerosis: Insufficient Evidence for the Diagnostic Value of the Carhart Notch

Abstract: Although there is insufficient high-quality evidence regarding the diagnostic value of the Carhart notch, it seems it is a useful hint for the presence of otosclerosis, but it cannot be used to confirm a diagnosis of otosclerosis.

Cited by 19 publications

References 14 publications

A Systematic Review of the Diagnostic Value of CT Imaging in Diagnosing Otosclerosis

A Systematic Review of the Diagnostic Value of CT Imaging in Diagnosing Otosclerosis

Effects of Otosclerosis on Middle Ear Function Assessed With Wideband Absorbance and Absorbed Power

The Impact of the Frequency-Specific Preoperative Sensorineural Hearing Loss to Postoperative Overclosure of Bone Conduction in Stapedotomy

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