The Correlation Between Negative Middle Ear Pressure and the Corresponding Conductive Hearing Loss in ChildrenA 12-month Study of 352 Unselected 7-year-old Children

Abstract

An epidemiological study of negative middle ear pressure in children made it possible to test its relationship to conductive hearing loss. About 350 children were subjected to a screening procedure recording audiogram and middle ear pressure five times during a 12-month period. Those children who failed to perceive just one tone or who had a middle ear pressure equal to or worse than -150 mmH2O in one or both ears were referred to the Hearing Clinic for conventional audiometry and middle ear pressure measurement each month. By computing the weighted average of the regressions for each child, a straight linear relationship was found between negative pressure and conductive hearing loss. In addition, a frequency dependence was found, the hearing loss being maximal at about 500 Hz. In general, the study shows that tympanometry is of limited value in predicting hearing loss in a child. The threshold for pathology of about -150 mmH2O, being a predisposing factor in secretory otitis media, corresponds to the upper confidence limit of the normal range of hearing loss found in this series. There is no distinct value of negative pressure that clearly distinguishes between normal and pathological condition, but it is concluded that a middle ear pressure worse than -150 mmH2O should be considered a probable hearing handicap.

Ear Canal Pressure Variations Versus Negative Middle Ear Pressure: Comparison Using Distortion Product Otoacoustic Emission Measurement in Humans

“…In the late 1930s, negative MEP was experimentally proved to be a cause of hearing loss by the fact that hearing was improved when a negative air pressure was applied in the ear canal of some patients, which presumably counterbalanced a negative MEP. Numerous later investigations in clinical populations showed high prevalence of negative MEP in children, which correlated with conductive hearing loss (Cooper et al 1977;Lildholdt et al 1979). Since the 1960s, tympanometry has been widely utilized for assessing the input impedance/ admittance of the middle ear, with tympanometric peak pressure (TPP) as an estimate of MEP (for a review, see Margolis & Hunter 1999).…”

Wideband aural acoustic absorbance predicts conductive hearing loss in children

“…These measures are useful for identifying middle-ear pathologies (Vanhuyse, 1975; Margolis & Hunter, 2000) including OME. However, the relationships between tympanometric measures and degree of CHL are not clear cut (Lildholdt et al, 1979; Margolis et al 1994; Medical Research Council (MRC), 2009a). Studies relating tympanometric measures and CHL have produced test sensitivities ranging from 58 to 95% and specificities ranging from 37 to 91% (Dempster & MacKenzie, 1991; MRC, 1999), with the highest combined values of sensitivity and specificity of 88% and 84%, respectively (MRC, 2009b).…”

Air-conduction estimated from tympanometry (ACET) 1: Relationship to measured hearing in OME

“…Other things equal, the strongest relationship must be found in samples having about half their cases in the upper half of this range. Regrettably, the basic physiological relationship between HL and tympanometric measures is only tight and nearlinear in the mild or resolving cases whose tympanograms are not B, and whose HLs are largely below 20-25 dB [5]. That part of the range showing a neat psycho-physical relationship is not the clinically important region.…”

“…Previous work on tympanometry as surrogate for HL (e.g. [5,7]) was not comprehensive enough to secure wide application, possibly due to shortcomings in the conceptualization, and insufficient severity of the cases giving the data. Our data align with and include replications of others' findings, so our more encouraging message is not based on conflicts between data of the same type, but on more appropriate definition of the appropriate data and clearer conceptualization.…”

“…The normal to mild A-C2 categories, have a definable admittance peak but are distinguished by the raw middle ear pressure (MEP) at which it occurs. In this region, Lildholdt et al [5] demonstrated a nearlinear relationship of pressure with hearing level, giving a monaural 0.54 correlation (29% variance explained). The percent variance explained for the binaural mean HL (quoted at 93%) was inflated by inappropriately including repeated measures, a common error of method.…”