Background: Pure tone audiometry is routinely used to determine conductive and sensorineural hearing status. Ossicular discontinuity is usually assessed intra-operatively. If ossicular discontinuity can be predicted by pure tone audiometry, perhaps the operative procedure of choice and prognosis for hearing can also be anticipated. Objective: To determine the predictive value of preoperative pure tone audiometry on the presence of gross ossicular discontinuity in chronic otitis media. Methods: Records of 205 patients, 7 to 75 years of age undergoing their first operation for chronic otitis media were reviewed. Preoperative audiograms and operative records for tympanomastoidectomy were evaluated. A total of 162 patients meeting inclusion criteria were included in the study. Likelihood ratios for positive and negative ossicular discontinuity for frequency-specific air-bone gap cut-offs were determined. Multiple logistic regression analysis for pure tone audiometry and operative findings to predict ossicular discontinuity was performed and a model for predicting ossicular discontinuity using logistic regression obtained. Results and Conclusion: Frequency-specific air bone gap (ABG) cut-off values can predict ossicular discontinuity in chronic suppurative otitis media namely: < 20 dB ABG at 500 Hz predicts absence of ossicular discontinuity while > 50 dB ABG at 500 Hz, >30 dB ABG at 2 KHz, and > 50 dB ABG at 4 KHz best predict the presence of ossicular discontinuity in general. In the absence of cholesteatoma, the air bone gaps of <30 dB at 500 Hz and <20 dB at 1 KHz decrease probability of ossicular discontinuity from 32.97 percent to 2.54 percent. Combination of air bone gaps of >50 dB at 500 Hz, >20 dB at 2 KHz and >40 dB at 4 KHz increase the probability of ossicular discontinuity from 32.97 percent to 85.9 percent. These findings suggest that ossicular exploration may not be necessary for the former while an evaluation of the ossicular chain may be mandatory for the latter in the setting where cholesteatoma is not present or suspected. Presence of cholesteatoma, granulation tissue and size of tympanic membrane perforation are important factors to consider in predicting ossicular discontinuity. (Author)
AUDIOMETRY AUDIOMETRY ; PURE-TONE OTITIS MEDIA OTITIS MEDIA ; SUPPURATIVE LOGISTIC MODELS HEARING TESTS SUPPURATION

OBJECTIVES: Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs). METHODS: Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests. RESULTS: Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds > or =10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB. CONCLUSION: Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM.
Audiometry, Pure-Tone ; Cold Temperature ; Ear ; Ear, Middle ; Hearing ; Humans ; Incidence ; Otitis ; Otitis Media ; Paresis ; Vertigo ; Vestibular Function Tests ; Vibration

OBJECTIVES: The problem of noise-induced hearing loss (NIHL) was objectively and systematically investigated by diagnosing three workers who complained of tinnitus and hearing disturbance. METHODS: Atypical hearing loss is diagnosed as a work-related disease by using general medical methods, such as environmental survey, neurological examination, otoscopy, pure-tone audiometry, speech audiometry, otoacoustic emissions (OAE), auditory-evoked potentials, and interview on the history of past disease, family and occupation. RESULTS: Three results were found according to the work-related hearing loss as follows; (1) hearing loss that is caused by exposure to continuous noise of less than 85 dB(A) or impact noise of greater than 135 dB peak, (2) mixed hearing loss that has progressed due to noise with past otitis media, and (3) atypical hearing loss that showed remarkable differences between air and bone conduction due to tinnitus. CONCLUSIONS: The criteria for work-related hearing loss should be carefully investigated by considering exposure to impact noise, the effect of continuous noise on mixed hearing loss patients, and the hearing loss caused by tinnitus.
Audiometry, Pure-Tone ; Audiometry, Speech ; Bone Conduction ; Hearing ; Hearing Loss ; Hearing Loss, Mixed Conductive-Sensorineural ; Hearing Loss, Noise-Induced* ; Humans ; Neurologic Examination ; Noise ; Occupations ; Otitis Media ; Otoscopy ; Tinnitus

OBJECTIVE: To evaluate the treatment and diagnosis of early tympanic isthmus obstruction and dysfunction of eustachian tube. METHOD: Three hundred patients (338ears) suffering from early tympanic isthmus obstruction were examinated and observed from 1991 to 2004, and were injected triamcinolone into tympanic cavity at the position of hypokinesis or blockaded the external acoustic meatus according to different state of the illness. RESULT: Two hundred and sixty of three hundred case were cured, thirty cases were improved, ten cases were inefficacy. CONCLUSION Tympanic isthmus obstruction is a pathognostic type of secretory otitis media. There is significant difference between tympanic isthmus obstruction and secretory otitis media caused by dysfunction of eustachian tube. Prolonged tympanic isthmus obstruction is a reason of primary cholesteatoma of epitympanum's pathogeny. It is important to diagnose and treat of the tympanic isthmus obstruction early.
Acoustic Impedance Tests ; Adolescent ; Adult ; Audiometry, Pure-Tone ; Child ; Ear, Middle ; pathology ; Early Diagnosis ; Eustachian Tube ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Otitis Media ; diagnosis ; surgery ; Young Adult

OBJECTIVE: To explore the different and common features between adults and children with otitis media with effusion (OME) on course of disease, clinical characteristics and audiometric changes. METHOD: Pure tone audiometry, tympanogram and clinical information were analyzed and compared between 34 cases of adults and 42 cases of children with OME. RESULT: The course of disease was relatively short in children. The adenoid vegetation inflammation was more frequently found in children, while the OME occurred more often in adults. The air conduction and bone conduction threshold increased both in children and adults, particularly at high frequencies of 2 and 4 kHz. The bone conduction threshold at 4 kHz in adults was significantly higher than that in children (P < 0.05). In the cases with C type tympanogram, the negative pressure in adults was even lower than that in children (P < 0.05). CONCLUSION The OME in children is often relatively shorter in course of disease, which is mainly caused by adenoid vegetation. Sensorineural deafness can occur both in children and adults, especially at high frequencies. OME in children is less severe, however, it may lead to negative effects in learning and cognition, which should be diagnosed and managed in time.
Acoustic Impedance Tests ; Adolescent ; Adult ; Audiometry, Pure-Tone ; Bone Conduction ; Child ; Child, Preschool ; Female ; Humans ; Inflammation ; pathology ; Male ; Otitis Media with Effusion ; physiopathology ; Young Adult

OBJECTIVE: To study the characteristic of destructive ossicular chain and to evaluate integrity of ossicular chain and its impact on bone-conduction hearing of patients with chronic suppurative otitis media. METHOD: The destruction of ossicular chain with microscopy during operation and the preoperative pure tone audiometry were observed in 148 patients (176 ears) with chronic suppurative otitis media. RESULT: Destruction of ossicular chain was often observed in patients with chronic otitis media of cholesteatoma type, granuloma type and pars flaccid perforation of tympanic membrane. It initiated destructed malleo-incudal and incudostapedial joint for pars flaccid and pars tensa perforation of tympanic membrane respectively. Normal ossicular chain structure was observed in 52 ears. Destruction of ossicular chain was observed in 124 ears. Difference were significant for speech frequency air-conduction threshold and air-bone gap between group of normal ossicular chain and group of abnormal ossicular chain (P< 0.01). There was no difference for bone-conduction threshold between the above two groups. CONCLUSION Destruction of ossicular chain was often observed in patients with chronic otitis media of cholesteatoma type and granuloma type. The ossicular chain was normal in the patients who were both less than 40 dB in speech frequency air-conduction threshold and 30 dB of air-bone gap. The ossicular chain was destructed in the patients who were both over 55 dB in air-conduction threshold and 40 dB of air-bone gap. High frequency hearing loss was observed in patients with chronic suppurative otitis media.
Adolescent ; Adult ; Aged ; Audiometry, Pure-Tone ; Bone Conduction ; Child ; Child, Preschool ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Otitis Media, Suppurative ; pathology ; physiopathology ; Young Adult

OBJECTIVE: To investigate the diagnostic value of 226 Hz tympanometry and middle ear resonant frequency (RF) in adults with hydrotympanum. Discuss whether the resonant frequency combined with conventional 226 Hz tympanometry could increase the effectiveness for diagnosis of hydrotympanum. METHOD: Prospective study was applied to compare the normal hearing group and the test group. The otoscopic findings, pure tone audiometry and GSI-33 middle ear analyzer were considered standard. A 90% range of RF values from normal hearing group was considered standard to distinguish normal from abnormal RF values in test group. The subjects who had type B, C or abnormal tympanograms were performed with tympanocentesis. Hydrotympanum were confirmed when the results were positive. RESULT: The middle ear resonant frequency in adults range from 900 Hz to 1100 Hz was considered normal. There was found to be a statistically significant decrease in RF values in ears with OME compared to normative data (P<0.01). The positive percentage of tympanocentesis on type "B" tympanograms were 83%, which was significantly higher than that of tympanocentesis on type "C" or abnormal tympanograms (P<0.05). The positive percentage of tympanocentesis was 0 when the resonant frequency was normal. The positive percentage of tympanocentesis which the resonant frequency were less than 500 Hz were significantly higher than the subjects whose resonant frequency were more than 500 Hz. CONCLUSION Middle ear resonant frequency testing has very important clinic value for diagnosis of hydrotympanum, especially for those patients with type C or abnormal tympanograms.
Adolescent ; Adult ; Aged ; Audiometry, Pure-Tone ; Ear, Middle ; physiology ; Female ; Hearing Tests ; Humans ; Male ; Middle Aged ; Otitis Media with Effusion ; diagnosis ; physiopathology ; Prospective Studies ; Young Adult

Widespread use of antimicrobial drugs in the management of otitis media has significantly reduced the incidence of labyrinthitis nowadays. Cases of tympanogenic labyrinthitis following acute otitis media have rarely been reported in recent literature on otolaryngology. We report an unusual case of tympanogenic labyrinthitis that presented with sudden sensorineural hearing loss (SNHL) following acute otitis media in an adult who had no previous otological complaints. An audiogram revealed SNHL with pure tone threshold of 43.7 dB in the left ear. MRI was helpful to identify the inflammatory change of the membranous labyrinth. The patient's hearing returned to normal after treatment. The definite diagnosis of serous labyrinthitis was established retrospectively.
Acute Disease ; Adult ; Audiometry, Pure-Tone ; Female ; Hearing Loss, Sensorineural/diagnosis/*etiology/therapy ; Humans ; Labyrinthitis/*complications/therapy ; Otitis Media, Suppurative/*complications/therapy ; Research Support, Non-U.S. Gov't ; Tympanic Membrane

OBJECTIVE: To investigate on the Indication and quality of life of the canal wall up and canal wall down surgery in chronic suppurative otitis media, to provide reference for surgical options. METHOD: The clinical data of patients underwent canal wall up or canal wall down surgery are analyzed. Follow up on 312 patients are accomplished with pure tone audiometry, acoustic impedance for surgical cavity volume, ear endoscopy and the Chinese chronic ear survey (CCES). RESULT: (1) The dry ear rate of canal wall up and canal wall down surgery are 98.7% and 98.6% respectively (P > 0.05). (2) The average cavity epithelization and dry ear time are 40.1 +/- 21.2 days for canal wall up surgery and 53.5 +/- 15.0 days for canal wall down surgery (P < 0.05). The postoperative ear volume to the contralateral normal ear volume ratio are 1.16 +/- 0.10 for canal wall up surgery and 2.05 +/- 1.19 for canal wall down surgery (P < 0.05). (4) Score of the CCES: 91.2 +/- 6.8 points for canal wall up surgery and 72.0 +/- 7.7 for canal wall down surgery (P < 0.05). (5) The proportion of patients feeling change of ear appearance is 5.7% for canal wall up surgery and 80.8% for canal wall down surgery (P < 0.05). (6) Hearing after surgery: objective hearing improvement rate is 58.9% for canal wall up surgery and 24.2% for canal wall down surgery (P < 0.05) according to the questionnaire, while the pure tone audiometry shows no significant difference in hearing thresh hold and air-bone gap. (7) The satisfactory score after surgery is 9.55 points for canal wall up surgery and 8.11 points for canal wall down surgery (P < 0.05). CONCLUSION (1) Patients underwent canal wall up surgery have near-normal external ear morphology, shorter dry ear time and much higher quality of life compared to canal wall down surgery. (2) For experienced ear surgeon, the indication for canal wall up surgery can be extended to cases with diploetic or sclerotic type of mastoid and part of the cases with anatomical variation and intracranial or extracranial complications.
Acoustic Impedance Tests ; Audiometry, Pure-Tone ; Chronic Disease ; Ear Canal ; anatomy & histology ; surgery ; Follow-Up Studies ; Hearing ; physiology ; Hearing Tests ; Humans ; Otitis Media, Suppurative ; surgery ; Otologic Surgical Procedures ; methods ; Quality of Life ; Treatment Outcome

OBJECTIVE: To evaluate the efficiency of autologous conchal cartlage in ossicular chain reconstruction in patients with chronic suppurative otitis media. METHOD: Seventy-three cases of chronic suppurative otitis media (COM) with or without cholesteatoma who had undergone mastoidectomy with tympanoplasty and ossicular chain reconstruction(OCR) using autologous conchal cartilage as prosthesis were studied retrospectively. Sixty-six cases of COM who had undergone mastoidectomy with tympanoplasty and without OCR were studied as control. The examination of pure tone hearing level of air conduction(AC) and bone conduction(BC) was done before operation, 2 months and 6 months after operation respectively. The pure tone average (PTA) of 0.5, 1.0, 2.0 kHz was observed. RESULT: The average air conduction gain was more than 15dB or the PTA (AC) was less than 25 dB 2 months after operation in 35 out of 73 cases who had undergone OCR. Nevertheless, the data became 56 out of 73 cases 6 months after operation. In the control group, The average air conduction gain was more than 15dB or the PTA(AC) was less than 25 dB 2 months after operation in 10 out of 66 cases who had not undergone OCR. The data became 14 out of 66 cases 6 months after operation. In OCR group, air bone gap(ABG) was less than 20 dB in 39 cases 2 months after operation and in 57 cases 6 months after operation. In the control group without OCR, ABG was less than 20 dB only in 11 cases 2 months after operation and in 16 cases 6 months after operation. By statistically analysis, there was significant difference of postoperative hearing improvement between the two groups. CONCLUSION The autologous conchal cartilage can be used as the material of prosthesis for ossicular chain reconstruction in the operation of chronic otitis media. It has many advantages, such as easily--obtained, good histocompatibility, easy to shape and so on.
Audiometry, Pure-Tone ; Bone Conduction ; Cartilage ; transplantation ; Cholesteatoma ; surgery ; Chronic Disease ; Ear Auricle ; Hearing ; Humans ; Mastoid ; surgery ; Ossicular Prosthesis ; Ossicular Replacement ; Otitis Media, Suppurative ; surgery ; Postoperative Period ; Reconstructive Surgical Procedures ; Retrospective Studies ; Treatment Outcome ; Tympanoplasty