Download PDF
J Am Acad Audiol 2017; 28(09): 838-860
DOI: 10.3766/jaaa.16172
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

Douglas H. Keefe
*   Boys Town National Research Hospital, Omaha, NE
,
Kelly L. Archer
*   Boys Town National Research Hospital, Omaha, NE
†   University of Nebraska Lincoln, Lincoln, NE
,
Kendra K. Schmid
‡   Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
,
Denis F. Fitzpatrick
*   Boys Town National Research Hospital, Omaha, NE
,
M. Patrick Feeney
§   National Center for Rehabilitative Auditory Research, Veterans Administration and Oregon Health & Science University, Portland, OR
,
Lisa L. Hunter
**   Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
› Author Affiliations
Further Information

Publication History

Publication Date:
26 June 2020 (online)

   Permissions and Reprints

Abstract

Background:

Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis.

Purpose:

To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis.

Research Design:

A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group.

Study Sample:

The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female).

Data Collection and Analysis:

Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25–8 kHz), reflectance tests (0.25–8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1–8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears.

Results:

Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7–1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35–0.7 kHz, and at 2.8–4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic.

Conclusions:

Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.

Key Words

absorbance - acoustic stapedius muscle reflex - ear canal - group delay - middle ear - otosclerosis - reflectance - transient evoked otoacoustic emission - tympanometry

NIH grants R01 DC010202 and P30 DC004662.


A preliminary oral presentation of results was given at the May 2014 meeting of the Acoustical Society of America in Providence, RI.


 

  • REFERENCES

  • Allen JB, Jeng PS, Levitt H. 2005; Evaluation of human middle ear function via an acoustic power assessment. J Rehabil Res Dev 42 (04) (Suppl 2) 63-78
    CrossrefPubMedGoogle Scholar
  • American National Standards Institute (ANSI). (2012) American National Standard Specifications for Instruments to Measure Aural Acoustic Impedance and Admittance (Aural Acoustic Immittance). ANSI S3.39–1987 (Reaffirmed by ANSI, June 15, 2012).
  • Cohen J. 1992; A power primer. Psychol Bull 112 (01) 155-159
    CrossrefPubMedGoogle Scholar
  • Cureoglu S, Baylan MY, Paparella MM. 2010; Cochlear otosclerosis. Curr Opin Otolaryngol Head Neck Surg 18 (05) 357-362
    CrossrefPubMedGoogle Scholar
  • Feeney MP, Grant IL, Marryott LP. 2003; Wideband energy reflectance measurements in adults with middle-ear disorders. J Speech Lang Hear Res 46 (04) 901-911
    CrossrefPubMedGoogle Scholar
  • Feeney MP, Hunter LL, Kei J, Lilly DJ, Margolis RH, Nakajima HH, Neely ST, Prieve BA, Rosowski JJ, Sanford CA, Schairer KS, Shahnaz N, Stenfelt S, Voss SE. 2013; Consensus statement: Eriksholm workshop on wideband absorbance measures of the middle ear. Ear Hear 34 (Suppl 1) 78S-79S
    CrossrefPubMedGoogle Scholar
  • Feeney MP, Keefe DH. 1999; Acoustic reflex detection using wide-band acoustic reflectance, admittance, and power measurements. J Speech Lang Hear Res 42 (05) 1029-1041
    CrossrefPubMedGoogle Scholar
  • Feeney MP, Keefe DH. 2001; Estimating the acoustic reflex threshold from wideband measures of reflectance, admittance, and power. Ear Hear 22 (04) 316-332
    CrossrefPubMedGoogle Scholar
  • Feeney MP, Keefe DH, Hunter LL, Fitzpatrick DF, Garinis AC, Putterman DB, McMillan GP. 2016; Normative wideband reflectance, equivalent admittance at the tympanic membrane, and acoustic stapedius reflex threshold in adults. Ear Hear 38: e142-e160
    Google Scholar
  • Feeney MP, Keefe DH, Marryott LP. 2003; Contralateral acoustic reflex thresholds for tonal activators using wideband energy reflectance and admittance. J Speech Lang Hear Res 46 (01) 128-136
    CrossrefPubMedGoogle Scholar
  • Feldman AS, Zwislocki J. 1965; Effect of the acoustic reflex on the impedance at the eardrum. J Speech Hear Res 8 (03) 213-222
    PubMedGoogle Scholar
  • Fisch U. 2009; Stapedotomy versus stapedectomy. Otol Neurotol 30 (08) 1166-1167
    CrossrefPubMedGoogle Scholar
  • Goodman SS, Fitzpatrick DF, Ellison JC, Jesteadt W, Keefe DH. 2009; High-frequency click-evoked otoacoustic emissions and behavioral thresholds in humans. J Acoust Soc Am 125 (02) 1014-1032
    CrossrefPubMedGoogle Scholar
  • Hannula S, Bloigu R, Majamaa K, Sorri M, Mäki-Torkko E. 2012; Ear diseases and other risk factors for hearing impairment among adults: an epidemiological study. Int J Audiol 51 (11) 833-840
    CrossrefPubMedGoogle Scholar
  • Herzog M, Shehata-Dieler WE, Dieler R. 2001; Transient evoked and distortion product otoacoustic emissions following successful stapes surgery. Eur Arch Otorhinolaryngol 258 (02) 61-66
    CrossrefPubMedGoogle Scholar
  • Hosmer DW, Lemeshow S. 2000. Applied Logistic Regression. New York, NY: John Wiley & Sons; doi: 10.1002/0471722146
    Google Scholar
  • Hunter LL, Ries DT, Schlauch RS, Levine SC, Ward WD. 1999; Safety and clinical performance of acoustic reflex tests. Ear Hear 20 (06) 506-514
    PubMedGoogle Scholar
  • Hunter LL, Keefe DH, Feeney MP, Fitzpatrick DF. 2017; Pressurized wideband acoustic stapedial reflex thresholds: Normal development and relationships to auditory function in infants. J Assoc Res Otolaryngol 18 (01) 49-63
    CrossrefPubMedGoogle Scholar
  • Keefe DH. 1998; Double-evoked otoacoustic emissions: I, measurement theory and nonlinear coherence. J Acoust Soc Am 103: 3489-3498
    CrossrefGoogle Scholar
  • Keefe DH. 2007. Influence of middle-ear function and pathology on otoacoustic emissions. In: Robinette MR, Glattke TJ. Otoacoustic Emissions: Clinical Applications. New York, NY: Thieme; 163-196
    Google Scholar
  • Keefe DH, Bulen JC, Arehart KH, Burns EM. 1993; Ear-canal impedance and reflection coefficient in human infants and adults. J Acoust Soc Am 94 (05) 2617-2638
    CrossrefPubMedGoogle Scholar
  • Keefe DH, Feeney MP, Hunter LL, Fitzpatrick DF. 2016; Comparisons of transient evoked otoacoustic emissions using chirp and click stimuli. J Acoust Soc Am 140 (03) 1949-1973
    CrossrefPubMedGoogle Scholar
  • Keefe DH, Feeney MP, Hunter LL, Fitzpatrick DF. 2017; Aural acoustic stapedius-muscle reflex threshold procedures to test human infants and adults. J Assoc Res Otolaryngol 18 (01) 65-88
    CrossrefPubMedGoogle Scholar
  • Keefe DH, Hunter LL, Feeney MP, Fitzpatrick DF. 2015; Procedures for ambient-pressure and tympanometric tests of aural acoustic reflectance and admittance in human infants and adults. J Acoust Soc Am 138 (06) 3625-3653
    CrossrefPubMedGoogle Scholar
  • Keefe DH, Levi E. 1996; Maturation of the middle and external ears: acoustic power-based responses and reflectance tympanometry. Ear Hear 17 (05) 361-373
    PubMedGoogle Scholar
  • Keefe DH, Ling R. 1998; Double-evoked otoacoustic emissions. II. Intermittent noise rejection, calibration and ear-canal measurements. J Acoust Soc Am 103 (06) 3499-3508
    CrossrefPubMedGoogle Scholar
  • Kemp DT. 1978; Stimulated acoustic emissions from within the human auditory system. J Acoust Soc Am 64 (05) 1386-1391
    CrossrefPubMedGoogle Scholar
  • Liu YW, Sanford CA, Ellison JC, Fitzpatrick DF, Gorga MP, Keefe DH. 2008; Wideband absorbance tympanometry using pressure sweeps: system development and results on adults with normal hearing. J Acoust Soc Am 124 (06) 3708-3719
    CrossrefPubMedGoogle Scholar
  • Margolis RH, Saly GL, Keefe DH. 1999; Wideband reflectance tympanometry in normal adults. J Acoust Soc Am 106 (01) 265-280
    CrossrefPubMedGoogle Scholar
  • Merchant GR, Merchant SN, Rosowski JJ, Nakajima HH. 2016; Controlled exploration of the effects of conductive hearing loss on wideband acoustic immittance in human cadaveric preparations. Hear Res 341: 19-30
    CrossrefPubMedGoogle Scholar
  • Merchant SN, Nadol Jr JB. 2010. Schuknecht’s Pathology of the Ear. 3rd ed. Shelton,CT: People’s Medical Publishing House-USA;
    Google Scholar
  • Metz O. 1946; The acoustical impedance measured on normal and pathological ears. Acta Otolaryngol 63 (Suppl) 3-254
    Google Scholar
  • Mukerji S, Windsor AM, Lee DJ. 2010; Auditory brainstem circuits that mediate the middle ear muscle reflex. Trends Amplif 14 (03) 170-191
    CrossrefPubMedGoogle Scholar
  • Nakajima HH, Pisano DV, Roosli C, Hamade MA, Merchant GR, Mahfoud L, Halpin CF, Rosowski JJ, Merchant SN. 2012; Comparison of ear-canal reflectance and umbo velocity in patients with conductive hearing loss: a preliminary study. Ear Hear 33 (01) 35-43
    CrossrefPubMedGoogle Scholar
  • Nikas JB, Low WC. 2011; ROC-supervised principal component analysis in connection with the diagnosis of diseases. Am J Transl Res 3 (02) 180-196
    PubMedGoogle Scholar
  • Plinkert PK, Bootz F, Vossieck T. 1994; Influence of static middle ear pressure on transiently evoked otoacoustic emissions and distortion products. Eur Arch Otorhinolaryngol 251 (02) 95-99
    CrossrefPubMedGoogle Scholar
  • Putterman DB, Keefe DH, Hunter LL, Garinis AC, Fitzpatrick DF, McMillan GP, Feeney MP. 2017; Assessing sensorineural hearing loss using various transient-evoked otoacoustic emission stimulus conditions. Ear Hear 38 (04) 507-520
    CrossrefPubMedGoogle Scholar
  • Rappaport JM, Provencal C. 2002. Neurotology for audiologists. In: Katz J, Burkard RF, Medwetsky L. Handbook of Clinical Audiology. Philadelphia, PA: Lippincott, Williams and Wilkins; 9-32
    Google Scholar
  • Schairer KS, Ellison JC, Fitzpatrick D, Keefe DH. 2007; Wideband ipsilateral measurements of middle-ear muscle reflex thresholds in children and adults. J Acoust Soc Am 121 (06) 3607-3616
    CrossrefPubMedGoogle Scholar
  • Shahnaz N, Bork K. 2006; Wideband reflectance norms for Caucasian and Chinese young adults. Ear Hear 27 (06) 774-788
    CrossrefPubMedGoogle Scholar
  • Shahnaz N, Bork K, Polka L, Longridge N, Bell D, Westerberg BD. 2009; Energy reflectance and tympanometry in normal and otosclerotic ears. Ear Hear 30 (02) 219-233
    CrossrefPubMedGoogle Scholar
  • Shahnaz N, Longridge N, Bell D. 2009; Wideband energy reflectance patterns in preoperative and post-operative otosclerotic ears. Int J Audiol 48 (05) 240-247
    CrossrefPubMedGoogle Scholar
  • Shahnaz N, Polka L. 1997; Standard and multifrequency tympanometry in normal and otosclerotic ears. Ear Hear 18 (04) 326-341
    CrossrefPubMedGoogle Scholar
  • Shanks JE, Shohet J. 2009. Tympanometry in clinical practice. In: Katz J, Medwetsky L, Burkard R, Hood L. Handbook of Clinical Audiology. Philadelphia, PA: Lippincott, Williams and Wilkins; 157-188
    Google Scholar
  • Sun XM, Shaver MD. 2009; Effects of negative middle ear pressure on distortion product otoacoustic emissions and application of a compensation procedure in humans. Ear Hear 30 (02) 191-202
    PubMedGoogle Scholar
  • Thys M, Van Camp G. 2009; Genetics of otosclerosis. Otol Neurotol 30 (08) 1021-1032
    CrossrefPubMedGoogle Scholar
  • Trine MB, Hirsch JE, Margolis RH. 1993; The effect of middle ear pressure on transient evoked otoacoustic emissions. Ear Hear 14 (06) 401-407
    CrossrefPubMedGoogle Scholar
  • Voss SE, Allen JB. 1994; Measurement of acoustic impedance and reflectance in the human ear canal. J Acoust Soc Am 95 (01) 372-384
    CrossrefPubMedGoogle Scholar
  • Weatherby LA, Bennett MJ. 1980; The neonatal acoustic reflex. Scand Audiol 9 (02) 103-110
    CrossrefPubMedGoogle Scholar
  • Werner LA, Levi EC, Keefe DH. 2010; Ear-canal wideband acoustic transfer functions of adults and two- to nine-month-old infants. Ear Hear 31 (05) 587-598
    CrossrefPubMedGoogle Scholar
  • Zhao F, Wada H, Koike T, Ohyama K, Kawase T, Stephens D. 2002; Middle ear dynamic characteristics in patients with otosclerosis. Ear Hear 23 (02) 150-158
    CrossrefPubMedGoogle Scholar
  • Zhao F, Wada H, Koike T, Ohyama K, Kawase T, Stephens D. 2003; Transient evoked otoacoustic emissions in patients with middle ear disorders. Int J Audiol 42 (03) 117-131
    CrossrefPubMedGoogle Scholar
  • Zwislocki JJ. 1962; Analysis of middle ear function. Part I: input impedance. J Acoust Soc Am 34: 1514-1523
    CrossrefGoogle Scholar