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AUDE 6140 - Pediatric Audiology > Middle Ear Measurements in Infants and Children > Flashcards

Middle Ear Measurements in Infants and Children Flashcards

1
Q

What is the middle ear test battery?

A

Single frequency tympanometry
Acoustic stapedial reflex
Broadband or multifrequency immittance measures

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2
Q

What are some benefits for immittance measures?

A

Quick
Easy to administer and interpret
Useful for cross-check with other physiologic ad behavioral measures

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3
Q

What are some clinical values of acoustic immittance?

A

Objectively measures TM mobility
Measures ME pressure
Confirms patency of ventilation tubes in the TM
Identifies TM perforation
Differentiates ME fixation form ossicular disarticulation
Aids in differential diagnosis of conductive hearing loss
Validates functional hearing loss
Provides objective inference of hearing sensitivity and pathology

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4
Q

What are some ways to keep the child quiet and sitting still?

A

Greet the child with an enticing toy in hand to take the child’s mind off the strangeness of the room
Have an experienced assistant
Help from parent can be helpful sometimes
Seat babies and toddlers in the lap of the parent during the test

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5
Q

What are some distractors to use during testing?

A

Animated toys
Hand puppets
Pendulum
Mirror
Sticky tape
Cotton ball or tissues

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6
Q

Can distractors also be used for OAEs?

A

Yes

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7
Q

Do children older than 3 require special distraction?

A

No

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8
Q

Can the behavior and reaction of children between 1 and 3 years be predicted?

A

No
They are mostly concerned about pain

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9
Q

What are some rules for testing?

A

Never ask a child for permission to conduct the physiologic tests.
Do not even bring up the word or the topic of “hurt”
Avoid undue explanation to the child regarding the test procedure
It is sufficient to say something like, “Here, listen to this,” or “Hold still for me,” and then proceed with the test

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10
Q

What are the factors that govern acoustic immittance?

A

Stiffness
Mass
Friction

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11
Q

Why are tymps typically done at 226 Hz?

A

Sensitive to the stiffness dominated middle ear
The susceptance component (the stiffness element) contributes more to overall admittance than conductance (the frictional element)

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12
Q

What is static compensated acoustic admittance?

A

Admittance at the tympanic membrane can be estimated by subtracting the admittance at the positive tail or at the negative tail (peak-to-tail difference method)
Subtracts what is got from atmospheric pressure compared to negative or positive tail

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13
Q

What are the three primary methods to compensate the tymp?

A

Negative tail: increases admittance, making it easier to distinguish between normal and abnormal tympanograms but can be problematic in infants
Positive tail: Prevents ear-canal collapse at negative pressures, has greater test-retest reliability but overestimate ECV
Two-tail method

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14
Q

What is the peak pressure in a tymp?

A

It is the maximum acoustic admittance at one single pressure value at which it occurred
Provides an indirect estimate of the air pressure in the middle ear space at which energy flows best into the conductive mechanisms

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15
Q

Could width of a tymp indicate ME pathology?

A

Yes, there is some research suggesting this

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16
Q

Can the flatness (vs peakness) of a tymp be quantified by its gradient?

A

Yes
Describes the relationship of its height and width
A gradient < 0.2 is generally considered abnormally low

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17
Q

What does a large width suggest?

A

ME dysfunction

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18
Q

What is the ear canal volume measuring?

A

It is an estimation of the volume that exists between the probe tip and the TM
Useful for detecting eardrum perforations
Can be used to monitor the course of middle ear disease after placement of tympanostomy tubes and with recurrence of otitis media

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19
Q

Are OME rates high in both normal newborns and newborns in the NICU?

A

Yes
Around 19% in healthy newborns and up to 30% in newborns in the NICU (due to the use of nasotracheal tubes for ventilation)

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20
Q

What is a great issue with newborn hearing screenings?

A

High false-positive rates
High due to transient conductive hearing loss caused by ME dysfunction
Reliable diagnosis of ME function may reduce these rates

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21
Q

Are fluids and debris present in the ME cavity for a few days after birth?

A

Yes, causes a conductive hearing loss
24 hrs after birth: 50% retain fluid
48 hrs after birth: 27% retain fluid
2 weeks after birth: 13% retain fluid

22
Q

Is there a need for a test of ME function after a failed NBHS?

A

Yes
This would distinguish between conductive (fluid) and SNHL

23
Q

What is the problem with doing tymps at 226 Hz on infants?

A

LF probe tones not useful for evaluating the ME system of infants
Low sensitivity to the presence of MEE
Flat tympanograms for the 226 Hz probe tone observed in some neonates with normal MEs
Might not have fluid and show a flat tymp, or might not have fluid and be flat

24
Q

What causes the physical properties of sound transmission to the cochlea to change within the first 2 years?

A

Structural changes to the canal and middle ear

25
Q

Are ear canals and middle ear cavities just smaller than adults?

A

No, they are also functionally different

26
Q

What are the anatomical differences of an infants EAC and ME?

A

Excessively compliant EAC
Small ear canal
Horizontal orientation of the TM
Under-ossified ossicular chain
Small ME space

27
Q

What are some anatomical changes of the external ear that occur in the first 2 years of life?

A

Increase in the rigidity of the ear canal (neonate ear canal is flaccid and prolapsed making visualization of the tympanic membrane difficult)
The inner half of the ear canal begins ossifying before birth and continues until the age of one
Stiffness of the ear canal increases as the medial bony canal wall ossifies and lengthens
Resonance frequency of the EAC decrease due to its increase in length

28
Q

What are some anatomical changes of the TM that occurs after birth?

A

TM gradually becomes perpendicular to the axis of the ear canal (better visualization)
TM thins due to loss of mesenchymal tissue (usually white and thick at birth)
TM assumes vertical position by age 2 (due to ossification of the canal)

29
Q

When does fusion of the annulus with the temporal bone occur?

A

Postnatally

30
Q

How do you pull on a babies ear?

A

Down and back

31
Q

What anatomical changes occur in the middle ear?

A

Increase in aeration and size of the ME cavity including pneumatization of the mastoid air cells (may not be completely aerated at birth)
Length of ME cavity increases
Increase in stiffness of the ME due to changes in orientation, fusion of the tympanic ring, and tightening of the ossicular joints

32
Q

Does the ME resonant frequency increase with age?

A

Yes
Resonant frequency being <500 Hz at 14 weeks of age

33
Q

What anatomical changes occur in the eustachian tube?

A

Becomes less horizontal, more rigid, and longer
Develops slowly taking approximately seven years to reach adult-like levels of structure and function

34
Q

Is the pattern of tympanometric results in infants influenced by the resonant frequency of the ME?

A

Yes
When the resonance frequency of the ME of a neonate approaches 226 Hz, double or multipeaked pattern will occur

35
Q

Is the infant ME system more mass dominated than stiffness dominated?

A

Yes

36
Q

Do the anatomical differences in an infants EAC and ME result in higher resonances?

A

Yes, such as lower static admittance, broader tympanometric width, and appearance of notching at low frequencies
This makes it so 226 Hz tone doesn’t work

37
Q

Can 660 Hz or 678 Hz be used for a tymp in infants?

A

More accurate diagnosis for children between 2 months and 12 years
Multipeaked tymps still an issue

38
Q

Can 1000 Hz be used for tymps in young infants?

A

Yes, more sensitive to changes in ME status in infants less than 4 months old
Tend to be single peaked or flat, which makes it easier to differentiate between normal and abnormal

39
Q

What are the admittance norms for a 1000 Hz tymp?

A

Birth to 4 weeks: negative tail (-400 daPa) - 0.6 to 4.3
Positive tail - 0.31 to 0.96 (varies due to study and age)
Cuff off at 0.35 (positive tail)

40
Q

What results from the ear canal collapse that occurs during the first week after birth?

A

Admittance abruptly decreases toward 0 mmho when negative pressures are occurred to the ear canal

41
Q

How do you measure ECV and peak pressure in an infant?

A

Have to use 226 Hz tymp
Only use 1000 Hz for assessing admittance

42
Q

Do you use the ABC system for classifying 1000 Hz tymps?

A

No
Just seeing if there is a positive or negative peak
It is common to have a steep slope and negative tail in infants

43
Q

Can you use a 226 Hz probe tone for acoustic reflexes in young infants?

A

No, they are absent in the majority of neonates
Use a 1000 Hz tone instead
Thresholds are similar to adults

44
Q

Why should you be cautious when doing acoustic reflexes in infants?

A

The potential risk of permanent threshold shift is higher in infants due to the smaller ear canal volumes and corresponding higher SPL and can be at least 10 dB higher than in an adult ear (110 dB in infant ears can reach 126 and 130 dB)
Acoustic reflexes should be done by 5 to 10 dB lower

45
Q

What are the ASHA guidelines for acoustic immittance?

A

The use of a 1000-Hz probe tone for tympanometry in infants is recommended when attempting to identify MEE to avoid false negative tympanograms
A low-frequency (226 Hz) probe tone is appropriate for older infant and children
For children (from birth to 5 years), acoustic reflex thresholds should be obtained for pure-tone activator frequencies 500, 1000, and 2000 Hz, ipsilaterally (measure contra if there is a question of neural pathology)
Absence of acoustic reflexes sometimes can be helpful in the diagnosis of MEE when tympanogram shape is equivocal

46
Q

What are the JCIH recommendations for acoustic immittance?

A

Either tympanometry or wideband reflectance can be used to characterize ME function
Use of the 1000 probe tone is recommended up to age 9 months
Measurement of acoustic reflex thresholds is completed using a 1000 Hz probe-tone for newborns and infants under 9 months of age

47
Q

What is wideband acoustic immittance?

A

An attempt to make it more accurate in identifying ME pathology
Multifrequency and multicomponent probe tunes used
Probe tone is swept through a series of frequencies
They are more accurate in identifying high admittance pathologies of the tympanic membrane and ossicular chain
A lot of pediatric audiologists are not comfortable using it

48
Q

What makes wideband acoustic immittance different than traditional audiometry?

A

Broad frequency range
More sensitive and specific
Less affected by ear canal volume and probe position

49
Q

What is reflectance?

A

A way to measure sound energy transfer in the middle ear across a broad frequency range

50
Q

What would be a mass dominated system?

A

ME effusion
Flaccid TM
Ossicular chain discontinuity
Resonant frequency lower

51
Q

What is a stiffness dominated system?

A

Ossicular chain fixation
Otosclerosis
Resonant frequency higher

52
Q

What are some advantages of wideband ME power reflectance?

A

It is measured at ambient pressure
An airtight seal between probe tip and ear canal wall is not required
The technique quickly provides information on middle ear function across a wide frequency region
Distinctive wideband reflectance patterns seem to be associated with normal middle ear function and different types of middle ear dysfunction

AUDE 6140 - Pediatric Audiology (15 decks)

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