Wideband Absorbance in Ears with Retraction Pockets and Cholesteatomas: A Preliminary StudyFunding This study was supported by the Queensland Health New Technology Funding and Evaluation Program grant (HQ000249 NTFEP2014/15).
Objectives The objective of this study was to describe wideband absorbance (WBA) findings in patients with cholesteatomas and retraction pockets (RPs).
Design In this prospective study, tympanometry, audiometry, and wideband tympanometry (WBT) were performed on 27 ears with an RP (eight with epitympanic RP and 19 ears with mesotympanic RP), 39 ears with a cholesteatoma (23 ears with epitympanic and 16 ears with mesotympanic cholesteatomas [MCs]), and 49 healthy ears serving as controls.
Results Mean WBA at ambient pressure (WBAamb) of both experimental groups was reduced significantly between 0.8 and 5 kHz relative to the control group. The difference between mean WBAamb and mean WBA at tympanometric peak pressure (WBATPP) was greater for the RP (0.12–0.16 between 0.5 and 1.5 kHz) than for the cholesteatoma group (0.03–0.11 between 0.6 and 3 kHz). Mean WBAamb of both epitympanic RP (ERP) and epitympanic cholesteatoma (EC) subgroups was significantly lower than that of the control group. Mean WBATPP of the ERP subgroup attained normal levels as per the control group, while mean WBATPP of EC subgroup was significantly lower than that of the control group at 0.8 to 1.5 kHz and 4 to 5 kHz. In contrast, both mesotympanic RP and MC subgroups demonstrated similar mean WBAamb and WBATPP values. No significant differences in WBAamb and WBATPP results between the RP and cholesteatomas groups were observed. Receiver operating characteristic (ROC) analyses indicated that the area under the ROC curve for distinguishing between the RP and cholesteatomas groups ranged from 0.44 to 0.60, indicating low accuracy in separating the two groups.
Conclusion While it is not possible to distinguish between the RP and cholesteatomas groups based on the WBAamb and WBATPP results, it is potentially feasible to differentiate between the EC and ERP conditions. Further study using a large clinical sample is recommended to determine the sensitivity and specificity of the WBA test to identify the EC and ERP conditions.
Keywordswideband absorbance - wideband tympanometry - cholesteatoma - retraction pockets - conductive hearing loss
Received: 08 August 2019
Accepted: 02 March 2020
15 February 2021 (online)
© 2021. American Academy of Audiology. This article is published by Thieme.
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- 1 Alper C, Olszewska E. Assessment and management of retraction pockets. Otolaryngol Pol 2017; a 71 (01) 1-21
- 2 Mierzwinksi J, Fishman AJ. Retraction pockets of tympanic membrane: protocol of management and results of treatment. Otolaryngologia 2014; 13: 114-121
- 3 Rosito LPS, Sperling N, Teixeira AR, Selaimen FA, da Costa SS. The role of tympanic membrane retractions in cholesteatoma pathogenesis. BioMed Res Int 2018; 2018: 9817123
- 4 Sadé J, Avraham S, Brown M. Atelectasis, retraction pockets and cholesteatoma. Acta Otolaryngol 1981; 92 (5-6): 501-512
- 5 Wells MD, Michaels L. Role of retraction pockets in cholesteatoma formation. Clin Otolaryngol Allied Sci 1983; 8 (01) 39-45
- 6 Fathy E, Al-Zamil WA, El-Monen SA. Management algorithm for tympanic membrane retraction pocket—a new concept for treatment. Med J Cairo Univ 2016; 84: 235-242
- 7 Kasbekar AV, Patel V, Rubasinghe M, Srinivasan V. The surgical management of tympanic membrane retraction pockets using cartilage tympanoplasty. Indian J Otolaryngol Head Neck Surg 2014; 66 (04) 449-454
- 8 Jesić S, Nesić V, Djordjević V. Clinical characteristics of the tympanic membrane retraction pocket. Srp Arh Celok Lek 2003; 131 (5-6): 221-225
- 9 Isaacson G. Diagnosis of pediatric cholesteatoma. Pediatrics 2007; 120 (03) 603-608
- 10 Chang P, Kim S. Cholesteatoma—diagnosing the unsafe ear. Aust Fam Physician 2008; 37 (08) 631-638
- 11 de Aquino JEAP, Filho NAC, de Aquino JNP. Epidemiology of middle ear and dmastoid cholesteatomas: study of 1146 cases. Brazilian J Otorhinolaryngol 2011; 77: 341-347
- 12 Kemppainen HO, Puhakka HJ, Laippala PJ, Sipilä MM, Manninen MP, Karma PH. Epidemiology and aetiology of middle ear cholesteatoma. Acta Otolaryngol 1999; 119 (05) 568-572
- 13 Kuo C-L, Shiao AS, Yung M. et al. Updates and knowledge gaps in cholesteatoma research. BioMed Res Int 2015; 2015: 854024
- 14 Tos M. Incidence, etiology and pathogenesis of cholesteatoma in children. Adv Otorhinolaryngol 1988; 40: 110-117
- 15 Ruah CB, Schachern PA, Paparella MM, Zelterman D. Mechanisms of retraction pocket formation in the pediatric tympanic membrane. Arch Otolaryngol Head Neck Surg 1992; 118 (12) 1298-1305
- 16 Cinamon U, Sadé J. Tympanometry versus direct middle ear pressure measurement in an artificial model: is tympanometry an accurate method to measure middle ear pressure?. Otol Neurotol 2003; 24 (06) 850-853
- 17 Hunter LL, Margolis RH. Effects of tympanic membrane abnormalities on auditory function. J Am Acad Audiol 1997; 8 (06) 431-446
- 18 Pau HW, Punke C, Just T. Tympanometric experiments on retracted ear drums—does tympanometry reflect the true middle ear pressure?. Acta Otolaryngol 2009; 129 (10) 1080-1087
- 19 Aithal S, Aithal V, Kei J, Anderson S, Liebenberg S. Eustachian tube dysfunction and wideband absorbance measurements at tympanometric peak pressure and 0 daPa. J Am Acad Audiol 2019; 30 (09) 781-791
- 20 Beers AN, Shahnaz N, Westerberg BD, Kozak FK. Wideband reflectance in normal Caucasian and Chinese school-aged children and in children with otitis media with effusion. Ear Hear 2010; 31 (02) 221-233
- 21 Ellison JC, Gorga M, Cohn E, Fitzpatrick D, Sanford CA, Keefe DH. Wideband acoustic transfer functions predict middle-ear effusion. Laryngoscope 2012; 122 (04) 887-894
- 22 Shahnaz N, Bork K, Polka L, Longridge N, Bell D, Westerberg BD. Energy reflectance and tympanometry in normal and otosclerotic ears. Ear Hear 2009; 30 (02) 219-233
- 23 Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol 1970; 92 (04) 311-324
- 24 Interacoustics. Technical specifications: Titan. 2015. Accessed September 20, 2019 at: https://wdh02.azureedge.net/-/media/e3-diagnostics/shared/pdf/data-sheets/interacoustics/interacoustics-technical-specifications-titan.pdf?la=en&rev=1365
- 25 Groon KA, Rasetshwane DM, Kopun JG, Gorga MP, Neely ST. Air-leak effects on ear-canal acoustic absorbance. Ear Hear 2015; 36 (01) 155-163
- 26 Greenhouse SW, Geisser S. On the methods in the analysis of profile data. Psychometrika 1959; 24: 95-112
- 27 Turner RG, Nielsen DW. Application of clinical decision analysis to audiological tests. Ear Hear 1984; 5 (03) 125-133
- 28 Zhou XH, Obuchowski NA, Obuchowski DM. Statistical Methods in Diagnostic Medicine. New York, NY: Wiley and Sons; 2002
- 29 Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 2000; 45 (1-2): 23-41
- 30 Guidelines for screening for hearing impairment and middle ear disorders. Working Group on Acoustic Immittance Measurements and the Committee on Audiologic Evaluation. American Speech-Language-Hearing Association. ASHA Suppl 1990; (02) 17-24
- 31 Voss SE, Merchant GR, Horton NJ. Effects of middle-ear disorders on power reflectance measured in cadaveric ear canals. Ear Hear 2012; 33 (02) 195-208
- 32 Nakajima HH, Rosowski JJ, Shahnaz N, Voss SE. Assessment of ear disorders using power reflectance. Ear Hear 2013; 34 (Suppl. 01) 48S-53S
- 33 Feeney MP, Grant IL, Marryott LP. Wideband energy reflectance measurements in adults with middle-ear disorders. J Speech Lang Hear Res 2003; 46 (04) 901-911
- 34 Rosowski JJ, Stenfelt S, Lilly D. An overview of wideband immittance measurements techniques and terminology: you say absorbance, I say reflectance. Ear Hear 2013; 34 (Suppl. 01) 9S-16S
- 35 Piskorski P, Keefe DH, Simmons JL, Gorga MP. Prediction of conductive hearing loss based on acoustic ear-canal response using a multivariate clinical decision theory. J Acoust Soc Am 1999; 105 (03) 1749-1764
- 36 Alper CM, Olszewska E. Assessment and management of retraction pockets. Otolaryngol Pol 2017; b 71: 1-21
- 37 Mikhasev GI, Bosiakov SM, Petrova LG, Maisyuk MM. Finite-element modelling of the tympanic membrane retraction pocket under negative pressure in the tympanic cavity. Mech Eng 2015; 13: 249-257
- 38 Martins O, Victor J, Selesnick S. The relationship between individual ossicular status and conductive hearing loss in cholesteatoma. Otol Neurotol 2012; 33 (03) 387-392
- 39 Rosito LPS, Teixeira AR, Netto LS, Selaimen FA, da Costa SS. Cholesteatoma growth patterns: are there audiometric differences between posterior epitympanic and posterior mesotympanic cholesteatoma?. Eur Arch Otorhinolaryngol 2016; 273 (10) 3093-3099
- 40 Zheng Y, Ou Y, Yang H, Liu X, Chen S, Liu W. [Clinical manifestation of attic retraction pocket]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2005; 19 (16) 737-739
- 41 Shaver MD, Sun XM. Wideband energy reflectance measurements: effects of negative middle ear pressure and application of a pressure compensation procedure. J Acoust Soc Am 2013; 134 (01) 332-341
- 42 Aithal V, Aithal S, Kei J, Manuel A. Normative wideband acoustic immittance measurements in Caucasian and Aboriginal children. Am J Audiol 2019; 28 (01) 48-61