CC BY-NC-ND 4.0 · Semin Hear 2023; 44(01): 065-083
DOI: 10.1055/s-0043-1763295
Original Article

Implementation of Wideband Acoustic Immittance in Clinical Practice: Relationships among Audiologic and Otologic Findings

Chris A. Sanford
1   Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
,
Jeff E. Brockett
1   Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
,
Venkatesh Aithal
2   Audiology Department, Townsville University Hospital and Hearing Research Unit for Children, University of Queensland, Queensland, Australia
,
Hammam AlMakadma
3   Department of Otolaryngology and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky
› Author Affiliations

Abstract

A number of studies have produced normative and developmental data and examples of wideband acoustic immittance (WAI) obtained in ears with pathologies and or dysfunction. However, incorporation of this tool into clinical audiology and otolaryngology practice has been slower than expected, potentially due to challenges with interpretation, integration into existing test batteries, and confidence in practical application. This article presents information aimed at helping clinicians increase their confidence in using this new tool by becoming more familiar and making connections with the ways that WAI outcomes both align with and add to standard immittance, audiometric and otologic diagnostic test outcomes. This article presents several case studies to demonstrate the use of WAI in realistic clinical settings. Each case presents a brief background, case history, audiologic/otologic findings, and initial recommendations, followed by a discussion on how the inclusion of WAI test outcomes aids in diagnostic decisions. The overall aim of this work is to identify the relationships among different diagnostic test outcomes, to demonstrate basic WAI interpretation principles, and encourage the reader to engage with this diagnostic tool in clinical practice.



Publication History

Article published online:
02 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Approved by the ASHA Legislative Council. Preferred practice patterns for the profession of audiology. American Speech-Language-Hearing Association 2006; 2006: PP2006-PP00274
  • 2 Zazove P, Atcherson SR, Moreland C, McKee MM. Hearing loss: diagnosis and evaluation. FP Essent 2015; 434: 11-17
  • 3 Kim SY, Han JJ, Oh SH. et al. Differentiating among conductive hearing loss conditions with wideband tympanometry. Auris Nasus Larynx 2019; 46 (01) 43-49
  • 4 Nakajima HH, Pisano DV, Roosli C. et al. Comparison of ear-canal reflectance and umbo velocity in patients with conductive hearing loss: a preliminary study. Ear Hear 2012; 33 (01) 35-43
  • 5 Sanford CA, Brockett JE. Characteristics of wideband acoustic immittance in patients with middle-ear dysfunction. J Am Acad Audiol 2014; 25 (05) 425-440
  • 6 Sim JH, Huber AM, Häfliger M, de Trey LA, Eiber A, Röösli C. Can an incomplete ossicular discontinuity be predicted by audiometric and clinical findings?. Otol Neurotol 2013; 34 (04) 699-704
  • 7 Ward BK, Carey JP, Minor LB. Superior canal dehiscence syndrome: lessons from the first 20 years. Front Neurol 2017; 8: 177
  • 8 Zhou G, Gopen Q, Poe DS. Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker. Otol Neurotol 2007; 28 (07) 920-926
  • 9 Lilly DJ, Margolis RH. Wideband acoustic immittance measurements of the middle ear: introduction and some historical antecedents. Ear Hear 2013; 34 (Suppl. 01) 4S-8S
  • 10 Keefe DH, Simmons JL. Energy transmittance predicts conductive hearing loss in older children and adults. J Acoust Soc Am 2003; 114 (6, Pt 1): 3217-3238
  • 11 Nakajima HH, Rosowski JJ, Shahnaz N, Voss SE. Assessment of ear disorders using power reflectance. Ear Hear 2013; 34 Suppl 1 (701) 48S-53S
  • 12 Feeney MP, Keefe DH, Hunter LL, Fitzpatrick DF, Putterman DB, Garinis AC. Effects of otosclerosis on middle ear function assessed with wideband absorbance and absorbed power. Ear Hear 2021; 42 (03) 547-557
  • 13 Merchant GR, Al-Salim S, Tempero RM, Fitzpatrick D, Neely ST. Improving the differential diagnosis of otitis media with effusion using wideband acoustic immittance. Ear Hear 2021; 42 (05) 1183-1194
  • 14 Liu YW, Sanford CA, Ellison JC, Fitzpatrick DF, Gorga MP, Keefe DH. Wideband absorbance tympanometry using pressure sweeps: system development and results on adults with normal hearing. J Acoust Soc Am 2008; 124 (06) 3708-3719
  • 15 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 1 (01) 9S-16S
  • 16 Jerger JF, Hayes D. The cross-check principle in pediatric audiometry. Arch Otolaryngol 1976; 102 (10) 614-620
  • 17 Merchant SN, Rosowski JJ. Conductive hearing loss caused by third-window lesions of the inner ear. Otol Neurotol 2008; 29 (03) 282-289
  • 18 Yasan H. Predictive role of Carhart's notch in pre-operative assessment for middle-ear surgery. J Laryngol Otol 2007; 121 (03) 219-221
  • 19 Harris PK, Hutchinson KM, Moravec J. The use of tympanometry and pneumatic otoscopy for predicting middle ear disease. Am J Audiol 2005; 14 (01) 3-13
  • 20 Sanford CA, Schooling T, Frymark T. Determining the presence or absence of middle ear disorders: an evidence-based systematic review on the diagnostic accuracy of selected assessment instruments. Am J Audiol 2012; 21 (02) 251-268
  • 21 Browning GG, Swan IRC, Gatehouse S. The doubtful value of tympanometry in the diagnosis of otosclerosis. J Laryngol Otol 1985; 99 (06) 545-547
  • 22 Curtin HD. Imaging of conductive hearing loss with a normal tympanic membrane. AJR Am J Roentgenol 2016; 206 (01) 49-56
  • 23 Wegner I, van Waes AMA, Bittermann AJ. et al. A systematic review of the diagnostic value of CT imaging in diagnosing otosclerosis. Otol Neurotol 2016; 37 (01) 9-15
  • 24 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
  • 25 Sanford CA, Hunter LL, Feeney MP, Nakajima HH. Wideband acoustic immittance: tympanometric measures. Ear Hear 2013; 34 (Suppl. 01) 65S-71S
  • 26 Feeney MP. Wideband acoustic immittance measurements of middle ear function. J Am Acad Audiol 2014; 25 (05) 424-424
  • 27 Margolis RH, Saly GL, Keefe DH. Wideband reflectance tympanometry in normal adults. J Acoust Soc Am 1999; 106 (01) 265-280
  • 28 Sanford CA, Feeney MP. Effects of maturation on tympanometric wideband acoustic transfer functions in human infants. J Acoust Soc Am 2008; 124 (04) 2106-2122
  • 29 Withnell RH, Parent P, Jeng PS, Allen JB. Using wideband reflectance to measure the impedance of the middle ear. Hear J 2009; 62 (10) 36
  • 30 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
  • 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 Peng KA, House JW. Schwartze sign. Ear Nose Throat J 2018; 97 (03) 54-54
  • 33 Rutkowska J, Özgirgin N, Olszewska E. Cholesteatoma definition and classification: a literature review. J Int Adv Otol 2017; 13 (02) 266-271
  • 34 Güneri EA, Ada E, Ceryan K, Güneri A. High-resolution computed tomographic evaluation of the cochlear capsule in otosclerosis: relationship between densitometry and sensorineural hearing loss. Ann Otol Rhinol Laryngol 1996; 105 (08) 659-664
  • 35 Kelava I, Ries M, Valent A. et al. The usefulness of wideband absorbance in the diagnosis of otosclerosis. Int J Audiol 2020; 59 (11) 859-865
  • 36 Danesh AA, Shahnaz N, Hall III JW. The audiology of otosclerosis. Otolaryngol Clin North Am 2018; 51 (02) 327-342
  • 37 Voss SE, Rosowski JJ, Merchant SN, Peake WT. How do tympanic-membrane perforations affect human middle-ear sound transmission?. Acta Otolaryngol 2001; 121 (02) 169-173
  • 38 Vanhuyse VJ, Creten WL, Van Camp KJ. On the W-notching of tympanograms. Scand Audiol 1975; 4 (01) 45-50
  • 39 Hunter LL, Margolis RH. Effects of tympanic membrane abnormalities on auditory function. J Am Acad Audiol 1997; 8 (06) 431-446
  • 40 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
  • 41 Aithal V, Aithal S, Kei J, Anderson S, Wright D. Predictive accuracy of wideband absorbance at ambient and tympanometric peak pressure conditions in identifying children with surgically confirmed otitis media with effusion. J Am Acad Audiol 2020; 31 (07) 471-484
  • 42 Grais EM, Wang X, Wang J. et al. Analysing wideband absorbance immittance in normal and ears with otitis media with effusion using machine learning. Sci Rep 2021; 11 (01) 10643
  • 43 Masud SF. Diagnosis of Mechanical Ear Pathologies Using Structure-Based Modeling and Machine Learning Techniques. Dissertation. Harvard; 2020. Accessed February 5, 2022 at: https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365115