Journal Reading

THT-KL

Comparison of Tympanometry
Results for Probe Tones of 226 Hz
and 1000 Hz in Newborns
Presenting by: dr. Ekky Rizky Maulana
Supervisor: dr. Sally Mahdiani., Sp. T.H.T.B.K.L., Subsp. Oto. (K)., M. Kes

Department of Ototrhinolaryngology Head an Neck Surgery

Faculty of Medicine Padjadjaran University
Dr. Hasan Sadikin General Hospital
Bandung
Contents

1 Introduction 4 Discussion

2 Materials & Method 5 Conclusions

3 Results 6 Critical Appraisal

1
2
Immitance Testing
Immittance testing is a type of audiological evaluation that
measures the compliance (movement) of the tympanic
membrane (eardrum) and the resistance of the middle ear
system to sound. The testing includes:

- Tympanometry
- Acoustic reflex testing
- Static acoustic impedance testing

It is used to diagnose various ear conditions such as otitis

media, tympanic membrane perforations, and Eustachian
tube dysfunction.

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 Immitance Testing
Measures the movement of the tympanic membrane in response to changes in air pressure in the ear canal. The
Tympanometry results of this test provide information about the status of the middle ear, including the presence of fluid,
perforation of the eardrum, or other issues that may impact hearing.

Acoustic Reflex Measures the involuntary contraction of the muscles in the middle ear in response to loud sounds. This test is
used to determine the integrity of the acoustic reflex pathway and to identify the type and degree of hearing
Testing
loss.

Static Acoustic Measures the amount of sound energy reflected back from the middle ear when a sound is introduced into the
ear canal. This test can provide information about the stiffness of the middle ear system and can be used to
Impedance Testing
diagnose various middle ear disorders.

Sebothoma B, Khoza-Shangase K. Acoustic immittance measures and middle ear assessment: Current practice
by South African audiologists. South African Journal of Communication Disorders. 2021;68(1).
4
 High Frequency Tympanometry (HFT)
Is a diagnostic test used to evaluate the function of the
middle ear at frequencies above the conventional range of
tympanometry (226 Hz). HFT typically uses frequencies up
to 1000 Hz

During HFT:
- A probe is inserted into the ear canal, and a small sound is
emitted at various frequencies.
- The sound waves reflect off the eardrum and middle ear
system, and the probe measures the response of the middle
ear to these sounds.
- The resulting data is displayed as a graph that shows the
compliance and impedance of the middle ear as a function
of frequency.
Emadi M, Rezaei M, Nahrani MH, Bolandi M. High frequency tympanometry (1,000 Hz) for neonates with normal
and abnormal transient evoked Otoacoustic emissions. Journal of Audiology and Otology. 2016;20(3):153–7.
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Introduction

6
 Introduction
Impedance Implementing
appropriate treatment, or
Audiometry Diagnosed rehabilitation and therapy
(Tympanometry) programs, early on

Hearing Disorders
in Newborn
(most common → OME)

Lead to temporary
or permanent
Undiagnosed
conductive hearing
loss

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 Introduction
Compliance of the
auditory canal are
different across age
group Use of 1000 Hz test
Common tone

Tympanometry Inconsistent ↓
Result higher frequency allows
Probe Frequency (False positive/negative) individual admittance
220 or 226 Hz components to be
Diameter of the ear canal assessed
may change by as much as
70% under the effect of
imposed tympanometric
pressure

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 Introduction
Normative data for
assessing 226 Hz
tympanometric
measurements in
newborns and infants In recent years numerous
studies have been
Tympanogram
published aimed at
classification was Produce too many
establishing normative
proposed by Jerger false positives
tables for assessing
and Liden tympanometric findings
Evaluation of the static particularly at 1000 Hz
compliance, ear canal
volume, and
tympanometric width

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Introduction
Aim of the Study

Compare tympanometric parameters and to assess

the rate of occurrence of individual types of
tympanograms for :

226 Hz 1000 Hz

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Material
and
Method
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Participants
● The study included 53 newborns (23 girls and 30 boys) hospitalized in the Pediatric
University Hospital in Lublin.
● Most frequently listed newborn hospitalization causes were upper respiratory
infection, pneumonia, hepatitis, anemia, urinary tract infection, and prematurity. In
some cases the diseases were concurrent.
● The youngest newborn to undergo testing was 2 days old, and the oldest was 60 days
old at the time of testing. Mean age was 26 days (SD = 15.5 days).
● In two children, tympanograms were registered in one ear only.
● The total number of ears analyzed was 104.

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 Procedures Assessed the status of newborn ears
using otoscopy and tympanometry

Tympanometric
Ear canal pressure Static compliance Middle ear pressure Ear canal volume
width

evaluated using classification

schemes from the literature

226 Hz 1000 Hz
(A, As, B, and E) (A, As, B, and E)

* The study was conducted with the consent of the parents and approval of the Ethics Committee of the Institute of 13
Physiology and Pathology of Hearing, Poland.
Procedures
The study assessed the status of newborn ears using otoscopy and tympanometry, which measures ear canal
pressure, static compliance, tympanometric width, middle ear pressure, and ear canal volume. Tympanograms
were registered at two frequencies (226 Hz and 1000 Hz) and evaluated using classification schemes from the
literature. For 226 Hz, the static compliance was assessed using the normal range for newborns and infants,
while for 1000 Hz, the criteria proposed by Kei et al. were adopted. Four types of tympanograms were
distinguished for 226 Hz (A, As, B, and E), while for 1000 Hz, four types were identified (type 1, 2, 3, and 4). The
study was conducted with the consent of the parents and approval of the Ethics Committee of the Institute of
Physiology and Pathology of Hearing, Poland.
Data Analysis
- Comparative statistical analysis of results was performed using a Mann–
Whitney U test (since the samples did not have a normal distribution)
- Analysis was done in StatSoft Statistica 7.0, and the differences were
assumed statistically significant if p < 0.05.

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Results

15
Results

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Results
- When a type A tympanogram (single-peaked) was
obtained with 226 Hz, it was also obtained with 1000
Hz in more than 60% of cases, while 15.3% registered
a type B tympanogram (flat) and 22% unclassified.
- Conversely, when a type B tympanogram was
obtained with 226 Hz, a matching result (type B in
both measurements) was obtained in only 26% of
cases; the rate of occurrence of other types was 66.7%
for type A (single-peaked) and 6.7% unclassified.
- For all groups of tympanograms recorded with 226
Hz, the most frequently occurring tympanogram for
1000 Hz was type A.

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Results

- The study analyzed the rate of occurrence of the same type of tympanogram for two different frequencies, 226 Hz
and 1000 Hz.
- The analysis showed that out of 104 ears, single-peaked tympanograms were registered in 37 ears (35.6%), while
type flat tympanograms were recorded in 4 ears (3.8%).
- This means that only 39.4% of tympanograms were concordant when measured using both frequencies. Table 2
presents these results. 18
Results

- Ear canal volume (ECV) was similar in both measurements for both frequencies, with no statistically significant
differences. The mean value of static compliance (SC) for 1000 Hz was three times higher than for 226 Hz.
Comparison of MEP values for both frequencies showed no statistically significant differences.
- The tympanometric width was not significantly different for either measurement frequency. The statistical analysis
showed that the static compliance values in type A tympanograms for 1000 Hz were significantly higher than for
226 Hz.

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Results
- The static compliance values for 1000 Hz had a
higher dispersion compared to 226 Hz.
- For 226 Hz, nearly 60% of the static compliance
scores did not exceed 0.3 mmho, whereas for 1000
Hz, most scores (68.2% of tympanograms) did not
exceed 0.9 mmho, with values ranging from 0.4 to 2
mmho.

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Discussion

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Discussion
To compares the parameters of tympanograms registered for 226 Hz and 1000 Hz in newborns and infants to assess how
frequently each tympanogram type occurred for similar measurement frequencies

The mean ECV was 0.5 mL for 226 Hz and 0.4 mL for 1000 Hz.

Showed no statistically significant differences

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Discussion
Mean ECV values were similar to those reported by other authors

Yang et al., [2020], the mean ECV for 1000 Hz

Yerraguntla et al., reported mean ECV values for
was 0.71 mL. Middle ear pressure for type A
1000 Hz in boys of 0.83 daPa for the right ear
tympanograms (single-peaked) and 226 Hz
and 0.86 daPa for the left ear and in girls 0.97
ranged from -63 daPa to 77 daPa, with a mean
daPa bilaterally.
value of 19.6 daPa

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Discussion
Middle ear pressure for type A tympanograms at 226 Hz ranged from 63 daPa to 77 daPa, with a mean
value of 19.6 daPa

MEP values differed from those obtained by Resende et al., but were similar for 1000 Hz in both
studies

Static susceptibility values were similar for 1000 Hz to those obtained by Yang et al., but values
differed for 226 Hz

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Discussion (Tympanogram type)
● Most often registered tympanogram for both frequencies was type A (single-peaked)
● No type C tympanograms were recorded for 226 Hz, which is inconsistent with results of
other authors
● Twice as many type B tympanograms were recorded for 1000 Hz compared to other studies
● Double-peaked tympanograms (type E) were recorded in 10.6% of ears for 226 Hz, but
none for 1000 Hz
● Many authors consider double-peaked tympanograms to be normal in children younger than
6 months

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Discussion (Frequency Occurence)
● Type A tympanograms were the most frequently appearing for 1000 Hz, regardless of the
tympanogram type present at 226 Hz
● Type A tympanograms were present for both frequencies simultaneously in only 35.6% of
cases, and type B in 3.8% of cases
● Disease detectability using 1000 Hz is threefold the rate using 226 Hz
● Mutlu et al. reported that with a measurement frequency of 1000 Hz, disease detectability
increased twofold compared to 226 Hz. They also reported that type A tympanograms were
present simultaneously at both frequencies in 30.7% of cases.

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Conclusions

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Conclusions
● This study suggests that assessments of middle ear status are not consistent when
frequencies of 226 and 1000 Hz are used.
● Moreover, in newborns, the rate of abnormal tympanograms is higher at 1000
Hz. Therefore, 1000 Hz seems to be a better frequency for assessing middle ear
conditions in newborns.

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Critical Appraisal

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Critical Appraisal
1. Were the criteria for inclusion in the sample clearly defined?
Yes No Unclear Not applicable

The study only stated the the

detail of the subject and settings,
the only certain inclusion reader
identify was the participants must
me a newborn patients in a
certain hospital.

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Critical Appraisal
2. Were the study subjects and the setting described in detail?
Yes No Unclear Not applicable

Described clearly as the high-

lighted words.

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Critical Appraisal
3. Was the exposure measured in a valid and reliable way?
Yes No Unclear Not applicable

Yes, as every details were

described in the procedures
section.

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Critical Appraisal
4. Were objective, standard criteria used for measurement of the
condition?
Yes No

✓
Unclear Not applicable

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Critical Appraisal
5. Were confounding factors identified?
Yes No Unclear Not applicable

2 confounders were identified:

- Underlying disease
- Different age → anatomical
structures are different across age
group as stated earlier →
inconsistent test result

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Critical Appraisal
6. Were strategies to deal with confounding factors stated?
Yes No Unclear Not applicable

For 2 confounders:
- Underlying disease → strategies was not stated
- Different age → they realize the impact to the test result (as they discuss it
earlier) but did not stated clearly how to deal with it

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Critical Appraisal
7. Were the outcomes measured in a valid and reliable way?
Yes No Unclear Not applicable

Yes, as the outcomes were measured exactly according to the standard criteria
we discussed before.

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Critical Appraisal
8. Was appropriate statistical analysis used?
Yes No Unclear Not applicable

Yes, as the author describe the

reason why exact statistical test
was used and the software to
support the analysis.

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Thank You.