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Pro Otology
Balkan Journal of Otology & Neuro-Otology, Vol. 2, No 1:11-13 © 2002
All rights reserved. Published by Pro Otology Association

The Importance of Tympanometry in Diagnosting the Complicaions of the Adenoid Vegetation

S. Konsulov, J. Jovchev, D. Pazardzhikliev, S. Andreeva, A. Beshkova

Department of Otorhinolaryngology, Medical Faculty, Plovdiv, Bulgaria

ABSTRACT

Objective: To confirm the importance of applying tympanometry the diagnosis of complications of adenoids.
Sudy Design: Randomized study.
Setting: ENT department HMI Plovdiv, Bulgaria.
Patients: 134 children with adenoids and hearing loss. Aged between 2 and 15 years. 86 boys and 48 girls.
Interventions: History, thorough ENT examination, pure tone audiometry, conditioned play audiometry, tympanometry.
Main Outcome Measures: Comparison of otoscopic, pure tone audiometry and tympanometry findings, which confirms the significance of tympanometry in cases different for diagnosis.
Results: Four groups: 64 patients with bilateral type B curve, 12 - with unilateral type B, 51 - with type C, and 7 - with type A.
Conclusions: Tympanometry is the sole objective method to establish the diagnosis in apresence or absence of effusion. It makes it possible to make the diagnosis in children with adenoids and hearing loss when pure tone audiometry is impossible to perform.
Key Words: Tympanometry, Audiometry, Adenoids.
Pro Otology 1: 11-13, 2002

INTRODUCTION

The most common reason of impaired hearing in the child's age is serous otitis media. The hypertrophy of the adenoids plays a major part in its pathogenesis. Diagnosis of serous otitis is difficult if we rely only on history and otoscopy. In this relation tympanometry is the best test to establish the presence or the absence of effusion (1,2).

Metz in 1946 described for the first time the method acoustic impedancemetry. In 1970 Yerger described in detail three tests that are the essence of inpedancemetry, namely: static acoustic immittance, tympanometry and acoustic reflex threshold. Tympanometry is a technique that assesses the mobility and immittance of tympanic membrane during pressure changes in the sealed ear canal. This results in different relationships between air pressure and immittance - tympanograms, each of which describe particular characteristic of the peripheral part of the auditory system. For diagnostic purposes and to assist pure tone audiometry, clinical examination, assessment of acoustic reflex, tympanometry offers valuable information on mobility of tympanic membrane, the pressure in the middle year, perforation of tympanic membrane, the function of auditory tube.

Many otorhinolaryngolgists believe that because of the difficulties to diagnose serous otitis, it is a disease much common than reported (3). In the literature is data, according to which diagnosis is established in time no more than in 50% of the cases (4).

Because of the mentioned reasons tympanometry is the method of choice that timely and reliably establishes the diagnosis serous otitis media with or without effusion (5).

MATERIAL AND METHODS

We examined 134 children with adenoids and impaired hearing aged from 2 to 15 years. We divided them in 3 age groups (Table 1).

86 were boys and 48 - girls. In all cases otoscopy and pure tone audiometry was performed. In the age group 2-5 years we used conditioned play audiometry.

Tympanomerty was performed with the impedancemeter " Amplaid 720" on both ears in all cases.

Table 1. Patients distributed in groups according to age. Groups 2-5 years 6-9 years 10-16 years Total Patients 62 60 12 134 % 46 45 9 100		Table 2. Patients distributed in groups according to type of tymponometry curve. Groups I - type В bilateraly II - type В unilateraly III - type С IV - type А Total Patients 64 12 51 7 134 % 48 9 38 5 100
FIG. 1. Tympanometric curve type A.		FIG. 2. Tympanometric curve type B bylaterally.
FIG. 3. Tympanometric curve type B unilaterally.		FIG. 4. B. Tympanometric curve type C.

RESULTS

We found several types of tympanometric curves that corresponded to normal conditions in the middle ear and different types of pathology. The curve type A (Fig. 1) corresponds to normal findings and was used for comparison.

In the study we found 4 types of curves and 4 groups were created (Table 2).

In the first group with "flat" tympanometric curve - type B were children with serous otitis with effusion bilateraly (Fig. 2). It comes into view that there are 5 children with normal findings in pure tone audiometry, but with evidence of middle ear effusion by tympanometry. In four children with heavy hearing impairment - perception only for low frequencies. For this reasons there were difficulties in the diagnosis of middle ear pathology. In these cases tympanometry played key role and diagnosing serous otitis was. In the latter cases tympanometry was the only objective and reliable method for detecting and assessing the middle ear pathology (4). In the remaining children of this group pure tone audiometry revealed conductive hearing impairment and otoscopy findigs were retraction and darkening of the membrane.

In the second group were kids with tympanometry type B - unilateraly (Fig.3). The other side was with normal tympanometry type A.

With shortened tympanometry type C were 51 kids. These lacked evidence of middle ear effusion, but we observed clearly expressed limitation of maximal immittance, that demostrated at negative pressure more than 100mmH2O (Fig. 4). This tympanometry curve differs from "flat" curve by the mobility of tympanic membrane which is a result of the retraction and the impaired function of auditory tube in cases of adenoids. In 10 kids with type C the curve was detected 10 days post adenectomy. Prior to surgery they had tympanometry type B. control examination 2 months postoperatively 9 children showed tympanometry type A, only in one child type C persisted.

In the fourth group we had 7 children with adenoids and normal tympanometry type A (Fig. 1). In four of them we had normal findings on pure tone audiometry. In 3 kids because of the small age and lack of cooperation conditioned play audiometry failed. In these children tympanometry was do only method to establish the state of the middle ear.

CONCLUSION

In the everyday practice if we rely only on otoscopy and pure tone audiometry diagnosis of serous otitis is a tough one. Tympanometry is the sole objective method to establish the diagnosis no matter the presence or absence of effusion. It makes it possible to make the diagnosis in children with adenoids and hearing impairment when pure tone audiometry is impossible to perform.

REFERENCES

1. Aithal V, Aithal S, Pulotn L. Otitis Media with Effusion in Children. An Audiological Case Series Study PNG Med J 1995;38:79-94.

2. Dimov P. Method of Diagnosis in the Diseases. In: Dimov P. Chronic Otitis Media with Effusion. St. Zagora: Ariel, 1997:28-35.

3. Stiwens T. Sensitivity, Specificity and Predictive Value of Tympanometry in Predicting Hearing Impairment in Otitis Media with Effusion. Clin Otolaryngology 1999;24:294-300.

4. Spremo S, Markuc ZK. Clinical Importance of Tympanometry in the Diagnosis of Chronic Secretory Otitis Str Arh Celok Cek 1998;126:242-7.

5. Van Balen JA, Aarts AM, De Melner RA. Tympanometry by General Practitioners: Reliable? Int J Pediatr Otorhinolaryngology 1999;48:117-23.

6. Watters GW, Jones JE, Freeland AP. The Predictive Value of Tympanometry in the Diagnosis of Middle Ear Effusion. Clin Otolaryngology 1997;22:343-5.