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Sensitivity and specificity of tympanometry in diagnosis of serous otisis media (SOM)


Journal of Otolaryngology-ENT Research
Eyad Darraj, Mouhannad Fakoury, Yusur Abdulghafoor

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Abstract

Background: Serous Otitis media (SOM) is one of the most commonly encountered pathologies in children population. Fluids collection often leads to hearing loss with subsequent speech and language delay. So early diagnosis and management are of paramount importance to prevent these sequela. Effective management is often surgical: myringotomy and fluid aspiration. Myringotomy is not only therapeutic procedure, it is also the gold standard diagnostic method. It has been noticed that many ENT Surgeons in Gulf region depend on Tympanometry only for SOM diagnosis and ignore a complete clinical approach (history, physical examination including pneumatic endoscopy), this has ended up to a considerable unnecessary surgeries with high false positive diagnosis. The aim of this study is to evaluate the sensitivity and specificity of Tympanometry in diagnosis of SOM in a local study, and to draw the attention of ENT Surgeons in this part of the world not to rush to book patients for myringotomy based on Tympanometry results only. Methods: This cross-sectional study involved patients aged ≤12 yo, whom underwent myringotomy for SOM management during the period: from June 2018 to March 2019 at the ENT - department Dubai Hospital. The evaluation included the presenting complaint, physical examination, preoperative tympanometry result and intraoperative findings. Typ B tympanometry was considered (positive) for the diagnosis of SOM, while other graph types were deemed (negative). Gold standard SOM diagnosis was the intraoperative existence of fluid (positive), and subsequently absence of fluids was (negative) Intraoperative findings were matched with the preoperative tympanometry results, proper statistical schedules were performed and tympanometry sensitivity and specificity were calculated. Results: The study included 139 patients: 90 patients are male (64.7%) and 49 are female (35.3%) with mean age of 5.2 year (SD=2.1). The most common complaint was hearing loss in 77 patient (55.4%). Type B tympanometry found in 113 patients (82.5%) and fluid was found in 111 patients (79.9%). The sensitivity and specificity of Type B tympanometry: 88.2% and 80.7% respectively. Statistical tests found significant findings with P value < 0.05. Conclusions: SOM is common in age group 3-7years. History of hearing loss along with dull tympanic membrane and type B tympanometry strongly suggest SOM. However, in our study we found out that Type B graph highly suggests SOM, while the absence of this graph not necessarily rule out fluid collections. So Physicians should be aware while interpreting tympanometry graphs and evaluate these results in the context of patients’ history and examination. In order to enhance SOM diagnosis, we suggest combining Pneumatic otoscopy findings with Tympanometry graphs. This could be a future research topic: the addition value of Pneumatic otoscopy to Tympanometry graphs in the diagnosis of SOM.

Keywords

tympanometry, otoscopic, pneumatic, nintypercent, diagnosis

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