Determining the Presence or Absence of Middle Ear Disorders: An Evidence-Based Systematic Review on the Diagnostic Accuracy of Selected Assessment Instruments Purpose: To conduct an evidence-based systematic review on the state of the evidence and the diagnostic accuracy of multifrequency tympanometry (MFT), 1000 Hz tympanometry, and wideband acoustic transfer functions in determining the presence or absence of middle ear disorders.Method: A systematic search of the literature published between 1975 ... Review
Review  |   December 2012
Determining the Presence or Absence of Middle Ear Disorders: An Evidence-Based Systematic Review on the Diagnostic Accuracy of Selected Assessment Instruments
 
Author Affiliations & Notes
  • Chris A. Sanford
    Idaho State University, Pocatello
  • Tobi Frymark
    American Speech-Language-Hearing Association, Rockville, MD
  • Correspondence to Tracy Schooling: tschooling@asha.org
  • Editor: Sheila Pratt
    Editor: Sheila Pratt×
  • Associate Editor: Lisa Hunter
    Associate Editor: Lisa Hunter×
  • © 2012 American Speech-Language-Hearing Association
Article Information
Hearing Disorders / Review
Review   |   December 2012
Determining the Presence or Absence of Middle Ear Disorders: An Evidence-Based Systematic Review on the Diagnostic Accuracy of Selected Assessment Instruments
American Journal of Audiology, December 2012, Vol. 21, 251-268. doi:10.1044/1059-0889(2012/11-0029)
History: Received September 1, 2011 , Accepted May 2, 2012
 
American Journal of Audiology, December 2012, Vol. 21, 251-268. doi:10.1044/1059-0889(2012/11-0029)
History: Received September 1, 2011; Accepted May 2, 2012
Web of Science® Times Cited: 3

Purpose: To conduct an evidence-based systematic review on the state of the evidence and the diagnostic accuracy of multifrequency tympanometry (MFT), 1000 Hz tympanometry, and wideband acoustic transfer functions in determining the presence or absence of middle ear disorders.

Method: A systematic search of the literature published between 1975 and 2011 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality.

Results: Ten studies were included and focused on participants with otosclerosis or otitis media. Two studies investigated 1000 Hz tympanometry, 7 examined MFT, and 2 addressed wideband reflectance (WBR). Methodological quality varied. Positive likelihood ratios (LR+) were predominantly uninformative for MFT and were mixed for 1000 Hz tympanometry. LR+ values for WBR ranged from diagnostically suggestive to informative. Negative likelihood ratios (LR−) for 1000 Hz tympanometry and WBR were at least diagnostically suggestive. LR− values for MFT were mixed, with half considered clinically uninformative and half considered diagnostically suggestive.

Conclusions: Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of these technologies. Additional investigations are needed to determine which tools can most accurately predict middle ear status.

Acknowledgments
This evidence-based systematic review was supported by the American Speech-Language-Hearing Association’s National Center for Evidence-Based Practice in Communication Disorders (N-CEP). The authors thank the following individuals, who contributed to the preparation of this article: Laura J. Cannon, N-CEP research assistant; and Rob Mullen, N-CEP director.
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