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Abstract Objective The video otoscope has already proven to be useful for the diagnosis of several pathologies, so the objective of this study was to evaluate the diagnostic accuracy of the video otoscope in cases of tympanic membrane perforation. Methods This is a diagnostic accuracy study performed at the hearing health division of a tertiary-level referral hospital. Patients older than 8 years of age who had any symptom that could be related to perforation (otalgia, otorrhea, tinnitus, and/or hypoacusis) were invited to participate in the study. Participants were evaluated by three different diagnostic methods (otomicroscope, conventional otoscope, and video otoscope) performed by three different evaluators in a blind fashion. The microscope was considered the reference standard. Results 176 patients were evaluated, totaling 352 tympanic membranes. Twenty-seven tympanic membrane perforations were diagnosed by the microscope, a prevalence of 7.7%. The video otoscope showed a sensitivity of 85.2% (95% CI 81.5%‒88.9%), specificity of 98.1% (95% CI 96.7%‒99.5%) and accuracy of 97.1% (95% CI 95.4 %-98.8 %). The conventional otoscope showed a sensitivity of 96.3% (95% CI 94.3-98.3), specificity of 98.8% (95% CI 97.7-99.9) and accuracy of 98.6% (95% CI 97.4-99.8). The Kappa value between the microscope and the video otoscope was 0.8 and between the microscope and the conventional otoscope was 0.9. Regarding the participants' perception, 53.4% (p < 0.001) considered the video otoscope as the best method for understanding the tympanic membrane condition presented by them. Conclusions The video otoscope showed relevant sensitivity and specificity for clinical practice in the diagnosis of tympanic membrane perforation. Moreover, this is an equipment that can facilitate the patient's understanding of the otologic pathology presented by him/her. In this regard, this method may be important for better patient compliance, requiring further studies to evaluate this hypothesis. Level of evidence Is this diagnostic or monitoring test accurate? (Diagnosis)—Level 2 (Individual cross-sectional studies with consistently applied reference standard and blinding).
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RESUMO Objetivo Padronizar os parâmetros de latência e amplitude obtidos com o estímulo Ichirp de banda estreita, na pesquisa dos potenciais evocados auditivos de tronco encefálico nas frequências de 500 Hz, 1 kHz, 2 kHz e 4 kHz. Métodos O estudo foi realizado na Divisão de Saúde Auditiva do Hospital de Reabilitação de Anomalias Craniofaciais, da Universidade de São Paulo. Participaram 20 adultos ouvintes normais, na faixa etária de 18 a 35 anos. Todos os participantes foram submetidos à audiometria tonal limiar, logoaudiometria, imitanciometria e aos potenciais evocados auditivos de tronco encefálico, pesquisados com o estímulo Ichirp de banda estreita, nas frequências de 500 Hz, 1 kHz, 2 kHz e 4 kHz. Resultados Em todas as frequências avaliadas foi observada a função latência-intensidade, ou seja, o aumento na latência da onda V, na medida em que a intensidade do estímulo foi diminuída, bem como a diminuição na latência da onda V com o aumento da frequência avaliada. Além disso, verificou-se a redução na amplitude da onda V com a diminuição da intensidade do estímulo. Constatou-se o nível mínimo de resposta, em todas as frequências, em níveis inferiores aos valores sugeridos pela literatura como critério de normalidade no registro dos potenciais evocados auditivos de tronco encefálico de frequência específica, sendo os maiores valores nas frequências de 500 Hz e 1 kHz. Conclusão Foram obtidos os valores de referência de normalidade para os potenciais evocados auditivos de tronco encefálico em adultos ouvintes normais com o estímulo Ichirp, valores estes que podem contribuir para o aprimoramento do exame, na prática clínica.
ABSTRACT Purpose Standardize the latency and amplitude parameters using the narrow band Ichirp stimulus on Brainstem Auditory Evoked Potential (BAEP) at frequencies of 500 Hz, 1 kHz, 2 kHz and 4 kHz. Methods The study was performed at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), Auditory Health Division, University of São Paulo (USP). Twenty normal hearing adults, aged between 18 and 35 years, were submitted to pure tone audiometry, speech audiometry, immittance and to BAEP with narrow band Ichirp stimulus at 500 Hz, 1 kHz, 2 kHz and 4 kHz frequencies. Results In all frequencies evaluated, the latency-intensity function was observed, that is, the increase in the latency of the V wave as the stimulus intensity was decreased, as well as the decrease in the latency of the V wave with the increase of the frequency. In addition, the reduction in the amplitude of the wave V was verified with the decrease of the intensity of the stimulus. The minimum response level, in all frequencies, was found to be lower than the values suggested in the literature as a criterion of normality in frequency - specific BAEP, with the highest values at frequencies of 500 Hz and 1 kHz. Conclusion Normal reference values to BAEP were obtained in normal hearing adults with the narrow band Ichirp stimulus, which may contribute to its improvement in clinical practice.