Treatment of otitis media with effusion based on politzerization with an automated device.

This study evaluated the efficacy of politzerization with an automated, hand-held device that controls volume velocity (airflow) in the treatment of 20 children with otitis media with effusion. These patients underwent politzerization twice a week for up to 6 weeks. Another 20 children with otitis media with effusion who were not treated with politzerization served as controls. Following treatment, resolution of the average air-bone gap to within normal limits was achieved in 70% of the treated group and 20% of the controls, which eliminated the need for grommet insertion in these patients. Improvement in tympanometric peak pressure was also significantly greater in the treated group. Politzerization was efficiently and successfully performed in all patients. The automated device's ease of administration and its ability to control airflow suggests that it has the potential to be an effective home treatment that can be administered by the parents or guardians of children who have otitis media with effusion.

Pure-tone assessment and screening of children with middle-ear effusion.

The purpose of this prospective investigation was to evaluate the sensitivity of pure-tone screening of children with middle-ear effusion (MEE) and to describe the short-term audiometric and otologic follow-up of children with MEE who pass versus fail a pure-tone screen. Eighty-two ears of 54 children with MEE based on pneumotoscopy/microtoscopy were investigated. A complete otolaryngologic evaluation, pure-tone screen, then complete audiologic evaluation were performed at the initial test. Retesting was done at 6-8 weeks post initial test. The sensitivity of the ASHA (1985) pure-tone screen to MEE was 54 percent when 500 Hz was excluded, 85 percent when 500 Hz was included, and 89 percent when 250 Hz was also included. Significant air-bone gaps were present in 100 percent of the MEE group that failed and in 92 percent of the MEE group that passed the screen (excluding 500 Hz). Of the cases with MEE at the initial test that returned for the retest, 53 percent to 54 percent continued to show MEE. The mean speech-recognition threshold (SRT) was in best agreement with the hearing-threshold levels at the low frequencies, regardless of the pure-tone screen outcome. The results suggest that 500 Hz, as well as 1000-4000 Hz, should be used in a pure-tone screen at 20 dB HL for detection of MEE. The results also question the assumption in the ASHA (1985) screening guidelines that passing a pure-tone screen at 1000-4000 Hz puts one at low risk for hearing impairments that "interfere with or have the potential for interfering with communication" (ASHA, 1985).

Acoustic-immittance screening for detection of middle-ear effusion in children.

The purpose of this investigation was to evaluate the sensitivity and specificity of the following acoustic-immittance protocols and their constituent measures for detection of middle-ear effusion in children: (a) tympanometric width; (b) absent ipsilateral acoustic reflex; (c) ASHA guidelines; (d) tympanometric peak pressure; and (e) static-acoustic middle-ear admittance. The middle-ear sample was composed of 82 ears of 54 subjects ranging in age from 3 to 11 years. The control (normal-hearing, normal middle-ear) sample was composed of 53 ears of 53 subjects ranging in age from 3 to 10 years. Each subject was given a complete otolaryngologic evaluation (including pneumotoscopy and/or microtoscopy) and audiologic (including acoustic-immittance) evaluation. In the group of middle ears with normal-hearing sensitivity, the sensitivity and specificity of the ASHA guidelines were 63 percent and 79 percent, respectively. An acoustic-immittance screening protocol, based on all of the individual acoustic-immittance measures, and characterized by high sensitivity and specificity, is proposed.