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Dr.Khabti Muhanna Mr.Khalid AlaqeelDepartment of Otolaryngology, PSMMCRiyadh, Saudi Arabia
MULTI-FREQUENCY TYMPANOMETRY :IS IT RELIABLE FOR PREOPERATIVE DIAGNOSIS OF OTOSCLEROSIS ?
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Introduction •Otosclerosis is a hereditary localized disease of the bone derived from the otic capsule.• It leads to a progressive conductive hearing loss due to fixation if stapes.•Stapedectomy is the procedure of choice for the treatment, it has good out come.•Clinical judgment is the only way for diagnosis off such disease.
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Introduction •Clinical Presentation
• Gradual onset of hearing loss at 15- 45 years
• More in female (1:2)
• Progressive course rather slow
• Majority (70%) are bilateral
• Accelerates with pregnancy
• Tinnitus
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Introduction
• Otomicroscopy• Usually Normal Tympanic
membrane • Most helpful in ruling out other
disorders
• Schwartze’s sign• Red shade in oval window niche
area
• 10% of cases
Normal TM
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IntroductionAudiological Evaluation
• Tympanometry• Impedance testing• Acoustic reflexes
• Multiple-frequency (MFT)
• Pure tones
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IntroductionMFT
• Otosclerosis • Normal
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Introduction
Multiple-frequency tympanometry(MFT):
• is a non-invasive, quick, and inexpensive method for examining the middle-ear function.
• It is applicable in cases of : • Otosclerosis • Partial and total discontinuity of the ossicular chain • Malformations of the middle ear • Primary cholesteatomas
Ref. : Ogut et al 2008. Int J Aud 47: 615- 620
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IntroductionMFT• Found to be higher in otosclerotic middle ears than normal.*
• Found to be superior to stander tympanometry in evaluation of middle ear function in particularly otosclerosis.**
• That caused researchers to evaluate its sensitivity to detecting Otosclerosis.
*Ref:Miani et al sacand adiol 29(4),225-37**Shahnaz Ear Hear,18,326-41
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Objective
To evaluate the efficiency and role of Multiple Frequency Tympanometry, in patients with otosclerosis, pre and post surgery
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Retrospective Study undertaken at the
Otolaryngology clinic of Prince Sultan
Military Medical City, Riyadh.
Chart review of patients who under
went stapes surgery during the last 7
yrs.
Methods
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Methods
• Including criteria: 1. Intact normal TM.2. MFT done preoperatively.3. Stapes fixation confirmed surgically.4. No other otological pathology.5. Conductive type of hearing loss.
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Methods
• 25 patients with confirmed otosclerosis
and operated on due to hearing loss, and
subjected to MFT pre and post surgery (12
females and 13 males mean age 34.88,
range 12-50 years)
• Control group of 24 individuals free from
any systemic and otolaryngological
disease (16 females and 8 males, mean
age 42.24, range 22-67 years
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Methods• Full audiological investigation done for the patients before surgery including the MFT by using GSI Tympstar.
•Diagnosis of stapes fixation conformed intra operative and stapes surgery done.
• Further more MFT done postoperatively for 10 patients to determine the sensitivity of the test.
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Results
Otosclerosis group
Minimum Maximum Mean Standard deviation.
Resonant frequency
850 1800 1290 293.68
Control group
Resonant frequency
550 1350 800 148.03
Postoperative group
Resonant frequency
700 1400 860 242.44
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Results
Control Pre operative Post Operative 0
200
400
600
800
1000
1200
1400*
#
Multiple Frequency Trypanometry
Fre
qu
en
cy H
Z
* p< 0.001 as compared with control and # p< 0.001 as compared with pre operative group using students t test
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Results and Conclusion
A significant increase in RF was observed in
Otosclerosis patients.
RF was significantly reduced in patients treated
surgically for otosclerosis
The results suggest MFT to be a sensitive and
useful tool in the detection of middle ear status and
mechanics in patients with otosclerosis.
MFT is highly recommended as an integral part of
diagnosis before stapes surgery.
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Thank you