Clin Exp Otorhinolaryngol.  2019 Aug;12(3):249-254. 10.21053/ceo.2018.01137.

Can Wideband Tympanometry Be Used as a Screening Test for Superior Semicircular Canal Dehiscence?

• Demir E
• Afacan NN
• Celiker M
• Celiker FB
• Ä°necikli
• Terzi S
• Dursun E

• KMID: 2455364
• DOI: http://doi.org/10.21053/ceo.2018.01137

Abstract

OBJECTIVES
We explored whether wideband tympanometry (WBT) could be used as a screening test for superior semicircular canal dehiscence (SSCD), and obtained new WBT data (given that the test is not yet in common clinical use) on patients with SSCD.
METHODS
We compared the WBT data of patients clinically and radiologically diagnosed with SSCD in our hospital between 2013 and 2018 to those of healthy volunteers. We compared the resonance frequency (RF), maximum absorbance frequency (MAF), and maximum absorbance ratio (MAR). The t-test was used for statistical analysis with the significance level set to P<0.05. In addition, we used receiver operating characteristic analysis to derive cutoff values for SSCD diagnosis in terms of sensitivity and specificity.
RESULTS
Seventeen patients (four with bilateral and 13 with unilateral disease; 17 ears) diagnosed with SSCD and 27 healthy volunteers (47 ears) were included. The mean RFs of the SSCD patients and healthy subjects were 548.7 Hz (range, 243 to 853 Hz) and 935.1 Hz (range, 239 to 1,875 Hz), respectively (P<0.001). The mean MARs of the SSCD patients and healthy subjects were 89.4% (range, 62% to 100%) and 82.4% (range, 63% to 99%), respectively (P=0.005). The mean MAFs of the SSCD patients and healthy subjects were 1,706.3 Hz (range, 613 to 3,816 Hz) and 2,668 Hz (range, 876 to 4,387 Hz), respectively (P<0.001). In terms of SSCD diagnosis, a MAR above 86% afforded 81% sensitivity and 77% specificity; an RF below 728 Hz, 86% sensitivity and 81% specificity; and an MAF below 1,835 Hz, 79% sensitivity and 67% specificity.
CONCLUSION
WBT may be a useful clinical screening test for SSCD. The RF and MAF were lower, and the MAR higher, in SSCD patients than in normal controls.

Keyword

Tympanometry; Semicircular Canal; Dehiscence; Resonance Frequency; Acoustic Impedance Test

MeSH Terms

Acoustic Impedance Tests*
Diagnosis
Healthy Volunteers
Humans
Mars
Mass Screening*
ROC Curve
Semicircular Canals*
Sensitivity and Specificity

Figure

• 

  Fig. 1. Receiver operating characteristic curves showing that (A) a maximum absorbance ratio (MAR) over 86% afforded 81% sensitivity and 77% specificity; (B) an resonance frequency (RF) below 728 Hz afforded 86% sensitivity and 81% specificity; and (C) an maximum absorbance frequency (MAF) below 1,835 Hz afforded 79% sensitivity and 67% specificity.

Reference

1. Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal. Arch Otolaryngol Head Neck Surg. 1998; Mar. 124(3):249–58.

2. Mau C, Kamal N, Badeti S, Reddy R, Ying YM, Jyung RW, et al. Superior semicircular canal dehiscence: diagnosis and management. J Clin Neurosci. 2018; Feb. 48:58–65.

3. Minor LB. Clinical manifestations of superior semicircular canal dehiscence. Laryngoscope. 2005; Oct. 115(10):1717–27.

4. Zhou G, Gopen Q, Poe DS. Clinical and diagnostic characterization of canal dehiscence syndrome: a great otologic mimicker. Otol Neurotol. 2007; Oct. 28(7):920–6.

5. Rauch SD. Vestibular evoked myogenic potentials. Curr Opin Otolaryngol Head Neck Surg. 2006; Oct. 14(5):299–304.

6. Rosowski JJ, Nakajima HH, Hamade MA, Mahfoud L, Merchant GR, Halpin CF, et al. Ear-canal reflectance, umbo velocity, and tympanometry in normal-hearing adults. Ear Hear. 2012; Jan-Feb. 33(1):19–34.

7. Feeney MP, Grant IL, Marryott LP. Wideband energy reflectance measurements in adults with middle-ear disorders. J Speech Lang Hear Res. 2003; Aug. 46(4):901–11.

8. Margolis RH, Van Camp KJ, Wilson RH, Creten WL. Multifrequency tympanometry in normal ears. Audiology. 1985; 24(1):44–53.

9. Shahnaz N, Davies D. Standard and multifrequency tympanometric norms for Caucasian and Chinese young adults. Ear Hear. 2006; Feb. 27(1):75–90.

10. Ozgur A, Mujdeci B, Terzi S, Ozergin Coskun Z, Yigit E, Dursun E. Wideband tympanometry normative data for different age groups in Turkish population. J Int Adv Otol. 2016; Apr. 12(1):82–6.

11. Roditi RE, Eppsteiner RW, Sauter TB, Lee DJ. Cervical vestibular evoked myogenic potentials (cVEMPs) in patients with superior canal dehiscence syndrome (SCDS). Otolaryngol Head Neck Surg. 2009; Jul. 141(1):24–8.

12. Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol. 1970; Oct. 92(4):311–24.

13. Merchant GR, Roosli C, Niesten ME, Hamade MA, Lee DJ, McKinnon ML, et al. Power reflectance as a screening tool for the diagnosis of superior semicircular canal dehiscence. Otol Neurotol. 2015; Jan. 36(1):172–7.

14. Klopp-Dutote N, Kolski C, Biet A, Strunski V, Page C. A radiologic and anatomic study of the superior semicircular canal. Eur Ann Otorhinolaryngol Head Neck Dis. 2016; Apr. 133(2):91–4.

15. Saliba I, Maniakas A, Benamira LZ, Nehme J, Benoit M, Montreuil-Jacques V. Superior canal dehiscence syndrome: clinical manifestations and radiologic correlations. Eur Arch Otorhinolaryngol. 2014; Nov. 271(11):2905–14.

16. Cloutier JF, Belair M, Saliba I. Superior semicircular canal dehiscence: positive predictive value of high-resolution CT scanning. Eur Arch Otorhinolaryngol. 2008; Dec. 265(12):1455–60.

17. Welgampola MS, Colebatch JG. Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology. 2005; May. 64(10):1682–8.

18. Kim KW, Jung JY, Lee JH, Suh MW. Capacity of rectified vestibular evoked myogenic potential in correcting asymmetric muscle contraction power. Clin Exp Otorhinolaryngol. 2013; Dec. 6(4):209–13.

19. Brantberg K, Bergenius J, Tribukait A. Vestibular-evoked myogenic potentials in patients with dehiscence of the superior semicircular canal. Acta Otolaryngol. 1999; 119(6):633–40.

20. Castellucci A, Brandolini C, Piras G, Modugno GC. Tympanometric findings in superior semicircular canal dehiscence syndrome. Acta Otorhinolaryngol Ital. 2013; Apr. 33(2):112–20.

21. Polat Z, Bas B, Hayır D, Bulut E, Atas A. Wideband tympanometry normative data for turkish young adult population. J Int Adv Otol. 2015; Aug. 11(2):157–62.

22. Sato E, Nakashima T, Lilly DJ, Fausti SA, Ueda H, Misawa H, et al. Tympanometric findings in patients with enlarged vestibular aqueducts. Laryngoscope. 2002; Sep. 112(9):1642–6.