Allergic factors are important, but not the only etiologic force in middle ear effusion. Nor do bacterial and viral infections, nasopharyngeal mass lesions, neuromuscular or regional anatomic abnormalities rank as sole etiologic factors. Some children have multiple components to their problem that requires specific identification before a workable approach to management can be tailored for each of them. Identification and management of allergic factors requires special skills and a greater commitment of time. Yet the marked increase in total yield when allergic techniques are added to the armamentarium of the otolaryngologist make these factors both worthwhile and satisfying.

Child↗

PubMedDate not supplied

Allergic factors in management of middle ear effusions.

There is no single specific therapy for the treatment of middle ear effusions and, therefore, a holistic approach to management is necessary. Current management involves multiple therapeutic modalities of which we believe tube and allergy are most efficient.

Allergens↗

PubMedDate not supplied

Acoustic reflex latency test in the evaluation of nontumor patients with abnormal brainstem latencies.

The acoustic reflex latency test (ARLT), an indirect measure of neural conduction time utilizing the electroimpedance method, was used to evaluate 43 highly suspect, nontumor patients who demonstrated abnormal latency results on brainstem electric response audiometry (BERA), false-positive for tumor. Normative values and criteria for tumor-positive ARLT results were established on a control group using a second generation test unit, comprised of dual impedance bridges and a digital signal averager, designed especially to perform the ARLT. When cut-off criteria for both absolute reflex latency and interaural latency difference (ILD) values were applied to this BERA false positive population, the ARLT correctly identified 93% of patients as having end-organ lesions. Differences in ARLT and BERA test results are attributed to differences in 1) method of measurement, 2) characteristics of the eliciting signal, and 3) generation of the response. These factors are discussed as sources of variability. Both ARLT and BERA are recommended as tandem procedures when screening for acoustic or angle tumors.

Audiometry↗

PubMedDate not supplied

Effects of conductive hearing loss on auditory brainstem response.

The purpose of this paper is not to propose that auditory brainstem response (ABR) be utilized for the assessment of conductive losses, but to define the effects of conductive hearing loss on the ABR when such a complication occurs. Conductive losses attenuate cochlear stimulation. Since wave V latency is inversely related to stimulus intensity, the magnitude of the conductive loss should be a predictor of the wave V latency delay. In this study, ABR wave V latencies from patients with known conductive losses due to canal occlusion, middle ear effusion, ossicular fixation and chain interruption were compared with latency values calculated from the magnitude of the loss. In those patients with occlusion of the external auditory canal and middle ear effusion, the shift of the wave V latency-intensity function correlated well with the air-bone gap. This correlation was poor for patients with ossicular chain disorders. In mixed hearing losses, the increased wave V latency due to the conductive component may totally mask an increase in latency caused by a retrocochlear component.

Acoustic Stimulation↗