Audiology - Communication Research E-ISSN: 2317-6431 [email protected] Academia Brasileira de Audiologia Brasil Cortez Neto, Letícia; Cibin, Bruna Carla; Mota Mamede Carvallo, Renata; Gandolfi Sanches, Seisse Gabriela Acoustic reflectance measurements in otosclerosis: case study Audiology - Communication Research, vol. 19, núm. 4, octubre-diciembre, 2014, pp. 421- 425 Academia Brasileira de Audiologia São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=391544060017 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative http://dx.doi.org/10.1590/S2317-64312014000300001420 Case Report Acoustic reflectance measurements in otosclerosis: case study Medidas de reflectância acústica na otosclerose: estudo de caso Letícia Cortez Neto1, Bruna Carla Cibin1, Renata Mota Mamede Carvallo1, Seisse Gabriela Gandolfi Sanches1 ABSTRACT RESUMO This research aimed to analyze the reflectance measurements in a patient O objetivo deste trabalho foi analisar as medidas de reflectância em uma with otosclerosis. The patient, female, 51 years old; she complained of paciente com otosclerose. A paciente, do gênero feminino, 51 anos, bilateral hearing loss and had a diagnosis hypothesis of otosclerosis. The apresentava queixa de hipoacusia bilateral e a hipótese diagnóstica de following audiological tests were performed in both ears: tympanometry, otosclerose. Foram realizados os seguintes testes de avaliação audioló- pure-tone audiometry, and speech audiometry tests and acoustic reflec- gica: imitanciometria, audiometria tonal, vocal e medidas de reflectância tance measurements. Through acoustic wideband reflectance analysis, acústica, em ambas as orelhas. Por meio da análise dos resultados da it was possible to observe an increase in reflectance, such as is seen in reflectância acústica de banda larga, foi possível observar aumento na otosclerotic ears, between the frequencies of 500 Hz and 1500 Hz and reflectância, característico de otosclerose, entre as frequências de 500 e to differentiate the left and right ear. Acoustic reflectance measurements 1500 Hz, e diferenciar a orelha esquerda e a orelha direita. As medidas have the potential to yield results that allow the differentiation between de reflectância permitiram a obtenção de resultados detalhados por fre- the two ears; thus, the use of the wideband acoustic reflectance is sug- quência que, em conjunto, possibilitaram a diferenciação entre as duas gested as a part of the otosclerosis diagnostic procedure. orelhas. O uso da reflectância de banda largaé sugerido para comple- mentar o diagnóstico da otosclerose. Keywords: Otosclerosis; Ear, middle; Acoustic impedance tests; Hearing loss; Hearing tests Descritores: Otosclerose; Orelha média; Testes de impedância acústica; Perda auditiva; Testes auditivos Human Hearing Investigation Laboratory, Department of Physical Therapy, Speech-Language and Audiology Sciences and Occupational Therapy, Faculty of Medicine, Universidade de São Paulo – USP – São Paulo (SP), Brazil. (1) Department of Physical Therapy, Speech-Language and Audiology Sciences and Occupational Therapy, Faculty of Medicine, Universidade de São Paulo – USP – São Paulo (SP), Brazil. Conflict of interests: No Authors’ contribution: LCN data colllection, data analysis, and manuscript writing; BCC data analysis, writing and revision of the manuscript; RMMC data analysis, and final revision of the manuscript; SGGS conception and study design, data analysis, writing and final revision of the manuscript. Correspondence address: Seisse Gabriela Gandolfi Sanches. R. Cipotânea, 51, Cidade Universitária, Butantã, São Paulo (SP), Brasil, CEP: 05360-160. E-mail: [email protected] Received on: 5/29/2014; Accepted on: 7/23/2014 Audiol Commun Res. 2014;19(4):421-5 421 Cortez Neto L, Cibin BC, Carvallo RMM, Sanches SGG INTRODUCTION (Comitê de Análise de Projetos de Pesquisa do Hospital das Clínicas da Universidade de São Paulo - CAPPesq) (Protocol During sound propagation, the emitted acoustic energy pas- No 305/10). The Informed Consent Term was signed, enabling ses through the external auditory canal and the middle ear, rea- participation in this study. ching the cochlea where the energy is absorbed by the system. The patient was female, 51 years old at the time of evalu- The middle ear works as an amplifier, increasing the efficiency ation and was diagnosed with otosclerosis five years prior to of sound transmission between the low-impedance air and the the assessment presented in this study. The patient came to our high-impedance fluid in the cochlea. Not all emitted energy department with reports of decreased hearing. According to the reaches the cochlea. When the energy reaches the middle ear, initial interview, the patient’s main complaints were not being some of it reaches the cochlea and is absorbed by the system, able to understand conversations with other people and very and some is reflected by the middle ear. This portion of energy low-volume hearing. She mentioned the presence of a constant that is reflected by the middle ear is called the reflectance(1). acute tonal tinnitus and severe wheezing in both ears. She also Acoustic reflectance measurements have been explored complained about difficulty hearing, even in silence. in the last decade and allow the sound energy reflected by No other case of otosclerosis has been reported in her fa- the middle ear to be quantified. Wideband reflectance (WBR) mily. However, several people in the patient’s maternal family measures the transfer function of the middle ear over a wide have developed hearing loss, without definitive diagnosis of frequency range and is being used as an alternative or comple- the otologic disease. According to reports, the younger sister mentary diagnosis to tympanometry(2-5). of the patient has tinnitus without hearing loss. Reflectance is a real number between 0 and 1 (or 0 and Air and bone conduction pure-tone audiometry was perfor- 100%), where 0 means that all of the energy is absorbed and med at 250 to 8000 Hz frequencies, in octave intervals, with the 1 means that all of the energy is reflected back to the external addition of 3000 and 6000 Hz frequencies (GSI 61 audiometer acoustic meatus. - Grason-Stadler®, TDH 50P phones) and logoaudiometry. Pure- The transmittance measurement is extracted from the reflec- tone audiometry by bone conduction was performed as follows: tance values and decibel (dB) is the unit of measurement. This first, a bone conduction free of masking was obtained with the measurement quantifies the energy absorbed by the middle ear. vibrator positioned in the left ear. Then, the bone conduction of The transmittance measurement facilitates the interpretation the left ear was obtained with approximately 20-25 dB SL contra- of the evaluation, as its values in dB decrease the intersubject lateral effective narrowband noise. After this step, the bone vibra- variability at low and high frequencies, enabling a better cor- tor was placed on the right mastoid, and the free bone conduction relation with audiometric values(6). of the right ear was obtained. At the end, maximum equipment Otosclerosis, or otospongiosis, is a progressive autosomal values with contralateral masking were applied, with no changes dominant disorder that affects the middle ear. Otosclerosis is in thresholds obtained without the presentation of contralateral predominant in females and is manifested between adolescence noise. The percentage rates of speech discrimination (SD) were and the fourth decade of life, most often in women between obtained in both ears with contralateral masking (speech noise). 20 and 30 years of age(7). In most cases, the disease manifests Acoustic immittance measurements were performed using the bilaterally. In otosclerosis patients, reflectance measurements AT 235H Interacoustics® Middle Ear Analyzer and consisted of can identify the rigidity of the tympanic-ossicular system in tympanometry with a probe tone of 226 Hz and ipsilateral and more detail: during the disease progression, fixation of the contralateral acoustic reflexes research. stapes footplate in the oval window occurs, hindering the Reflectance measurements were performed using the transmission of energy by the middle ear(3). MEPA 3 instrument (Middle Ear Power Analyzer - Mimosa As WBR evaluates wide frequency bands, it provides more Acoustics®, version 3.3). Before each reflectance test session, detailed and specific results on the tympanic-ossicular system. the probe was calibrated using a four-chamber set (CC4-V). Thus, WBR is a tool that enables the differential diagnosis of Two measurements were made using the chirp stimulus and otosclerosis. In many cases, immittance results in patients with another measurement with pure tone stimulus. Data were otosclerosis reveal normal tympanometry (type A). To aid in collected with the chirp stimulus in 248 frequencies from 211 differential diagnosis, reflectance conditions should be better to 6000 Hz at intervals of 23 Hz, intensity of 60 dB sound studied in ears with otosclerosis. Therefore, the present study pressure level (SPL), lasting from 0.1 to 10 seconds per point. aimed to obtain and analyze the reflectance measurements of For the pure tone stimulus, the reflectance was tested with the a patient with otosclerosis. stimulus presented