Diagnosing Middle Ear Pathology in 6- to 9-Month-Old Infants Using Wideband Absorbance: A Risk Prediction Model Purpose The aim of this study was to develop a risk prediction model for detecting middle ear pathology in 6- to 9-month-old infants using wideband absorbance measures. Method Two hundred forty-nine infants aged 23–39 weeks (Mdn = 28 weeks) participated in the study. Distortion product otoacoustic emissions and ... Research Article
Research Article  |   September 19, 2018
Diagnosing Middle Ear Pathology in 6- to 9-Month-Old Infants Using Wideband Absorbance: A Risk Prediction Model
 
Author Affiliations & Notes
  • Joshua Myers
    Department of Audiology, Townsville Hospital and Health Service, Australia
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Joseph Kei
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Sreedevi Aithal
    Department of Audiology, Townsville Hospital and Health Service, Australia
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Venkatesh Aithal
    Department of Audiology, Townsville Hospital and Health Service, Australia
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Carlie Driscoll
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Asaduzzaman Khan
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Alehandrea Manuel
    Department of Audiology, Townsville Hospital and Health Service, Australia
  • Anjali Joseph
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
  • Alicja N. Malicka
    School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
    School of Allied Health, La Trobe University, Melbourne, Australia
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Joshua Myers: myers.josh@gmail.com
  • Editor-in-Chief: Frederick (Erick) Gallun
    Editor-in-Chief: Frederick (Erick) Gallun×
  • Editor: Steve Aiken
    Editor: Steve Aiken×
Article Information
Hearing & Speech Perception / Acoustics / Hearing Disorders / Special Populations / Early Identification & Intervention / Professional Issues & Training / Hearing / Research Articles
Research Article   |   September 19, 2018
Diagnosing Middle Ear Pathology in 6- to 9-Month-Old Infants Using Wideband Absorbance: A Risk Prediction Model
Journal of Speech, Language, and Hearing Research, September 2018, Vol. 61, 2386-2404. doi:10.1044/2018_JSLHR-H-18-0004
History: Received January 8, 2018 , Revised April 26, 2018 , Accepted May 18, 2018
 
Journal of Speech, Language, and Hearing Research, September 2018, Vol. 61, 2386-2404. doi:10.1044/2018_JSLHR-H-18-0004
History: Received January 8, 2018; Revised April 26, 2018; Accepted May 18, 2018

Purpose The aim of this study was to develop a risk prediction model for detecting middle ear pathology in 6- to 9-month-old infants using wideband absorbance measures.

Method Two hundred forty-nine infants aged 23–39 weeks (Mdn = 28 weeks) participated in the study. Distortion product otoacoustic emissions and high-frequency tympanometry were tested in both ears of each infant to assess middle ear function. Wideband absorbance was measured at ambient pressure in each participant from 226 to 8000 Hz. Absorbance results from 1 ear of each infant were used to predict middle ear dysfunction, using logistic regression. To develop a model likely to generalize to new infants, the number of variables was reduced using principal component analysis, and a penalty was applied when fitting the model. The model was validated using the opposite ears and with bootstrap resampling. Model performance was evaluated through measures of discrimination and calibration. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC); and calibration, with calibration curves, which plotted actual against predicted probabilities.

Results AUC of the fitted model was 0.887. The model validated adequately when applied to the opposite ears (AUC = 0.852) and with bootstrap resampling (AUC = 0.874). Calibration was satisfactory, with high agreement between predictions and observed results.

Conclusions The risk prediction model had accurate discrimination and satisfactory calibration. Validation results indicate that it may generalize well to new infants. The model could potentially be used in diagnostic and screening settings. In the context of screening, probabilities provide an intuitive and flexible mechanism for setting the referral threshold that is sensitive to the costs associated with true and false-positive outcomes. In a diagnostic setting, predictions could be used to supplement visual inspection of absorbance for individualized diagnoses. Further research assessing the performance and impact of the model in these contexts is warranted.

Acknowledgments
This project was funded through a grant from the Australian National Health and Medical Research Council (APP1046477) awarded to Joseph Kei, a scholarship from the Nursing and Allied Health Scholarship and Support Scheme funded by the Commonwealth Department of Health, and an Australian Government Research Training Program Scholarship awarded to Joshua Myers. The views expressed in this article do not necessarily represent those of the National Health and Medical Research Council; the Nursing and Allied Health Scholarship and Support Scheme or its administrator, Services for Australian Rural and Remote Allied Health; or the Commonwealth Department of Health.
We are grateful to the Surgical Services and Health and Wellbeing Service Groups of the Townsville Hospital and Health Service for supporting the study, the Healthy Hearing Team at Townsville Hospital for recruiting participants, Karen Nielsen from the Audiology Department at Townsville Hospital for clerical support, and Interacoustics A/S (Denmark) for loaning equipment for the study.
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