Dear Dr. Portnuff,

Thank you very much for your concern about my question, and also giving new insights.

Sincerely,

Aly El-Makhzangy, MD

Associate Professor of Otolaryngology,

Faculty of Medicine- Ain Shams University,

Cairo- Egypt

Dear Dr, Aly, although MFT is not widely used in the clinic because of the limited range of frequency (up to 2 kHz) and the long testing time, I would recommend doing MFT when standard 226 Hz tympanogram is within norma despite the presence of middle ear disorders. With MFT, we get additional information regarding the resonant frequency (RF) of the middle ear (abnormally high RF suggests stiffness pathology, whereas abnormally low RF sugegsts mass pathology) and the relationship between the two components (susceptance [B] and conductance [G]) of the admittance of the middle ear. Vanhuyse and colleagues presented four nromal types/categories of the relationship between B and G (1B1G, 3B1G, 3B3G, and 5B3G based on the peak and notching of each of the B and G tympanograms). For example, recording flat B&G tympanograms or any category outside the above 4 categoris indicates middle ear problem. I know that most VA hospitals in the USA use MFT as one of their basic audiologic evaluation; this is not the case with other clinics because of the un-necessary extra cost to the patient for conducting MFT!! Personally, I would recommend performing MFT on every patient with conductive hearing loss to help determine the type of the middle ear pathology. It would be an ideal if you have patients with CONFIRMED diagnosis of a specific middle ear pathologies (e.g., Otosclerosis, OME, ETD, or Ossicular dislocation/subluxation, etc.) and rum standard tymp and MFT to study characteristics of the MFT response in each pathology comapred to standard tymp. This is a needed area for research specifically if we also add Wideband tympanometry to the testing protocol (more info below).

Recently, Wideband Energy Reflectance (WBER) and now Wideband Tympanometry (WBT) with pressurization of the ear canal are potential sensitive measures to assess middle ear status using click/chirp stimuli for a comprehensive, quick assessment of the middle ear over a wide frequency range (100 Hz to 10,000 Hz) compared to the use of ONLY 226 Hz for standard tymp or the limited frequency range (200 to 2000 Hz) of MFT. This procedure, however, is still in the research phase to validate its sensitivity and specificity before it's approved for clinical use. I've attached my published paper about the use of WBER in children with Down's syndrome. I hope that you'll find it interesting. We are in the process of preparing another manuscript (data collection completed - first of its kind) to investigate the sensitivity of WBT in detecting MICE with acute OM after being inoculated with micro-organism (B-hinzii) that is known to cause URIs such as running nose, sinusitis and otitis media. Our findings in mice support the high sensitivity of WBT in the presence of OM and its high specificity when mice were not infected with OM (baseline recording) and in the control group. Also, I am in the process of collecting WBT data on normal-hearing, healthy children and adults with normal middle ear status to determine what consitiutes normative WBT to serve as normative data. Data collection for t...

no, it doesnt look like students in RSA are even trained on administering and interpreting results from it.

Musa,

As a university professor, I teach MFT in-depth and requests students to test each others using MFT before applying it for their actual case presentation if their subject has a middle ear problem. This means that they get the theoretical knowledge, indications, interpretation and clinical training for the use of standards Tymp and MFT as well as WBT in my Diagnostic I class. Since I have the equipment that does all these procedures, they are well trained in knowing normal vs. abnormal and differential diagnosis for a diagnosis based on the overall test findings. However, I agree with you that students in other programs may not have the same opportunity and thus won't get the same training in middle ear measures.