Int J Pediatr Otorhinolaryngol. 2009 Jan;73(1):21-42. doi: 10.1016/j.ijporl.2008.09.014. Epub 2008 Oct 28.
In otitis media with effusion (OME), the accuracy of predicting air-conduction hearing-level (HLs) from tympanometry has generally been seen as too poor for use in clinical practice. Previous studies of the relationship have mostly concerned single ears, many using samples with predominantly mild cases of OM and weak statistical approaches. A better understanding of the interrelations between these tests might improve efficiency in testing and decision-making for individuals.
Binaural average HL was adopted as the measure to be predicted most relevant to auditory disability. Multiple regression from modified Jerger tympanogram categories B, C2, C1 and A tympanogram types on 3085 children aged 3(1/4)-6(3/4) years gave formulae which we tested for replication, stability and generalization across distributions differing in severity.
Age-adjusted formulae explained up to 49% of the variance in binaural HL (i.e. a multiple correlation of 0.70), and were robust across phase of disease. Best predictions were seen in a severe sample permitting exploitation of the strong conditioning effect by a B tympanogram in one ear upon the tympanometry/HL relationship in the other. This permits a trichotomous approximation (0, 1, or 2 B-tympanograms) to also perform well.
We name the HL prediction formula "ACET" - Air Conduction Estimated from Tympanometry. We do not recommend replacing audiometry with tympanometry, particularly not at first assessment. However, where the diagnosis is, or likely from history to be, OME (even if fluid is absent on test day), the informativeness of further air-conduction audiometry on the same or later occasion may not always be worth the further effort or cost. It is therefore clinically useful to have a dB measure, from an evidence-based formula justifying a principled estimate. Non-clinical uses include imputation when research data are missing, and non-intensive applications where audiometry is impracticable, e.g. field clinics and large scale or longitudinal research. A companion paper shows how the part of the air-conduction HL variance that is not explicable by ACET, also offers a surrogate, but for bone-conduction HL (BC), where BC testing may be problematic, as in the very young. This surrogate can also define cases needing true BC testing.
在分泌性中耳炎（OME）中，通过鼓室图预测气导听力水平（HLs）的准确性在临床实践中通常被认为太差。以往关于两者关系的研究大多关注单耳，许多研究使用的样本主要是轻度中耳炎病例，且统计方法薄弱。更好地理解这些测试之间的相互关系可能会提高个体测试和决策的效率。
双耳平均HL被用作与听觉障碍最相关的待预测指标。对3085名3（1/4）-6（3/4）岁儿童的改良杰格鼓室图类别B、C2、C1和A鼓室图类型进行多元回归分析，得出公式，我们对这些公式在不同严重程度分布中的重复性、稳定性和通用性进行了测试。
年龄校正公式解释了双耳HL中高达49%的方差（即多重相关系数为0.70），并且在疾病各阶段都很稳健。在一个严重样本中观察到最佳预测结果，该样本允许利用一只耳朵的B型鼓室图对另一只耳朵的鼓室图/HL关系产生的强烈调节作用。这使得三分近似法（0、1或2个B型鼓室图）也能表现良好。
我们将HL预测公式命名为“ACET”——通过鼓室图估计气导。我们不建议用鼓室图取代听力测定，尤其是在初次评估时。然而，在诊断为OME或根据病史可能为OME的情况下（即使在测试当天未发现积液），在同一时间或之后进行进一步气导听力测定的信息量可能并不总是值得付出更多努力或成本。因此，从基于证据的公式获得一个dB测量值以进行有原则的估计在临床上是有用的。非临床用途包括在研究数据缺失时进行插补，以及在听力测定不可行的非密集应用中，例如现场诊所和大规模或纵向研究。一篇配套论文展示了ACET无法解释的气导HL方差部分如何也提供了一个替代指标，但用于骨导HL（BC），在非常年幼的儿童中，BC测试可能存在问题。这个替代指标还可以确定需要进行真正BC测试的病例。
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