title: Accurate tympanometric criteria for Chinese schoolchildren.
abstract: OBJECTIVE
  Recent normative investigations have revealed significant differences between tympanometric values obtained from Chinese children and those obtained from Caucasians. Furthermore, it has been suggested that the use of non-population-specific tympanometric criteria to identify otitis media with effusion in Chinese children could contribute to the misdiagnosis of middle ear pathology. The current study aimed to establish whether population-specific pass/fail criteria are necessary for the tympanometric testing of Chinese schoolchildren.
  
  
  METHODS
  A total of 154 Chinese children were recruited from a school in Nanjing, China. Participants ranged between 6 and 13 years of age with both genders equivalently represented. Participants with a history of hearing loss, otological problems, or previous referral to an otolaryngologist, and those with abnormal pneumatic otoscopy or pure tone audiometry results on the day of testing, were excluded from the normal database (N=125). Tympanometry was performed using a Madsen Zodiac 901 Middle Ear Analyzer. The 90% range of the tympanometry results was used to produce two sets of tympanometric pass/fail criteria (OURPASS and OURPASS2). The test performance of OURPASS, OURPASS2, and two previously established criteria; ASHA [ASHA, Guidelines for audiologic screening, ASHA, Rockville, MD, 1997] and Shahnaz and Davies [N. Shahnaz, D. Davies, Standard and multifrequency tympanometric norms for Caucasian and Chinese young adults, Ear Hear. 27 (2006) 75-90], was determined against the gold standard of pneumatic otoscopy, using signal detection theory.
  
  
  RESULTS
  The newly developed OURPASS tympanometric criteria, presented in the current study, possessed superior test performance in the prediction of otitis media with effusion than previously suggested Caucasian pediatric and Chinese adult criteria. An overall accuracy value of 0.68 and a hit rate of 0.79 were obtained.
  
  
  CONCLUSIONS
  The present study provides strong support for the use of a population-specific criterion for tympanometry testing in Chinese schoolchildren. Changes to the standard pass/fail criterion may be necessary following replication and expansion of the investigation.
authors.affiliation: Division of Audiology, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland 4072, Australia. carlie.driscoll@uq.edu.au
authors.forename: Carlie
authors.initials: C
authors.lastname: Driscoll
authors.forename: Xiaolu
authors.initials: X
authors.lastname: Li
authors.forename: Trinette
authors.initials: T
authors.lastname: Walmsley
authors.forename: Jason
authors.initials: J
authors.lastname: Le Dilly
authors.forename: Nyssa
authors.initials: N
authors.lastname: Hanley
authors.forename: William
authors.initials: W
authors.lastname: Bannah
authors.forename: Christopher
authors.initials: C
authors.lastname: Adelaide
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods* / Q000592:standards; D000293:Adolescent; D044466:Asian People; D002648:Child; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D010034:Otitis Media with Effusion / Q000175:diagnosis; D038781:Otoscopy; D012016:Reference Values; D012737:Sex Factors