title: Video pneumatic otoscopy for the diagnosis of conductive hearing loss with normal tympanic membranes.
abstract: OBJECTIVE
  To evaluate the usefulness of video pneumatic otoscopy (VPO) for the diagnosis of conductive hearing loss (CHL) with normal tympanic membranes (TM).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  Thirty-seven ears with CHL and 9 control ears with normal TMs were included. The VPO was performed preoperatively in all patients. The authors captured TM images in 3 stages of the VPO (static, positive, and negative pressure stage) in all subjects and measured the amount of relative position differences of the umbo. Pure-tone audiometry and temporal bone computed tomography (TBCT) were performed preoperatively. The possible causes of hearing loss were evaluated during exploratory tympanotomy in the patients with CHL.
  
  
  RESULTS
  Fifteen patients had stapedial fixation, 10 had fixation of the malleus or incus (MIF), and 12 had ossicular discontinuity. The positional differences between the negative and positive pressure stage of the MIF group were significantly smaller between the CHL and control groups (P = .001). The air-bone gap showed no significant difference among the CHL groups. The sensitivity, specificity, and diagnostic accuracy of the VPO for the diagnosis of MIF, with a cutoff value of 1.5% or less in terms of the movement of umbo, were 80.0%, 92.6%, and 89.2%, respectively. These findings were comparable to those of the TBCT, which were 90.0%, 85.2%, and 86.5%, respectively.
  
  
  CONCLUSIONS
  The VPO is a simple, noninvasive, and accurate tool for the differential diagnosis of CHL with a normal TM.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jae Kwon
authors.initials: JK
authors.lastname: Lee
authors.forename: Yang-Sun
authors.initials: YS
authors.lastname: Cho
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Ko
authors.forename: Won Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Hyung-Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Eunhee
authors.initials: E
authors.lastname: Kim
authors.forename: Won-Ho
authors.initials: WH
authors.lastname: Chung
authors.forename: Sung Hwa
authors.initials: SH
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006314:Hearing Loss, Conductive / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D038781:Otoscopy / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014432:Tympanic Membrane / Q000033:anatomy & histology*; D014741:Video Recording; D055815:Young Adult