title: Determining the presence or absence of middle ear disorders: an evidence-based systematic review on the diagnostic accuracy of selected assessment instruments.
abstract: OBJECTIVE
  To conduct an evidence-based systematic review on the state of the evidence and the diagnostic accuracy of multifrequency tympanometry (MFT), 1000 Hz tympanometry, and wideband acoustic transfer functions in determining the presence or absence of middle ear disorders.
  
  
  METHODS
  A systematic search of the literature published between 1975 and 2011 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality.
  
  
  RESULTS
  Ten studies were included and focused on participants with otosclerosis or otitis media. Two studies investigated 1000 Hz tympanometry, 7 examined MFT, and 2 addressed wideband reflectance (WBR). Methodological quality varied. Positive likelihood ratios (LR+) were predominantly uninformative for MFT and were mixed for 1000 Hz tympanometry. LR+ values for WBR ranged from diagnostically suggestive to informative. Negative likelihood ratios (LR-) for 1000 Hz tympanometry and WBR were at least diagnostically suggestive. LR- values for MFT were mixed, with half considered clinically uninformative and half considered diagnostically suggestive.
  
  
  CONCLUSIONS
  Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of these technologies. Additional investigations are needed to determine which tools can most accurately predict middle ear status.
authors.affiliation: Idaho State University, Pocatello, ID, USA.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Sanford
authors.forename: Tracy
authors.initials: T
authors.lastname: Schooling
authors.forename: Tobi
authors.initials: T
authors.lastname: Frymark
mesh_terms: D000158:Acoustic Impedance Tests / Q000379:methods*; D006801:Humans; D010033:Otitis Media / Q000175:diagnosis*; D010040:Otosclerosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity