Research Article: Sub-clinical middle ear malfunctions in elderly patients; prevalence, pattern and predictors

Date Published: December , 2017

Publisher: Makerere Medical School

Author(s): Olusola Ayodele Sogebi, Taiwo Olugbemiga Adedeji, Olatundun Ogunbanwo, Emmanuel Abayomi Oyewole.


Little is known about functioning of the middle ear with advancing age.

To estimate the prevalence and describe tympanometric patterns of sub-clinical middle ear malfunctions,( S-MEM) in elderly patients. It also assessed clinical factors that could predict S-MEM.

Cross-sectional, analytical study of patients aged ≥ 60 years in a tertiary hospital in Nigeria between 2011–2014. Pure tone audiometry (PTA), tympanometry and acoustic reflexes were recorded. S-MEM was based on audiometric and tympanometric evident abnormalities. Descriptive, univariate and multivariate analyses performed to detect independent clinical predictors of S-MEM at p-value of <0.05. 121 patients , M: F of 1.1:1. Mean age was 70.1 ± 6.2 years, 77.7% were married. Prevalence of S-MEM was 21.5%. Abnormal tympanometric tracings were type AS>C>B>AD. The parameters that were statistically-significant on univariate analyses were subjected to logistic regression analysis which confirmed previous head injury, diabetes, osteoarthritis of knee joint, and absent acoustic reflex as clinical predictors for S-MEM.

21.5% of elderly Africans had subclinical abnormalities in their middle ear functioning, mostly with type AS tympanogram. Independent clinical predictors of S-MEM included previous head injury, diabetes, history of osteoarthritis of knee joints, and absent acoustic reflex.

Partial Text

Hearing impairment has been reported to be one of the common chronic medical conditions which can reduce quality of life among the elderly. Hearing impairment is grossly classified as conductive, sensorineural or mixed in type. Substantial emphasis has been laid, with concomitant research performed regarding age related-changes presenting with sensorineural hearing impairment1–3. Thus information and documentation on age-related hearing impairment (ARHI), and factors associated with it are substantial in the medical literature3–5. Except for common diseases like otitis media of different types, perhaps little is known about the functioning of the middle ear among elderly subjects6. Middle ear structures are mainly concerned with transmission of sound waves from the external auditory canal, through the tympanic cavity to the inner ear. This function is performed by three bony ossicles which articulate with each other, one of which is attached to the tympanic membrane (stimulated from the external ear), and another one to the oval window (transmits to the inner ear). Furthermore, the middle ear structures have protective mechanism of binaural acoustic reflexes that prevent unduly loud and hazardous sounds from getting transmitted fully into the inner ear.

Study design: This was a cross-sectional, analytical study that was conducted among elderly patients attending the Ear Nose and Throat (ENT) clinics of Olabisi Onabanjo University Teaching Hospital, Sagamu Nigeria between January 2011 and December 2014. Consecutive elderly patients aged sixty years and above who attended the clinics were approached as participants in the study. The general nature, significance, requirements of the patients as well as the fact that a decline to participate in the study would not affect treatment was emphasized to the patients.

One hundred and twenty one patients participated in this study which comprised of 52.1% males, M: F = 1.1:1. The age ranged from 61 to 96 with a mean of 70.1 ± 6.2 years. The details of the demographic characteristics of the patients is shown in Table 1.

In clinical practice it is generally assumed that when features of middle ear disease are absent, hearing impairment in elderly subjects are usually due to sensorineral hearing loss (SNHL), especially age related hearing loss, (ARHL). It is important that the functioning of the middle ear be assessed and clarified even when the index of suspicion for SNHL is high. The fact that one in every five (21.5%) of our elderly patients had S-MEM gives credence to this.

21.5% of elderly native Africans had sub-clinical abnormalities in their middle ear functioning, mostly with impaired ossicular mobility pattern. The independent clinical predictors of these malfunctions included previous head injury, diabetes, a history of osteoarthritis of the knee joints, and absent acoustic reflex.




Leave a Reply

Your email address will not be published.