Abstract

Pneumatic otoscopy to assess the mobility of the tympanic membrane (TM) is a highly recommended diagnostic method of otitis media (OM), a widespread middle ear infection characterized by the fluid accumulation in the middle ear. Nonetheless, limited depth perception and subjective interpretation of small TM displacements have challenged the appropriate and efficient examination of TM dynamics experienced during OM. In this paper, a pneumatic otoscope integrated with low coherence interferometry (LCI) was adapted with a controlled pressure-generating system to record the pneumatic response of the TM and to estimate middle ear pressure (MEP). Forty-two ears diagnosed as normal (n = 25), with OM (n = 10), or associated with an upper respiratory infection (URI) (n = 7) were imaged with a pneumatic LCI otoscope with an axial, transverse, and temporal resolution of 6 µm, 20 µm, and 1 msec, respectively. The TM displacement under pneumatic pressure transients (a duration of 0.5 sec with an intensity of ± 150 daPa) was measured to compute two metrics (compliance and amplitude ratio). These metrics were correlated with peak acoustic admittance and MEP from tympanometry and statistically compared via Welch’s t-test. As a result, the compliance represents pneumatic TM mobility, and the amplitude ratio estimates MEP. The presence of a middle ear effusion (MEE) significantly decreased compliance (p<0.001). The amplitude ratio of the OM group was statistically less than that of the normal group (p<0.01), indicating positive MEP. Unlike tympanometry, pneumatic LCI otoscopy quantifies TM mobility as well as MEP regardless of MEE presence. With combined benefits of pneumatic otoscopy and tympanometry, pneumatic LCI otoscopy may provide new quantitative metrics for understanding TM dynamics and diagnosing OM.

© 2018 Optical Society of America under the terms of the OSA Open Access Publishing Agreement

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    [Crossref] [PubMed]
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    [Crossref] [PubMed]
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    [Crossref] [PubMed]
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    [Crossref] [PubMed]
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    [Crossref] [PubMed]
  24. C. A. Ostergard and D. R. Carter, “Positive middle ear pressure shown by tympanometry,” Arch. Otolaryngol. 107(6), 353–356 (1981).
    [Crossref] [PubMed]
  25. M. Fiellau-Nikolajsen, “Tympanometry and middle ear effusion: a cohort-study in three-year-old children,” Int. J. Pediatr. Otorhinolaryngol. 2(1), 39–49 (1980).
    [Crossref] [PubMed]
  26. C. D. Bluestone, Q. C. Beery, and J. L. Paradise, “Audiometry and tympanometry in relation to middle ear effusions in children,” Laryngoscope 83(4), 594–604 (1973).
    [Crossref] [PubMed]
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    [Crossref] [PubMed]
  29. P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
    [Crossref] [PubMed]
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    [Crossref] [PubMed]

2017 (3)

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

2016 (2)

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

2015 (1)

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

2014 (2)

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

2013 (3)

X. Guan and R. Z. Gan, “Mechanisms of tympanic membrane and incus mobility loss in acute otitis media model of guinea pig,” J. Assoc. Res. Otolaryngol. 14(3), 295–307 (2013).
[Crossref] [PubMed]

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

2012 (2)

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

2010 (2)

C. T. Nguyen, H. Tu, E. J. Chaney, C. N. Stewart, and S. A. Boppart, “Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear,” Biomed. Opt. Express 1(4), 1104–1116 (2010).
[Crossref] [PubMed]

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

2009 (1)

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

2004 (1)

E. Onusko, “Tympanometry,” Am. Fam. Physician 70(9), 1713–1720 (2004).
[PubMed]

2003 (2)

W. S. Jones and P. H. Kaleida, “How helpful is pneumatic otoscopy in improving diagnostic accuracy?” Pediatrics 112(3), 510–513 (2003).
[Crossref] [PubMed]

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

2001 (1)

J. Welzel, “Optical coherence tomography in dermatology: a review,” Skin Res. Technol. 7(1), 1–9 (2001).
[Crossref] [PubMed]

2000 (1)

V. J. Jaisinghani, L. L. Hunter, Y. Li, and R. H. Margolis, “Quantitative analysis of tympanic membrane disease using video-otoscopy,” Laryngoscope 110(10), 1726–1730 (2000).
[Crossref] [PubMed]

1999 (1)

A. Palmu, H. Puhakka, T. Rahko, and A. K. Takala, “Diagnostic value of tympanometry in infants in clinical practice,” Int. J. Pediatr. Otorhinolaryngol. 49(3), 207–213 (1999).
[Crossref] [PubMed]

1991 (1)

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

1989 (3)

P. H. Karma, M. A. Penttilä, M. M. Sipilä, and M. J. Kataja, “Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings,” Int. J. Pediatr. Otorhinolaryngol. 17(1), 37–49 (1989).
[Crossref] [PubMed]

D. W. Teele, J. O. Klein, and B. Rosner, “Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study,” J. Infect. Dis. 160(1), 83–94 (1989).
[Crossref] [PubMed]

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

1981 (1)

C. A. Ostergard and D. R. Carter, “Positive middle ear pressure shown by tympanometry,” Arch. Otolaryngol. 107(6), 353–356 (1981).
[Crossref] [PubMed]

1980 (1)

M. Fiellau-Nikolajsen, “Tympanometry and middle ear effusion: a cohort-study in three-year-old children,” Int. J. Pediatr. Otorhinolaryngol. 2(1), 39–49 (1980).
[Crossref] [PubMed]

1973 (1)

C. D. Bluestone, Q. C. Beery, and J. L. Paradise, “Audiometry and tympanometry in relation to middle ear effusions in children,” Laryngoscope 83(4), 594–604 (1973).
[Crossref] [PubMed]

Abbott, P.

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Allen, J. B.

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

Anwar, K.

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

Arguedas, A.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Barbiero, C.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Bavcar, A.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Beery, Q. C.

C. D. Bluestone, Q. C. Beery, and J. L. Paradise, “Audiometry and tympanometry in relation to middle ear effusions in children,” Laryngoscope 83(4), 594–604 (1973).
[Crossref] [PubMed]

Bluestone, C. D.

C. D. Bluestone, Q. C. Beery, and J. L. Paradise, “Audiometry and tympanometry in relation to middle ear effusions in children,” Laryngoscope 83(4), 594–604 (1973).
[Crossref] [PubMed]

Bonhoeffer, J.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Boppart, S. A.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

C. T. Nguyen, H. Tu, E. J. Chaney, C. N. Stewart, and S. A. Boppart, “Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear,” Biomed. Opt. Express 1(4), 1104–1116 (2010).
[Crossref] [PubMed]

Carroll, A. E.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Carter, D. R.

C. A. Ostergard and D. R. Carter, “Positive middle ear pressure shown by tympanometry,” Arch. Otolaryngol. 107(6), 353–356 (1981).
[Crossref] [PubMed]

Chan, L. S.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Chaney, E. J.

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

C. T. Nguyen, H. Tu, E. J. Chaney, C. N. Stewart, and S. A. Boppart, “Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear,” Biomed. Opt. Express 1(4), 1104–1116 (2010).
[Crossref] [PubMed]

Chang, W.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Cho, Y.-S.

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

Chonmaitree, T.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Coggins, R.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Cohen, R.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Corrigan, M. D.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Dagan, R.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Dhooge, I.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
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Fiellau-Nikolajsen, M.

M. Fiellau-Nikolajsen, “Tympanometry and middle ear effusion: a cohort-study in three-year-old children,” Int. J. Pediatr. Otorhinolaryngol. 2(1), 39–49 (1980).
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Fletcher, E. R.

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

Flotte, T.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Fujimoto, J. G.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Gagnon, L.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Gan, R. Z.

X. Guan and R. Z. Gan, “Mechanisms of tympanic membrane and incus mobility loss in acute otitis media model of guinea pig,” J. Assoc. Res. Otolaryngol. 14(3), 295–307 (2013).
[Crossref] [PubMed]

Ganiats, T. G.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Grasso, D.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Gregory, K.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Guan, X.

X. Guan and R. Z. Gan, “Mechanisms of tympanic membrane and incus mobility loss in acute otitis media model of guinea pig,” J. Assoc. Res. Otolaryngol. 14(3), 295–307 (2013).
[Crossref] [PubMed]

Gunasekera, H.

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Hackell, J. M.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Hee, M. R.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Hill, M. C.

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

Hoberman, A.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Hoelting, D.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Hu, W.

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Huang, D.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Hunter, L. L.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

V. J. Jaisinghani, L. L. Hunter, Y. Li, and R. H. Margolis, “Quantitative analysis of tympanic membrane disease using video-otoscopy,” Laryngoscope 110(10), 1726–1730 (2000).
[Crossref] [PubMed]

Jackson, M. A.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Jaisinghani, V. J.

V. J. Jaisinghani, L. L. Hunter, Y. Li, and R. H. Margolis, “Quantitative analysis of tympanic membrane disease using video-otoscopy,” Laryngoscope 110(10), 1726–1730 (2000).
[Crossref] [PubMed]

Javaid, M.

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

Joffe, M. D.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Jones, W. S.

W. S. Jones and P. H. Kaleida, “How helpful is pneumatic otoscopy in improving diagnostic accuracy?” Pediatrics 112(3), 510–513 (2003).
[Crossref] [PubMed]

Jung, W.

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

Kaleida, P. H.

W. S. Jones and P. H. Kaleida, “How helpful is pneumatic otoscopy in improving diagnostic accuracy?” Pediatrics 112(3), 510–513 (2003).
[Crossref] [PubMed]

Karma, P. H.

P. H. Karma, M. A. Penttilä, M. M. Sipilä, and M. J. Kataja, “Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings,” Int. J. Pediatr. Otorhinolaryngol. 17(1), 37–49 (1989).
[Crossref] [PubMed]

Kataja, M. J.

P. H. Karma, M. A. Penttilä, M. M. Sipilä, and M. J. Kataja, “Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings,” Int. J. Pediatr. Otorhinolaryngol. 17(1), 37–49 (1989).
[Crossref] [PubMed]

Khan, S.

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

Kim, J.

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

Klein, J. O.

D. W. Teele, J. O. Klein, and B. Rosner, “Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study,” J. Infect. Dis. 160(1), 83–94 (1989).
[Crossref] [PubMed]

Ko, M. H.

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

Kummer, A. W.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Lee, C.-K.

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

Lee, D.-K.

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

Lee, H.-S.

Y.-S. Cho, D.-K. Lee, C.-K. Lee, M. H. Ko, and H.-S. Lee, “Video pneumatic otoscopy for the diagnosis of otitis media with effusion: a quantitative approach,” Eur. Arch. Otorhinolaryngol. 266(7), 967–973 (2009).
[Crossref] [PubMed]

Li, Y.

V. J. Jaisinghani, L. L. Hunter, Y. Li, and R. H. Margolis, “Quantitative analysis of tympanic membrane disease using video-otoscopy,” Laryngoscope 110(10), 1726–1730 (2000).
[Crossref] [PubMed]

Lieberthal, A. S.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Liese, J.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Lin, C. P.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Mangione-Smith, R.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Marchetti, F.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Marchisio, P.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Margolis, R. H.

V. J. Jaisinghani, L. L. Hunter, Y. Li, and R. H. Margolis, “Quantitative analysis of tympanic membrane disease using video-otoscopy,” Laryngoscope 110(10), 1726–1730 (2000).
[Crossref] [PubMed]

McCormick, D. T.

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

Miller, D. T.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Monasta, L.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Monroy, G. L.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

Montico, M.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Morphew, T.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Morton, S. C.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Nguyen, C. T.

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

C. T. Nguyen, H. Tu, E. J. Chaney, C. N. Stewart, and S. A. Boppart, “Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear,” Biomed. Opt. Express 1(4), 1104–1116 (2010).
[Crossref] [PubMed]

Nolan, R. M.

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

Novak, M.

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

Novak, M. A.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

Onusko, E.

E. Onusko, “Tympanometry,” Am. Fam. Physician 70(9), 1713–1720 (2004).
[PubMed]

Ostergard, C. A.

C. A. Ostergard and D. R. Carter, “Positive middle ear pressure shown by tympanometry,” Arch. Otolaryngol. 107(6), 353–356 (1981).
[Crossref] [PubMed]

Palmu, A.

A. Palmu, H. Puhakka, T. Rahko, and A. K. Takala, “Diagnostic value of tympanometry in infants in clinical practice,” Int. J. Pediatr. Otorhinolaryngol. 49(3), 207–213 (1999).
[Crossref] [PubMed]

Palmu, A. A.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Pande, P.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

Paradise, J. L.

C. D. Bluestone, Q. C. Beery, and J. L. Paradise, “Audiometry and tympanometry in relation to middle ear effusions in children,” Laryngoscope 83(4), 594–604 (1973).
[Crossref] [PubMed]

Payne, S. C.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Pelton, S. I.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Penttilä, M. A.

P. H. Karma, M. A. Penttilä, M. M. Sipilä, and M. J. Kataja, “Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings,” Int. J. Pediatr. Otorhinolaryngol. 17(1), 37–49 (1989).
[Crossref] [PubMed]

Phillips, Y. Y.

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

Poe, D. S.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Porter, R. G.

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

Puhakka, H.

A. Palmu, H. Puhakka, T. Rahko, and A. K. Takala, “Diagnostic value of tympanometry in infants in clinical practice,” Int. J. Pediatr. Otorhinolaryngol. 49(3), 207–213 (1999).
[Crossref] [PubMed]

Puliafito, C. A.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Rahko, T.

A. Palmu, H. Puhakka, T. Rahko, and A. K. Takala, “Diagnostic value of tympanometry in infants in clinical practice,” Int. J. Pediatr. Otorhinolaryngol. 49(3), 207–213 (1999).
[Crossref] [PubMed]

Ray, G. T.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Reath, J.

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Rehman, H. U.

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

Richmond, D. R.

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

Robinson, S. R.

C. T. Nguyen, S. R. Robinson, W. Jung, M. A. Novak, S. A. Boppart, and J. B. Allen, “Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements,” Hear. Res. 301, 193–200 (2013).
[Crossref] [PubMed]

Ronfani, L.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Rosenfeld, R. M.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Rosenkranz, S.

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Rosner, B.

D. W. Teele, J. O. Klein, and B. Rosner, “Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study,” J. Infect. Dis. 160(1), 83–94 (1989).
[Crossref] [PubMed]

Sanders, E. A.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Sayegh, S. I.

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

Schuman, J. S.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Schwartz, R. H.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Schwartz, S. R.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Sevilla, X. D.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Shahabi, I.

K. Anwar, S. Khan, H. U. Rehman, M. Javaid, and I. Shahabi, “Otitis media with effusion: Accuracy of tympanometry in detecting fluid in the middle ears of children at myringotomies,” Pak. J. Med. Sci. 32(2), 466–470 (2016).
[PubMed]

Shekelle, P.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Shelton, R. L.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

R. L. Shelton, R. M. Nolan, G. L. Monroy, P. Pande, M. A. Novak, R. G. Porter, and S. A. Boppart, “Quantitative pneumatic otoscopy using a light-based ranging technique,” J. Assoc. Res. Otolaryngol. 18(4), 555–568 (2017).
[Crossref] [PubMed]

P. Pande, R. L. Shelton, G. L. Monroy, R. M. Nolan, and S. A. Boppart, “Low-cost hand-held probe for depth-resolved low-coherence interferometry,” Biomed. Opt. Express 8(1), 338–348 (2017).
[Crossref] [PubMed]

G. L. Monroy, R. L. Shelton, R. M. Nolan, C. T. Nguyen, M. A. Novak, M. C. Hill, D. T. McCormick, and S. A. Boppart, “Noninvasive depth-resolved optical measurements of the tympanic membrane and middle ear for differentiating otitis media,” Laryngoscope 125(8), E276–E282 (2015).
[Crossref] [PubMed]

R. L. Shelton, W. Jung, S. I. Sayegh, D. T. McCormick, J. Kim, and S. A. Boppart, “Optical coherence tomography for advanced screening in the primary care office,” J. Biophotonics 7(7), 525–533 (2014).
[Crossref] [PubMed]

Shin, J. J.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Simões, E. A.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Sipilä, M. M.

P. H. Karma, M. A. Penttilä, M. M. Sipilä, and M. J. Kataja, “Otoscopic diagnosis of middle ear effusion in acute and non-acute otitis media. I. The value of different otoscopic findings,” Int. J. Pediatr. Otorhinolaryngol. 17(1), 37–49 (1989).
[Crossref] [PubMed]

Spillman, D. R.

G. L. Monroy, P. Pande, R. L. Shelton, R. M. Nolan, D. R. Spillman, R. G. Porter, M. A. Novak, and S. A. Boppart, “Non-invasive optical assessment of viscosity of middle ear effusions in otitis media,” J. Biophotonics 10(3), 394–403 (2017).
[Crossref] [PubMed]

Stewart, C. N.

C. T. Nguyen, W. Jung, J. Kim, E. J. Chaney, M. Novak, C. N. Stewart, and S. A. Boppart, “Noninvasive in vivo optical detection of biofilm in the human middle ear,” Proc. Natl. Acad. Sci. U.S.A. 109(24), 9529–9534 (2012).
[Crossref] [PubMed]

C. T. Nguyen, H. Tu, E. J. Chaney, C. N. Stewart, and S. A. Boppart, “Non-invasive optical interferometry for the assessment of biofilm growth in the middle ear,” Biomed. Opt. Express 1(4), 1104–1116 (2010).
[Crossref] [PubMed]

Stinson, W. G.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Swanson, E. A.

D. Huang, E. A. Swanson, C. P. Lin, J. S. Schuman, W. G. Stinson, W. Chang, M. R. Hee, T. Flotte, K. Gregory, C. A. Puliafito, and J. G. Fujimoto, “Optical coherence tomography,” Science 254(5035), 1178–1181 (1991).
[Crossref] [PubMed]

Takala, A. K.

A. Palmu, H. Puhakka, T. Rahko, and A. K. Takala, “Diagnostic value of tympanometry in infants in clinical practice,” Int. J. Pediatr. Otorhinolaryngol. 49(3), 207–213 (1999).
[Crossref] [PubMed]

Takata, G. S.

G. S. Takata, L. S. Chan, T. Morphew, R. Mangione-Smith, S. C. Morton, and P. Shekelle, “Evidence assessment of the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion,” Pediatrics 112(6), 1379–1387 (2003).
[Crossref] [PubMed]

Tamburlini, G.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Teele, D. W.

D. W. Teele, J. O. Klein, and B. Rosner, “Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study,” J. Infect. Dis. 160(1), 83–94 (1989).
[Crossref] [PubMed]

Thomas, P. A.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Tu, H.

Tunkel, D. E.

A. S. Lieberthal, A. E. Carroll, T. Chonmaitree, T. G. Ganiats, A. Hoberman, M. A. Jackson, M. D. Joffe, D. T. Miller, R. M. Rosenfeld, X. D. Sevilla, R. H. Schwartz, P. A. Thomas, and D. E. Tunkel, “The diagnosis and management of acute otitis media,” Pediatrics 131(3), e964–e999 (2013).
[Crossref] [PubMed]

Uhari, M.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

van Eldere, J.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Vecchi Brumatti, L.

L. Monasta, L. Ronfani, F. Marchetti, M. Montico, L. Vecchi Brumatti, A. Bavcar, D. Grasso, C. Barbiero, and G. Tamburlini, “Burden of disease caused by otitis media: systematic review and global estimates,” PLoS One 7(4), e36226 (2012).
[Crossref] [PubMed]

Veling, M.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Vergison, A.

A. Vergison, R. Dagan, A. Arguedas, J. Bonhoeffer, R. Cohen, I. Dhooge, A. Hoberman, J. Liese, P. Marchisio, A. A. Palmu, G. T. Ray, E. A. Sanders, E. A. Simões, M. Uhari, J. van Eldere, and S. I. Pelton, “Otitis media and its consequences: beyond the earache,” Lancet Infect. Dis. 10(3), 195–203 (2010).
[Crossref] [PubMed]

Vila, P. M.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Walsh, S. A.

R. M. Rosenfeld, J. J. Shin, S. R. Schwartz, R. Coggins, L. Gagnon, J. M. Hackell, D. Hoelting, L. L. Hunter, A. W. Kummer, S. C. Payne, D. S. Poe, M. Veling, P. M. Vila, S. A. Walsh, and M. D. Corrigan, “Clinical practice guidelines: otitis media with effusion (update),” Otolaryngol. Head Neck Surg. 154(1S), S1–S41 (2016).
[PubMed]

Welzel, J.

J. Welzel, “Optical coherence tomography in dermatology: a review,” Skin Res. Technol. 7(1), 1–9 (2001).
[Crossref] [PubMed]

Yelverton, J. T.

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

Am. Fam. Physician (1)

E. Onusko, “Tympanometry,” Am. Fam. Physician 70(9), 1713–1720 (2004).
[PubMed]

Ann. Otol. Rhinol. Laryngol. Suppl. (1)

D. R. Richmond, J. T. Yelverton, E. R. Fletcher, and Y. Y. Phillips, “Physical correlates of eardrum rupture,” Ann. Otol. Rhinol. Laryngol. Suppl. 98(5_suppl), 35–41 (1989).
[Crossref] [PubMed]

Arch. Otolaryngol. (1)

C. A. Ostergard and D. R. Carter, “Positive middle ear pressure shown by tympanometry,” Arch. Otolaryngol. 107(6), 353–356 (1981).
[Crossref] [PubMed]

Biomed. Opt. Express (2)

BMC Fam. Pract. (1)

P. Abbott, S. Rosenkranz, W. Hu, H. Gunasekera, and J. Reath, “The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease,” BMC Fam. Pract. 15(1), 181 (2014).
[Crossref] [PubMed]

Eur. Arch. Otorhinolaryngol. (1)

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Supplementary Material (1)

NameDescription
» Data File 1       We utilized low coherence interferometry (LCI), a non-scanning method of optical coherence tomography (OCT), to quantitatively assess mobility of the tympanic membrane for pediatric subjects with otitis media (middle ear infection), and to correlate

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Figures (6)

Fig. 1
Fig. 1 Schematic diagram of pneumatic LCI-otoscope separated into (A) base module, (B) handheld imaging probe, and (C) pressure module: LSC, line scan camera; L, lens; DG, diffraction grating; C, collimator; 50/50, fiber coupled beam splitter; PC, polarization controller; NDF, neutral density filter; DC, dispersion compensation; M, mirror; DM, dichroic mirror; OBJ, objective lens; CCD, charge-coupled device camera.
Fig. 2
Fig. 2 The handheld probe uses a standard ear speculum with a rubber earbud to ensure a pressure seal within the ear canal. The pneumatic pressure stimulus is provided via a pneumatic port (bottom right) and surgical tube (red arrows).
Fig. 3
Fig. 3 Comparison of the representative in vivo pneumatic LCI data from (A) a normal ear and (B) an ear with a MEE. (A-1) and (B-1) show M-scans of the TM when pressure was applied. The start of the pneumatic stimulus is indicated with a red arrow. White arrows point to scattering from the middle ear effusion (MEE). The inset images in (A-1) and (B-1) show the corresponding en face surface views of the TM. Strong reflections near the edge in (B-1) are from earwax. (A-2) and (B-2) represent A-scans. (A-3) and (B-3) illustrate the plot of the TM displacement and the pressure dynamics. The compliance and amplitude ratio are calculated based on Eq. (1) and Eq. (2). The scale bars represent 200 µm in depth. a.u.: arbitrary units.
Fig. 4
Fig. 4 Correlating pneumatic LCI metrics with tympanometric parameters. The plot (A) shows the comparison between the compliance and peak admittance, the maximum acoustic admittance determined by tympanometry. In (B), the amplitude ratio and the MEP from tympanometry show a linear relationship, suggesting that the amplitude ratio may be an indicative of the MEP. The p-value for the F-test on the linear regression model was 2.3e-05. The MEPs of ears with a ‘type B’ tympanogram were estimated based on the amplitude ratio.
Fig. 5
Fig. 5 Characterization using pneumatic LCI metrics (compliance and amplitude ratio). (A) and (B) describe the overall distribution of the compliance and amplitude ratio with tympanogram-based color codes and physician diagnosis-based color codes, respectively. In (A), ears with ‘type A’ and ‘type B’ tympanograms can be roughly separated by the dashed red line, with the exception of subject indicated by a blue arrow. Also in (A), while ‘type C’ measurements are inconclusive, it can be expected that the data points in the blue oval are likely to have no MEE, and the data points in the orange ovals are likely to have a MEE. See Data File 1 for underlying values.
Fig. 6
Fig. 6 Statistical analysis of pneumatic LCI metrics based on (A) tympanometry and (B) physician diagnosis. The statistical findings are illustrated in bar graphs and also tabulated with t-test results. Overall, the compliances of ears with ‘type A’ tympanograms and the normal group were significantly greater than that of ears with ‘type B’ tympanograms and the MEE group, respectively. Similarly, the amplitude ratio of ears with ‘type B’ tympanograms and the MEE group were significantly less than that of the ‘type A’ data and the normal group.

Equations (2)

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compliance = displacement MAX |pressure| MAX
amplitude ratio = (+)displacement MAX (+)pressure MAX |(-)pressure| MAX |(-)displacement| MAX ,

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