Frontiers in surgery · 2026
Application of wideband tympanometry combined with kempthorne criteria in the diagnosis of otitis media with effusion in adults: a prospective study.
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Trieu Viet Nguyen, Thi Ngoc Lien Nguyen, Thanh The Pham, Chieu Hoa Chau, Thi Kieu Tuyen Nguyen
Аннотация
INTRODUCTION: To describe clinical and audiological characteristics and evaluate the diagnostic value of wideband tympanometry (WBT) combined with Kempthorne otoscopic features in adults with otitis media with effusion (OME).
METHODS: A prospective descriptive study with surgical intervention was conducted on 66 ears with clinically suspected OME in patients aged ≥16 years at Can Tho University of Medicine and Pharmacy Hospital from June 2024 to October 2025. Kempthorne score >5 was used solely as an eligibility threshold. Clinical examination, rigid otoscopy, pure-tone audiometry, conventional 226-Hz tympanometry, and WBT were performed. Intraoperative middle-ear fluid at myringotomy served as the positive reference standard in 31 operated ears; the remaining 35 non-operated ears were classified as disease-negative without surgical verification (composite reference standard with partial verification). An a priori sample-size calculation targeted ≥28 surgically verified ears (α=0.05, power 80%); post hoc power for AUC comparison was 84.6%. Three diagnostic strategies were evaluated: (1) standard 226-Hz tympanometry (type B or C); (2) WBT alone; (3) combined model-positive WBT plus ≥1 high-yield Kempthorne morphological feature (air-fluid level and/or absent mobility), excluding the enrollment threshold.
RESULTS: All enrolled ears had Kempthorne scores >5. Against the 66-ear composite reference dataset (31 fluid-positive, 35 assumed fluid-negative), sensitivity/specificity/AUC were 100.0%/68.2%/0.84 for standard tympanometry, 77.4%/81.8%/0.91 for WBT alone, and 93.5%/86.4%/0.94 for the combined model (McNemar p = 0.042). Among surgically verified ears, standard 226-Hz tympanometry detected all fluid-positive cases (sensitivity 100.0%). Operated and non-operated ears did not differ significantly on key preoperative indices (all p > 0.05).
CONCLUSION: WBT combined with specific Kempthorne morphological features provided complementary morphological and absorbance information in adult OME. However, because standard tympanometry already achieved 100% sensitivity in the operated subset, any apparent advantage of the combined model in specificity, NPV, and AUC is derived largely from the surgically unverified reference-negative subset and must be interpreted with caution in light of severe partial verification bias.
METHODS: A prospective descriptive study with surgical intervention was conducted on 66 ears with clinically suspected OME in patients aged ≥16 years at Can Tho University of Medicine and Pharmacy Hospital from June 2024 to October 2025. Kempthorne score >5 was used solely as an eligibility threshold. Clinical examination, rigid otoscopy, pure-tone audiometry, conventional 226-Hz tympanometry, and WBT were performed. Intraoperative middle-ear fluid at myringotomy served as the positive reference standard in 31 operated ears; the remaining 35 non-operated ears were classified as disease-negative without surgical verification (composite reference standard with partial verification). An a priori sample-size calculation targeted ≥28 surgically verified ears (α=0.05, power 80%); post hoc power for AUC comparison was 84.6%. Three diagnostic strategies were evaluated: (1) standard 226-Hz tympanometry (type B or C); (2) WBT alone; (3) combined model-positive WBT plus ≥1 high-yield Kempthorne morphological feature (air-fluid level and/or absent mobility), excluding the enrollment threshold.
RESULTS: All enrolled ears had Kempthorne scores >5. Against the 66-ear composite reference dataset (31 fluid-positive, 35 assumed fluid-negative), sensitivity/specificity/AUC were 100.0%/68.2%/0.84 for standard tympanometry, 77.4%/81.8%/0.91 for WBT alone, and 93.5%/86.4%/0.94 for the combined model (McNemar p = 0.042). Among surgically verified ears, standard 226-Hz tympanometry detected all fluid-positive cases (sensitivity 100.0%). Operated and non-operated ears did not differ significantly on key preoperative indices (all p > 0.05).
CONCLUSION: WBT combined with specific Kempthorne morphological features provided complementary morphological and absorbance information in adult OME. However, because standard tympanometry already achieved 100% sensitivity in the operated subset, any apparent advantage of the combined model in specificity, NPV, and AUC is derived largely from the surgically unverified reference-negative subset and must be interpreted with caution in light of severe partial verification bias.