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Abnormal tympanometry increased mortality risk in those with nontraumatic coma
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Children with acute nontraumatic coma and abnormal tympanometry had increased odds for mortality compared with those with normal tympanometry, according to recent study findings published in Pediatrics.
“Our study reveals an unexpected finding of a significant association between abnormal tympanometry and death in children who had acute nontraumatic encephalopathy independent of etiology and clinical features of increased [intracranial pressure],” Samson Gwer, MBChB, MRCPCH, PhD, of the College of Health Sciences, Kenyatta University in Nairobi,Kenya, and colleagues wrote. “Specifically, children who died had significantly lower compliance than those who survived.”
The study included 72 children (median age, 3.2 years; 43% female) with acute nontraumatic coma. Tympanometry was performed on the right ear before tympanic membrane displacement analyzer measurements.
The researchers found that 53% had cerebral malaria; 11% acute bacterial meningitis; 6% sepsis; and 30% encephalopathy of unknown etiology. Overall, 28% of participants died. Participants with abnormal tympanometry had increased odds of dying compared with those with normal tympanometry, when adjusted for diagnosis and clinical features of increased cranial pressures (adjusted OR=17%; 95% CI, 1.9-152.4). Lower compliance was found in children who died (0.29 mL) compared with those who survived (0.48 mL).
“Potentially, because the tympanometer is relatively inexpensive and simple to use, it may greatly aid in monitoring and providing additional information on prognosis in children with acute coma, allowing for greater insights into the pathophysiology of childhood acute encephalopathies,” the researchers concluded.
Disclosure: One researcher reports funding from a Wellcome Trust fellowship award.
Perspective
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Jerome O. Klein, MD
I found this study to be of limited value. Children with acute non-traumatic coma in Kenya were recruited with a variety of etiologies: bacterial meningitis, sepsis, cerebral malaria. Many died (28%) and among those a feature was abnormal tympanometry. The authors suggest that the abnormal findings were indicative of imiddle ear abnormality and stiffness of the tympanic membrane. They conclude that tympanometry could be used to predict the outcome of acute coma.
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