Screening for middle ear disease in a school for the deaf.

During the 1977-78 academic year, a study was conducted at the Western Pennsylvania School for the Deaf (WPSD) to evaluate, in a population of profoundly deaf students: 1) the incidence of middle ear (ME) effusion; 2) the correlation between high negative ME pressure (HNP) and ME effusion; and 3) the effect of HNP (> -100 mm H2L) on auditory acuity. All 446 students at WPSD were screened three times (fall, winter, and spring) by both otoscopy and tympanometry and were then classified as belonging to one of five categories according to the status of their ME. Otoscopic, tympanometric, and audiometric evaluations were conducted monthly for 41 study-group students with HNP and 41 controls with normal ears. Tabulations of the incidence of ME conditions over the year-long period showed that 8% of the students had effusion, 21% HNP, 1% inactive disease, 26% residual disease, and 44% normal ME. The majority of severe ME problems occurred in children between the ages of two and eight years. HNP proved insufficient to predict the occurrence of an effusion in children aged 6 to 21 years. However, only 21% of the ears in which HNP was identified returned to and remained normal for the entire year, as contrasted with the initially normal or "controls," of which 77% remained normal. In this profoundly deaf population, the correlation between HNP and threshold shifts proved difficult to document. A small but significantly greater fluctuation in threshold during the period of a year was noted, however, when the students with HMP were compared with the controls.