Wideband energy reflectance findings in presence of normal tympanogram in children with Down's syndrome


Objectives: The prevalence of middle ear disorders in children with Down syndrome is higher than normal children due to the associated craniofacial abnormalities. The goal of this study is to evaluate middle ear function using wideband energy reflectance at ambient pressure in 14 young children with Down syndrome and matched control group (2-5 years old; N=19 ears per group) who each have a normal 226. Hz tympanogram.

Methods: All children underwent otoscopic examination, hearing screening using play audiometry (500-4000. Hz), and middle ear testing using 226. Hz tympanometry and wideband energy reflectance. The chirp signals for the wideband energy reflectance were presented to the child's ear at 65. dB SPL stimulus level and the recording was done over 220-8000. Hz range. The measured energy reflectance represents the ratio of the sound energy reflected from the tympanic membrane to the incident sound energy transmitted to the middle ear at a specific frequency. Paired Samples t-test was computed for the mean, 95th, 75th, 25th, and 5th percentile data of each frequency of the two groups.

Results: Despite the presence of normal tympanometric findings in both groups, results revealed abnormal wideband energy reflectance findings in 63% of the children with Down syndrome compared to the normal wideband energy reflectance findings in the control group. The mean energy reflectance ratio of the Down syndrome group was abnormally lower than that of the control at 5700-8000. Hz (p< 0.0005). The 5th and 95th percentile ratios of the Down syndrome group fell outside the 5th and 95th percentile of the control group (p< 0.0005).

Conclusions: Abnormally low energy reflectance ratios above 4000. Hz in the presence of normal tympanograms in the Down syndrome group may suggest associated congenital middle ear anomalies in children with DS. The present findings suggest that wideband energy reflectance has the potential to be of more practical value in children with DS than tympanometry. Further research with a larger number of Down syndrome children will illuminate the potential of wideband energy reflectance in diagnosing middle ear disorders in children with Down syndrome.


Communication Sciences and Disorders

Document Type





Children, Down syndrome (DS), Energy reflectance (ER) ratio, Middle ear function, Tympanometry, Wideband energy reflectance (WBER)

Publication Date


Journal Title

International Journal of Pediatric Otorhinolaryngology