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American Academy of Pediatrics
Article

Unexpected Relationship Between Tympanometry and Mortality in Children With Nontraumatic Coma

Samson Gwer, Eddie Chengo, Charles R.J.C. Newton and Fenella J. Kirkham
Pediatrics September 2013, 132 (3) e713-e717; DOI: https://doi.org/10.1542/peds.2012-3264
Samson Gwer
aDepartment of Medical Physiology, College of Health Sciences, Kenyatta University, Nairobi, Kenya;
bDepartment of Clinical Research, Afya Research Africa, Nairobi, Kenya;
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Eddie Chengo
cCentre for Geographic Medicine Research–Coast, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya;
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Charles R.J.C. Newton
cCentre for Geographic Medicine Research–Coast, Kenya Medical Research Institute–Wellcome Trust Research Programme, Kilifi, Kenya;
dDepartment of Psychiatry, University of Oxford, Oxford, United Kingdom;
eNeurosciences Unit, Institute of Child Health, University College London, London, United Kingdom; and
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Fenella J. Kirkham
eNeurosciences Unit, Institute of Child Health, University College London, London, United Kingdom; and
fDepartment of Child Health, Southampton University Hospital, Southampton, United Kingdom
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Abstract

OBJECTIVE: We sought to further examine the relationship between tympanometry and mortality after noting an unexpected association on assessment of baseline data of a study whose primary aim was to investigate the utility of noninvasive tympanic membrane displacement measurement for monitoring intracranial pressure in childhood coma.

METHODS: We recruited children who presented with acute nontraumatic coma to the high-dependency unit of Kilifi District Hospital on the rural coast of Kenya. We excluded children with sickle cell disease, epilepsy, and neurodevelopmental delay. We performed tympanometry on the right ear before tympanic membrane displacement analyzer measurements. All children were managed according to standard World Health Organization guidelines.

RESULTS: We recruited 72 children with a median age of 3.2 years (interquartile range [IQR]: 2.0–4.3 years); 31 (43%) were female. Thirty-eight (53%) had cerebral malaria, 8 (11%) acute bacterial meningitis, 4 (6%) sepsis, and 22 (30%) encephalopathy of unknown etiology. Twenty (28%) children died. Tympanometry was normal in 25 (35%) children. Adjusting for diagnosis and clinical features of increased intracranial pressure, both associated with death on univariable analysis, children with abnormal tympanometry had greater odds of dying than did those with normal tympanometry (adjusted odds ratio: 17.0; 95% confidence interval: 1.9–152.4; P = .01). Children who died had a lower compliance (0.29 mL; IQR: 0.09–0.33 mL) compared with those who survived (0.48 mL; IQR: 0.29–0.70 mL) (P < .01).

CONCLUSIONS: Abnormal tympanometry appears to be significantly associated with death in children with acute nontraumatic coma. This finding needs to be explored further through a prospective study that incorporates imaging and intensive physiologic monitoring.

  • encephalopathy
  • infectious disease
  • child
  • tympanometry
  • outcome
  • Abbreviations:
    ABM —
    acute bacterial meningitis
    BCS —
    Blantyre coma score
    CI —
    confidence interval
    CM —
    cerebral malaria
    CSF —
    cerebrospinal fluid
    ICP —
    intracranial pressure
    IQR —
    interquartile range
    LP —
    lumbar puncture
    TMD —
    tympanic membrane displacement
    • Accepted June 4, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 132, Issue 3
    1 Sep 2013
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    Unexpected Relationship Between Tympanometry and Mortality in Children With Nontraumatic Coma
    Samson Gwer, Eddie Chengo, Charles R.J.C. Newton, Fenella J. Kirkham
    Pediatrics Sep 2013, 132 (3) e713-e717; DOI: 10.1542/peds.2012-3264

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    Unexpected Relationship Between Tympanometry and Mortality in Children With Nontraumatic Coma
    Samson Gwer, Eddie Chengo, Charles R.J.C. Newton, Fenella J. Kirkham
    Pediatrics Sep 2013, 132 (3) e713-e717; DOI: 10.1542/peds.2012-3264
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