Artigo Original

Contralateral Occlusion Test (COT): the effect of external ear canal occlusion with aging

Luís Roque Reis; Luís Castelhano; Filipe Correia; Pedro Escada

Downloads: 0
Views: 30


 Purpose: This study aimed to evaluate the effects of complete external ear canal occlusion on hearing thresholds with aging. The goal was to decide which tuning fork is more appropriate to use for the contralateral occlusion test (COT), in individuals of different ages. Methods: Forty-two normal hearing subjects between 21 and 67 years were divided into three age groups (20-30 years, 40-50 years, and 60-70 years). Participants underwent sound field audiometry tests with warble tones, with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz). The contralateral ear was suppressed by masking. Results: Hearing thresholds showed an increase as the frequency increased from 20.85 dB (250 Hz, 20-30 years group) to 48 dB (2000 Hz, 60-70 years group). The threshold differences between occlusion and no occlusion conditions were statistically significant and increased ranging from 11.1 dB (250 Hz, 20-30 years group) to 32 dB (2000 Hz, 20-30 years group). We found statistically significant differences for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. We found no statistically significant differences between right and left ears and gender for all measurements. Conclusion: We conclude that the use of the 512 Hz tuning fork is the most suitable for COT, and its use may allow clinicians to distinguish mild from moderate unilateral conductive hearing loss.


Hearing Loss Conductive; Audiometry; Ear Canal; Hearing Tests; Bedside Testing; Auditory Threshold.


1. Verghese A, Charlton B, Cotter B, Kugler J. A history of physical examination texts and the conception of bedside diagnosis. Trans Am Clin Climatol Assoc. 2011;122:290-311. PMid:21686233.

2. Price CP. Point of care testing. BMJ. 2001;322(7297):1285-8. http://dx.doi. org/10.1136/bmj.322.7297.1285. PMid:11375233.

3. St John A, Price CP. Economic evidence and point-of-care testing. Clin Biochem Rev. 2013;34(2):61-74. PMid:24151342.

4. Ehrmeyer SS, Laessig RH. Point-of-care testing, medical error, and patient safety: a 2007 assessment. Clin Chem Lab Med. 2007;45(6):766-73. http:// PMid:17579530.

5. Porter ME. What is value in health care? N Engl J Med. 2010;363(26):2477- 81. PMid:21142528.

6. Ruckenstein MJ. Hearing loss: a plan for individualized management. Postgrad Med. 1995;98(4):197-200, 203, 206 passim. 0.1080/00325481.1995.11946065. PMid:7567720.

7. Chole RA, Cook GB. The Rinne test for conductive deafness: a critical reappraisal. Arch Otolaryngol Head Neck Surg. 1988;114(4):399-403. PMid:3348896.

8. Doyle PJ, Anderson DW, Pijl S. The tuning fork: an essential instrument in otologic practice. J Otolaryngol. 1984;13(2):83-6. PMid:6726852.

9. Reis LR, Fernandes P, Escada P. Contralateral Occlusion Test: The effect of external ear canal occlusion on hearing thresholds. Acta Otorrinolaringol Esp. 2017;68(4):197-203. PMid:28193471.

10. Isaacson JE, Vora NM. Differential diagnosis and treatment of hearing loss. Am Fam Physician. 2003;68(6):1125-32. PMid:14524400.

11. Kelly EA, Li B, Adams ME. Diagnostic accuracy of tuning fork tests for hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2018;159(2):220-30. PMid:29661046.

12. Miltenburg DM. The validity of tuning fork tests in diagnosing hearing loss. J Otolaryngol. 1994;23(4):254-9. PMid:7996624.

13. Stevens JR, Pfannenstiel TJ. The otologist’s tuning fork examination: are you striking it correctly? Otolaryngol Head Neck Surg. 2015;152(3):477-9. PMid:25475500.

14. Behn A, Westerberg BD, Zhang H, Riding KH, Ludemann JP, Kozak FK. Accuracy of the Weber and Rinne tuning fork tests in evaluation of children with otitis media with effusion. J Otolaryngol. 2007;36(4):197-202. http:// PMid:17942032.

15. Shuman AG, Li X, Halpin CF, Rauch SD, Telian SA. Tuning fork testing in sudden sensorineural hearing loss. JAMA Intern Med. 2013;173(8):706-7. PMid:23529707.

16. ISO: International Organization for Standardization. ISO 7029: acoustics: statistical distribution of hearing thresholds as a function of age. Geneva: International Organization for Standardization; 2017.

17. ANSI: American National Standards Institute. ANSI S3.391: american national standard specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance). New York: ANSI; 1987.

18. Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care: scientific review. JAMA. 2003;289(15):1976- 85. PMid:12697801.

19. Chandler JR. Partial occlusion of the external auditory meatus: its effect upon air and bone conduction hearing acuity. Laryngoscope. 1964;74(1):22- 54. PMid:14119590.

20. Roeser RJ, Lai L, Clark JL. Effect of ear canal occlusion on pure-tone threshold sensitivity. J Am Acad Audiol. 2005;16(9):740-6. http://dx.doi. org/10.3766/jaaa.16.9.10. PMid:16515144.

21. Bricco E. Impacted cerumen as a reason for failure in hearing conservation programs. J Sch Health. 1985;55(6):240-1. http://dx.doi. org/10.1111/j.1746-1561.1985.tb04130.x. PMid:3850233.

22. Roland PS, Smith TL, Schwartz SR, Rosenfeld RM, Ballachanda B, Earll JM, et al. Clinical practice guideline: cerumen impaction. Otolaryngol Head Neck Surg. 2008;139(3, Suppl. 2):S1-21. otohns.2008.06.026. PMid:18707628.

23. Wong BJ, Cervantes W, Doyle KJ, Karamzadeh AM, Boys P, Brauel G, et al. Prevalence of external auditory canal exostoses in surfers. Arch Otolaryngol Head Neck Surg. 1999;125(9):969-72. archotol.125.9.969. PMid:10488981.

24. Chaplin JM, Stewart IA. The prevalence of exostoses in the external auditory meatus of surfers. Clin Otolaryngol Allied Sci. 1998;23(4):326-30. http:// PMid:9762494.

25. Kroon DF, Lawson ML, Derkay CS, Hoffmann K, McCook J. Surfer’s ear: external auditory exostoses are more prevalent in cold water surfers. Otolaryngol Head Neck Surg. 2002;126(5):499-504. mhn.2002.124474. PMid:12075223.

Submetido em:

Aceito em:

5d1444de0e88257a7c5a3d52 codas Articles
Links & Downloads


Share this page
Page Sections