{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:05:20Z","timestamp":1787018720139,"version":"build-2736575974"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,7,1]],"date-time":"2013-07-01T00:00:00Z","timestamp":1372636800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether the Carhart notch on pure\u2010tone audiometry is reliable as a diagnostic test for predicting otosclerosis in patients with conductive hearing loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>PubMed, Embase, the Cochrane Library, CINAHL, and Scopus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted. Studies reporting original study data were included. After assessment of directness of evidence and risk of bias of the selected articles, the prevalences and the positive and negative predictive values were extracted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1402 unique studies was retrieved. Three of these satisfied the eligibility criteria. One study provided direct evidence, while all studies carried moderate to high risk of bias. One study with moderate directness of evidence and high risk of bias was not further analyzed. In a study with a high directness of evidence, a high risk of bias, and a low prevalence of otosclerosis (8%) in patients with conductive hearing loss, the presence of a Carhart notch at 2000\u00a0Hz increased the risk of otosclerosis with 33%. In a second study with moderate directness of evidence, moderate risk of bias, and a high prevalence of otosclerosis (72%) in patients with a surgically confirmed congenital ossicular anomaly or otosclerosis, the presence of a Carhart notch at 2000\u00a0Hz increased the risk of otosclerosis with 2%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Recommendation<\/jats:title>\n                    <jats:p>Although there is insufficient high\u2010quality evidence regarding the diagnostic value of the Carhart notch, it seems it is a useful hint for the presence of otosclerosis, but it cannot be used to confirm a diagnosis of otosclerosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599813495661","type":"journal-article","created":{"date-parts":[[2013,7,2]],"date-time":"2013-07-02T00:41:41Z","timestamp":1372725701000},"page":"528-532","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Pure\u2010tone Audiometry in Otosclerosis: Insufficient Evidence for the Diagnostic Value of the Carhart Notch"],"prefix":"10.1002","volume":"149","author":[{"given":"Inge","family":"Wegner","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold J. N.","family":"Bittermann","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Medical Center Utrecht the Netherlands"},{"name":"Rudolf Magnus Institute of Neuroscience University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayke A.","family":"Hentschel","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert J. M.","family":"van der Heijden","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Medical Center Utrecht the Netherlands"},{"name":"Julius Centre for Health Sciences and Primary Care Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilko","family":"Grolman","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery University Medical Center Utrecht the Netherlands"},{"name":"Rudolf Magnus Institute of Neuroscience University Medical Center Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,7]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"699","article-title":"The clinical application of bone conduction audiometry","volume":"54","author":"Carhart R","year":"1950","journal-title":"Trans Am Acad Ophthalmol Otolaryngol"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0165-5876(02)00080-0","article-title":"Carhart's notch: a finding in otitis media with effusion","volume":"64","author":"Ahmad I","year":"2002","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1365-2273.1989.tb00346.x","article-title":"Conductive hearing loss assessment in children with otitis media with effusion. A comparison of pure tone and BERA results","volume":"14","author":"Conijn EA","year":"1989","journal-title":"Clin Otolaryngol Allied Sci"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1017\/S0022215107009474","article-title":"Ossicular chain reconstruction improves bone conduction threshold in chronic otitis media","volume":"122","author":"Lee HS","year":"2008","journal-title":"J Laryngol Otol"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1288\/00005537-198108000-00012","article-title":"Primary malleus fixation: diagnosis and treatment","volume":"91","author":"Moon CN","year":"1981","journal-title":"Laryngoscope"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1159\/000323010","article-title":"Evaluation of the Carhart effect in congenital middle ear malformation with both an intact external ear canal and a mobile stapes footplate","volume":"73","author":"Sakamoto 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