检测婴儿中耳炎的听力学方法敏感性比较

目的 探讨常规听力学检查中婴儿中耳炎诊断相关的的敏感因素.方法 研究对象为听力筛杳未通过的婴儿48例(96耳),男31例,女17例;年龄1.5～12个月(平均4.3个月).所有受试者均接受了颞骨CT薄层扫描和常规听力学测试.听力学检查包括气导和骨导听性脑干反应(ABR)、40 Hz-听觉相关电位(40 Hz-auditory event related potential,40 Hz-AERP)、畸变产物耳声发射(DPOAE)、声反射及226 Hz、1000 Hz探测音鼓室声导抗.统计软件采用SPSS14.0标准统计软件包.以颞骨CT结果作为诊断的依据,与以下9项因素进行Kappa一致性栓验、单因素X2检验和多因素Logistic回归分析.分析因素包括:226 Hz及1000 Hz探测音鼓室声导抗、ABR气导反应阈值、ABR骨气导反应阈值差值、ABR Ⅰ波潜伏期、ABR Ⅰ～Ⅴ波间期、40 Hz-AERP反应阈值、DPOAE反应幅值及声反射阈值.结果 96耳中,CT确诊中耳炎77耳,中耳正常19耳.以颞骨CT扫描结果作为金标准,Kappa-致性检验表明,1000 Hz鼓室声导抗测试、ABR气导反应阈值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE与颞骨CT具有较好一致性(Kappa值均＞0.04,P值均＜0.001).单因素分析提示,有7个因素与婴儿中耳功能有关(P值均＜0.001):1000 Hz探测音鼓室声导抗、声反射阈值、ABR气导反应阈值、ABR气骨导反应阈值差值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE.Logistic回归分析显示,1000 Hz探测音鼓室声导抗(P＜0.001)和40 Hz-AERP反应阈值(P=0.004)可以列入Logistic回归方程.结论 1000 Hz鼓室声导抗可作为婴儿中耳炎检出的敏感因素,ABR气导反应阈值、ABR Ⅰ波潜伏期、40 Hz-AERP反应阈值和DPOAE可较好地反映婴儿的中耳功能.

Comparison of sensitivity of audiological tests to identify otitis media with effusion in newborn infants

Objective To investigate the sensitive factors which Were used in routine audiological tests to find out otitis media with effusion(OME)in newborn infants.Methods Subiects of this study were 48 infants.including 31 males and 17 females.who failed in the universal newborn heating screening.The age ranged from 1.5 to 12 months with the average age of 4.3 months.All subjects accepted temporal bone CT and routine audiological assessments.including air.conduction and bone.conduction auditory brainstem response(ABR),40 Hz-auditory event related potential(40 Hz-AERP),distortion.product otoacoustic emission(DPOAE),acoustic reflex,tympanometries using 226 Hz and 1000 Hz probe tone.Nine factors were statistically analyzed using Kappa test,Univariate X2 test and multivariate condition Logistic stepwise regression analysis.which included the results of acoustic immitance.the air-conduction and boneconduction ABR thresholds,the difierence between air-conduction and bone-conduction ABR thresholds.the latency of ABR wave Ⅰ,duration between ABR wave Ⅰ and Ⅴ,40 Hz-AERP thresholds,amplitudes and thresholds of DPOAE,and acoustic reflex thresholds(ART).Results Seventy-seven ears were diagnosedwith OME.and 19 ears were normal.CT scan of temporal bone was set as a comparative standard.Kappa test indicated that the results of tympanometry with 1000 Hz probe tone(Kappa:0.745,P＜0.001),the air-conduction ABR threshold(Kappa=0.453,P＜0.001),the latency of ABR wave Ⅰ(Kappa=0.430,P＜0.001),the threshold of 40 Hz-AERP(Kappa=0.582,P＜0.001),and DPOAE(Kappa=0.495,P＜0.001)had agreement with the results of temporal bone CT on evaluating the function of middle ear.Univariate analysis indicated that sensitive factors of middle ear function in newborn infants were tympanometry with 1000 Hz probe tone(P＜0.001),ART(P＜0.001),the air-conduction ABR threshold (P＜0.001),the difierence between air-conduction and bone-conduction ABR thresholds(P＜0.001).the latency of ABR wave I(P＜0.001),the threshold of40 Hz-AERP(P＜0.001)and DPOAE(P＜0.001).And multivariate conditional Logistie stepwise regression model showed that tympanometry with 1000 Hz probe tone(P＜0.001)and 40 Hz-AERP threshold(P=0.004)can be substituted into Logistic stepwise regression equation.Conclusions Tympanometry with 1000 Hz probe tone and are sensitive factors to find out OME in newborn infants.The air conduction ABR threshold.ABR wave Ⅰ latency,40 Hz-AERP threshold and DPOAE could reflect the middle ear function of newborn infants effectively.