3～6岁儿童鼓膜置管术后宽频声导抗变化

目的 以环境压力(0 daPa)宽频声导抗声能吸收率(wideband acoustic immittance, WAI-0 daPa)曲线的变化探索3～6岁儿童分泌性中耳炎鼓膜置管术后中耳功能变化，为判断鼓膜置管术后通风管状态提供客观依据。方法 对71例121耳3～6岁儿童进行0 daPa宽频声导抗测试，其中中耳功能正常组20耳，鼓室积液组20耳，分泌性中耳炎鼓膜置管术后组81耳，并根据鼓膜置管时长和通风管状态分为0～1月组(19耳)、3月组(19耳)、6月组(17耳)、≥12月组通风管通畅(19耳)和通风管堵塞组(7耳)。共获得107个频率的WAI-0 daPa。利用Kruskal-WallisH和Nemenyi统计法，分析中耳功能状态、鼓膜置管时长、通风管状态对WAI-0daPa的影响。结果 (1)鼓室积液组除226 Hz和5 339 Hz外，各频率WAI-0 daPa均显著低于中耳功能正常组；鼓膜置管术后0～1月组在226～667 Hz、1 000～1 297 Hz处WAI-0 daPa显著高于中耳功能正常组(P<0.05);鼓室积液组除4 000～5 339 Hz外，余...     

宽频声导抗应用于评估0-24月龄婴幼儿中耳功能检查的临床研究

目的建立正常0-2周岁中国婴幼儿宽频声导抗(wideband tympanometry,WBT)吸收率的参考值范围。对比正常耳和分泌性中耳炎患儿宽频声导抗的鼓室图结果以及宽频能量吸收率(wideband absorbance,WBA)的差异,探讨宽频声导抗对婴幼儿中耳功能诊断的意义。方法入选者中耳功能正常155例(269耳),诊断为分泌性中耳炎者50例(80耳),绘制正常耳、分泌性中耳炎耳WBT曲线,并对绘制出的曲线吸收率进行比较。结果0~6月龄、7-12月龄和13-24月龄婴幼儿WBT各频率吸收率所分析的31个频率吸收率差异均有统计学意义,三组婴幼儿WBA曲线图形似一个左侧峰高右侧峰低的不对称M形状。分泌性中耳炎组WBA曲线下降最显著的频率范围集中在891~2245Hz。中耳正常0-6月龄组平均鼓室图(averaged tympanogram,AT)的吸收率要均高于7-12月龄组和13-24月龄组,分泌性中耳炎组AT的图形为平坦型。结论本研究建立了0-24月龄中国人群正常耳WBT吸收率以及AT90%参考值,吸收率(WBA)和AT测试可用于临床诊断婴幼儿分泌性中耳炎。     

不同声阻抗试验对积液型分泌性中耳炎临床应用

目的　对比分析226、1000Hz声导抗和宽频声导抗（wideband immittance,WBI）在积液型分泌性中耳炎（OME）鉴别诊断中的临床应用价值,探讨WBI的临床应用价值。方法　检测中耳功能正常者12例（24耳）和2017年9月～2018年3月我科经耳内镜下鼓膜穿刺确诊为积液型OME患者64例（95耳）,单侧33例（33耳）,双侧31例（62耳）的226 Hz声导抗、1000 Hz声导抗和WBI检查,分析积液型OME在三种声导抗的敏感度、特异度和准确度。采用独立样本t 检验分析中耳功能正常者和积液型OME患者,WBI在外耳道压力为0 da Pa和峰压值时9个频率的能量吸收率。结果　①外耳道压力为0 da Pa和峰压值时,中耳功能正常者与积液型OME患者的能量吸收率在667、1000、1681、2669、3363、5339和8000 Hz比较,差异均有统计学意义（P＜0.05）,在226和408 Hz频率比较,无统计学意义（P＞0.05）;②对于积液型OME诊断而言,226 Hz声导抗敏感度87.30%,特异度40.63%,准确度71.58%;1000 Hz声导抗敏感度93.65%,特异度37.50%,准确度74.74%;WBI敏感度98.41%,特异度96.88%,准确度97.89%;③WBI敏感度、特异度和准确度最佳,1000 Hz声导抗敏感度和准确度优于226 Hz声导抗检查,226 Hz声导抗特异度优于1000 Hz声导抗检查。结论　相较于226和1000 Hz声导抗检查,WBI检查在积液型OME的鉴别诊断中具有较高临床应用价值。     

正常新生儿宽频声导抗能量吸收率及其可重复性研究

目的 探讨正常新生儿中耳宽频声导抗(wideband acoustic immittance,WAI)能量吸收率及其相关的影响因素,评价宽频声导抗测试的可重复性.方法 选取通过瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)听力初筛的正常新生儿124例(193耳),在其出生48～72小时进行WAI测试,分析不同频率能量吸收率的变化规律、两次测试的重复性及外耳道处于不同压力、性别、侧别、分娩方式对WAI能量吸收率的影响.结果 正常新生儿宽频声导抗能量吸收率随频率增大呈"两峰两谷"形态,即在低频及3 363 Hz附近较低、在1 296 Hz附近及高频较高;两次测试的重复性显示外耳道处于峰压时,1 000 Hz和2 000 Hz两次测试差值的绝对值较外耳道压力处于0 daPa时小,且差异有统计学意义(P＜0.05),而其余各频率差异无统计学意义(P＞0.05).外耳道压力处于0 daPa时与峰压时相比,除1 000、6 727 Hz外,其余各频率WAI能量吸收率的差异均有统计学意义(P＜0.05);不同性别、侧别、分娩方式的新生儿WAI能量吸收率差异无统计学意义(P＞0.05).结论 正常新生儿外耳道处于峰压时,两次WAI测试的重复性较好;外耳道处于不同压力对大部分频率WAI能量吸收率有一定影响;性别、侧别、分娩方式对WAI能量吸收率无明显影响.     

低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用

目的评价低频和高频探测音鼓室声导抗测试在诊断婴儿中耳功能异常中的作用。方法使用GSI Tympstar中耳分析仪，对年龄5—25周的听性脑干反应（auditory brainstem response，ABR）检查正常婴儿15例（30耳）和Ⅰ波潜伏期延长提示可能存在中耳功能异常婴儿17例（20耳），进行226、678、1000Hz探测音鼓室声导抗测试的比较。结果226Hz探测音鼓室声导纳图的静态声导纳值、图形、峰压和梯度在2组间的差异无统计学意义。678Hz探测音鼓室声导纳图、声纳图及声导图在2组中均可见无峰型、单峰型、双峰型、三峰型图形，其与ABR检查的一致率分别为70．0％、58．0％、64．0％，kappa值分别为0．324、0．234、0．118。1000Hz探测音鼓室声导纳图、声纳图及声导图在正常组中单峰型分别为28耳（93．3％）、25耳（83．3％）、26耳（86．7％），在异常组中无峰型分别为15耳（75％）、17耳（85％）、13耳（65％），其与ABR的一致率分别为90．0％、92．0％、86．0％，kappa值分别为0．783、0．831、0．690。结论1000Hz探测音鼓室声导抗测试是诊断小于25周婴儿中耳功能的较准确的检查方法，226、678Hz探测音鼓室声导抗测试则不能提供这些婴儿中耳功能的准确的信息。     

听力正常青年人宽频声导抗能量吸收率的初步研究

目的 探讨听力正常青年人宽频声导抗(WAI)能量吸收率(EA)的特点,并比较EA在耳别、性别之间的差异。 方法 选择听力正常青年人60例(120耳),分别行纯音测听、声导抗、宽频声导抗检查,分析检查结果,进行统计学分析。 结果 EA值呈不规则的倒“W”型。左右耳的能量吸收率仅在2 000 Hz频率段有统计学意义,余频率段无统计学意义。在250 Hz~630 Hz之间的女性能量吸收率稍低于男性的能量吸收率,在630 Hz~3 150 Hz之间女性的能量吸收率稍高于男性的能量吸收率,其差异无统计学意义。 结论 正常青年人宽频声导在低频时能量吸收率较低,后迅速增长;中高频能量吸收率值较高。宽频声导抗能量吸收率在耳别、性别之间无明显差异。在临床应用中通过比较宽频声导抗能量吸收率的差异性,可增加中耳疾病诊断的特异度和灵敏度。     

72例新生儿的声导抗图形分析

目的分别用226、678、1000Hz探测音鼓室声导抗测试分析72例新生儿的中耳功能状态。方法使用GSITympstar中耳分析仪，对年龄在0～1月的72例新生儿（144耳）进行226、678、1000Hz探测音鼓室声导抗测试，测试异常可疑者再行颞骨薄层CT检查以明确有无中耳积液。结果226Hz探测音鼓室声导抗图形均为“A型”，其中单峰型图形41．7％（60／144），双峰型图形58.3％（84／144）；678Hz探测音鼓室声导抗测试显示异常图形有39耳，1000Hz探测音鼓室声导抗测试显示异常图形有9耳，声导抗测试异常可疑者23例（双耳异常者18例，单耳异常者5例）再行颞骨薄层CT检查，结果显示其中8耳存在中耳腔内积液。结论226Hz探测音鼓室声导抗测试不能准确地反映正常新生儿的中耳功能状态；678Hz探测音鼓室声导抗测试诊断的敏感性较好，但特异性较差；1000Hz探测音鼓室声导抗测试诊断的敏感性及特异性最佳。     

婴儿分泌性中耳炎的听力学结果分析

目的 探讨226、1 000 Hz鼓室声导抗测试和气-骨导听性脑干反应（ABR）以及畸变产物耳声发射（DPOAE）在诊断低月龄婴儿分泌性中耳炎（OME）中的作用。方法 回顾性分析年龄为1～6个月的119例（192耳）中耳积液患儿（异常组）和66例（132耳）正常婴儿（正常组）的226、1 000 Hz鼓室声导抗测试和气-骨导ABR,以及DPOAE检测结果。结果 （1）OME婴儿,1 000 Hz鼓室声导抗异常图形（As型、B型、C型）有189耳（98.44%）,226 Hz鼓室声导抗异常图形（As型、B型、C型）有135耳（70.31%）;(2)OME婴儿ABR波Ⅰ潜伏期延长179耳（93.23%）,ABR波Ⅴ反应阈中度异常69耳（35.94%）、轻度异常97耳（50.52%）、阈值正常26耳（13.54%）,骨导ABR阈值正常164耳（85.42%）,阈值轻度异常28耳（14.58%）,气-骨导ABR阈值差值变大162耳（84.37%）;(3)OME婴儿DPOAE未引出151耳（78.65%）。结论 1 000 Hz声导抗异常、气-骨导ABR阈值差变大、ABR波I潜伏期延长和气导AB...     

正常婴幼儿1000Hz和226Hz探测音声导抗结果分析

目的 评价1 000 Hz和226 Hz探测音声导抗测试在检测0～36月龄正常婴幼儿中耳功能中的作用.方法 将听力正常的648例(1 296耳)0～36月龄的婴幼儿分为四组,一组:0～月龄110例(220耳);二组:3～月龄109例(218耳);三组:6～月龄105例(210耳);四组:9～36月龄324例(648耳).使用丹麦MADSEN公司OTOFLE100多频声导抗检测仪对各组分别进行1 000 Hz和226 Hz探测音声导抗测试,对结果进行比较.结果 226 Hz探测音声导抗结果:一组中有66.82%(147/220)异常,二组中有33.49%(33/218)异常,三组中34.76%(73/210)异常,四组中有1.85%(12/648)异常.1 000 Hz探测音声导抗结果:一组中有4.09%(9/220)异常,二组中有11.01%(24/218)异常,三组中有32.86%(69/210)异常,四组中有57.10%(370/648)异常.结论 226 Hz探测音鼓室声导抗测试不能准确反映0～6月龄婴幼儿的中耳功能,1 000 Hz探测音声导抗测试评估0～6月龄婴幼儿的中耳功能最佳;1 000 Hz和226 Hz探测音声导抗测试的联合应用可客观评估6～9月龄婴幼儿的中耳功能;226 Hz探测音鼓室声导抗测试能客观反映9～36月龄婴幼儿的中耳功能.     

多频鼓室声导抗测试在婴幼儿中耳功能诊断中的应用

目的探讨不同频率探测音声导抗测试法及多频率扫描声导抗测试法对婴幼儿中耳功能的评价效率。方法 122例听力正常婴幼儿和141例听力异常婴幼儿,应用GSI Tympstar中耳分析仪,分别以226、678、1000Hz探测音及多频率扫描声导抗测试法检测中耳功能,比较分析其测试效果。结果比较听力正常组和异常组检测结果,各月龄组的678、1000Hz探测音鼓室导纳图图形特点均有统计学意义(P0.05),但226Hz探测音鼓室导纳图在6月龄婴儿的差异无统计学意义(P0.05);组间的共振频率差异在6月龄婴儿虽无统计学意义(P0.05),在6月龄婴儿则有统计学意义(P0.05)。结论 3种频率探测音声导抗测试法对6月龄婴幼儿中耳功能诊断均较敏感,而678、1000Hz探测音对于6月龄婴儿中耳功能的诊断较为准确。随月龄增长,婴幼儿中耳共振频率逐渐升高,有助于评价6月龄婴幼儿的中耳功能。     

Postoperative change in wideband absorbance after tympanoplasty in chronic suppurative otitis media

ObjectiveTo identify the wideband absorbance (WBA) of reconstructed TM comparing with perforated and normal TM, and to investigate the efficacy of WBA to predict postoperative hearing outcome.MethodsNinety-eight adults (128 ears) with normal TM and 40 patients (40 ears) who were diagnosed with chronic suppurative otitis media (CSOM) and underwent tympanoplasty type 1 were enrolled. Pure tone audiometry and WBA were measured before and 6 and 12 months after surgery. Finally, only 29 patients in CSOM group completed all the tests.ResultsSignificant differences in WBA were observed between normal ears, CSOM, and reconstructed ears at middle to high frequencies. During follow-up, absorbance decreased at low frequencies and increased at middle to high. Significant positive correlation at low to middle frequency was observed between change in air-bone gaps (ABG) and absorbance at corresponding frequencies.ConclusionWBA in patients with CSOM was significantly different from normal TM, and a significant change in WBA was observed after tympanoplasty with improvement of ABG. WBA may be a useful tool for monitoring the postoperative change in absorbance of sound energy in the middle ear.     

Effect of ear canal pressure and age on wideband absorbance in young infants

Objective: The study investigated the effect of ear canal pressure and age on wideband absorbance (WBA) in healthy young infants.

Design: Using a cross-sectional design, WBA at 0.25 to 8?kHz was obtained from infants as the ear canal pressure was swept from?+200 to ?300 daPa. Study sample: The participants included 29 newborns, 9 infants each at 1 and 4 months and 11 infants at 6 months of age who passed distortion product otoacoustic emissions test. Results: In general, negative-ear canal pressures reduced WBA across the frequency range, while positive-ear canal pressures resulted in reduced WBA from 0.25 to 2?kHz and above 4?kHz with an increase in absorbance between 2 and 3?kHz compared to WBA at ambient pressure. The variation in WBA below 0.5?kHz, as the pressure was varied, was the greatest in newborns. But, the variation was progressively reduced in older infants up to the age of 6 months, suggesting stiffening of the ear canal with age. Conclusions: Significant changes in WBA were observed as a function of pressure and age. In particular, developmental effects on WBA were evident during the first six months of life.     

Wideband absorbance pattern in adults with otosclerosis and ossicular chain discontinuity

ObjectivesEvidence from previous literature had shown that the use of a single frequency probe tone is not sensitive enough to detect middle ear pathologies, especially related to the ossicles, which hinders accurate diagnosis. The goal of the present study was to compare the outcome of wideband absorbance (WBA) tympanometry and to determine the difference in WBA pattern in adults with otosclerosis and ossicular chain discontinuity.Materials and methodsEstimated adult cases of otosclerosis (10 ears) and ossicular chain discontinuity (06 ears) along with healthy individuals (10 ears) in the age range of 24 to 48 years (mean age: 38.6 years) were considered for the study. WBA was measured at peak and ambient pressure along with resonance frequency and compared with the data obtained from the healthy individuals to determine the WBA pattern.ResultsData analysis revealed a distinct WBA pattern showing high absorbance at 750 Hz for ossicular chain discontinuity compared to healthy individuals, whereas the otosclerosis group showed reduced absorbance (p < 0.05) at low frequencies (250 Hz to 1500 Hz). WBA measured at the peak and ambient pressure did not elicit any significant difference across the frequencies. Also, the average WBA tympanogram measured between 375 Hz and 2000 Hz showed a significant difference in ambient pressure only in the otosclerosis group. In comparison to healthy individuals (901 Hz), ossicular chain discontinuity showed a significant reduction in resonance frequency (674 Hz), whereas in cases with otosclerosis had higher resonance frequency (1445 Hz).Conclusions and significanceThe present study showed different WBA patterns between the groups and the absorbance values were significantly different at the low frequencies. This suggests that WBA has the potential to differentiate ossicles related pathologies from normal and also between the ear with otosclerosis and ossicular chain discontinuity.     

耳硬化症和中耳畸形患者的宽频声导抗研究

目的探讨宽频声导抗测试对耳硬化症和中耳畸形辅助诊断中的应用价值。方法收集耳硬化症组45耳,先天性中耳畸形组13耳,另有正常组76耳作为对照,所有受试者均行宽频声导抗测试,对各组峰压下的声能吸收率进行分析比较。结果峰压下,耳硬化症组的声能吸收率在917/972~1029/1091~1297/1456/1731/2059~3462/4000~5339Hz比正常组的显著减小(P<0.05)。耳硬化症患者在1kHz以下较正常组无异常切迹。峰压下,先天性中耳畸形组的声能吸收率在408~749/7336~7772Hz比正常组的显著增大(P<0.05),在1059~1224/1297/1414~1456/4000~4490Hz比正常组的显著减小(P<0.05)。69%(9/13)的先天性中耳畸形患者在1kHz以下有一切迹。结论声能吸收率鼓室图在1kHz以下出现切迹提示患者存在镫骨畸形合并锤骨和/或砧骨畸形。仅镫骨固定患者1kHz以下无切迹。宽频声导抗对于术前评估耳硬化症和中耳畸形患者中耳听骨链情况具有现实意义,可作为辅助耳硬化症和中耳畸形诊断的听力学检查之一。     

不同类型鼓室图患者中耳共振频率分析

目的 探讨不同类型鼓室图患者的听力损失情况及其对应的中耳共振频率变化。方法 使用听力计对患者进行纯音测听检查,了解其听力损失的性质、程度;使用中耳分析仪进行常规中耳功能分析,根据不同类型的静态鼓室图形进行分组;分别对听力正常组(30耳)、异常组(116耳)［鼓室图为A型(30耳)、Ad型(22耳)、As型(21耳)和C型(43耳)］行中耳共振频率检查。结果 正常组的中耳共振频率为(951.00±198.85)Hz;听力异常组中A型鼓室图的中耳共振频率为(861.00±137.60) Hz (P<0.01), Ad型为(725.00±158.14) Hz (P<0.01), C型为(499.00±146.27) Hz(P<0.01),三组中耳共振频率分别比正常组低;As型为(1088.00±199.38) Hz(P<0.05)比正常组高。结论 中耳共振频率的检测有助于中耳疾病的诊断及治疗。     

Detection of the acoustic stapedius reflex in infants using wideband energy reflectance and admittance

This study examined the measurement of the contralateral acoustic stapedius reflex in six-week-old infants and adults using wideband shifts in admittance and energy reflectance (YR). The reflex activator was bandpass noise from 2,500 to 11,000 Hz presented at a maximum spectrum level of 51 dB SPL measured in the ear canal. Reflexes were detected by calculating a cross-correlation between one-twelfth-octave measurements of YR for the highest activator level and responses to lower levels. The reflex-induced shifts in YR for the infant ears were similar in pattern to adult responses but were noisy at frequencies below 1000 Hz. Infant reflexes were more successfully detected when the cross-correlation was calculated from 1000 to 8000 Hz, whereas adult reflexes were more successfully detected for a cross-correlation from 250 to 2000 Hz. This method may be useful in capturing the most robust frequency region for acoustic reflex detection across postnatal middle ear development.     

Wideband acoustic immittance in superior semicircular canal dehiscence

ObjectiveThe apparent effect of superior semicircular canal dehiscence (SSCD) on middle ear- and cochlear impedance has led researchers to investigate the use of wideband acoustic immittance as a screening tool when SSCD is suspected. The purpose of the study was to describe the absorbance characteristics and tympanometric values of ears with confirmed SSCD measured at tympanometric peak pressure (TPP) and at ambient pressure.MethodsWideband Acoustic Immittance was performed at ambient pressure and at TPP on ten participants (12 ears) with confirmed SSCD, as well as on an age- and gender matched control group (12 ears). Inferential statistics were used to determine whether statistical differences existed for the absorbance values at each of the averaged frequencies, the resonance frequency (RF) and tympanometric data between the SSCD and control groups.ResultsThe mean absorbance of the SSCD group reached a maximum at 890.9 Hz and a minimum at 6349.6 Hz. When testing absorbance at TPP, a statistically significant increase/peak in the absorbance values of the SSCD group (compared to those of the control group) was found from 630 to 890.9 Hz and a decrease from 4489.8 to 6349.6 Hz. Similar patterns were observed for absorbance at ambient pressure. A lower mean RF for ears with SSCD as well as an increased mean admittance magnitude (AM) value at RF was found compared to those of the control group.ConclusionThe use of SSCD as a screening tool when SSCD is suspected was strengthened by results similar to those of previous studies. As a result of the significant difference in RF of SSCD ears compared to the RF of the control group, the potential value of measuring the RF of the middle ear to differentiate between mass-and stiffness dominated pathologies, was also illustrated.     

Wideband aural acoustic absorbance predicts conductive hearing loss in children

Abstract

Objective: This study tested the hypothesis that wideband aural absorbance predicts conductive hearing loss (CHL) in children medically classified as having otitis media with effusion. Design: Absorbance was measured in the ear canal over frequencies from 0.25 to 8 kHz at ambient pressure or as a swept tympanogram. CHL was defined using criterion air-bone gaps of 20, 25, and 30 dB at octaves from 0.25 to 4 kHz. A likelihood-ratio predictor of CHL was constructed across frequency for ambient absorbance, and across frequency and pressure for absorbance tympanometry. Performance was evaluated at individual frequencies and for any frequency at which a CHL was present. Study sample: Absorbance and conventional 0.226-kHz tympanograms were measured in children of age three to eight years with CHL and with normal hearing. Results: Absorbance was smaller at frequencies above 0.7 kHz in the CHL group than the control group. Based on the area under the receiver operating characteristic curve, wideband absorbance in ambient and tympanometric tests were significantly better predictors of CHL than tympanometric width, the best 0.226-kHz predictor. Accuracies of ambient and tympanometric wideband absorbance did not differ. Conclusions: Absorbance accurately predicted CHL in children and was more accurate than conventional 0.226-kHz tympanometry.