正常听力新生儿低频探测音鼓室导抗测试特点

目的:探讨瞬态诱发耳声发射(TEOAE)听力筛查通过的正常新生儿(2～7 d龄)低频(226 Hz)探测音鼓室导抗图的特点,获得外耳道容积,峰声导纳值等指标的特征.方法:采用AccuScreen Pro型TEOAE听力筛查仪对135名新生儿进行筛查;然后,采用GSI-33型中耳分析仪对首次双耳通过TEOAE听力筛查的新生儿进行低频探测音下的鼓室导抗测试,并获取鼓室导抗图、声导纳值和外耳道容积等相关数据.结果:135名新生儿中有105名新生儿首次双耳通过TEOAE听力筛查;在测得的鼓室导抗图中,双峰型202耳(占96.19%),单峰型8耳(占3.81%).双峰型鼓室导抗图第一峰的声导纳值为(0.91±0.18)mmho,峰声导纳值处外耳道压力为(18.02±12.26)daPa;第二峰的声导纳值为(1.05±0.23)mmho,峰声导纳值处外耳道压力为(-35.05±16.80)daPa;两峰间最低点处声导纳值为(0.74±2.57)mmho,其对应的外耳道压力为(0.37±7.61)daPa;外耳道容积(0.50±0.08)ml.结论:听力筛查通过的新生儿低频探测音鼓室导抗图以双峰型为主,相应的峰声导纳值、峰声导纳值处外耳道压力、外耳道容积等指标的正常值为临床新生儿中耳功能的评估提供了参考依据.     

正常新生儿高频探测音的鼓室导抗测试

目的探讨经瞬态诱发耳声发射(transient evoked otoacoustic emission,TEOAE)听力筛查通过的正常新生儿(2~7天龄)高频(1000Hz)探测音鼓室导抗图的特点。方法采用AccuScreen Pro型TEOAE听力筛查仪对135例新生儿进行听力筛查;对双耳通过TEOAE听力筛查的新生儿采用GSI-33型中耳分析仪检测在高频(1000Hz)探测音下的鼓室导抗图,对其进行分型,并分析外耳道容积、峰声导纳值等指标的正常值。结果135例新生儿中有100例(200耳)新生儿双耳通过TEOAE听力筛查,其鼓室导抗图单峰型有180耳(占90.0%)、双峰型5耳(占2.5%)、平坦无峰型7耳(占3.5%)、其它型8耳(占4.0%)。其中,单峰型鼓室导抗图的峰声导纳值为2.21±0.53mmHo,峰压点处外耳道压力为11.19±41.35daPa,外耳道容积约0.50±0.08ml。男性与女性相比:外耳道容积、峰声导纳值、 200daPa时的声顺值、峰补偿静态声导纳值的差异均有统计学意义(P<0.05);峰声导纳值对应的外耳道压力在性别中的差异无统计学意义(P>0.05)。结论通过听力筛查的新生儿高频(1000Hz)探测音的鼓室导抗图以单峰型为主,相应的峰声导纳值、峰压点处外耳道压力、外耳道容积等指标的正常值可以作为新生儿中耳状态评估时的参考依据。     

中青年国人鼓室导抗图正常值

目的 研究中青年国人鼓室导抗图各个测试项目的正常值范围及中年组和青年组之间的鼓室导抗图的差异。方法 选取纯音听阈正常、无耳科疾病的正常中青年人58例，在隔声室中，AA222中耳分析仪、226Hz探测音测试鼓室导抗图。结果 所有鼓室导抗图均符合Jerger分类法中的“A”型曲线，其静态声顺值比国外的稍小；中年组和青年组间等效外耳道容积和峰压值差异具有统计学意义（P〈0．05），而声顺和坡度差异则无统计学意义（P〉0．05）。结论 青年组与中年组鼓室导抗图等效外耳道容积和峰压值存在的显著性差异，可能与年龄增长所致外耳道壁松弛、外耳道容积变大、咽鼓管调节功能下降等因素有关。     

豚鼠鼓室导抗图正常值测试及结果分析

目的研究豚鼠鼓室导抗图（tympanogram）各个测试项目的正常值范围及不同性别、耳别之间的差异。方法选取ABR反应阈正常、无耳科疾病的正常豚鼠40只,在麻醉状态下测试其鼓室导抗图,并对不同性别、耳别的各个测试项目的结果进行比较。结果所有鼓室导抗图均符合Jerger分类法中的“A”型曲线,其等效外耳道容积约为0．09&#177;0．02ml,静态声顺值约为0．10&#177;0．03ml,坡度约为0．14&#177;0．06ml,峰压值约为一99．44&#177;75．06daPa。等效外耳道容积在性别间的差异具有统计学意义（P=0．012）,而静态声顺值、坡度和峰压值差异均无统计学意义（P〉0．05）。左右耳间各指标差异均无统计学意义（P〉0．05）。结论雄性与雌性豚鼠鼓室导抗图的等效外耳道容积存在显著性差异,其他各指标的结果在不同性别、耳别之间无明显差异。     

颞骨CT正常儿童1kHz鼓室声导纳特征

目的探讨颞骨CT正常儿童1 kHz鼓室声导纳的特点。方法双耳或单耳颞骨薄层CT示外、中、内耳结构均正常的儿童93例(162耳),其中,男58例(97耳),女35例(65耳),年龄2~66月龄(中位数19月),采用GSI-Tympstar中耳分析仪对其行1 kHz探测音鼓室导纳测试,记录鼓室导纳图形及峰导纳值(tympanometricpeak admittance,Ypeak)、鼓室图峰压(tympanometric peak pressure,TPP)、负尾部补偿导纳值(negative tail com-pensated admittance,Comp Y-400,为Ypeak值与-400 daPa处的导纳值之差)等指标的均值、标准差及95%可信区间,并分析耳别、性别及年龄对上述各指标的影响。结果①鼓室导纳图形态:单峰型149耳(91.98%,149/162),双峰型3耳(1.85%,3/162),平坦型5耳(3.09%,5/162),其它类型5耳(3.09%,5/162)。②各指标均值、标准差及95%可信区间分别为:Ypeak:4.13±1.42 mmHo,2.12~7.96 mmHo,TPP:29.56±74.92 daPa,-186.75~142.63 daPa,CompY-400:2.11±1.14 mmHo,0.89~5.25 mmHo。③不同耳别间Ypeak、TPP及CompY-400的差异无统计学意义(P>0.05);④不同性别间Ypeak和CompY-400的差异有统计学意义(男性高于女性,P=0.001,P=0.000),但TPP的性别间差异无统计学意义;⑤不同年龄组间Ypeak、CompY-400及TPP的差异有统计学意义,0~6月龄婴儿Ypeak及CompY-400均值显著低于其他年龄组。结论①颞骨CT正常儿童1 kHz鼓室导纳图多数为单峰型,但其Ypeak、TPP、CompY-400的95%可信区间范围较大。②男性的Ypeak显著高于女性;Ypeak和CompY-400随着年龄的增长而增长,Ypeak在12月龄、CompY-400在6月龄时此增长趋于缓和;TPP随年龄变化的特点不明显。     

四川地区青年人鼓室导抗筛查的正常值

目的 探讨四川地区青年人群(20—30岁)的鼓室导抗筛查的正常值及其影响因素。方法 采取完全重复Roup(1998)测试成人鼓室导抗筛查值的方法，测试了102例四川地区青年人的峰补偿静态声导纳值(PeakYtm)，外耳道等效容积(Vea)和鼓室测量坡度(TW)的正常值，并将结果与Roup的测试值进行了比较。结果 本研究与Roup的测试结果在各项鼓室导抗筛查值之间均存在显著性差异。具体而言，本研究的峰补偿静态声导纳值及外耳道等效容积均小于Roup的测试值，而鼓室测量坡度大于其测试值。男女分性别比较时，本研究中男性的峰补偿静态声导纳值及外耳道等效容积均大于女性。结论 本研究验证了四川地区青年人群与西方人群间的鼓室导抗筛查正常值之间的确存在显著性差异，提示我们应该建立自己的正常参考值标准，而非盲目地参照国外的标准。     

正常新生儿声导抗特性分析

目的通过大样本的筛查了解新生儿鼓室导抗图特性,收集新生儿的外耳道容积、鼓室压力、声顺值等相关数据,对声导抗测试在新生儿的临床应用中的作用进行初步探讨。方法采用226Hz探测音,对生后1～3天内的2617名(5234耳)正常新生儿进行声导抗测试。结果鼓室导抗图型分为单峰、双峰、平缓、负压四型,各型分别占16.22%、83.38%、0.29%、0.11%;新生儿声顺值的正常范围约为0.34～1.08ml;外耳道容积的正常范围约为0.3～1.0ml;鼓室压力的正常范围约为-121.12～ 82.36daPa。结论采用226Hz探测音测得的新生儿鼓室导抗图双峰的比例明显高于单峰,与成人和儿童有明显的区别。     

负压型鼓室导抗图诊断成人鼓室积液的研究

目的:探讨负压型鼓室导抗图对成人鼓室积液的诊断价值.方法:采用美国GSI-Tympstar Ⅱ型中耳分析仪,对所有疑似分泌性中耳炎的成人患者行声导抗检查,包括鼓室导抗图峰压、宽度、中耳共振频率及镫骨肌反射,选择其中为负压型鼓室导抗图的207耳行鼓膜穿刺,根据穿刺积液量将患耳分为无积液组(123耳)、少量积液组(45耳)及多量积液组(39耳),分别就3组患者的声导抗指标及同侧镫骨肌反射引出情况进行统计学分析.结果:无积液组的鼓室导抗图峰压、中耳共振频率与少量积液组和多量积液组之间的差异均有统计学意义(P<0.05或P<0.01);无积液组鼓室导抗图宽度与多量积液组之间的差异有统计学意义(P<0.01);3组间的同侧镫骨肌反射引出情况均差异有统计学意义(均P<0.01).结论:鼓室导抗图峰压、宽度,中耳共振频率结合同侧镫骨肌反射对判断成人负压型鼓室导抗图的鼓室有无积液具有诊断价值.     

实验性中耳积液大鼠的鼓室导抗图测试

目的 建立客观、稳定的检测大鼠中耳积液的方法。方法 将健康SD大鼠15只（30耳）建立实验性中耳职液大鼠模型，利用GSI－33Version Ⅱ型中耳分析仪，加用自制探头，分别对建立模型前后的大鼠进行鼓室导抗图检测，获取相关指标。结果 正常大鼠鼓室导抗图测试图型为A型或As型，大鼠中耳积液模型的鼓室导抗图测试有26耳变为B型，4耳仍为有峰型图但其导纳值、峰压值和梯度值均发生相应变化。造模前后大鼠鼓室导抗图曲线平滑，A型和As型对称性较好。结论 鼓室导抗图测试能够稳定、客观、敏感地反映大鼠的中耳传音功能。     

TEOAE听力初筛通过与未通过新生儿1000Hz鼓室导抗图型比较

目的分析未通过瞬态诱发性耳声发射（TEOAE）听力初筛新生儿的1000 Hz声导抗特点。方法采用GSI-70型自动耳声发射听力筛查仪对新疆自治区人民医院及乌鲁木齐市妇幼保健院出生的新生儿进行听力初筛,同时采用GSI TympStar Version Ⅱ中耳分析仪进行中耳功能测试,收集1000 Hz鼓室导抗图及相关指标,包括鼓室图峰压（the pressure of the peak admittance ,Tpp）、峰声导纳值（peak admittance ,Yp）,峰补偿静态声导纳值（Peak compensated static admittance ,Ypc）,鼓室导抗图宽度（tympanometric width ,TW）。对听力初筛未通过的47耳（未通过组）和通过的1300耳（通过组）的鼓室导抗图分型及单峰型声导纳图各指标进行比较。结果1000 Hz鼓室导抗图分型中,未通过组单峰型声导纳图比例（59．57％）显著低于通过组（74．00％）,而未通过组平坦型声导纳图比例（23．40％）显著高于通过组（8．54％）;通过组单峰型、双峰型声导纳图比例明显高于未通过组,平坦型声导纳图的比例低于未通过组（均为 P＜0．05）。两组间单峰型声导纳图的各指标比较差异无统计学意义。结论 TEOAE听力初筛通过的新生儿1000 Hz声导纳图以单峰型为主,而未通过的新生儿单峰型所占比例较低,平坦型比例高。     

Tympanometry measures in native and non-native Hawaiian children

BACKGROUND: Ethnicity has been readily accepted as a variable affecting the incidence of otitis media, with certain indigenous groups having an increased risk of middle ear dysfunction. Tympanometry provides objective information on middle ear status, and findings obtained from this procedure have often served as a criterion for medical referral. OBJECTIVE: To extend previous research and to facilitate use of normative tympanometry measures obtained from children with native Hawaiian ancestry. METHODS: Data were collected from 718 ears of 359 children in academic levels ranging from preschool to third grade. Subjects were matched across groups (182 native Hawaiian; 177 non-native Hawaiian) for academic level and gender. Variables included physical ear-canal volume (Vec), tympanometric peak compliance (peak Y, also known as static admittance), tympanometric width (TW), and tympanometric peak pressure (TPP). RESULTS: Significantly higher TW (F1,714=8.82, P=0.008) and TPP (F1,714=9.98, P=0.002) values occurred in ears of native Hawaiian children. Statistical interaction between gender and age was not significant. CONCLUSION: Differences in tympanometric findings between groups suggest differences in middle ear function, and these findings continue to underscore the importance of including tympanometry within a hearing screening protocol for early identification of possible hearing impairment.     

Tympanometric norms for Chinese young adults

OBJECTIVE: To obtain tympanometric norms in Southern Chinese young adult population and compare the results with data obtained for a Caucasian population. DESIGN: Ear canal volume (Vea), tympanometric compensated static acoustic admittance (Peak Ytm), tympanometric width (TW) and tympanometric peak pressure (TPP) were obtained on 100 Southern Chinese young adults. Results were compared with findings from Roup et al. (1998). Inter-tester reliability was established. RESULTS: Compared with the results obtained by Roup et al. (1998) on non-Hispanic Caucasian population, Southern Chinese subjects were found to have lower Peak Ytm, wider TW and more positive TPP values. No gender difference was noted for Peak Ytm, TW and TPP values in Chinese subjects. Inter-tester reliability was good. CONCLUSION: The tympanometric norms obtained in this study are recommended when evaluating middle ear function among Southern Chinese young adults.     

Tympanometry of a diverse group of preschool aged children

OBJECTIVE: Ethnicity has been previously described as a risk factor for middle ear disease. Little data exist on the presence of middle ear disease based on tympanometry screening comparing Asian children and children of other races. METHODS: Two hundred and seventy children aged 3-5 were screened with tympanometry at six Head Start sites in St. Paul, Minnesota during the months of September and October of 2004. Gender, age, and race/ethnicity was recorded and entered into a database, along with values for canal volume, static admittance, peak pressure, and tympanometric width. RESULTS: Criteria for abnormal tympanometry were based on American Speech-Language Hearing Association (ASHA) recommendations for a failed tympanogram for 1-5 year olds (admittance <0.3 mmho or width >200 daPa). There were no statistically significant differences in failure rates between males and females. There were, however, more failures for Asian (predominantly Hmong) children compared to children of other races/ethnicities after adjusting for age and gender differences (OR=6.39, CI 3.65-11.2, p<0.001) and for children <4-years-old compared to children 4-5-years-old after adjusting for race and gender differences (OR=1.99, CI 1.03-3.84, p<0.05). CONCLUSIONS: Asian children were more than six times as likely to fail tympanometry as children of other races/ethnicities. The explanation for this difference is likely to be multifactorial, and further research is needed to characterize this difference.     

Screening Tympanometry: Criteria for Medical Referral

Tympanograms were obtained from normal preschool and adult subjects with a prototype hand-held tympanometer to obtain normative values for four tympanometric variables: static admittance, equivalent ear canal volume, tympanometric peak pressure, and gradient. Effects of age group, sex, and pump speed (200 or 400 daPa/s) were determined. The results were incorporated into a four-part screening protocol (history, visual inspection, audiometry, and tympanometry) designed to reduce the excessive error rates associated with screening strategies that rely exclusively on tympanometry.     

Tympanometric characteristics of Chinese school-aged children

OBJECTIVES: To investigate the tympanometric characteristics of Chinese school-aged children with normal middle ear function. DESIGN: Measurements were made for four tympanometric variables [peak, compensated static acoustic admittance (peak Ytm); equivalent ear canal volume (Vec); tympanometric width (TW); and tympanometric peak pressure] from 278 Chinese children aged between 6 and 15 yrs. Data from the right ear were compared across age groups with those of Chinese young adults and with Western children of comparable ages. Data from the left ear were used to examine specificity using tympanometric screening criteria suggested in the present study. RESULTS: The developmental pattern in tympanometric variables found with the Chinese school-aged children in the study was similar to that found with white children in Western studies. Increasing age was accompanied by an increase in peak Ytm and Vec values, a decrease in TW values, and less negative and less varied tympanometric peak pressure values. The lower limit of peak Ytm 90% range of the Chinese school-aged children in the study was lower and their TW values were wider than those of white children. Age-specific data also suggested that the upper Vec limits of children between 6 and 7 yrs of age differed from those of older children. Racial differences in peak Ytm and TW values were noted, in that the Chinese school-aged children had a lower peak Ytm limit and wider TW values than white children. The use of ASHA 1997 guidelines for identifying ears for referral with respect to Chinese school-aged children may therefore not be highly sensitive and specific. Gender differences noted in peak Ytm and Vec values were too small to be of clinical significance. CONCLUSIONS: To increase the accuracy of tympanometry in determining ears to be referred for further assessment, the use of the tympanometric characteristics observed in the Chinese school-aged children in the present study (i.e., peak Ytm lower limit < 0.2 mmhos and Vec upper limit > 1.5 cm3) should be considered in addition to ASHA 1997 tympanometric screening guidelines.     

Evaluation of middle ear function in young children: clinical guidelines for the use of 226- and 1,000-Hz tympanometry.

HYPOTHESIS: The aims of the study were to evaluate tympanometry with regard to age and classification system using two probe-tone frequencies and to provide clinical guidelines. METHODS: Six subject groups were included in the evaluation: (1) neonatal intensive care unit babies, (2) children younger than 3 months, (3) children 3 to 6 months old, (4) children 6 to 9 months old, (5) children 9 to 32 months old, and (6) adults. Hearing of all subjects was screened by means of auditory brainstem responses, transient-evoked otoacoustic emissions, or behavioral audiometry. Tympanograms, recorded with probe-tone frequencies of 226 and 1,000 Hz, were classified according to shape and middle ear pressure. Additionally, 1,000-Hz tympanograms were classified based on the Vanhuyse model of tympanometric shapes. Furthermore, tympanometric parameters equivalent ear canal volume, admittance value at +200 daPa, middle ear admittance, tympanometric peak pressure, and tympanometric width were calculated for each tympanogram. RESULTS: For clinical purposes, the visual admittance classification system was more suitable than the Vanhuyse model. Furthermore, in children younger than the age of 3 months, 1,000-Hz tympanometry was easier to interpret and more reliable than 226-Hz tympanometry. From the age of 9 months, 226-Hz tympanometry was more appropriate. In children between 3 and 9 months, the reliability of tympanometry was independent of probe-tone frequency. A two-stage evaluation with a 1,000- to 226-Hz tympanometry sequence was preferred because this reduced the total number of tests. CONCLUSION: The current study provides normative data and age-related guidelines for the use of tympanometry in clinical practice. These results have led to a successful implementation of 1,000-Hz tympanometry in neonatal hearing assessment.     

Normative values for tympanometry in 4-5-year-old children

The objective of this study was to determine normative values for tympanometric variables for 4-5-year-old children. Tympanometry was performed at a pre-scheduled visit at the age of 49-68 months on children recruited to a follow-up visit in a vaccine efficacy trial (n=756 children). Tympanograms obtained successfully from healthy ears were analysed. At the time of the visit, mean static acoustical admittance (SAA) was 0.52 cm3, mean tympanometric peak pressure (TPP) was -48 daPa, and mean tympanometric width (TW) was 101. Compared to results obtained for the same study population at 24 months of age, the SAA had increased significantly with age, while the values for TPP and TW had decreased with age. A history of previous tympanostomy tubes increased the admittance of the tympanic membrane by producing atrophic scars. Thus, the tympanograms obtained from ears with previous tubes were considerably higher and narrower (high SAA and low TW). In conclusion, this study further emphasizes the need for age-specific normative values for interpretation of SAA and TW.     

Normative values for tympanometry in 7- and 24-month-old children

The objective was to determine normative values for tympanometric variables for 7- and 24-month-old children and to assess the effect of various factors on these variables. Tympanometry was performed at scheduled health visits at 7 and 24 months of age on children recruited to a prospective vaccine efficacy trial (n=2497 children at enrolment). Tympanograms obtained successfully from healthy ears with no recent otitis media were analysed. Normative values for static acoustic admittance (SAA), tympanometric peak pressure (TPP) and tympanometric width (TW) were calculated. The mean SAA was 0.25 cm3 at the 7-month visit compared to 0.34 cm3 at the 24-month visit. The TW decreased and TPP remained unchanged with age. Higher SAA values were found in boys. A history of recurrent acute otitis media and history of tympanostomy tubes were found to increase SAA and decrease TW at 24 months. In conclusion, age-specific normative values for interpretation of SAA and TW are necessary.     

Aging and middle ear function in rhesus monkeys (Macaca mulatta).

This study provided tympanometric data on rhesus monkeys (Macaca mulatta) and more support for this monkey as a good model for human peripheral auditory function. There have been few published reports concerning middle ear function in rhesus monkeys, and these experiments addressed that need. In the first experiment, peak acoustic admittance (Ytm) and ear-canal volume (Vea) were measured in 17 older adult monkeys and 16 younger adult monkeys. In the second experiment, middle ear resonance frequency was measured in eight younger adult monkeys and four older adult monkeys. Overall, peak Ytm, Vea, and resonance frequency were similar for monkeys and humans. Specifically, peak mean Ytm and mean Vea in monkeys were comparable to those values in human children. There was a trend for older monkeys to have decreased peak Ytm and Vea, but these trends did not reach statistical significance. There was a significant sex effect similar to what has been reported in humans. Male monkeys had larger peak Ytm values and larger Vea values compared with female monkeys regardless of age. Finally, there were no significant age or sex effects on resonance frequency.     

Tympanometry with 226 and 1000 Hertz tone probes in infants

This study aimed at describing and analyzing tympanometric results obtained with 226Hz and 1000Hz probe tones; checking for correlations between tympanometry, otoacoustic emissions and otoscopic examination; describing abnormal results found in the evaluation procedures.MethodsDouble-blind and prospective study. Our sample included 70 babies, between 7 days and one month and 13 days of age, without risk indicators for hearing loss, evaluated in the State Neonatal Hearing Screening Program. Transient evoked otoacoustic emissions, otoscopic examination and tympanometry with 226Hz and 1000Hz probe tones were used as assessment tools. The study was approved by the Ethics Committee from the institution.ResultsStatistically significant differences were observed (p<0.05) in the tympanometric measures correlation and also between transient evoked otoacoustic emissions and compliance obtained with both probe tones. Most test results were within the normal range (94.28%). Three children (4.28%) were referred to diagnostic follow-up and one (1.42%) had middle ear dysfunction confirmed by otoscopy and 1000Hz tympanometry.Conclusions1000Hz tympanometry is the most reliable probe tone used to evaluate children under three months of age. More studies focusing on middle ear acoustics and mechanics are necessary to provide reliable and precise interpretation in the evaluation of middle ear functions in babies.