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.     

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.     

Standard and multifrequency tympanometric norms for Caucasian and Chinese young adults

OBJECTIVE: This study examined differences between a group of normal-hearing Caucasian and Chinese young adults on six tympanometric parameters. The goal of this study was to determine if the Chinese group had different low and multifrequency tympanometry results than the Caucasian group. DESIGN: There were a total of 159 subjects (303 ears) between the ages of 18 and 34 years, with 76 subjects in the Caucasian group and 83 subjects in the Chinese group. Tympanometric data were gathered on a clinical immittance machine, the Virtual 310 equipped with a high frequency option. Four of the parameters-static admittance (SA), tympanometric width (TW), tympanometric peak pressure (TPP), and ear-canal volume (ECV)-were measured automatically at a standard 226 Hz frequency. The remaining two parameters-resonant frequency (RF) and SA up to 1,200 Hz-were measured by multifrequency, multicomponent tympanometry, using a mathematical approach. RESULTS: The Chinese group had significantly lower SA, wider TW, more positive TPP, and lower ECV than their Caucasian counterparts. The parameter of SA up to 1,200 Hz showed a significant group effect (Caucasian versus Chinese) until 900 Hz in the male group and up to 1,120 Hz in the female group. The Chinese group had significantly higher RF than the Caucasian group. Once the effect of body size was compensated by adjusting for the ear canal and the middle ear volumes, the differences observed between the Caucasian and the Chinese groups were no longer significant for tympanometric parameters obtained at standard probe tone frequency of 226 Hz; however, the effect was still significant for SA obtained at higher probe tone frequencies (560, 630, 710, 800, and 900 Hz) and for RF. Applying the Caucasian norms to a group of mainly Caucasian adults with surgically confirmed otosclerosis resulted in improved overall test performance when compared with the combined Caucasian and Chinese norms and the Chinese only norms. CONCLUSIONS: It seems that the body size plays a crucial factor in the observed differences between the Caucasian group and Chinese groups at a standard probe tone frequency of 226 Hz; however, other mechano-acoustical properties of the middle ear may contribute to these differences at higher probe tone frequencies. Findings of this study suggest that further research is needed to investigate the effects of body size on immittance measures with other ethnic groups. In the meantime, overall test performance may be improved by using a more homogenous norm when testing the Caucasian or Chinese individuals.     

Analysis of wideband tympanometry in Ménière’s disease

IntroductionEndolymphatic hydrops is the pathophysiological substrate of Ménière’s disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease.ObjectiveTo characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease.MethodsWe carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9).ResultsDifferent peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (?11 daPa) and the symptomatic group (?192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction.ConclusionsThe Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.     

Quantification of hearing loss associated with superior semi-circular canal dehiscence

Introduction

Superior semi-circular canal dehiscence (SSCD) is a known cause of hearing loss. This study quantifies hearing loss in SSCD ears in a frequency-specific fashion.

Methods

A meta-analysis of English language literature pertaining to SSCD was performed, with extraction and evaluation of available human audiometric data. Our own institution's case series of SSCD patients was also similarly analysed. Hearing loss in SSCD ears was compared to same patient control ears and to age-matched normative audiometric data.

Results

Ears with SSCD had statistically significant worse hearing as compared to both normative data and to own normal ear controls at 2000 Hz and below. The effect appears to diminish with increasing frequency.

Discussion

The presence of statistically significant conductive hearing loss in the low frequencies was confirmed for SSCD ears. SSCD may also predispose ears to high frequency sensorineural hearing loss.     

中耳功能正常与异常婴儿的宽频声导抗能量吸收率特性研究

目的：对比中耳功能正常与异常婴儿宽频声导抗（wideband acoustic immittance ，WAI）能量吸收率（wideband absorbance ，WBA）的差异，探讨宽频声导抗对婴儿中耳功能诊断的作用。方法根据高频（1 kHz）声导抗（high frequency tympanometry ，HFT ）、畸变产物耳声发射（DPOAE）及听性脑干反应（ABR）结果将3～12月龄婴儿46例分为中耳功能正常组31例（50耳）和中耳异常组15例（20耳），用96 dB peSPL 的宽频短声（频率范围226～8000 Hz）对两组进行宽频声导抗测试，比较两组能量吸收率特性，分析中耳功能对不同频率能量吸收率的影响。结果无论外耳道压力为峰压还是0 daPa时，除8000 Hz外，中耳功能正常组婴儿的宽频声导抗能量吸收率均高于中耳功能异常组，且2000 Hz处两者差异最大。当外耳道压力为峰压时，中耳功能正常组与异常组226～6727 Hz WBA差异均有统计学意义（P＜0．05）；当外耳道压力为0 daPa时，中耳功能正常组与异常组500～6727 Hz WBA差异有统计学意义（P＜0．05）。结论中耳功能正常与异常婴儿宽频声导抗能量吸收率差异有统计学意义，宽频声导抗可作为有效检测婴儿中耳功能的方法之一。     

The sensitivity and specificity of wideband absorbance measure in identifying pathologic middle ears in adults living with HIV

BackgroundLimited research exists on the sensitivity and specificity of wideband acoustic immittance (WAI) in adults living with human immunodeficiency virus (HIV). This study forms part of the bigger study titled ‘wideband acoustic immittance in adults living with HIV’.ObjectivesTo determine the sensitivity and specificity of the wideband absorbance measure at tympanic peak pressure (TPP), as a screening tool for detecting middle ear pathologies in adults living with HIV.MethodA prospective nonexperimental study comprising 99 adults living with HIV was performed. All participants underwent a basic audiological test battery which included case history, video otoscopy, tympanometry, wideband absorbance at TPP and pure tone audiometry. Middle ear pathologies were established by two otorhinolaryngologists using asynchronous video otoscopic images analysis. The outcomes of the otorhinolaryngologists served as the gold standard against which the wideband absorbance at TPP and tympanometry were measured. The receiver operating characteristics (ROC) curve was calculated.ResultsROC revealed the sensitivity of wideband absorbance at TPP to be higher in low to mid frequencies, but significantly lower in frequencies above 971.53 Hz. The sensitivity of tympanometry was lower. However, there was no difference between the specificity of wideband absorbance at TPP and tympanometry, indicating that when there are no pathologies, tympanometry is equally accurate.ConclusionThe current findings reveal that wideband absorbance at TPP can distinguish middle ear pathologies better than the tympanometry. Incorporating wideband absorbance at TPP in clinical practice may improve early identification and intervention of middle ear pathologies.     

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.     

听力正常新生儿1000Hz声导抗分析

目的 分析通过耳声发射(OAE)听力筛查正常新生儿1000 Hz声导抗测试的特点,为新生儿听力筛查及新生儿中耳功能的评估提供参考依据.方法 采用GSI-70型自动耳声发射听力筛查仪对新生儿进行听力筛查,将双耳通过OAE听力筛查的正常新生儿按照纳入标准选为研究对象,共650例(1300耳),然后采用GSI TympStar VersionⅡ中耳分析仪对该研究对象进行中耳功能测试,收集探测音为1000 Hz的鼓室导抗图及其相关指标,对图形进行分型并计算各指标的95％医学参考值范围.结果 将纳入的1300耳的鼓室导抗图分类,其中1Y1B1G型732耳(占56.3％)、1Y3B1G型145耳(占11.2％)、0Y0B0G型269耳(占20.7％)、其他154耳(占11.8％).其中声导纳图Y中单峰型有967耳,计算单峰型声导纳图Y各指标的95％医学参考值范围,其中鼓室图峰压(tympanometric peak pressure,Tpp)为- 55.0～180.0 daPa、峰补偿静态声导纳值(peak compensated static acoustic admittance,Peak Ytm)为0.03 ～1.18 mmHo、鼓室图宽度(tympanometric width,TW)为70.0～230.0 daPa.结论 通过OAE听力筛查的正常新生儿1000 Hz探测音的声导纳图Y以单峰型为主.1000 Hz探测音的单峰型声导纳图Y的Tpp、Peak Ytm、TW的95％医学参考值范围可作为新生儿听力筛查及新生儿中耳功能评估时的参考依据.     

Wideband reflectance in Down syndrome

ObjectiveChildren with Down syndrome (DS) have a high incidence of middle ear disorders and congenital abnormalities of the external, middle and inner ear. Energy reflectance (ER), a wideband acoustic immittance (WAI) measurement parameter, can measure the sound energy reflected or absorbed in the ear canal over a wider range of frequencies more efficiently and faster than conventional single-tone 226 Hz tympanometry. The aim of the present study was to compare the WAI measurements of children with DS with those of typically developing, normal-hearing children according to their tympanometric findings.MethodsFour groups of children with Down syndrome (age range: 2 years and 4 months to 16 years and 3 months; mean age: 8.5 yr) with normal tympanograms (19 ears), flat tympanograms (13 ears), mild negative pressure tympanograms (6 ears between −100 and −199 daPa at the admittance peak) and severe negative pressure tympanograms (4 ears at −200 daPa or lower at the admittance peak) were assessed. All findings were compared with data obtained from 21 ears of a healthy control group (age range: 3 years and 1 month to 13 years and 11 months; mean age: 7.9 yr). The subjects underwent tympanometry with a 226-Hz probe tone frequency and ER measurements along the 200–6,000 Hz range with a chirp stimulus using the Middle-Ear Power Analyzer (MEPA3 – HearID) by Mimosa Acoustics (Champaign, IL), software, version 3.3 [38].ResultsStatistically significant differences were observed in the ER curves for some comparisons between the studied groups. There was also a negative correlation between the static acoustic admittance at the tympanic membrane level and ER measured with a chirp stimulus at 500 and 1,000 Hz. The discriminant analysis technique, which used a chirp stimulus at 1,000 and 1,600 Hz to classify the participants' data based on ER values, achieved a correct classification rate of 59.52% for participants with DS.ConclusionWhile groups with abnormal middle ear status, as indicated by tympanometry, showed higher ER values compared to the DS tymp A group and the control group, similar reflectance curves were observed between control group and the DS tymp A group. WAI shows promise as a clinical diagnostic tool in investigating the impact of middle ear disorders in DS group. However, further research is required to investigate this issue in narrower age range group and a larger sample size.     

正常新生儿226Hz及1 000Hz探测音鼓室导抗测试

探讨通过瞬态诱发耳声发射(TEOAE)筛查的正常新生儿低频（226Hz）及高频（1000Hz）探测音鼓室导抗图的特点、获得峰声导纳值等指标的正常值范围,为临床新生儿及婴幼儿中耳功能评估和诊断提供依据。方法采用中耳分析仪（GSI-33型）对足月顺产,并通过TEOAE筛查的正常新生儿分别进行低、高频探测音下的鼓室导抗测试,分析鼓室导抗图形态特征并对峰声导纳值等重要数据进行统计。结果在100例首次双耳通过TEOAE筛查的新生儿鼓室导抗测试中,低频鼓室导抗图以双峰型为主（占96%）,高频鼓室导抗图以单峰型为主（占90%）;低频探测音鼓室导抗图为双峰型而其高频探测音鼓室导抗图为单峰型的有174耳（占总耳数87%）;低频及高频探测音鼓室导抗图均为单峰型的仅有6耳（占总耳数3%）。结论正常新生儿低频探测音鼓室导抗图以双峰型为主,高频探测音鼓室导抗图以单峰型为主,应将两者结合来对新生儿及婴幼儿中耳功能进行评估;所获得相应的峰声导纳值、峰声导纳值处外耳道压力、外耳道容积等指标的正常值可以用于初步评估新生儿中耳功能状态。     

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.     

Clustering upper airway physicals,otitis media with effusion and auditory functions in children

ObjectiveAdenoid hypertrophy (AH) has been identified as a cause of otitis media with effusion (OME), which is the most common cause of childhood hearing loss. Indeed, there may be other upper airway-related predisposing factors such as, location of the adenoid, accompanying tonsillar hypertrophy (TH) and nasal septal deviation (NSD) for the development of OME. In this study, we aimed to evaluate the associations between the upper airway physicals and OME with auditory functions.MethodsEighty-six ears of 43 children, aged 3–11 years were included in this prospective clinical study. Findings of otolaryngologic examinations were noted. Data of pure tone audiometry (PTA), traditional tympanometry (TT) and wideband tympanometry (WBT) parameters were collected. Cluster analysis was performed to the following variables: age, sex; the adenoid choana percentage (ACP), the presences of adenoid around torus tubarius (AATT), TH, NSD and OME; peak pressure (PP) values on TT, resonance frequencies (RF) on WBT, ambient pressure absorbance ratios (APAR) and PTA hearing thresholds.ResultsTwo groups of ears revealed by clustering; cluster-1 (n = 46) and cluster-2 (n = 40), at the similarity level of 0.662. The presences of AH, AATT, OME and the medians of ACP, PP, RF, WBT APARs at all frequencies except 5656 Hz and 8000 Hz, all PTA thresholds were significantly different between two clusters (p < 0.05). The lower WBT APARs and higher PTA thresholds were associated with higher levels of ACP and higher frequencies of the presence of AATT and OME in cluster-1.ConclusionThere are associations between AH, AATT and OME together with decline in hearing and SEA. Whereas, TH and NSD are not related to the formation of clusters and they are insignificant factors.     

Multifrequency multicomponent tympanometry in normal and otosclerotic ears

A multifrequency multicomponent admittance meter was used to evaluate 70 ears of patients affected by fenestral otosclerosis (Os ears), monolateral (16 cases) or bilateral (27 cases). The 16 contralateral ears of the patients with monolateral otosclerosis who presented a pure-tone air-bone gap less than 10 dB were evaluated separately (Cos ears). A group of 48 ears belonging to 24 otologically normal subjects (N ears), with hearing thresholds better than or equal to 10dB HL in the frequencies between 250 and 8000 Hz served as a control group. The purpose of the study was to evaluate the acoustic admittance characteristics of the three groups of ears, with particular regard to the parameters represented by the resonance frequency (RF), the acoustic conductance value (G) at RF and the individual interaural differences in these two parameters in the N and Cos groups. The degree to which fenestral otosclerosis can influence variations of RF and the correlation between the value of RF and conductive hearing loss in patients with clinically confirmed pictures and in the controlateral ears in the cases where the disease was clinically unilateral were also investigated. The study reveals statistically significant differences between the RF means in the N group (1085 +/- 244Hz) vs the Os group (1264 +/- 320 Hz) (p < 0.001) and between the G means in the N group (5.33 +/- 1.72 mmhos) vs the Os group (4.46 +/- 2.54 mmhos) (p = 0.04) and N group vs Cos group (3.42 +/- 2.27 mmhos) (p < 0.001). No correlation was found between the value of RF and conductive hearing loss. This study also shows how prognostic value may also be attributed to conductance at middle-ear pressure balancement: extremely low values for this parameter at RF are indicative of initial otosclerotic involvement of the oval window.     

Wideband acoustic immitance – Absorbance measurements in ears after stapes surgery

ObjectivesThe study aimed to thoroughly assess absorbance in ears after stapes surgery (stapedotomy/stapedectomy) and how stapes surgery affects wideband acoustic immittance (WAI) metrics.MethodsEighty-three otosclerotic ears were analyzed pre- and postoperatively. The analysis comprised: air-bone gap (ABG) and WAI which included absorbance measurements, resonance frequency assessment, low frequency tympanometry and metrics derived from these measures.ResultsAbsorbance after stapes surgery changed considerably compared to otosclerotic ears before surgery and also differed from normal ears. Absorbance after stapes surgery revealed two significantly different plot types: single-low-frequency-peak absorbance and two-peaks absorbance. Stapes surgery reduced resonance frequency in majority of operated ears and increased static compliance in low frequency tympanometry. Static compliance difference was directly proportional to ABG improvement at low frequencies. Postoperative ABG at 250 Hz and 500 Hz was most commonly correlated with postoperative WAI parameters. ABG improvement at 3000 Hz and 4000 Hz was directly proportional to absorbance difference at ~3000 Hz and 4000 Hz. It influenced the width of the postoperative absorbance by shifting both sides of the plot (negative values shift the points of the plot toward lower frequencies) with the correlation being more pronounced in postoperative two-peaks absorbance type ears.ConclusionsAbsorbance by itself is not sufficient for assessment of changes to middle function following stapes surgery, and should be complemented with other measures. WAI measurements including absorbance, resonance frequency assessment, low frequency tympanometry, and metrics derived from these measures combined with air-bone gap provide insight into mechano-acoustic changes in the middle-ear system as a result of stapes surgery.     

Investigation of serum calcium and vitamin D levels in superior semicircular canal dehiscence syndrome: A case control study

Objective: It remains unknown whether calcium metabolism has any effect on the clinical presentation of superior semicircular canal dehiscence(SSCD). Our aim was to analyse the adjusted calcium and vitamin D levels in SSCD patients compared to a control group.Methods: This was a prospective case-control study performed in a tertiary referral center, university teaching hospital in the UK. It included all new patients with SSCD seen in a dedicated skull base clinic over a 5-year period(2015-2019)...     

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.     

A型鼓室图儿童单频率单成份鼓室图测试正常值研究

目的 探讨A型鼓室导抗图儿童单频率单成份鼓室图正常值范围及影响因素.方法 2014年12月至2015年3月对符合Jerger分类法中A型鼓室导抗图的120例(240耳)2~15岁儿童进行单频率单成分鼓室图测试(Y-226),获取外耳道等效容积(acoustic equivalent volume,Vea)、峰补偿静态声导纳(peak-compensated static admittance,Ytm)、峰值处鼓室压(tympanometric peak pressure,TPP)和鼓室图梯度(tympanometric gradi-ent,TG)等,比较不同年龄、性别间的差异.结果 本组对象中,男性和女性TPP值分别为-32.35±22.40和-35.38±18.70 daPa,差异有统计学意义(P<0.05);2~6岁组和7~15岁组Vea值分别为0.79±0.13和0.90±0.19 ml,TPP值分别为-40.78±23.83和-30.21±18.80 daPa,组间差异均有显著性意义(均为P<0.05),其余指标差异均无统计学意义.结论 本组2~15岁A型鼓室图儿童单频率单成分鼓室图在2~6岁、7~15岁组间及不同性别组间峰值处鼓室压有差异;7~15岁组外耳道容积大于2~6岁组;可能与外耳道骨部及软骨部随着年龄增长而自然发育有关.     

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。     

Pressurized Wideband Acoustic Stapedial Reflex Thresholds: Normal Development and Relationships to Auditory Function in Infants

This study analyzed effects of pressurization on wideband acoustic stapedial-muscle reflex (ASR) tests in infants cared for in normal newborn (NN) and neonatal intensive care units (NICU). Effects of hearing-screening outcomes on ASR threshold measurements were also evaluated, and a subsequent longitudinal study established normative threshold ranges over the first year after birth. An initial experiment compared thresholds in newborns measured at ambient pressure in the ear canal and at the tympanometric peak pressure. ASR thresholds for broadband noise were higher for ears that did not pass newborn hearing screening and ASR threshold was 14 dB higher for real-ear compared to coupler conditions. Effects of pressurization were significant for ears that passed screening; thus, ASR testing in infants should be conducted at tympanometric peak pressure. ASR threshold was significantly higher for ears that referred on transient evoked otoacoustic emissions and Auditory Brainstem Response (ABR) screening tests and also for ears with conductive and sensorineural hearing loss diagnosed by ABR. Developmental ASR changes were significant over the first year for both normal and NICU infants. Wideband pressurized ASR thresholds are a clinically relevant measure of newborn hearing screening and diagnostic outcomes.