声导抗检查对分泌性中耳炎早期诊断的意义

声导抗检查对分泌性中耳炎早期诊断的意义钱宇虹１宋江顺１李苏卫１分泌性中耳炎是以鼓室积液及听力下降为主要特征的中耳非化脓性疾病。初期大多听力正常，耳科检查指征不典型，用常规纯音测听法检出率敏感性低。本文采用纯音测听结合声导抗检查，以早期发现患者的听力损...     

儿童分泌性中耳炎诊断方法比较

目的 探讨耳内镜、颞骨高分辨率CT、鼓室声导抗及纯音测听等检查对儿童分泌性中耳炎(secretory otitis media,SOM)的诊断价值.方法 对207例(414耳)腺样体肥大患几分别行耳内镜、鼓室声导抗、纯音测听及颞骨高分辨率CT检查,以颞骨CT检查结果作为分泌性中耳炎的诊断标准,分别计算耳内镜、声导抗及纯音测听诊断分泌性中耳炎的准确度.结果 207例414耳中,CT诊断SOM(中耳积液)125耳(30.19％％,125/414),其中116耳(92.80％,116/125)鼓膜穿刺证实有中耳积液;与颞骨CT结果比较,耳内镜(诊断中耳积液128耳,其中CT检查阴性4耳)、鼓室声导抗(B型导抗图133耳,其中CT检查阴性8耳)、纯音测听(0.5～4 kHz气骨导差≥15dB 81耳,其中CT检查阴性2耳)三种检查诊断SOM的敏感性分别为99.20％ (124/125)、100％ (125/125)、63.20％(79/125),特异性分别为98.62％ (285/289)、97.23％ (281/289)、99.31％ (287/289),诊断符合率分别为98.79％ (409/414)、98.07％ (406/414)、88.41％ (366/414).耳内镜下见鼓室积液联合B型鼓室导抗图诊断SOM的符合率(99.52 ％)高于任一种单项检查和其他任何两种联合检查.结论 以耳内镜下见鼓室积液联合B型鼓室导抗图诊断分泌性中耳炎准确、安全.     

109例分泌性中耳炎患儿测听结果分析

分泌性中耳炎 (ｓｅｃｒｅｔｏｒｙｏｔｉｔｉｓｍｅｄｉａ ,ＳＯＭ)是儿童时期耳科常见病 ,它以渗液滞留在中耳腔内而没有急性感染体征为特征 ,而常被忽视 ,尽管如此以听力下降为主诉的患儿仍不少见。为此对耳聋门诊中发现的 4岁以上分泌性中耳炎患儿进行声导抗测试及纯音测听 ,现将结果分析报告如下 :1　对象与方法1 1　对象 :1997年 1月至 5月天津市儿童医院耳聋门诊收治的全部 4岁以上临床诊断为ＳＯＭ的患儿共 10 9例 (191耳 )。平均年龄为 8.72± 2 .6 4岁 ,最大 14岁 ,最小 4岁 ;男 6 5例 ,女44例 ;4～ 7岁组、～ 10岁组和～ 14岁组…     

儿童分泌性中耳炎听力学检查结果分析及意义探讨

目的探讨听力学相关检查对分泌性中耳炎患儿的诊断的临床意义方法 57例患儿,男30例、女27例,年龄5岁至9岁,平均年龄7岁4个月。每位患儿均进行纯音测听,鼓室声导抗测试、镫骨肌声反射测试、畸变产物耳声发射、听性脑干反应测试。结果 57例患儿(114耳)中99耳证实有分泌性中耳炎,99耳中C型鼓室图42耳(42.4%),B型鼓室图53耳(53.5%),A型鼓室图4耳(4.04%)。纯音测听有气骨导差89耳(89.9%),听力正常10耳(10.1%)。听性脑干反应正常26耳(26.3%)。在鼓室图异常的95耳中,33耳(34.7%)能引出声反射,有声反射组患儿与无声反射组患儿及DPOAE通过组与未通过组分别进行纯音听阈进行t检验统计学分析,两者阈值均具有显著统计学差异(P<0.01)。结论听力学的相关综合检查对于儿童分泌性中耳炎的诊断有一定的临床意义。     

分泌性中耳炎低频探测音鼓室导抗图的分析

分泌性中耳炎的特征是鼓室内有非化脓性积液,仅凭耳镜检查和纯音测听诊断有一定的局限性[1．2]。声导抗测试有客观、敏感、迅速、无创伤等优点,文中对各类鼓室导抗图,尤其是双峰型作了重点讨论。1资料和方法1．1临床资料临床确诊为分泌性中耳炎,共188例（251耳）,均经统音测听及声导抗测试,最后经鼓膜穿刺证实鼓室有积液。其中男99例,女89例．年龄4～75岁,平均34．75岁。右耳62例、左耳63例、双耳63例。1．2仪器及方法纯音测所采用AS72型听力计,在环境噪音＜30dB（A）隔声室内,用上升法测试0．125～8kHz气导听阈及0．25～4kHz…     

12例分泌性中耳炎误诊原因分析

分泌性中耳炎为耳科常见病 ,是导致听力障碍的一个重要原因 ,我科自 1996年～ 1999年 8月共诊治 10 9例 ,其中曾误诊、漏诊的有 12例 ,现报告分析如下 :12例中儿童 5例 ,成年 7例。 5例儿童临床表现为听力下降、耳闭塞感 ,病史均在 1年以上 ,曾多次在外院行耳镜检查、纯音测听 ,以感音神经性耳聋治疗无效后来本院就诊 ,我们除给于作纯音测听检查外 ,又行声导抗测试 :均为Ｂ型鼓室导抗图 ,声反射消失 ,初诊为分泌性中耳炎 ,后经鼓膜穿刺抽液而确诊。7例成人有 2例临床表现为听力下降伴耳闭塞感 2月余 ,既往有噪声接触史 ,常规行纯音测听、声…     

小儿腺样体肥大与分泌性中耳炎

目的探讨腺样体肥大患儿的不同鼓室图与分泌性中耳炎的关系及分泌性中耳炎的诊断。方法对2009年1月—2011年6月期间本院收治的328例腺样体肥大患儿(包括单纯腺样体肥大及合并有慢性扁桃体炎及扁桃体肥大者)的病例资料进行回顾性分析。分析统计分泌性中耳炎的发病率及声导抗测试诊断分泌性中耳炎的阳性率。结果 328例腺样体肥大患儿中有105例最终经鼓膜穿刺或鼓膜置管确诊为分泌性中耳炎(32.31%);声导抗测试鼓室导抗图表现为B型者89例152耳,其中最终确诊为分泌性中耳炎者为86例147耳,阳性率为96.63%;C导抗图(负压在-150dapa以上)者33例49耳,其中最终确诊为分泌性中耳炎者为16例20耳,阳性率为40.82%;As导抗图2例2耳亦最终确诊为分泌性中耳炎。结论对于腺样体肥大患儿不论主诉有无听力下降,常规进行声导抗测试,同时结合认真的体格检查及电耳镜或耳内镜检查,可大大降低小儿分泌性中耳炎的误诊率。     

鼓膜穿刺术联合药物治疗急性分泌性中耳炎

目的探讨鼓膜穿刺术联合药物治疗急性分泌性中耳炎的疗效。方法 146例急性分泌性中耳炎患者均经过耳内镜及纯音测听、声导抗检查确诊为分泌性中耳炎,中耳腔积液,其中114例行鼓膜穿刺术联合药物治疗,32例单纯药物治疗,结果鼓膜穿刺术联合药物治疗患者听力当时即有明显提高,再经相应药物治疗,3月内无复发。而单纯药物治疗患者听力大多无明显改善,需再次复诊行鼓膜穿刺术才能治愈。结论鼓膜穿刺术联合药物治疗急性分泌性中耳炎疗效明显、安全无并发症。     

分泌性中耳炎的听力状况分析

分泌性中耳炎是一种引起听力下降的常见病，小儿及成人均可发病，本文通过对本病患者治疗前进行纯音听阈及声导抗测试，了解分泌性中耳炎患者的听力状况并分析其原因。     

分泌性中耳炎的声导抗测试

分泌性中耳炎的声导抗测试杜福荣，钱善明，张子征分泌性中耳炎是耳科常见多发病。用声导抗测试可以了解中耳的功能状态，为临床诊断提供依据。我们采用ＭａｄｓｅｎＺＳ７７－ＭＢ型声阻抗仪，对８８例（１００耳）进行了鼓室压图和声反射测试，随后立即作鼓室穿刺，证实...     

Auditory steady-state responses (ASSR): effects of modulation and carrier frequencies

Presented are results relevant to extending the utility of the auditory steady-state response (ASSR) in threshold estimation at high-frequency carriers and to the accuracy of thresholds estimated using modulation frequencies near 40 versus 80?Hz. Initially, efforts were directed at confirming various findings reported in the literature apropos effects of several basic ASSR parameters. Results supplement others’ observations suggesting that ASSR detection limits overestimate behavioral thresholds for conventional audiometric (carrier) frequencies from 500 to 4000?Hz. Further investigation revealed even greater errors of threshold estimates for 8000 and 12?000?Hz, by about 14 and 22?dB on average, respectively. Although suggesting high-frequency ASSR testing to be efficacious, technical advances and additional work is needed to establish clinical utility. Comparison of effects of modulation frequency suggested ASSR thresholds with 40?Hz modulation to fall closer to behavioral threshold than those estimated at 80?Hz. Consequently, when circumstances permit, 40?Hz ASSR testing may be the method of choice (e.g. in the assessment of malingers, who may be tested awake/alert).     

Efficiency of Subjective Audiometry in Children up to the Third Year of Age

After a discussion of possible methods for measuring the hearing of infants, we present a more appropriate method which we have developed and used over a number of years. The method applied is called ‘sound orientation audiometry’ and is based on the readiness of infants to seek out the sources of sounds. As the infants are observed by means of a one-way mirror, no distraction is possible. In the light of our experience, the proof of intentional application is most favorable when the infants are 5-6 months or 3-4 years old. The application threshold is at 40-50 dB SPL. The results gained by this measuring method are compared with sound threshold audiometric results gained 4-9 years after the first examination. Judging from the evaluation, we can see a good correlation of the measuring results obtained by sound orientation audiometry during the first examination with audiometric hearing loss values determined later. The correlation coefficient of the group examined is r = 0.77. The procedure is being discussed as to its value and is considered especially valuable because the whole auditory apparatus as far as the central auditory center is under control. This method is clinically appropriate without much expenditure and may be applied at any time.

Parmi les méthodes d'audiométrie du jeune enfant, le test COR de Suzuki est bien connu, mais présente, à notre avis, quelques inconvénients. Nous lui avons substitué un test d'orientation un peu différent: l'enfant est laissé seul dans un pare et ses réactions à divers stimuli sonores lui parvenant par des haut-parleurs placés aux quatre coins de la pièce insonorisée sont observées à travers une glace sans tain. Le seuil d'audition se situe autour de 40-50 dB SPL. 4-9 ans plus tard nous avons examine un certain nombre d'en-fants par audicmetrie standard et avons obtenu un coefficient de corrélation de 0,77 entre les deux tests. Notre méthode, certes, ne peut être appliquée qu' à des enfants men-talement normaux, mais, grâce à elle, c'est l'ensemble de la fonction auditive que nous pouvons apprécier de façon satisfaisante.     

Audiologic evaluation in patients with acquired hypothyroidism

Hearing loss in hypothyroidism has been reported by many authors but its pathophysiology is unclear.Aimsto study the audiological evaluation of patients with acquired hypothyroidism.Materials and Methodstwo groups were included: a hypothyroidism group (HG, n-30), and a control group (CG, n-30). Parameters studied: gender, time of hypothyroidism, comorbidities, cochleovestibular symptoms, biochemistry and hormonal exams (TSH, T4), tonal audiometry, TOAEs and BERA.Resultsall participants were women, 70% of the HG had Hashimoto thyroiditis, 60% of the HG had had the diagnostic of the hypothyroidism for at least five years. Depression and hypertension were frequent in HG. All HG patients had altered TSH values and 50% had diminished T4 values. Sensorineural hearing loss was detected in 22 ears from the HG and in seven from the CG. BERA was normal in the CG and altered in 10 ears from the HG, showing L-V increase. TOAEs were absent in 12 ears from the HG and in four from the CG.ConclusionsHG patients had more cochleovestibular symptoms, higher audiometric thresholds, increase in L-V in the BERA and absence or reduction in TOAEs amplitudes. Such alterations were not associated with THS and free T4 levels.     

Comparison between Brainstem-Evoked Response Audiometry and Behavioral Audiometry in 270 Infants and Children

The authors refer their results obtained with brainstem-evoked response audiometry (BSERA) and behavioral audiometry in a group of 270 children (aged from 6 months to 12 years) divided into subjects with (group A) and without (group B) reliable audiograms. In group A an agreement between the two methods was found in 77% of cases and a serious discrepancy in 5%. In group B an agreement was found only in 34% of cases, while a serious discrepancy was found in 20% of the children. BSERA was useful because many diagnostic mistakes were avoided. The authors think that BSERA is a reliable technique, as their data show, but in at least 4 cases they found that BSERA gave a hearing level much higher than that obtained with behavioral audiometry or that observed in the children's responses to everyday sounds. Since click gives only partial information of the tonal field and because it is possible to make technical mistakes, the authors believe that BSERA must not be used as the only diagnostic test but that it should be part of a test battery which includes, at least, behavioral audiometry and impedance audiometry.     

A hearing survey in diabetes mellitus

A sample of 50 diabetics was compared with a control group matched for age and sex. Twenty-two of the diabetics were insulin-dependent. Subjects and controls were examined otologically and then tested audiometrically using pure tone audiometry, speech audiometry and tone decay after the method of Owens. No significant difference was found between the two groups on pure tone audiometry and speech testing showed all diabetics and controls to be normal. A statistically significant incidence of type-2 tone decay was found in the overall group of diabetics at 2000 Hz. This may reflect early presbycusis.     

Clinical validation of the AMTAS automated audiometer

Abstract

Objective: To validate the air- and bone-conduction AMTAS automated audiometry system. Design: Prospective study. Test-retest reliability was determined by assessing adults with AMTAS air- and bone-conduction audiometry. Accuracy was determined by comparing AMTAS and manual audiometry conducted on adults. AMTAS testing was conducted in a quiet room and manual audiometry in a sound booth. Study sample: Ten participants for test-retest reliability tests and 44 participants to determine accuracy were included. Participants had varying degrees of hearing loss. Results: For test-retest reliability the overall difference in air-conduction hearing thresholds (n = 119) was 0.5 dB. The spread of differences (standard deviation of absolute differences) was 4.9 dB. For bone-conduction thresholds (n = 99) the overall difference was ? 0.2 dB, and the spread of differences 4.5 dB. For accuracy the overall difference in air-conduction hearing thresholds (n = 509) between the two techniques was 0.1 dB. The spread of differences was 6.4 dB. For bone-conduction thresholds (n = 295) the overall difference was 0 dB, and the spread of differences 7.7 dB. Conclusions: Variations between air- and bone-conduction audiometry for automated and manual audiometry were within normally accepted limits for audiometry. However, AMTAS thresholds were elevated but not significantly different compared to other contemporary studies that included an automated audiometer.     

The Canadian French Hearing in Noise Test

Abstract

Objective: To create a user-operated pure-tone audiometry method based on the method of maximum likelihood (MML) and the two-alternative forced-choice (2AFC) paradigm with high test-retest reliability without the need of an external operator and with minimal influence of subjects’ fluctuating response criteria. User-operated audiometry was developed as an alternative to traditional audiometry for research purposes among musicians. Design: Test-retest reliability of the user-operated audiometry system was evaluated and the user-operated audiometry system was compared with traditional audiometry. Study sample: Test-retest reliability of user-operated 2AFC audiometry was tested with 38 naïve listeners. User-operated 2AFC audiometry was compared to traditional audiometry in 41 subjects. Results: The repeatability of user-operated 2AFC audiometry was comparable to traditional audiometry with standard deviation of differences from 3.9 dB to 5.2 dB in the frequency range of 250–8000 Hz. User-operated 2AFC audiometry gave thresholds 1–2 dB lower at most frequencies compared to traditional audiometry. Conclusions: User-operated 2AFC audiometry does not require specific operating skills and the repeatability is acceptable and similar to traditional audiometry. User operated 2AFC audiometry is a reliable alternative to traditional audiometry.     

Simultaneous Four-Channel Electric-Response Audiometry Results in 8 Years of Hearing Evaluation among Small Children

The results of 8 years’ experience with slow cortical-evoked responses obtained by a four-channel method are reported. The conclusion is that, even in this form, ERA is not a reliable tool for diagnosing hearing defects in children. The time course of the mean ERA threshold of 138 children examined in Turku University for periods ranging from 6 months to over 3 years is presented. The results are discussed. Electrocochleography or brain stem audiometry is recommended for clinical use.     

High-Frequency Audiometry above 8 kHz Comparative Results of Normative Thresholds Obtained with a Headphone System and a Quasi-Free-Field System

Since a standard method for high-frequency audiometry does not yet exist, the authors, using 20 young subjects, compare the results obtained with a quasi-free-field system devised by Osterhammel et al. [Scand. Audiol. 6: 91-95, 1977] and those obtained by a headphone system. The headphone system is considered to be better, because it offers many practical advantages.

Audiométrie haute fréquences au-dessus de 8 kHz: étude comparative des seuils normaux obtenus avec un système à quasi champ libre et un système à écouteur.

‘il’ existe pas encore de méthode standard pour ‘audiométrie à fréquences élevées, les auteurs ont étudié 20 jeunes et ils ont comparé les résultats obtenus avec un système à quasi champ libre, dérivé de Osterhammel et al. [Scand. Audiol. 6: 91-95, 1977] et ceux obtenus avec un système à écouteurs. On a considéré que le système à écouteurs est meilleur parce’ il présente un certain nombre 'avantages pratiques.