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±0．02ml,静态声顺值约为0．10±0．03ml,坡度约为0．14±0．06ml,峰压值约为一99．44±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。     

原发性高血压患者听觉功能早期损害的临床研究

目的：探讨高血压对听觉功能早期损害的听力学特征,为临床研究和防治耳聋提供参考。方法：将68例（136耳）原发性高血压患者分为无眼底动脉硬化的高血压A组35例（70耳）,及伴有眼底动脉硬化的高血压B组33例（66耳）;另选30例（60耳）年龄、性别匹配且无高血压,听力正常者为对照组,分别进行纯音听阈、畸变产物耳声发射（DPOAE）等听力学测试。结果 高血压B组2000～8000Hz纯音听阈提高（P〈0．05）,高血压A组的纯音听阈与对照组比较差异均无统计学意义（P〉0．05）;高血压A、B组的DPOAE反应幅值下降（P〈0．01）,仅高血压B组4000Hz的DPOAE检出率下降（P〈0．05）。结论：高血压会影响患者的听觉系统,即使患者主观上无明显的听力下降,但听觉功能可能已出现早期改变。     

分泌性中耳炎患者声导抗与耳声发射特性分析

目的　探究分泌性中耳炎的听力学诊断方法。方法　对53例（106耳）患者行声导抗测试和耳声发射检查，按照临床常规分类标准将声导抗结果分A、B、C三个组（不考虑A型中亚型As和Ad型），其中A组为对照组。比较不同声导抗分型耳的对应耳声发射检查特征。结果　A组与B组声导抗在声顺和梯度值比较，差异均有统计学意义（Z =5.09、4.96，P 均＜0.05）。B与C组声导抗在容积、声顺和梯度值比较，差异均有统计学意义（Z =-5.07、-5.14、5.32，P 均＜0.05）。A组与C组声导抗压力比较，差异有统计学意义（Z =-5.24，P 均＜0.05）。耳声发射检查A组通过率90.00%（9/10），B组通过率10.00%（5/50），C组通过率41.30%（19/46）。两组间耳声发射通过率比较，A组与B组差异有统计学意义（Z =-5.414，P 均＜0.05）；B组与C组差异有统计学意义（Z =-5.030，P 均＜0.05）；A组与C组差异无统计学意义（Z =-1.856，P =0.064）；A组与C组间各个频率DPOAE结果比较，仅1.5、2和3 kHz三个频率差异有统计学意义（Z =-5.09、-5.12、5.42，P 均＜0.05）。结论　分泌性中耳炎时声导抗结合耳声发射检查，弥补单独声导抗检查的不足，可提高鉴别诊断精准度。     

年龄因素对不同频率探测音声导值和声纳值测试结果的影响

目的：探讨年龄对声导纳测试的声导值和声纳值的影响。方法：采用GSI－33version2中耳分析仪，对9－72岁共9个耳科正常人按年龄分六组，均采用三种频率探测音进行声导值和声纳值检测，结果：使用226Hz探测音时，第Ⅳ组的声纳分别与第Ⅰ、Ⅱ组的比较，其差异有显著性（P＜0．05），第Ⅱ组的声导值与第Ⅵ组的比较差异有显著性（P＜0．05）；使用678Hz探测音时，第Ⅳ组的声纳值分别与第Ⅰ、Ⅱ、Ⅲ、Ⅴ组等各组的声纳值比较差异有显著性（P＜0．05），第Ⅳ组声纳值分别与第Ⅰ、Ⅱ、Ⅴ组等各组的比较差异有显著性（P＜0．05），第Ⅳ组的声导值分别为第Ⅰ、Ⅲ、Ⅴ、Ⅳ组等各组的比较差异有显著性（P＜0．05），结论：随着年龄的变化，鼓膜－中耳传音系统的质量因素作用的增长较为明显，摩擦及粘度因素作用则视声波的频率而异。     

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。     

自觉听力正常的后循环缺血患者纯音听阈与耳声发射结果分析

目的：探讨自觉听力正常的后循环缺血（posterior circulation ischemia ,PCI）患者的纯音测听和耳声发射的结果及临床意义。方法选择经临床确诊为PCI且自觉听力正常的患者40例（80耳）作为实验组,健康成年人30例（60耳）作为对照组,两组均行纯音测听、瞬态诱发耳声发射（TEOAE）和畸变产物耳声发射（DPOAE）检查,对结果进行统计学分析。结果 PCI组125～8000 Hz各频率气导听阈与对照组比较差异无统计学意义（ P＞0．05）;PCI组的TEOAE检出率（47．5％,38／80）低于对照组（95．0％,57／60）,差异有统计学意义（P＜0．01）;PCI组DPOAE各频率检出率、幅值均低于健康对照组（P＜0．05）,尤以高频区明显（P＜0．01）。结论后循环缺血可以影响耳蜗的血液供应,导致常规纯音测听难以发现的耳蜗功能损害,尤以高频区明显。     

Wistar大鼠畸变产物耳声发射长期稳定性观察

目的：观察Wistar大鼠畸变产物耳声发射（DPOAE）长期稳定性。方法：对12只（21耳）健康、无耳疾病Wistar大鼠，分别于产后2、4、8、16周时测试F2为553、783、1105、1560、2211、3125、4416、6250、837Hz各点DPOAE（2f1-f2,f2/f1=1.2,L1=L2=70dB SPL)幅值。结果：除2周龄Wistar大鼠在F2为553、783、1105Hz三点DPOAE幅值较其后各周低，且差异有显著性意义（P＜0．05）外，其他各周龄在各频率点DPOAE幅值差异均无显著性意义（P＞0．05）。结论：4－16周龄Wistar大鼠DPOAE幅值在各频率点相对稳定，DPOAE可作为4－16周龄Wistar大鼠听力跟踪实验的指标，以此判断相应时期内耳蜗功能的改变。     

突变截面管式通气孔对耳模声学特性的影响

目的通过改变耳模通气孔的形状，探讨突变截面管式通气孔在耳模声学特性中的优势。方法利用埋管的方法为每位受试者分别制取通气孔为平行、扩张和收缩形状的耳模，然后受试者佩戴每个耳模进行真耳分析，测量佩戴各个耳模时的REOG和REIG值。结果①2 mm平行通气孔耳模与扩张管式通气孔耳模的REOG值相比较，在500 Hz和750 Hz处有显著性差异（P〈0.05）；与收缩管式通气孔耳模的REOG值相比较在各个频率上均无显著性差异（P〉0.05）。②2 mm平行通气孔耳模与扩张管式通气孔耳模的REIG值相比较，在2 kHz处具有显著性差异（P〈0.05）；与收缩管式通气孔耳模的REIG值相比较在2 kHz和3 kHz处具有显著性差异（P〈0.05）。结论突变截面管式通气孔中收缩管式在解决堵耳效应问题上与2 mm平行通气孔有着相似的效果，但突变截面管式通气孔扩张和收缩式耳模可获得更大的助听增益，其中收缩管式通气孔耳模的作用要优于扩张管式通气孔耳模。     

听力学检查对儿童急性非化脓性中耳炎诊断的意义

目的：探讨声导抗、畸变产物耳声发射（DPOAE）和听性脑干反应（ABR）测试在儿童急性非化脓性中耳炎诊断中的作用。方法回顾性分析182例急性非化脓性中耳炎患儿的临床资料，比较218耳有症状耳与146耳无症状耳的声导抗、DPOAE及ABR结果。结果有症状耳鼓室导抗图、DPOAE、ABR 异常的检出率分别为64．7％、72．0％、57．8％，明显高于无症状耳的41．8％、39．7％、35．6％，差异均有统计学意义（均为P＜0．05）；有症状耳至少一项结果异常者高达196耳（89．9％），高于无症状耳（90耳，61．6％），差异有统计学意义（P＜0．05）；有症状耳鼓室导抗图为B型或C型者占60．6％，无症状耳鼓室导抗图为B型或C型者占41．8％。结论儿童急性非化脓性中耳炎的诊断不仅根据症状和体征，还应结合声导抗、DPOAE和ABR等检查综合考虑，尤其是对于无症状耳可减少误诊和漏诊。     

In situ measurements for determining the effect of additional boring of the earmold

To investigate the effect of earmould venting on the insertion gain of hearing aids in patients' ear canal, the authors sealed 35 earmould ventings with soft silicone after measurement under normal conditions and repeated the measurement. The size of the ventings varied from 0.8 mm to 3.5 mm in diameter. The results show the expected SPL-reducing effect of the ventings between 500 Hz and 1,000 Hz. Below 500 Hz the effect found was only slight, because of the low amplification in this frequency range. Above 1 kHz an increasing sound pressure level was measured as a result of resonance effects. This study illustrates the effect of earmould venting on insertion gain. To improve the hearing aid fitting the earmould venting should be used, deliberately and specifically, far more often than at present. The resulting effects of earmould modifications of real ear gain can only be determined by in situ measurements on the patient's eardrum. This method also enables resonance to be compensationed for in a controlled manner.     

Is the real-ear to coupler difference independent of the measurement earphone?

Direct measurement of real-ear hearing aid performance can be obtained using a probe tube microphone system. Alternatively, it can be derived by adding the real-ear to coupler difference (RECD) to the electroacoustic performance of the hearing instrument measured in a 2-cc coupler. Inherent in this derivation is the assumption that the RECD measured with one transducer can be applied to a coupler measurement performed with a different transducer. For the RECD procedure to be valid, it should be independent of the measurement transducer. The Audioscan RM500 is an example of a commercially available real-ear measurement system that incorporates a clinical protocol for the measurement of the RECD. The RECD can be measured on the Audioscan RM500 using a standard EAR-Tone ER-3A insert earphone or the Audioscan's own RE770 insert earphone. The aim of this study was to compare the RECDs obtained with these two earphones. The Audioscan RM500 was used to measure the RECD from the right ears of 18 adult subjects ranging in age from 22 to 36 years (mean 25 years). Measurements were made with the EAR-Tone ER-3A and RE770 insert earphone and three earmould configurations: (1) the EARLINK foam ear-tip; (2) a hard acrylic shell earmould with the same length of acoustical tubing as the foam ear-tip (25 mm); and (3) the shell ear mould with the appropriate length of tubing for a behind-the-ear (BTE) hearing aid fitting (approximately 35-45 mm). The results show that the mean RECD was around 3 dB higher at 1.5 kHz with the foam ear-tip when measured with the RE770 earphone than when measured with the ER-3A earphone. The same magnitude of difference was obtained with the shell earmould and 25-mm tubing; however, this increased to 9 dB when the tubing was increased to around 40 mm for a BTE fitting. The difference in mean RECD with the two earphones was statistically significant on a repeated-measures ANOVA for every earmould configuration (p<0.001). The results of this study demonstrate that the RECD procedure that uses an HA2 coupler and earmould is not independent of the measurement earphone. This has important implications for clinical practice.     

The effects of middle ear muscle contraction on auditory and overload thresholds

The present investigation examined psychophysically the frequency-specific and nonlinear attenuation of sound energy provided by middle ear muscle contraction in normal hearers. Aural overload and absolute auditory thresholds were measured at 500, 1 000 and 2 000 Hz prior to and during acoustic stapedial reflex contraction. Reflex contraction was elicited with contralateral broad-band noise. Results revealed that over-load thresholds were elevated at 500 and 1 000 Hz and a slight decrease in overload threshold was apparent at 2 000 Hz during reflex contraction while absolute thresholds remained essentially unchanged. These data are consistent with previous psychophysical and physiological findings. The aural overload test having been derived directly from observations of cochlear microphonic saturation, moreover, affords direct comparison to results of electrophysiological experimentation.     

中耳共振频率对鼓室积液的诊断价值

目的:探讨226 Hz静态鼓室图与中耳共振频率诊断鼓室积液的价值,观察两者结合可否提高诊断效能.方法:前瞻性研究对比观察分泌性中耳炎组和对照组,以耳镜检查、纯音测听及GSI-33型中耳分析仪测试结果为标准,将对照组共振频率90%的可信区间(5%～95%)设为正常范围,对分泌性中耳炎组的共振频率进行正常或不正常归类,并对其鼓室图形为B、C型或异型者进行鼓膜穿刺抽液,以抽出液体者为阳性.结果:中耳共振频率在900～1100 Hz之间为正常,分泌性中耳炎组的共振频率明显低于对照组(P＜0.01).B型曲线的抽液阳性率为83%,明显高于C型和异型曲线抽液阳性率(P＜0.05).共振频率正常者,其抽液阳性率为0.≤500 Hz者的鼓室积液阳性率明显高于＞500 Hz者(P＜0.01).结论:通过测试中耳共振频率对判断鼓室是否积液,尤其是对鼓室图形为C型或异型者有重要临床意义.     

The acoustics of the open mastoid cavity (so-called "radical cavity") and its modification by surgical measures. II. Clinical studies]

The acoustic resonance of a severely altered outer ear channel (radical mastoid cavity) is investigated in a series of 18 patients who underwent revision surgery by means of in-situ measurements of the sound-pressure-level near the tympanic membrane. While the average volume of the open cavity differs from the normal ear channel for the factor 2.5, the size of the external meatus is--in average--only 20% larger. This leads to an average frequency in patients with open cavity of 1939 Hz, more than 1000 Hz less than in a series (n = 20) of normal ears (average resonance frequency: 2942 Hz). The altered acoustic behaviour of the open cavity leads to partial extensive discrepancies of the resonance-caused sound-pressure augmentation in the frequencies of 3 and 4 kHz, which are important for speech perception. The average difference is more than 10 dB (SPL). Proved surgical techniques of cavity obliteration and meatoplasty can lead to a nearly normalized acoustic behaviour of the outer ear in a statistic significant way. Due to these surgical procedures, an average postoperative resonance frequency of 2421 Hz could be reached in our patients. Especially, the resonance-caused sound-pressure augmentation in 3-4 kHz could nearly be equalized to such of a normal outer ear. Differences in the acoustic behaviour of the outer ear as can be found between patients with an open mastoid cavity and normal ears can almost be eliminated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical study on sweep-frequency tympanometry--data analysis using principal component analysis

A sweep-frequency tympanometer has been developed to diagnose auditory ossicular lesions more precisely. This device measures acoustic middle ear features by changing the probe tone frequency continuously. The oscillator sweeps frequency of the probe tone from 200 to 2,500Hz 1.5 seconds. A microphone picks up the changes in the acoustic pressure and the phase in the external auditory meatus during the frequency change of the probe tone. These measurements are performed under pressures at -200 and 0 dapa, and differences of both the acoustic pressure and the phase between these two pressures are graphically displayed using a microcomputer. This device can also measure and digitally display the frequency (BHz) and the sound pressure (BdB) at the minimum point (B) of the sound pressure curve, the frequency (ZHz) at 0 crossing point (Z) of the sound pressure curve, and the frequency (PHz) and the phase difference (Pdeg) at the maximum point (P) of the phase curve. Normal ranges of these five values were obtained to establish diagnostic criteria from 200 normal ears. The normal values were as follows: BHz, 480 to 1,070Hz; BdB, -6.0 to -1.8dB; ZHz, 1,100 to 1,860Hz; PHz, 910 to 1,820Hz; and Pdeg, 16.3 to 47.9 degrees. Eight cases of ossicular dislocation and 14 cases of ossicular fixation, all of which had normal external auditory meatus and tympanic membrane, were evaluated based on these values. All the cases with ossicular dislocation and 12 cases out of 14 with ossicular fixation were correctly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.