儿童简捷-RECD与常规-RECD对照研究

目的通过比较简捷真耳耦合腔差值与常规真耳耦合腔差值,分析两种测试方法所得RECD结果差异,以及同种测试方法所得RECD的耳间差异,寻求更为适用于低龄儿童RECD测试的快捷方法。方法共28名选配助听器的听障儿童参与本次研究,年龄4~7岁,平均年龄5.65±1.32岁。研究组采用Oticon Easy-RECDTM与Interacoustics AffinityTM.真耳分析仪,分别获得受试儿童双耳0.25,0.5,0.75,1,1.5,2,3,4,6k Hz处Easy-RECD与Regular-RECD数值。采用配对样本t检验及两组独立样本t检验对测试值进行统计学分析,得到两种RECD测试方法间及左右耳间RECD数值差异。结果(1)经配对样本t检验,28例儿童其Easy-RECD与Regular-RECD除0.5、2k Hz外,其余各频率均无显著性差异(p>0.05)。(2)经两组独立样本t检验,左右耳间Easy-RECD及Regular-RECD各频率间皆无显著性差异(p>0.05)。结论(1)Easy-RECD操作快速,不适感小,且测量稳定,可作为低龄儿童助听器验配的一种快速RECD测试方法。(2)儿童双耳间RECD值无显著性差异,因此对于难以配合双耳RECD测试的低龄儿童可在临床中考虑进行一侧耳RECD测试应用于双耳验配。     

小儿助听器验配

RECD测量的优点：整个RECD测量过程，包括系统设置的过程，不超过5分钟，而真正在儿童真耳上的给声过程只有几秒，大大缩短了要求儿童配合的时间。同时，由于是通过插入式耳机给声，即使儿童头和身体晃动也对测量不产生影响，克服了传统的探管麦克风在声场测量时儿童最易产生的偏差，对儿童的配合要求不高，90％的儿童在初次测试时就能测得RECD。而且RECD的重复性较好，在整个儿童助听器选配过程中，只需完成一次RECD的测量，就可将助听器选择及验证过程中的真耳电声学测量转化到无须儿童参与的、便于控制的2cc耦合腔中来完成。RECD的应用使得对6月龄以下聋儿的真耳选配也成为可能。     

鼓膜穿孔对真耳-耦合腔差的影响

目的:探讨鼓膜穿孔对真耳一耦合腔差(RECD)的影响.方法:34例(34耳)中耳功能及听力正常成人为对照组,30例(34耳)干性鼓膜穿孔患者为实验组,用真耳分析仪测试RECD.结果:实验组与对照组RECD值比较在1 kHz以下(含1 kHz)及4 kHz差异有统计学意义(P＜0.05),实验组比对照组要小;实验组的标准差变化较大,平均为4.4 dB,而对照组为1.4 dB;实验组RECD值与等效外耳道容积大小在0.75 kHz以下呈显著负相关(r=-0.70,P＜0.01),而1 kHz以上无相关性;鼓膜穿孔大小对RECD值无影响.结论:鼓膜穿孔患者RECD值在不同频率变化较大,选配助听器时应进行真耳测量以测试个体RECD,尽量不用平均值,适当增加低频的增益.     

四川地区成年人真耳-耦合腔差值分析

目的：了解四川地区成年人真耳耦合腔差值（RECD）的平均值。方法：对95例四川地区成年人进行双耳RECD测定．并进行性别及左右耳间的比较及与欧美地区成年人的RECD平均值比较。结果：四川地区与欧美地区成年人的RECD平均值差异有统计学意义。结论：在助听器验配过程中,使用RECD值时不能盲目采用欧美地区成年人的平均值标准。     

笛听1600真耳测试功能在助听器选配中的应用

目的 验证笛听1600自带的真耳测试功能在助听器选配中的准确性和有效性.方法 选择22例(30耳)配戴笛听1600(其中4耳是BTE),年龄9～70岁,平均40岁,测试耳裸耳纯音听阈≤90 dB HL,言语分辨率﹥60%.进行两步评价,第一次在最佳选配(不使用RECD测试)6周后进行验证和评估,第二次在应用笛听1600的RECD测试6周后进行验证和评估.评估分别采用言语分辨率测试和IOI-HA国际性助听器效果调查表,比较两次不同方法选配后的结果.结果 使用笛听1600 RECD测试6周后71.4%的患者平均言语识别率比第一次测试(不使用真耳测试)6周后平均言语识别率有所提高,14耳平均言语识别率提高5.4%.IOI-HA助听器调查效果调查表结果显示,使用笛听1600真耳测试后患者对助听器的作用的肯定和满意度均提高.结论 笛听1600真耳测试能快速简便地测量个人RECD值,使助听器选配更加精确,提高了选配的满意度.特别是在儿童选配中由为重要.     

鼓膜穿孔患者真耳耦合腔差(RECD)的测量和应用

鼓膜穿孔在临床上较常见，多由外伤或慢性化脓性中耳炎引起。由于鼓膜穿孔导致的传导性耳聋者，可以通过手术提高听力。然而并不是所有的鼓膜穿孔患者都愿意接受中耳手术，有些患者(尤其是长期干耳者)要求通过配戴助听器来补偿听力。这类患者由于鼓膜穿孔，其外耳道容积、劲度、质量及阻抗特性和正常人相比有很大不同，因此其听力损失和声学特性也差别较大．为他们选配助听器时，要考虑这些因素并对其进行定量。这种真耳和助听器耦合腔的差别称为真耳耦合腔差(RECD)。本文就鼓膜穿孔患者RECD的测量和应用综述如下：     

用RECD合理替代真耳验证

儿童助听器验证过程最重要的步骤之一就是测试耳道的声学特性。耳道中声音的频谱和强度在同年龄的儿童中不尽相同,即使是同一儿童的双侧外耳道,也会随着耳道生长而发生变化。这些声学改变意味着在为婴幼儿和较小年龄的儿童选配助听器时需尽力匹配一个会改变的目标公式。
　　在助听器验配时,如果不能了解儿童的耳道解剖特性如何影响耳道中的声音强度,那么很可能就会出现过度放大或放大不足。幸运的是,现在可用探管麦克风测量（probe microphone measurement , PM M ）进行验证,评估个体耳道声学特性,用于助听器验配。其中的一个方法就是使用探管麦克风系统测试儿童耳道内助听器的声输出。因为助听器与耳道耦合,该技术被称为原位（in sit u ）或真耳验证技术,这是验证儿童助听器声输出最准确、最现实的方法。     

学龄前听障儿童助听后言语流畅性的特征及影响因素

目的 分析学龄前听障儿童助听后言语流畅性的特征,探讨辅听装置、年龄、性别、语训时长对其言语流畅性的影响.方法 以109例3.5~6.5岁学龄前健听及听障儿童为研究对象,其中健听儿童30例(健听组),双耳佩戴助听器的听障儿童28例(助听器组),右耳植入人工耳蜗的听障儿童26例(人工耳蜗组),同时佩戴助听器和人工耳蜗双耳双模式助听的听障儿童25例(双模式组),通过主题对话的形式分别采集各组儿童的语音样本,比较各组儿童在自发性言语语言任务下的语速、停顿、重复和拖延差异;分析辅听装置、年龄、性别、语训时长等因素对听障儿童言语流畅性的影响.结果 ①健听组儿童的语速显著高于其他三组(P<0.05),健听组停顿次数显著低于人工耳蜗组(P=0.001)和双模式组(P=0.032);健听组拖延次数显著低于助听器组(P=0.001)和双模式组(P=0.001),极显著低于人工耳蜗组(P<0.001);②不同性别听障儿童语速、停顿、重复次数和拖延次数差异无统计学意义(P>0.05),而助听器组语速显著高于人工耳蜗组(P=0.045),人工耳蜗组停顿次数显著高于助听器组(P=0.028);3.5~5岁听障儿童语速显著低于5.1~6.5岁组(P=0.042);语训0~2.5年听障儿童语速显著低于语训>2.5年者(P=0.002),停顿及重复次数均高于语训>2.5年者(分别P=0.047,P=0.02).结论 听障儿童的语速低于健听儿童,停顿次数、拖延次数高于健听儿童;年龄、辅听装置、语训时长影响学龄前听障儿童的言语流畅性,性别影响不大.     

高频陡降型听损患者助听前后ANL的研究

目的探讨可接受噪声级(acceptable noise level,ANL)测试是否适用于评估高频陡降型听力损失人群的助听器选配效果。方法选取佩戴助听器半年以上的20位高频陡降型的听障患者,对其进行裸耳和助听后的ANL测试、助听情况下的Speechmap测试,通过软件SPSS19.0分析对比助听前后的ANL值和真耳分析的测试结果,比较其差异性,评估助听器效果,得出结果。结果 (1)20位听障者在裸耳状态时最舒适响度级(most comfortable level,MCL)为80.70±8.05d B HL,助听情况下MCL为65.80±9.03d B HL,具有统计学意义;裸耳状态下背景噪声级(back-ground noise level,BNL)值为73.75±7.16d B HL,助听后BNL值为59.25±6.93d B HL,该结果具有统计学意义(P<0.001),而助听前后ANL值分别为6.95±4.20 d B HL和6.55±4.21 d B HL,该结果无统计学意义(P<0.05),表明患者ANL值与配戴助听器与否无相关性;(2)助听后Speechmap得分验证了裸耳ANL值小于7d B HL时,助听效果很好;但裸耳ANL值大于7d B HL时患者Speechmap得分偏低,助听效果不好。结论通过测试裸耳的可接受噪声级(ANL值)可以较为准确地预测高频陡降型听力损失患者选配助听器的效果,并对此类患者是否选配助听器进行指导。     

助听器耳模的堵耳效应及解决方案

目的分析佩带助听器耳模造成的堵耳效应的特点,并寻求适宜的解决方案.方法应用真耳探管传声器测量系统,用两种给声方式(受试者自主发出低频元音、或以骨振器振动颅骨给声),测试了用海绵耳塞、助听器耳模堵耳后的堵耳效应增益曲线.实验分三个部分:1.以海绵耳塞堵耳,骨振器给声强度逐渐增强,了解堵耳效应值是否随骨导信号强度而变化;2.以海绵耳塞和助听器耳模堵耳,骨振器给声强度为35dBHL,了解堵耳效应的频率特征.3.由受试者自主发出低频元音,在耳模上施加不同尺寸的通气孔,评价其解决堵耳效应的实际效果.结果1.探管麦克风在外耳道中记录的堵耳响应REOR随骨导强度增强呈1:1线性增长;2.堵耳效应主要表现在1000Hz以下的低频,250Hz、500Hz、1000Hz的堵耳效应依次为24.1±1.6dB,19.3±0.8dB,9.7±0.5dB(n=10),性别间差异不显著;3.配戴助听器耳模后的堵耳效应在400Hz以下的低频最为显著.普通的2mm平行通气孔可使该频带的堵耳效应平均下降15dB以上,短的2mm通气孔则可使堵耳效应降低约20dB.结论堵耳效应不因骨导信号的强度变化而改变,主要集中在1000Hz以下的低频;配戴助听器耳模后,堵耳效应在400Hz以下最为显著,加开通气孔可显著解决堵耳效应问题.     

A comparative evaluation of ear diseases in children of higher versus lower socioeconomic status

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35,000 per month. Three thousand children between the ages of 5-12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.     

Nasopharyngeal and middle ear flora in children with acute otitis media

Nasopharyngeal flora can be a reservoir of bacteria caused acute otitis media in children. The aim of the study was to identify microorganisms and antimicrobial susceptibilities of pathogens from the nasopharynx and middle ear of children with acute otitis media. The study comprised 128 children ages 1 year to 14 years with diagnosed of acute otitis media with purulent discharge. The nasopharyngeal and middle ear samples were collected at the same time. Agar, chocolate, blood and Chapman plates were inoculated for isolation of bacteria. The plates were incubated at 37 degrees C and examined at 24 hours. The susceptibility of bacteria was determined by disk diffusion technique containing concentration gradients for following antibiotics: penicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefaclor, cefprozil, cefuroxime, erythromycin, azithromycin, clindamycin and trimethoprim/sulfamethoxazole. 196 organisms from nasopharynx and 325 organisms from middle ear were isolated. Most frequent cultured bacteria were: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis--75.6% in nasopharynx and 77.8% in middle ear. We observed statistically significant (p < 0.01) increased of Moraxella catarrhalis in specimens from the middle ear than from nasopharynx. Most of the organisms were susceptible to amoxicillin/clavulanate--83.2% of bacteria from nasopharynx and 81.8% of bacteria from middle ear. Most organisms were resistant to trimethoprim/sulfamethoxazole--60.7% of bacteria from nasopharynx and 62.6% of bacteria from middle ear. Penicillin resistance was observed in 25.0% of bacteria from nasopharynx and 25.6% of bacteria from middle ear. The correlation in resistance of bacteria between trimethoprim/sulfamethoxazole and erythromycin (r = 0.4886) and between trimethoprim/sulfamethoxazole and penicillin (r = 0.5027) was observed. Nasopharyngeal and middle ear flora in children with acute otitis media is similar. In that case susceptibility of bacteria from the nasopharynx can be useful for empirical treatment of acute otitis media in children.     

Insertion gain measurements using two low-powered analogue hearing aids

Differences between insertion gain measurements and coupler measurements were investigated using two different hearing aids, to assess the accuracy of hearing aid fitting methods which involve the use of real-ear-to-coupler differences (RECDs). The hearing aids used were the NHS BE19 and the Lavis X11. They were allocated alternately to 80 new adult hearing aid users, and insertion gain measurement was carried out with the allocated aid on all subjects, and with both hearing aids on 36 subjects. Coupler measurements were also carried out with both hearing aids, at two different gain settings. Comparison of the coupler measurements and the insertion gain measurements suggests that the differences in insertion gain produced by different hearing aids cannot be predicted accurately from the differences in coupler gain measurements produced by the same aids. Although the use of RECDs measured using insert earphones may accurately predict the real-ear performance of some models of hearing aid, this method may not produce equally satisfactory results with other models.     

Probe-tube microphone measures in patients with open-mastoid surgery: real-ear-to-coupler differences and real-ear unaided responses

Real-ear-to-coupler differences (RECDs) and real-ear unaided responses (REURs) were measured using a probe-tube microphone system in 15 patients who underwent open mastoid surgery. The results show that RECDs are significantly smaller at higher frequencies (1.5, 2.0, 3.0, 4.0 and 6.0 kHz) in mastoid ears. The intrasubject variability of RECDs measures in these patients is on average 2.6 dB larger than for controls. For REURs, mastoid surgery significantly reduced the mean peak resonant frequency without affecting the amplitude and bandwidth. In operated ears, mean resonant frequency is by a factor of 1.4 lower than that for normal ears. Reduced responses (negative gains) at frequencies above the resonance peak occurred in 7 out of the 15 patients. These reduced responses corresponded to the smaller RECD at the middle and high frequencies. The results support the need for individual RECD measures to be made in operated ears instead of using average values from normal subjects. Otherwise, real-ear measures of the aided response should be made for each patient with open-mastoid cavity and the fitting should be done in terms of the target response at the eardrum rather than by defining a target insertion gain.     

Measuring the real-ear to coupler difference transfer function with an insert earphone and a hearing instrument: are they the same?

OBJECTIVE: The purpose of the study was to compare the real-ear to coupler difference (RECD) measured with an insert earphone and two models of hearing instrument. DESIGN: The RECD was obtained from one ear of 18 normal-hearing subjects by subtracting the 2-cc coupler (HA1 and HA2) response from a real-ear aided response, using a conventional probe-tube microphone system. The measurements were made with a conventional ER-3A earphone and two models of behind-the-ear hearing instrument (Unitron US80, Unitron, Kitchener, Canada; and Widex Diva, Widex, Vaerloese, Denmark). RESULTS: The procedures were very reliable, with mean differences on retest of less than 1 dB. There were statistically significant differences between the mean RECDs obtained using an insert earphone compared with those obtained with each hearing instrument (p < 0.05). The differences were greatest when using the HA2 2-cc coupler. For example, the maximum difference in mean RECD between the insert earphone and the Widex Diva was 6 dB and 11 dB when using the HA1 and the HA2 2-cc coupler, respectively. CONCLUSIONS: The RECD is dependent on the acoustic impedance of the sound source, the coupling system, and the coupler and ear. The acoustic impedance may be different for an insert earphone and a given hearing instrument. Therefore, the RECD measured with an insert earphone may not always accurately represent the difference in performance of a hearing instrument measured in the real ear and the 2-cc coupler.     

Anomalies of the ear in the Pierre Robin triad

OBJECTIVES: The Pierre Robin triad (PRT) consists of micrognathia-retrognathia, glossoptosis, and an oval or cleft palate. The goal of this study was to identify patterns of similarity to and differences from the two previous temporal bone studies of the PRT. METHODS: Seven children with the PRT (ages, 45 minutes to 2 years; gestational ages, 41 to 43 weeks) were studied. Thirteen temporal bones were decalcified, sectioned at a thickness of 20 microm, and studied by light microscopy. RESULTS: Our study demonstrated multiple architectural anomalies involving the entire ear, including abnormal auricles, and anomalies of the ossicles, including abnormal stapes footplates (6/13). All children showed signs of middle ear infection (12/13). Anomalies of the inner ear included aplasia of the lateral semicircular canals (5/13), a large vestibular aqueduct (2/13), and unusually large otoconia (1/13). In the mastoid process there were islands of cartilage in the expected position of Reichert's cartilage (9/13) and dehiscence of the fallopian canal (11/13). Loss of cochlear hair cells was seen in children who had antemortem hypoxia. CONCLUSIONS: Although the PRT is caused by various genes, most anomalies can be traced to the development of the first and second branchial arches.     

Hearing loss in school children. A longitudinal study of sensorineural hearing impairment

In a longitudinal study, 2325 children were hearing tested at age 7, 10 and 13 with screening audiometry. The screening level was 20 dB HL. Approximately 75% of the children passed the screening level at all ages. Hearing loss was more frequent in boys than in girls at age 13 (16%:9%). The left ear was more commonly affected than the right ear. High frequency dips increased for boys with age, but not for girls. The increasing incidence of hearing loss for boys with age is probably due to noisy leisure time activities.     

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.     

儿童分泌性中耳炎漏诊原因分析

目的探讨儿童分泌性中耳炎的漏诊原因,提高对儿童分泌性中耳炎的认识,避免误诊。方法选择2002年1月～2007年12月我科收治94例（110耳）分泌性中耳炎患儿,其中男54例,女40例,年龄2.7～11岁,平均6.8岁,病程1周～1个月,其中误诊或漏诊7例（12耳）,分析患儿的临床资料及检查方法。结果患儿声导抗鼓室图多为B型,其次为C型,72例患儿鼓膜穿刺抽出淡黄色液,占76.6%。结论声阻抗是诊断分泌性中耳炎的主要手段,对防止漏诊有重要意义。