正常新生儿宽频声导抗能量吸收率及其可重复性研究

目的 探讨正常新生儿中耳宽频声导抗(wideband acoustic immittance,WAI)能量吸收率及其相关的影响因素,评价宽频声导抗测试的可重复性.方法 选取通过瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)听力初筛的正常新生儿124例(193耳),在其出生48～72小时进行WAI测试,分析不同频率能量吸收率的变化规律、两次测试的重复性及外耳道处于不同压力、性别、侧别、分娩方式对WAI能量吸收率的影响.结果 正常新生儿宽频声导抗能量吸收率随频率增大呈"两峰两谷"形态,即在低频及3 363 Hz附近较低、在1 296 Hz附近及高频较高;两次测试的重复性显示外耳道处于峰压时,1 000 Hz和2 000 Hz两次测试差值的绝对值较外耳道压力处于0 daPa时小,且差异有统计学意义(P＜0.05),而其余各频率差异无统计学意义(P＞0.05).外耳道压力处于0 daPa时与峰压时相比,除1 000、6 727 Hz外,其余各频率WAI能量吸收率的差异均有统计学意义(P＜0.05);不同性别、侧别、分娩方式的新生儿WAI能量吸收率差异无统计学意义(P＞0.05).结论 正常新生儿外耳道处于峰压时,两次WAI测试的重复性较好;外耳道处于不同压力对大部分频率WAI能量吸收率有一定影响;性别、侧别、分娩方式对WAI能量吸收率无明显影响.     

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。     

宽频声导抗应用于评估0-24月龄婴幼儿中耳功能检查的临床研究

目的 建立正常0-2周岁中国婴幼儿宽频声导抗(wideband tympanometry,WBT)吸收率的参考值范围.对比正常耳和分泌性中耳炎患儿宽频声导抗的鼓室图结果以及宽频能量吸收率(wideband absorbance,WBA)的差异,探讨宽频声导抗对婴幼儿中耳功能诊断的意义.方法 入选者中耳功能正常155例(...     

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。     

不同声阻抗试验对积液型分泌性中耳炎临床应用

目的　对比分析226、1000Hz声导抗和宽频声导抗（wideband immittance,WBI）在积液型分泌性中耳炎（OME）鉴别诊断中的临床应用价值,探讨WBI的临床应用价值。方法　检测中耳功能正常者12例（24耳）和2017年9月～2018年3月我科经耳内镜下鼓膜穿刺确诊为积液型OME患者64例（95耳）,单侧33例（33耳）,双侧31例（62耳）的226 Hz声导抗、1000 Hz声导抗和WBI检查,分析积液型OME在三种声导抗的敏感度、特异度和准确度。采用独立样本t 检验分析中耳功能正常者和积液型OME患者,WBI在外耳道压力为0 da Pa和峰压值时9个频率的能量吸收率。结果　①外耳道压力为0 da Pa和峰压值时,中耳功能正常者与积液型OME患者的能量吸收率在667、1000、1681、2669、3363、5339和8000 Hz比较,差异均有统计学意义（P＜0.05）,在226和408 Hz频率比较,无统计学意义（P＞0.05）;②对于积液型OME诊断而言,226 Hz声导抗敏感度87.30%,特异度40.63%,准确度71.58%;1000 Hz声导抗敏感度93.65%,特异度37.50%,准确度74.74%;WBI敏感度98.41%,特异度96.88%,准确度97.89%;③WBI敏感度、特异度和准确度最佳,1000 Hz声导抗敏感度和准确度优于226 Hz声导抗检查,226 Hz声导抗特异度优于1000 Hz声导抗检查。结论　相较于226和1000 Hz声导抗检查,WBI检查在积液型OME的鉴别诊断中具有较高临床应用价值。     

36个月内婴幼儿1000Hz和226Hz探测音声导抗的特点和意义

目的分析0-36个月婴幼儿226 Hz和1000 Hz探测音声导抗结果,探讨在临床上如何选择226 Hz和/或1000 Hz探测音声导抗方法将1645例(共3290耳)0-36个月婴幼儿按听力评估结果分为两个大组:听力正常组938例(1876耳)和听力异常组707例(1414耳),按月龄分为七个小组:第一组:新生儿(≦28天)54例(108耳),其中听力正常组34例(68耳);第二组:2³月龄355例(710耳),其中听力正常组149例(298耳);第三组:43月龄355例(710耳),其中听力正常组149例(298耳);第三组:4⁶月龄537例(1074耳),其中听力正常组201例(402耳);第四组:76月龄537例(1074耳),其中听力正常组201例(402耳);第四组:7⁹月龄236例(472耳),其中听力正常组143例(286耳);第五组:109月龄236例(472耳),其中听力正常组143例(286耳);第五组:10¹2月龄97例(194耳),其中听力正常组62例(124耳);第六组:1312月龄97例(194耳),其中听力正常组62例(124耳);第六组:13²4月龄259例(518耳),其中听力正常组249例(498耳);第七组:2524月龄259例(518耳),其中听力正常组249例(498耳);第七组:25³6月龄107例(214耳),其中听力正常组100例(200耳)。结果正常组226 Hz和1000 Hz探测音鼓室声导抗图均存在正峰,并且均以宽大的单峰型最多见,少数为双峰型.其中226 Hz单峰1403耳(74.79%),双峰290耳(15.46%);1000 Hz单峰1407耳(64.07%),双峰175耳(5.17%).第一至第五月龄组组间1000Hz与226Hz探测音声导抗正常和异常结果均有统计学意义(P<0.05)。其中第一至第四月龄组1000Hz组一致率(97.06%,91.95%,91.04%,81.82%)均高于226Hz组(38.24%,68.46%,66.92%,66.78%),第五月龄组226Hz组的一致率(95.16%)高于1000Hz组(58.87%)。第六至第七月龄组组间1000Hz与226Hz探测音声导抗正常和异常结果均有统计学意义(P<0.05)。结论单纯226 Hz探测音鼓室声导抗测试不能准确反映O36月龄107例(214耳),其中听力正常组100例(200耳)。结果正常组226 Hz和1000 Hz探测音鼓室声导抗图均存在正峰,并且均以宽大的单峰型最多见,少数为双峰型.其中226 Hz单峰1403耳(74.79%),双峰290耳(15.46%);1000 Hz单峰1407耳(64.07%),双峰175耳(5.17%).第一至第五月龄组组间1000Hz与226Hz探测音声导抗正常和异常结果均有统计学意义(P<0.05)。其中第一至第四月龄组1000Hz组一致率(97.06%,91.95%,91.04%,81.82%)均高于226Hz组(38.24%,68.46%,66.92%,66.78%),第五月龄组226Hz组的一致率(95.16%)高于1000Hz组(58.87%)。第六至第七月龄组组间1000Hz与226Hz探测音声导抗正常和异常结果均有统计学意义(P<0.05)。结论单纯226 Hz探测音鼓室声导抗测试不能准确反映O¹0月龄婴幼儿的中耳功能,1000 Hz探测音声导抗测试能更好的评估O10月龄婴幼儿的中耳功能,1000 Hz探测音声导抗测试能更好的评估O¹0月龄婴幼儿的中耳功能;;226 Hz探测音鼓室声导抗测试能客观反映1110月龄婴幼儿的中耳功能;;226 Hz探测音鼓室声导抗测试能客观反映11³6月龄婴幼儿的中耳功能。     

DPOAE与高刺激率ABR在听力正常耳鸣患者中的应用价值

目的 观察分析听力正常的耳鸣患者畸变产物耳声发射(DPOAE)与高刺激率听性脑干反应(ABR)检测的特征,探讨其在耳鸣评估中的应用价值。 方法 选取耳鼻咽喉科门诊听力正常的青年耳鸣患者31例(46耳)为耳鸣组,另外选取听力结果正常的青年无耳鸣者25例(50耳)为正常对照组,分别进行纯音听阈测定、声导抗测听、DPOAE和高低刺激率ABR的检测,对比两组受试者DPOAE各频检出率和信噪比以及高低刺激率ABR各波潜伏期(PL)、波间期(IPL)、波幅以及两种刺激速率下的潜伏期和波间期差值(△PL和△IPL)。 结果 DPOAE各频检出率两组无显著性差异;信噪比在8 kHz,耳鸣组较对照组降低,差异有统计学意义(P<0.05);高低刺激率ABR结果中,不同刺激速率下两组Ⅰ、Ⅲ、Ⅴ波波幅差异均无统计学意义;高刺激速率下,耳鸣组Ⅰ~Ⅴ IPL较对照组延长,差异有统计学意义(P<0.05),两种刺激速率下,耳鸣组Ⅰ△PL较对照组缩短,差异有统计学意义(P<0.05),耳鸣组Ⅴ△PL、Ⅰ~Ⅴ△IPL较对照组延长,差异有统计学意义(P<0.05)。 结论 DPOAE与高刺激率ABR可作为诊断耳鸣的一种客观检查方法,其对耳鸣的早期评估有重要的应用价值;增加ABR刺激速率,可提高耳鸣检测的敏感性。     

宽频声导抗对耳硬化症及先天性听骨链畸形的诊断价值

目的　探讨宽频声导抗测试对耳硬化症及听骨链畸形在辅助诊断中的应用价值。方法　选取就诊于厦门大学附属第一医院耳科门诊的耳硬化症患者40耳，先天性中耳畸形患者10耳，另以正常健康志愿者（70耳）作为正常对照组，所有受试者术前均行宽频声导抗测试，比较各组患者峰压下的声能吸收率。结果　峰压下，正常对照组3%（2/70）在1 kHz附近出现一切迹；峰压下，耳硬化症组5%（2/40）在1 kHz附近出现切迹；峰压下，先天性听骨链畸形组70%（7/10）的患者在1 kHz附近有一切迹。先天性听骨链畸形组患者在1 kHz附近出现切迹的患者比例与耳硬化症组和正常对照组有显著性差异（P<0.05）。结论　大部分先天性听骨链畸形患者的宽频声导抗在1 kHz附近会出现一切迹。宽频声导抗测试可作为术前辅助诊断耳硬化症和听骨链畸形的听力学检查方法之一。     

单侧人工耳蜗植入术前后双耳残余听力变化的初步研究

目的 通过观察单侧人工耳蜗植入术后儿童双耳残余听力情况,分析其变化趋势,探讨各种可能的影响因素。 方法 将29例单侧人工耳蜗植入的重度极重度感音神经性耳聋儿童纳入研究,根据术前颞骨CT分为A组(有大前庭导水管综合征)和B组(非大前庭导水管综合征),分别于术前、术后1周、开机时、术后半年定期进行裸耳纯音测听,比较植入耳残余听力保存情况及非植入耳残余听力的变化。 结果 患儿术前双耳均不同程度存在残余听力,术后均定期行纯音测听或行为测听,各频率仍部分存有残余听力,主要分布在低频区,且随频率升高其残余听力保留率逐渐下降,各频率残余听力保留率之间差异有统计学意义(Wald χ2=16.980, P=0.001);植入耳与非植入耳各频率残余听力保留率之间差异有统计学意义(Wald χ2=10.031, P=0.002);术前后各时间节点残余听力保留率之间差异无统计学意义(Wald χ2=3.384, P=0.336); AB两组之间残余听力保留率之间差异无统计学意义(Wald χ2=0.906, P=0.341)。 结论 人工耳蜗植入对植入耳残余听力的保留主要分布在低频区;随着植入时间的延长,残余听力可以基本保持;少部分患儿行单侧植入后对非植入耳残余听力有影响;前庭导水管扩大症患儿行单侧耳蜗植入术后,非植入耳残余听力在短期内可有波动。     

人工耳蜗植入患儿的宽频声导抗测试声能吸收率特征分析

目的 对比人工耳蜗植入者和非人工耳蜗植入者宽频声导抗测试声能吸收率(wideband absorbance,WBA)的差异,探讨人工耳蜗植入者的宽频声导抗测试声能吸收率的特征.方法 选取12例(12耳,男女各6耳)无外中耳疾病史的重度或极重度感音神经性聋行人工耳蜗植入术后一个月的幼儿为实验组,14例(28耳,男女各14...     

Effects of endolymphatic hydrops on acoustic energy absorbance

Abstract

Background: The presence of endolymphatic hydrops (EH) may cause hearing loss and affect the transmission of acoustic energy to the inner ear.

Objectives: Acoustic energy absorbance on wideband acoustic immittance (WAI) was evaluated, focusing especially on EH in the vestibule.

Material and methods: A total of 32 ears from 16 patients who underwent 3-T magnetic resonance imaging (MRI) to evaluate the presence of EH were examined, retrospectively. The degree of EH in the vestibule was classified into three grades (no, mild, and significant), and pure tone audiometry (PTA) and WAI were measured before and after a glycerol drip.

Results: Ears with significant EH showed significantly higher hearing levels and air-bone gaps (ABG), and higher absorbance values on WAI at low frequencies (560–600?Hz) than ears with mild or no EH. Changes in absorbance values were observed in some ears without threshold change on PTA.

Conclusions and Significance: This study showed significantly higher absorbance values of acoustic energy with significant vestibular EH at low frequencies. Considering ABGs observed in ears with significant EH, the presence of EH in the vestibule might cause an obstacle to the transmission of acoustic energy to the inner ear.     

大前庭水管综合征患者鼓膜吸收率特征初探

目的 探讨大前庭水管综合征(Large Vestibular Aqueduct Syndrome,LVAS)患者宽频声导抗(Wideband Acoustic Immittance,WAI)测试中的声导抗峰压值的鼓膜吸收率特征.方法 选取40例经CT确诊大前庭水管综合征患者,进行声导抗峰压值的鼓膜吸收率测试,并收集相同...     

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.     

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.     

Wideband acoustic immittance in superior semicircular canal dehiscence

ObjectiveThe apparent effect of superior semicircular canal dehiscence (SSCD) on middle ear- and cochlear impedance has led researchers to investigate the use of wideband acoustic immittance as a screening tool when SSCD is suspected. The purpose of the study was to describe the absorbance characteristics and tympanometric values of ears with confirmed SSCD measured at tympanometric peak pressure (TPP) and at ambient pressure.MethodsWideband Acoustic Immittance was performed at ambient pressure and at TPP on ten participants (12 ears) with confirmed SSCD, as well as on an age- and gender matched control group (12 ears). Inferential statistics were used to determine whether statistical differences existed for the absorbance values at each of the averaged frequencies, the resonance frequency (RF) and tympanometric data between the SSCD and control groups.ResultsThe mean absorbance of the SSCD group reached a maximum at 890.9 Hz and a minimum at 6349.6 Hz. When testing absorbance at TPP, a statistically significant increase/peak in the absorbance values of the SSCD group (compared to those of the control group) was found from 630 to 890.9 Hz and a decrease from 4489.8 to 6349.6 Hz. Similar patterns were observed for absorbance at ambient pressure. A lower mean RF for ears with SSCD as well as an increased mean admittance magnitude (AM) value at RF was found compared to those of the control group.ConclusionThe use of SSCD as a screening tool when SSCD is suspected was strengthened by results similar to those of previous studies. As a result of the significant difference in RF of SSCD ears compared to the RF of the control group, the potential value of measuring the RF of the middle ear to differentiate between mass-and stiffness dominated pathologies, was also illustrated.     

Wideband acoustic immittance in children with Down syndrome: prediction of middle-ear dysfunction,conductive hearing loss and patent PE tubes

Objective: The purpose of this study was to evaluate pressurised wideband acoustic immittance (WAI) tests in children with Down syndrome (DS) and in typically developing children (TD) for prediction of conductive hearing loss (CHL) and patency of pressure equalising tubes (PETs). Design: Audiologic diagnosis was determined by audiometry in combination with distortion-product otoacoustic emissions, 0.226?kHz tympanometry and otoscopy. WAI results were compared for ears within diagnostic categories (Normal, CHL and PET) and between groups (TD and DS). Study sample: Children with DS (n?=?40; mean age 6.4 years), and TD children (n?=?48; mean age 5.1 years) were included. Results: Wideband absorbance was significantly lower at 1–4?kHz in ears with CHL compared to NH for both TD and DS groups. In ears with patent PETs, wideband absorbance and group delay (GD) were larger than in ears without PETs between 0.25 and 1.5?kHz. Wideband absorbance tests were performed similarly for prediction of CHL and patent PETs in TD and DS groups. Conclusions: Wideband absorbance and GD revealed specific patterns in both TD children and those with DS that can assist in detection of the presence of significant CHL, assess the patency of PETs, and provide frequency-specific information in the audiometric range.     

噪声性听觉损害的声反射增长函数

目的　探讨噪声暴露对声反射增长函数 (acousticreflexgrowthfunction ,ARGF )的影响。方法　对有长期噪声暴露史的工人 5 7例 (10 6耳 )及正常听力青年人 2 5例 (5 0耳 )进行ARGF测试 ,观察受试耳对 10 0 0Hz纯音刺激级由声反射阈 (acousticreflexthreshold ,ART)水平增加至 12 5dBHL时声抗量值变化的函数关系。根据纯音平均听阈 (pure-tonethresholdaverage ,PTA)将噪声暴露耳分为三组。结果　噪声暴露组的声反射 (acousticreflex ,AR)动态范围变窄 ,声抗增长量值减小 ,ARGF曲线坡度变缓 ,反射振幅及声抗增长量值与正常青年组相比有显著下降 (P <0 .0 1) ,而听力损失程度不同的三个病变组间的差异不显著 (P >0 .0 5 )。分别用声抗量值及声抗量增幅比随AR刺激级的增加而变化两种方法分析所得数据 ,发现噪声暴露组的ARGF与正常耳有明显差别 (P <0 .0 5 ,P <0 .0 1)。结论　噪声暴露对ARGF有显著影响。ARGF可用作监测早期噪声性听觉损害 (noiseinducedhearingloss,NIHL)的敏感指标     

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.