226Hz和1000Hz鼓室声导纳在不同年龄婴幼儿分泌性中耳炎应用探讨

目的：以影像学检查为诊断分泌性中耳性的标准，分析不同年龄段分泌性中耳炎常婴幼儿226Hz和1000Hz2种探测音鼓室声导纳曲线类型分布特点和趋势，比较2种方法在敏感度和特异度，为临床诊断提供依据。方法：经颞骨薄层CT证实为分泌性中耳炎婴幼儿177例（226耳），中耳结构正常的婴幼儿158例（266耳），年龄1～60个月。根据年龄分为6组，分别为O～6月龄组，6～12月龄组，12～18月龄组。18～24月龄组，24～36月龄组，36～60月龄组，分别进行226Hz和1000Hz探测音鼓室声导纳测试。用配对Y。检验对不同年龄组受试儿童两种声导纳测试法结果进行检验，并用ROC方法分析2种方法的敏感度和特异度。结果：分泌性中耳炎婴幼儿各组226Hz鼓室声导纳异常检出率分别为21．1％、35．2％、46．9％、42．0％、62．5％及68％，1000Hz鼓室声导纳异常检出率分别为94．7％、98．1％、96．9％、91．2％、95．8％及88．0％。中耳功能正常婴幼儿，226Hz鼓室声导纳正常型检出率分别为95．1％、88．6％、85．1％、93．3％、88．5％及93．5％，l000Hz鼓室声导纳正常型检出率分别是为87．8％、94．3％、89．4％、95．6％、94．2％及97．8％。2种测试方法对分泌性中耳炎的检出率在36月龄以下差异有统计学意义，2种测试方法的敏感度和特异度在0～36个月差异有统计学意义，36个月以上差异无统计学意义。结论：36月龄以下婴幼儿探测分泌性中耳炎应以1000Hz鼓室声导纳为主，36～60月龄幼儿应同时测试226及1000Hz鼓室声导纳。以单峰型和双峰型1000Hz鼓室声导纳作为分泌性中耳炎的正常标准，具有很高的可靠性和实用性。

A comparison of 226 Hz and 1 000 Hz tympanometry in diagnosis of infants otitis media effusion

Objective： To provide a clinical reference by comparing the conventional 226 Hz tympanometry with 1000 Hz tympanometry in two groups of young children with miffs media effusion evidenced by CT scan. Method.. One hundred and seventy-seven young children （226 ears） , from 1 to 60 months, with otitis media effusion were involved in this study. They were divided into six groups by age： 0-6 months group, 6-12 months group, 12-18 months group, 18-24 months group, 24-36 months group, 36-60 months group. They were tested with tympanometry of 2 probe-tones of 226 and 1 000 Hz. Type A tympanogram was defined as a normal middle ear function in 226 Hz and single-or double-peak in 1 000 Hz tympanometry. One hundred and fifty-eight normal young children （266 ears） were selected as control group. The results were analysed with Chi square test. Receiver operator characteristic （ROC） analysis was performed to evaluate the two methods. Result..In the young children with otitis media effusion, the detection rate of 226 Hz tympanogram in six groups was 21.1% ,35.2%, 46.9% ,42%,62.5% and 68% respectively, while 94.7%,98.1% ,96.9% ,91.2%,95.8% and 88% respectivelyin 1 000 Hz tympanogram. In the young children with normal middle ear function, the detection rate of 226 Hz tympanogramin six groups was 95.1%,88.6%,85.1%,93.3%,88.5% and 93. 5%, while 87.8%,94.3%, 89.4% ,95.6%,94.2% and 97.8% respectively in 1 000 Hz tympanogram. The detection rate was significantly different between 226 and 1 000 Hz tympanogram in the young children under 36-month old. Conclusion： A single-or double-peak 1000 Hz tympanometric patterns as normal criteria was a simple way to evaluate young children ＇s middle ear function. 1 000 Hz tympanometry should be given priority to the children within 36-month old in detection middle ear function,the 226 and 1 000 blz tympanometry should be done at the same time within 36-60 months old.