Piskorski P, Keefe D H, Simmons J L, Gorga M P
Boys Town National Research Hospital, Omaha, Nebraska 68131, USA.
J Acoust Soc Am. 1999 Mar;105(3):1749-64. doi: 10.1121/1.426713.
This study evaluated the accuracy of acoustic response tests in predicting conductive hearing loss in 161 ears of subjects from the age of 2 to 10 yr, using as a "gold standard" the air-bone gap to classify ears as normal or impaired. The acoustic tests included tympanometric peak-compensated static admittance magnitude (SA) and tympanometric gradient at 226 Hz, and admittance-reflectance (YR) measurements from 0.5 to 8 kHz. The performance of individual, frequency-specific, YR test variables as predictors was assessed. By applying logistic regression (LR) and discriminant analysis (DA) techniques to the multivariate YR response, two univariate functions were calculated as the linear combinations of YR variables across frequency that best separated normal and impaired ears. The tympanometric and YR tests were also combined in a multivariate manner to test whether predictive efficacy improved when 226-Hz tympanometry was added to the predictor set. Conductive hearing loss was predicted based on air-bone gap thresholds at 0.5 and 2 kHz, and on a maximum air-bone gap at any octave frequency from 0.5 to 4 kHz. Each air-bone gap threshold ranged from 5 to 30 dB in 5-dB steps. Areas under the relative operating characteristic curve for DA and LR were larger than for reflectance at 2 kHz, SA and Gr. For constant hit rates of 80% and 90%, both DA and LR scores had lower false-alarm rates than tympanometric tests-LR achieved a false-alarm rate of 6% for a sensitivity of 90%. In general, LR outperformed DA as the multivariate technique of choice. In predicting an impairment at 0.5 kHz, the reflectance scores at 0.5 kHz were less accurate predictors than reflectance at 2 and 4 kHz. This supports the hypothesis that the 2-4-kHz range is a particularly sensitive indicator of middle-ear status, in agreement with the spectral composition of the output predictor from the multivariate analyses. When tympanometric and YR tests were combined, the resulting predictor performed slightly better or the same as the predictor calculated from the use of the YR test alone. The main conclusion is that these multivariate acoustic tests of the middle ear, which are analyzed using a clinical decision theory, are effective predictors of conductive hearing loss.
本研究评估了声学反应测试在预测2至10岁受试者161只耳朵的传导性听力损失方面的准确性，以气骨导间距作为“金标准”将耳朵分类为正常或受损。声学测试包括鼓室导抗图的峰值补偿静态声导纳幅值（SA）和226Hz时的鼓室导抗梯度，以及0.5至8kHz的声导纳-声反射（YR）测量。评估了各个频率特异性的YR测试变量作为预测指标的性能。通过将逻辑回归（LR）和判别分析（DA）技术应用于多变量YR反应，计算出两个单变量函数，作为跨频率的YR变量的线性组合，其能最佳地区分正常和受损耳朵。鼓室导抗测试和YR测试也以多变量方式组合，以检验当将226Hz鼓室导抗测试添加到预测指标集中时预测效能是否提高。基于0.5和2kHz时的气骨导间距阈值以及0.5至4kHz任何倍频程频率处的最大气骨导间距来预测传导性听力损失。每个气骨导间距阈值以5dB步长在5至30dB范围内变化。DA和LR的相对操作特征曲线下面积大于2kHz时的声反射、SA和导抗梯度。对于80%和90%的恒定命中率，DA和LR评分的误报率均低于鼓室导抗测试——LR在灵敏度为90%时实现了6%的误报率。总体而言，作为首选的多变量技术，LR的表现优于DA。在预测0.5kHz处的听力损伤时，0.5kHz处的声反射评分作为预测指标不如2kHz和4kHz处的声反射准确。这支持了以下假设，即2至4kHz范围是中耳状态的一个特别敏感的指标，这与多变量分析输出预测指标的频谱组成一致。当鼓室导抗测试和YR测试组合时，所得预测指标的表现略优于或等同于仅使用YR测试计算出的预测指标。主要结论是，这些使用临床决策理论进行分析的中耳多变量声学测试是传导性听力损失的有效预测指标。
