Dempster J H, MacKenzie K
Department of Otolaryngology, Royal Infirmary, Glasgow, UK.
Clin Otolaryngol Allied Sci. 1991 Apr;16(2):157-9. doi: 10.1111/j.1365-2273.1991.tb01967.x.
The monitoring of children with otitis media with effusion ties up considerable resources in audiology departments. Impedance audiometry is frequently used when investigating these children. It has been shown to be highly sensitive in detecting middle ear effusion, but its value in identifying those children with a significant hearing impairment secondary to this is in question because of the wide range of hearing impairments possible with a type B tympanogram. This study quantified the sensitivity and specificity of impedance audiometry in detecting a hearing impairment greater than or equal to 25 dB HL due to otitis media with effusion. The subjects were 285 children of whom 20% had hearing thresholds greater than or equal to 25 dB HL. A peaked tympanogram (types A or C) virtually eliminated the possibility (98% confidence) of such a hearing impairment. A flat type B tympanogram was satisfactorily sensitive (93%) in detecting a hearing impairment, but non-specific (76%). The positive predictive value was 49%, i.e. 51% of ears with this type of tympanogram had hearing within acceptable limits. Assuming that a sensorineural impairment has been excluded and a population is being monitored for hearing impairment associated with otitis media with effusion, it is suggested that the presence of a peaked tympanogram indicates normal hearing, whereas those children with a flat tympanogram would require their hearing to be evaluated. Increased use of impedance audiometry to monitor children with otitis media with effusion would reduce the number requiring full pure-tone audiometry with a subsequent reduction in the workload of an audiology department.
对患有中耳积液的儿童进行监测在听力学科占用了大量资源。在对这些儿童进行检查时，经常会使用声阻抗测听法。研究表明，该方法在检测中耳积液方面具有高度敏感性，但由于B型鼓室图可能出现的听力损伤范围广泛，其在识别继发于此的有明显听力损伤的儿童方面的价值受到质疑。本研究对声阻抗测听法检测因中耳积液导致的听力损伤大于或等于25 dB HL的敏感性和特异性进行了量化。研究对象为285名儿童，其中20%的儿童听力阈值大于或等于25 dB HL。尖峰型鼓室图（A型或C型）几乎消除了出现这种听力损伤的可能性（98%置信度）。平坦型B型鼓室图在检测听力损伤方面具有令人满意的敏感性（93%），但特异性不强（76%）。阳性预测值为49%，即具有这种鼓室图类型的耳朵中有51%的听力在可接受范围内。假设已排除感音神经性损伤，并且正在对与中耳积液相关的听力损伤人群进行监测，建议尖峰型鼓室图的出现表明听力正常，而那些平坦型鼓室图的儿童则需要对其听力进行评估。增加使用声阻抗测听法来监测患有中耳积液的儿童，将减少需要进行全面纯音听力测试的人数，从而减轻听力学科的工作量。
