Eaton-Peabody Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts 02114, USA.
Ear Hear. 2012 Jan-Feb;33(1):19-34. doi: 10.1097/AUD.0b013e31822ccb76.
This study compares measurements of ear-canal reflectance (ECR) to other objective measurements of middle ear function including audiometry, umbo velocity (VU), and tympanometry in a population of strictly defined normal-hearing ears.
Data were prospectively gathered from 58 ears of 29 normal-hearing subjects, 16 females and 13 males, aged 22 to 64 yr. Subjects met all of the following criteria to be considered as having normal hearing: (1) no history of significant middle ear disease; (2) no history of otologic surgery; (3) normal tympanic membrane on otoscopy; (4) pure-tone audiometric thresholds of 20 dB HL or better for 0.25 to 8 kHz; (5) air-bone gaps no greater than 15 dB at 0.25 kHz and 10 dB for 0.5 to 4 kHz; (6) normal, type-A peaked tympanograms; and (7) all subjects had two "normal" ears (as defined by these criteria). Measurements included pure-tone audiometry for 0.25 to 8 kHz, standard 226 Hz tympanometry, ECR for 0.2 to 6 kHz at 60 dB SPL using the Mimosa Acoustics HearID system, and umbo velocity (VU) for 0.3 to 6 kHz at 70 to 90 dB SPL using the HLV-1000 laser Doppler vibrometer (Polytec Inc).
Mean power reflectance (|ECR|) was near 1.0 at 0.2 to 0.3 kHz, decreased to a broad minimum of 0.3 to 0.4 between 1 and 4 kHz, and then sharply increased to almost 0.8 by 6 kHz. The mean pressure reflectance phase angle (∠ECR) plotted on a linear frequency scale showed a group delay of approximately 0.1 msec for 0.2 to 6 kHz. Small significant differences were observed in |ECR| at the lowest frequencies between right and left ears and between males and females at 4 kHz. |ECR| decreased with age but reached significance only at 1 kHz. Our ECR measurements were generally similar to previous published reports. Highly significant negative correlations were found between |ECR| and VU for frequencies below 1 kHz. Significant correlations were also found between the tympanometrically determined peak total compliance and |ECR| and VU at frequencies below 1 kHz. The results suggest that middle ear compliance contributes significantly to the measured power reflectance and umbo velocity at frequencies below 1 kHz but not at higher frequencies.
This study has established a database of objective measurements of middle ear function (ECR, umbo velocity, tympanometry) in a population of strictly defined normal-hearing ears. These data will promote our understanding of normal middle ear function and will serve as a control for comparison to similar measurements made in pathological ears.
本研究比较了耳道反射率(ECR)与其他客观测量中耳功能的指标,包括听力计、鼓室声导抗(VU)和鼓室图,这些指标均来自严格定义的正常听力人群。
本研究的数据是前瞻性地从 29 名正常听力受试者的 58 耳中收集的,其中包括 16 名女性和 13 名男性,年龄为 22 至 64 岁。受试者均符合以下所有标准,被认为具有正常听力:(1)无中耳疾病史;(2)无耳科手术史;(3)耳镜检查鼓膜正常;(4)0.25 至 8 kHz 的纯音听阈为 20 dB HL 或更好;(5)0.25 kHz 处气骨导差不超过 15 dB,0.5 至 4 kHz 处不超过 10 dB;(6)正常的 A 型鼓室图;(7)所有受试者均有两只“正常”耳朵(符合这些标准)。测量包括 0.25 至 8 kHz 的纯音听力计、226 Hz 鼓室声导抗、60 dB SPL 下使用 Mimosa Acoustics HearID 系统进行的 0.2 至 6 kHz 的 ECR 测量、70 至 90 dB SPL 下使用 HLV-1000 激光多普勒测振仪(Polytec Inc.)进行的 0.3 至 6 kHz 的鼓室声导抗图(VU)测量。
0.2 至 0.3 kHz 时,平均功率反射率(|ECR|)接近 1.0,在 1 至 4 kHz 之间降至 0.3 至 0.4 kHz 之间的宽最小值,然后在 6 kHz 时急剧增加至近 0.8。在以线性频率标度绘制的平均压力反射率相位角(∠ECR)上,0.2 至 6 kHz 之间的群延迟约为 0.1 msec。在 4 kHz 时,右耳和左耳之间以及男性和女性之间观察到 ECR 在最低频率处有较小的显著差异。|ECR|随年龄增长而下降,但仅在 1 kHz 时达到显著水平。我们的 ECR 测量结果与之前发表的报告大致相似。在低于 1 kHz 的频率下,发现 ECR 与 VU 之间存在高度显著的负相关。在低于 1 kHz 的频率下,还发现了鼓室声导抗图确定的总顺应性峰值与 ECR 和 VU 之间的显著相关性。结果表明,中耳顺应性在低于 1 kHz 的频率下对测量的功率反射率和鼓室声导抗图(VU)有显著影响,但在更高频率下则没有。
本研究建立了一个严格定义的正常听力人群中耳功能(ECR、鼓室声导抗、鼓室图)的客观测量数据库。这些数据将促进我们对正常中耳功能的理解,并作为与病理耳类似测量结果进行比较的对照。