Carpenter Michelle S, Cacace Anthony T, Mahoney Marty J
Department of Communication Sciences and Disorders, Wayne State University, Detroit, MI, USA.
J Am Acad Audiol. 2012 Feb;23(2):106-14. doi: 10.3766/jaaa.23.2.5.
Broadband middle ear power reflectance (BMEPR) is an emerging noninvasive electroacoustic measure that evaluates transmission/reflection properties of the middle ear in high resolution. It is applicable over the entire age continuum and is rapid to perform. However, it remains to be determined if BMEPR is just an incremental step in the evolution of middle ear assessment or a major advance in the way middle ear function can be evaluated.
To evaluate effects of age, gender, ear, and frequency on BMEPR measurements in adults without a history of middle ear disease and to assess whether these factors require consideration in test development; to review how these data may influence active physiologic process within the inner ear; to consider how they reconcile with previously published results; and to suggest applications for future research.
Prospective, cross-sectional, multivariate analysis to evaluate the effects of age, gender, ear, and frequency on BMEPR in humans without a history of middle ear disease and no air-bone gaps exceeding 10 dB for any frequency.
Fifty-six adults in two age groups (Group 1: 18-25 yr, n = 28; Group 2: ≥50 and <66 yr, n = 28). Each age group was stratified by ear and gender in a balanced design.
Pure tone air conduction and bone-conduction audiometry was conducted in a commercial sound booth, using a clinical audiometer with standard earphones enclosed in supra-aural ear cushions, and a standard bone-conduction oscillator and headband to evaluate for air-bone gaps. Broadband middle ear power reflectance was measured using a calibrated, commercially available computer-controlled system that incorporated a high quality probe assembly to transduce stimuli and record acoustic responses from the ear canal. Data were analyzed with a four-way (2 × 2 × 2 × 16) repeated measures analysis-of-variance (ANOVA) to evaluate the effects of age group (young vs. old), gender (male vs. female), ear (left vs. right), and frequency (258 to 5040 Hz) on BMEPR.
The ANOVA revealed a significant main effect of frequency. There were also gender × ear, gender × frequency, and age × gender × ear interactions. The three-way, age × gender × ear interaction captured the essence of results and revealed lowest power reflectance values in younger females and for right ears. This trend partially reversed in the older age group where higher power reflectance values were observed only in right ears of older females.
The significant effects of age, gender, ear, and frequency on BMEPR parallel ear- and gender-related differences in hearing sensitivity, ear, and gender differences in the prevalence of spontaneous otoacoustic emissions (OAEs), gender differences in the magnitude of transient evoked OAEs, and ear differences in transient evoked contralateral OAE suppression effects reported in the literature. While original discussions of these aforementioned effects focused primarily on endocochlear and olivocochlear mechanisms, the BMEPR measurements reported herein suggest that middle ear transmission characteristics may also play a role.
宽带中耳功率反射率（BMEPR）是一种新兴的非侵入性电声学测量方法，可高分辨率评估中耳的传输/反射特性。它适用于所有年龄段，且操作快速。然而，BMEPR究竟只是中耳评估发展过程中的一个渐进步骤，还是在评估中耳功能方式上的一项重大进展，仍有待确定。
评估年龄、性别、耳别和频率对无中耳疾病史成年人BMEPR测量值的影响，并评估在测试开发中是否需要考虑这些因素；回顾这些数据如何可能影响内耳内的活跃生理过程；思考它们如何与先前发表的结果相协调；并提出未来研究的应用方向。
前瞻性、横断面、多变量分析，以评估年龄、性别、耳别和频率对无中耳疾病史且任一频率气骨导差不超过10 dB的人类BMEPR的影响。
两个年龄组的56名成年人（第1组：18 - 25岁，n = 28；第2组：≥50岁且<66岁，n = 28）。每个年龄组按耳别和性别进行均衡设计分层。
在商业隔音室中使用临床听力计进行纯音气导和骨导测听，该听力计配备置于耳罩内的标准耳机，以及标准骨导振荡器和头带以评估气骨导差。使用校准的商用计算机控制系统测量宽带中耳功率反射率，该系统包含高质量探头组件以转换刺激并记录来自耳道的声学响应。数据采用四因素（2×2×2×16）重复测量方差分析（ANOVA）进行分析，以评估年龄组（年轻与年老）、性别（男性与女性）、耳别（左与右）和频率（258至5040 Hz）对BMEPR的影响。
方差分析显示频率有显著主效应。还存在性别×耳别、性别×频率以及年龄×性别×耳别的交互作用。年龄×性别×耳别的三因素交互作用抓住了结果的本质，显示年轻女性和右耳的功率反射率值最低。在老年组中这种趋势部分逆转，仅在老年女性的右耳观察到较高的功率反射率值。
年龄、性别、耳别和频率对BMEPR的显著影响与听力敏感度、耳别和性别相关的差异、自发性耳声发射（OAE）患病率的耳别和性别差异、瞬态诱发耳声发射幅度的性别差异以及文献中报道的瞬态诱发对侧耳声发射抑制效应的耳别差异平行。虽然上述这些影响的最初讨论主要集中在内耳和橄榄耳蜗机制上，但本文报道的BMEPR测量结果表明中耳传输特性可能也起作用。
