使用鼓室图和声反射测试对婴幼儿传导性听力损失的鉴定。

Identification of conductive hearing loss in young infants using tympanometry and wideband reflectance.

机构信息

Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, Syracuse, NY 13244, USA.

出版信息

Ear Hear. 2013 Mar-Apr;34(2):168-78. doi: 10.1097/AUD.0b013e31826fe611.

DOI:10.1097/AUD.0b013e31826fe611

PMID:23263407

Abstract

OBJECTIVE

The goal of the study was to evaluate the effectiveness of tympanometry and wideband reflectance (WBR) in detecting conductive hearing loss (CHL) in young infants.

METHODS

Type of hearing loss was determined using auditory brainstem response using air- and bone-conducted tone bursts in 84 ears from 70 infants (median age = 10 weeks). Of these 84 ears, 60 are included in the current analysis: 43 with normal hearing (NH) and 17 with CHL. Tympanometry was measured using probe tone frequencies of 226, 678, and 1000 Hz. Tympanograms were evaluated in two ways: (1) Acoustic middle ear admittance (Ya, in millimhos); and (2) two-category classification (normal/abnormal), as described by Baldwin (2006). Measures of Ya were evaluated in two ways: by admittance-magnitude tympanograms and calculated admittance magnitude from subcomponents (conductance and susceptance). WBR was measured in response to a chirp stimulus after probe calibration. WBR was analyzed into thirteen 1/3 octave bands. Tests for statistical differences for two-category classification were analyzed using Chi-squared and Ya, and WBR were analyzed using repeated-measures analyses of variances. Cohen's d and likelihood ratios were computed for comparison with statistically significant differences.

RESULTS

Ya measured with 678- and 1000 Hz probe tones was significantly different between ears with CHL and NH. Two-category classification of tympanograms using a 1000 Hz probe tone was significantly different between ears with CHL and NH. Neither two-category classification nor Ya was significantly different between ears identified with CHL and NH using a 226 Hz probe tone. WBR was significantly higher in the frequency bands 800 to 2500 Hz and in the frequency band centered at 6300 Hz in infants with CHL. Effect sizes (Cohen's d) were greater than 2 for several WBR frequency bands and Ya measured with 1000 Hz probe tones. The results were similar for calculations of Ya from admittance-magnitude and subcomponent tympanograms. Positive likelihood ratios for WBR ranged between 8.1 and 38, and those for Ya using 1000 Hz ranged between 12.5 and 32.

CONCLUSIONS

CHL in young infants can be detected well with WBR or tympanometry using probe frequencies of 678 and 1000 Hz.

摘要

目的

本研究旨在评估鼓室声导抗测试（ tympanometry ）和宽带反射率（ wideband reflectance ，WBR ）在检测婴幼儿传导性听力损失（ conductive hearing loss ，CHL ）中的有效性。

方法

使用听觉脑干反应（ auditory brainstem response ），通过空气和骨导声脉冲，对 70 名婴儿（中位年龄= 10 周）的 84 只耳朵进行听力损失类型的评估。这 84 只耳朵中，有 60 只被纳入本次分析：43 只具有正常听力（ normal hearing ，NH ），17 只具有 CHL 。使用 226 、678 和 1000 Hz 的探测音频率进行鼓室声导抗测试。鼓室图通过两种方式进行评估：（1）声顺值（ Ya ，以毫西门子计）；（2）根据 Baldwin （ 2006 ）的描述，进行两类分类（正常/异常）。 Ya 通过导纳幅度鼓室图和亚分量（导纳和电纳）的计算导纳幅度进行评估。在探头校准后，使用啁啾刺激测量 WBR 。WBR 被分析为 13 个 1/3 倍频带。使用卡方检验和 Ya 对两类分类的统计差异进行分析，使用重复测量方差分析对 WBR 进行分析。计算 Cohen 的 d 和似然比，以与统计学上的显著差异进行比较。

结果

使用 678 和 1000 Hz 探测音的 Ya 在 CHL 耳和 NH 耳之间存在显著差异。使用 1000 Hz 探测音的鼓室图两类分类在 CHL 耳和 NH 耳之间存在显著差异。使用 226 Hz 探测音时，CHL 耳和 NH 耳之间的两类分类或 Ya 均无显著差异。CHL 婴儿的 WBR 在 800 至 2500 Hz 频段和 6300 Hz 频段中心的频率范围内显著较高。使用 1000 Hz 探测音测量的 Ya 及几个 WBR 频带的效应量（ Cohen 的 d ）大于 2 。从导纳幅度和亚分量鼓室图计算 Ya 的结果相似。WBR 的正似然比范围为 8.1 至 38 ，使用 1000 Hz 的 Ya 的正似然比范围为 12.5 至 32 。