CE 线性调频脉冲的诊断准确性。

Diagnostic accuracy of CE Chirp.

作者信息

Biagio-de Jager Leigh, van Dyk Zandri, Vinck Bart Hme

机构信息

Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Hatfield, 0028, South Africa.

出版信息

Int J Pediatr Otorhinolaryngol. 2020 Aug;135:110071. doi: 10.1016/j.ijporl.2020.110071. Epub 2020 May 4.

DOI:10.1016/j.ijporl.2020.110071

PMID:32497908

Abstract

OBJECTIVE

There has been an increase in the use of the CE-Chirp stimulus in automated auditory brainstem response (AABR) equipment for neonatal hearing screening. The purpose of this study is to evaluate the diagnostic accuracy of the LS CE-Chirp-evoked auditory brainstem response (ABR) compared to the click-evoked ABR for the identification of different degrees and configurations of sensorineural (SNHL) hearing loss.

METHOD

49 ears with mild to moderate SNHL were assessed: 16 ears with rising SNHL and 33 ears with sloping high frequency SNHL. Behavioural pure tone thresholds were obtained at 125-8000 Hz and ABR thresholds were measured using the click and LS CE-Chirp stimuli respectively. Click- and LS CE-Chirp-evoked thresholds were compared with each other and with behavioural pure tone average at 500, 1000, 2000 Hz (PTA), high frequency average at 2000, 4000, 8000 Hz (HFA) and low frequency average at 250, 500, 1000 Hz (LFA). Diagnostic accuracy of the two ABR stimuli was also compared by using ROC curves.

RESULTS

Differences between click- and LS CE Chirp-evoked ABR, and behavioural thresholds were not statistically significant (p > 0.05). The highest significant correlations for ABR using clicks to behavioural thresholds was found at 2000 and 4000 Hz, whereas, the highest correlation for LS CE-Chirp ABRs to behavioural thresholds was found at 1000, 2000 and 4000 Hz (r > 0.7, p < 0.001). A very strong, positive correlation was found between both click (r = 0.805, p < 0.001) and LS CE-Chirp (r = 0.825, p < 0.001) and the behavioural PTA. LS CE-Chirp ABR thresholds were closer to mid and low frequency thresholds than the click ABR while the click-evoked thresholds were in closer proximity to HFA. Sensitivity and specificity and false negative rates were identical. Diagnostic accuracy of the LS CE-Chirp ABR was equal to or better than click for low (area under the curve (AUC) = 0.83), mid (AUC = 0.89) and high frequency hearing losses (AUC = 0.73). However, scatterplots indicated more frequent underestimation of behavioural pure tone thresholds at mid and high frequencies with the LS CE-Chirp than for the click ABR.

CONCLUSION

The diagnostic accuracy of the LS CE Chirp-evoked ABR is equivalent or better than the click-evoked ABR. The importance of ongoing surveillance and consideration of ABR screening protocols is consequently emphasized.

摘要

目的

在用于新生儿听力筛查的自动听性脑干反应（AABR）设备中，CE - 啁啾刺激的使用有所增加。本研究的目的是评估与短声诱发的听性脑干反应（ABR）相比，LS CE - 啁啾诱发的听性脑干反应（ABR）在识别不同程度和类型的感音神经性（SNHL）听力损失方面的诊断准确性。

方法

对49只患有轻度至中度SNHL的耳朵进行评估：16只耳朵为上升型SNHL，33只耳朵为高频斜坡型SNHL。在125 - 8000Hz获得行为纯音阈值，并分别使用短声和LS CE - 啁啾刺激测量ABR阈值。将短声和LS CE - 啁啾诱发的阈值相互比较，并与500、1000、2000Hz的行为纯音平均值（PTA）、2000、4000、8000Hz的高频平均值（HFA）以及250、500、1000Hz的低频平均值（LFA）进行比较。还通过使用ROC曲线比较两种ABR刺激的诊断准确性。

结果

短声和LS CE - 啁啾诱发的ABR与行为阈值之间的差异无统计学意义（p>0.05）。短声ABR与行为阈值的最高显著相关性出现在200 和4000Hz，而LS CE - 啁啾ABR与行为阈值的最高相关性出现在1000、2000和4000Hz（r>0.7，p<0.001）。短声（r = 0.805，p<0.001）和LS CE - 啁啾（r = 0.825，p<0.001）与行为PTA之间均发现非常强的正相关。LS CE - 啁啾ABR阈值比短声ABR更接近中低频阈值，而短声诱发的阈值更接近HFA。敏感性、特异性和假阴性率相同。LS CE - 啁啾ABR对于低频（曲线下面积（AUC）= 0.83）、中频（AUC = 0.89）和高频听力损失（AUC = 0.73）的诊断准确性等于或优于短声。然而，散点图表明，与短声ABR相比，LS CE - 啁啾在中高频时更频繁地低估行为纯音阈值。