VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, Oregon, USA.
Department of Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Ear Hear. 2023;44(4):740-750. doi: 10.1097/AUD.0000000000001321. Epub 2023 Jan 12.
This study compared the measurement of the acoustic stapedius reflex threshold (ART) obtained using a traditional method with that obtained using an automated adaptive wideband (AAW) method. Participants included three groups of adults with normal hearing (NH), mild sensorineural hearing loss (SNHL), or moderate SNHL. The purpose of the study was to compare ARTs for the three groups and to determine which method had the best performance in detecting SNHL.
Ipsilateral and contralateral ARTs were obtained using 0.5, 1, and 2 kHz tonal activators, and broadband noise (BBN) activators on a traditional admittance system (Clinical) at tympanometric peak pressures (TPP) and on an experimental wideband system using an AAW method at both ambient pressure and TPP. ART data previously reported for 39 NH adults with a mean age of 47.7 years were compared with data for 25 participants with mild SNHL with a mean age of 63.8 years, and 20 participants with moderate SNHL with a mean age of 65.7 years. Differences in ARTs between the normal-hearing and SNHL groups for the three methods were examined using a General Linear Model Repeated-Measures test. A receiver operating characteristic curve (ROC) analysis was also used to determine the ability of an ART test to detect SNHL.
For the 0.5 kHz activator condition, there were no significant group mean differences in ART between NH and SNHL groups for either ipsilateral or contralateral activator presentation modes for the Clinical or AAW methods. There were significant group mean differences for the 1 and 2 kHz tonal activators and BBN activator for both ipsilateral and contralateral modes with greater differences in ART between groups for the AAW method than the Clinical method. In these conditions, the mean ART was lower for the AAW tests relative to the Clinical test. The greatest difference between groups was for the ipsilateral AAW tests for the comparison of NH with moderate SNHL for the BBN activator. This difference was approximately 20 dB for the AAW tests and 8 dB for the Clinical test. The ROC analysis showed that the area under the ROC curve (AUC) increased with the frequency of the activator stimulus and with the degree of hearing loss and was maximal for the BBN activator for both the AAW and Clinical methods for both ipsilateral and contralateral presentations.
For ipsilateral and contralateral ART tests for activator frequencies above 0.5 kHz and BBN, listeners with SNHL generally had elevated ARTs compared with those with NH. The AAW method resulted in greater differences between SNHL groups and NH than the Clinical method. The AUC for detecting SNHL also increased with activator frequency and degree of hearing loss and was greatest for the BBN activator for the AAW method in both the ambient and TPP conditions. The results are encouraging for the use of an AAW ART method for the assessment of individuals with SNHL.
本研究比较了传统方法和自动自适应宽带（AAW）方法测量声反射阈（ART）的结果。参与者包括三组听力正常（NH）、轻度感音神经性听力损失（SNHL）和中度 SNHL 的成年人。研究目的是比较三组的 ARTs，并确定哪种方法在检测 SNHL 方面表现最好。
在传统导纳系统（Clinical）上，使用 0.5、1 和 2 kHz 的纯音刺激器和宽带噪声（BBN）刺激器，在鼓室压峰值（TPP）下以及在实验性宽带系统上，使用 AAW 方法在环境压力和 TPP 下，同侧和对侧获得 ART。将先前报道的 39 名平均年龄为 47.7 岁的 NH 成年人的 ART 数据与 25 名平均年龄为 63.8 岁的轻度 SNHL 参与者和 20 名平均年龄为 65.7 岁的中度 SNHL 参与者的数据进行比较。使用广义线性模型重复测量检验比较三种方法中正常听力和 SNHL 组之间的 ARTs 差异。还使用接收器工作特征曲线（ROC）分析来确定 ART 测试检测 SNHL 的能力。
对于 0.5 kHz 刺激器条件，对于临床或 AAW 方法的同侧或对侧刺激器呈现模式，NH 和 SNHL 组之间的 ART 组平均差异没有统计学意义。对于 1 和 2 kHz 的纯音刺激器和 BBN 刺激器，同侧和对侧模式均存在显著的组平均差异，对于 AAW 方法，组间 ART 差异大于临床方法。在这些条件下，AAW 测试的平均 ART 低于临床测试。组间差异最大的是同侧 AAW 测试，用于比较 BBN 激活器的 NH 与中度 SNHL。对于 AAW 测试，这种差异约为 20 dB，对于临床测试，这种差异为 8 dB。ROC 分析表明，ROC 曲线下面积（AUC）随激活器刺激频率和听力损失程度的增加而增加，对于双侧 AAW 和临床方法，对于同侧和对侧呈现，最大 AUC 为 BBN 激活器。
对于高于 0.5 kHz 的刺激器频率和 BBN 的同侧和对侧 ART 测试，SNHL 患者的 ARTs 通常高于 NH 患者。AAW 方法导致 SNHL 组与 NH 组之间的差异大于临床方法。用于检测 SNHL 的 AUC 也随激活器频率和听力损失程度的增加而增加，对于双侧 AAW 方法，在环境和 TPP 条件下，BBN 激活器的 AUC 最大。这些结果令人鼓舞，表明 AAW ART 方法可用于评估 SNHL 患者。
