Gates G A
Am J Otolaryngol. 1986 Mar-Apr;7(2):147-50. doi: 10.1016/s0196-0709(86)80044-8.
Management of otitis media, both acute and chronic, is one of the most common problems in clinical medicine. Among the many unresolved issues in otitis media research is accurate diagnosis which, in turn, depends heavily on valid otoscopic observation. Yet even today clinical otoscopy remains more of an art than a science. Because precise therapy is predicated on precise diagnosis, efforts to improve the validity and reliability of otoscopic techniques are warranted. Of great importance to the otoscopist is the visual estimate of tympanic membrane mobility secondary to hand-generated pneumatic pressure (pneumotoscopy). The degree of motion is usually graded in relative terms. In addition to pneumotoscopy, tympanometry is also used to assess the status of the middle ear. This is done indirectly through the plot of induced pressure versus acoustic immitance (tympanogram). Thus, both procedures depend on the differential application of induced pneumatic pressure on the tympanic membrane. If the middle ear is air-containing and the tympanic membrane is normal, even a slight pressure rise in the ear canal will displace the membrane. If the middle ear is fluid-filled, even large amounts of pressure produce no motion of the tympanic membrane. The pressure gradients, normal threshold, and optimal frequency of application for pneumotoscopy have not been studied previously in humans. Data are presented to compare the sensitivity, specificity, and predictive value of pneumotoscopy and tympanometry in the detection of effusion due to chronic secretory otitis media. In addition, preliminary data obtained by a new procedure, quantitative pneumotoscopy, are discussed.
急慢性中耳炎的治疗是临床医学中最常见的问题之一。中耳炎研究中有许多未解决的问题，其中准确诊断是一个重要问题，而准确诊断又在很大程度上依赖于有效的耳镜检查。然而，即使在今天，临床耳镜检查仍然更多是一门艺术而非科学。由于精确的治疗是以精确的诊断为前提的，因此有必要努力提高耳镜检查技术的有效性和可靠性。对于耳镜检查者来说，通过手动产生的气压（气耳镜检查）对鼓膜活动度进行视觉评估非常重要。活动程度通常用相对术语进行分级。除了气耳镜检查外，鼓室导抗图也用于评估中耳的状况。这是通过绘制外加压力与声导抗的关系图（鼓室导抗图）间接完成的。因此，这两种方法都依赖于在鼓膜上施加不同的外加气压。如果中耳含有空气且鼓膜正常，即使耳道内压力稍有升高也会使鼓膜移位。如果中耳充满液体，即使施加大量压力也不会使鼓膜运动。气耳镜检查的压力梯度、正常阈值和最佳应用频率以前在人类中尚未进行过研究。本文提供数据以比较气耳镜检查和鼓室导抗图在检测慢性分泌性中耳炎积液方面的敏感性、特异性和预测价值。此外，还讨论了通过一种新方法——定量气耳镜检查获得的初步数据。
