宽频声导抗在分泌性中耳炎诊断中的临床应用价值

潘骏良; 杨军

doi:10.13201/j.issn.1001-1781.2018.17.005

宽频声导抗在分泌性中耳炎诊断中的临床应用价值

潘骏良,
杨军^,

- 上海交通大学医学院附属新华医院耳鼻咽喉头颈外科(上海, 200092)
基金项目:
上海申康医院发展中心医疗事业部项目（No：16CR4007A）

详细信息

通讯作者: 杨军,E-mail:yangjun@xinhuamed.com.cn

中图分类号: R764.21

收稿日期: 2018-02-01

The clinical value of wideband tympanometry in the diagnosis of otitis media with effusion

PAN Junliang,
YANG Jun^,

- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China

More Information

Corresponding author: YANG Jun, E-mail: yangjun@xinhuamed.com.cn

Received Date: 01 February 2018

摘要

摘要: 目的：建立中国人正常耳宽频声导抗（WBT）吸收率参考值范围。建立正常耳以及分泌性中耳炎耳WBT吸收率曲线，为临床应用提供参考。研究2~16岁人群与>16岁人群正常耳WBT吸收率是否存在差异。比较WBT和普通单频率声导抗对诊断中耳积液的敏感度及特异性。方法：入选者为2015-01-2015-12期间就诊的经临床体检、耳内镜、声导抗、纯音测听或听性脑干反应等明确诊断的176例（342耳）。比较儿童与成人正常耳WBT各频率吸收率有无差异。建立正常耳WBT吸收率参考值并测绘中国人正常耳、中耳积液耳、中耳负压耳WBT曲线，并将正常WBT曲线命名为N型曲线，中耳积液曲线命名为E型曲线，中耳负压曲线命名为P型曲线。对绘制出的N型、E型和P型曲线的吸收率进行比较。另外选取经鼓室探查术明确诊断的分泌性中耳炎患者40例（66耳），40例患者于术前均行普通声导抗和WBT检查，比较二者对于分泌性中耳炎检出的敏感度及特异性。结果：建立2岁以上中国人正常耳WBT吸收率参考值。2~16岁人群与>16岁人群在31个频率有10个频率差异有统计学意义。分泌性中耳炎与正常耳的吸收率差异主要集中在500~2 000 Hz。在500~2 000 Hz频率范围内，测绘所得N型曲线各频率吸收率与P型曲线及E型曲线两两间均差异有统计学意义。在500~2 000 Hz频段，N型曲线吸收率>P型曲线>E型曲线。WBT对中耳积液的敏感度为94.8%，特异性为87.5%，均高于普通单频率声导抗91.38%的敏感度和62.50%的特异性。结论：WBT吸收率在2岁以上中国人群中大部分频率一致。正常耳、中耳积液耳和中耳负压耳可通过WBT曲线区别，分别为N型、E型、P型曲线。WBT测试可用于临床诊断分泌性中耳炎，且较普通声导抗有更高的敏感度及特异性。
- 宽频声导抗 /
- 吸收率 /
- 分泌性中耳炎 /
- 儿童 /
- 成人
Abstract: Objective: To establish normative data for wideband absorbance measurements in Chinese with normal ear and effusion ear using wideband tympanometry (WBT) and determine the WBT curves of normal ears and effusion ears to facilitate the use of it. To investigate whether there are difference between the WBT absorbance in children aged 2-16 and adults above 16. To compare the sensitivity and specificity of WBT and conventional tympanometry tests for diagnosing otitis media with effusion (OME).Method: One hundred and seventy-six patients (342 ears), from January 2015 to December 2015, were enrolled, including 96 males and 80 females whose ages ranged from 2 to 74 years. All of these patients, who underwent physical examination, ear endoscopy, conventional tympanometry and pure tone audiometry, were divided into three groups, namely normal, negative pressure and effusion according to the clinical diagnosis. WBT was carried out in these patients to analyze whether there are difference in the absorbance between children and adults in normal ears. The absorbance diagram of normal, effusion and negative pressure ears were mapped in Chinese population. The normal WBT curve was named as type N (normal) curve, the middle ear effusion curve as type E (effusion) curve, and the middle ear negative pressure curve as type P (negative pressure) curve. Pairwise comparison was carried out to analyze the difference of the WBT absorbance among these WBT curves. Other 40 patients (66 ears) with clinical diagnosis of middle ear effusion, including 22 males and 18 females with ages ranged from 3 to 36 years old, underwent exploratory tympanotomy. These 40 cases were detected preoperatively by both conventional tympanometry and WBT by which the sensitivity and specificity were compared in the diagnosis of middle ear effusion.Result: The normative data of WBT absorbance in Chinese with normal ear over 2 years old was established. The WBT absorbance at all frequencies between children and subject over 16 years old showed no statistically significant difference except for 10 frequencies in all 31 frequencies detected. The variations in the absorbance were mainly concentrated on the frequencies ranged from 500-2 000 Hz, in patients with OME. In the frequency range of 500-2 000 Hz, the absorbance amplitudes in type N curve > type P curve > type E curve. There were significant differences in WBT absorbance at all frequencies between type N and type E between within 500-2 000 Hz.The sensitivity and specificity of WBT for middle ear effusion were 94.8% and 87.5%, respectively, which were higher than that of conventional tympanometry with 91.3% of the sensitivity and 62.5% of the specificity.Conclusion: The WBT absorbance is consistent at most of the frequencies in Chinese. The normal ear, effusion and negative pressure in the middle ear can be distinguished by WBT curve. WBT can be useful for clinical diagnosis of OME, which has a higher sensitivity and specificity than conventional tympanometry.
- wideband tympanometry /
- absorbance /
- otitis media with effusion /
- children /
- adult

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