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摘要: 目的 探讨声导抗与咽鼓管评分(ETS)得分在咽鼓管功能测试中的相关性。方法 研究对象为107例鼓膜紧张部穿孔慢性化脓性中耳炎患者，共计124耳，均进行声导抗正压平衡法和ETS检测。根据声导抗正压平衡测试结果将开放压100~200 daPa的耳赋值2，开放压200~300 daPa耳赋值3，开放压300~400 daPa的耳赋值4，大于400 daPa咽鼓管未开放吞咽后咽鼓管开放的耳赋值5，最大压力未开放通过反复吞咽仍未开放的耳赋值6。声导抗咽鼓管功能测试得分与ETS、咽鼓管测压(TMM)及ETS主观部分得分进行统计学分析。结果 124耳中，无开放压在100 daPa以下，开放压在100~200 daPa占8.1%(10/124)，开放压在200~300 daPa占12.9%(16/124)，开放压在300~400 daPa占37.1%(46/124)，400 daPa未开放吞咽后咽鼓管开放占15.3%(19/124)，400 daPa以上咽鼓管未开放通过反复吞咽仍未开放的占26.6%(33/124)。声导抗咽鼓管功能测试得分与ETS、TMM及ETS主观部分得分关联性差异均有统计学意义(P < 0.05)，其中声导抗结果得分与ETS(r=-0.439)、TMM(r=-0.425)呈中等程度负相关，与ETS主观部分呈弱的负相关(r=-0.249)。将声导抗法得分2~5分(即所有声导抗测试法中咽鼓管能开放的患耳)定义为正常组，得分6分定义为异常组。声导抗正常组与异常组的ETS、TMM、ETS主观得分差异有统计学意义。以声导抗赋值得分进行分组，与ETS的结果(< 5为异常)进行一致性比较，其结果的一致性差(Kappa值均为负值)，结果差异有统计学意义(P < 0.05)。结论 声导抗正压平衡法开放压的大小是ETS、TMM及ETS主观得分的较好的预测指标，开放压越小，ETS、TMM及ETS主观得分均可能越好。两种方法的结果一致性差，需要更多考虑中耳情况，声导抗正压平衡法的开放压、平衡压及两者差值可能会得到更好的结果。Abstract: Objective To investigate the correlation between acoustic immittance and eustachian tube score(ETS) in eustachian tube function test.Methods 124 ears eustachian tube function with tympanic tension perforation of 107 patients with chronic suppurative otitis media were measured by acoustic immittance positive pressure balance method and ETS. According to the positive pressure balance test results of acoustic immittance, the ear eustachian tube open pressure between 100 and 200 daPa is assigned 2, the ear with open pressure between 200 and 300 daPa is assigned 3, the ear with open pressure betwween 300 and 400 daPa is assigned 4, the ear open pressure is greater than 400 daPa but eustachian tube open after swallowing is assigned 5, and the ear which eustachian tube open pressure is greater than 400 daPa and cannot open after swallowing is assigned 6. Then compare the results.Results In the acoustic immittance test, there was no ears whose eustachian tube opening pressure less than 100 daPa, 10 ears(8.1%) open pressure between 100 and 200 daPa, 16 ears(12.9%) open pressure between 200 and 300 daPa, 46 ears(37.1%) open pressure between 300 and 400 daPa, 19 ears(15.3%) whose eustachian tube don't open pressure at 400 daPa but open after swallowing, and the cumulative percentage of the above was 73.4%. There were 33 ears(26.6%) whose eustachian tubes not opening after receiving maximum pressure(400 daPa) and repeated swallowing. The score of acoustic immittance eustachian tube function test was significantly correlated with the scores of ETS, eustachian tube manometry(TMM) and subjective part of ETS(P < 0.05). The result of acoustic immittance was moderately negatively correlated with ETS(r=-0.439) and TMM(r=-0.425), and weakly negatively correlated with subjective part of ETS(r=-0.249). The scores of 2-5 points (the affected ears with open eustachian tube in all acoustic impedance test methods) were defined as the normal group, and the scores of 6 point were defined as the abnormal group. The results of acoustic immittance between the normal group and the abnormal group showed that there were significant differences with the subjective scores of ETS, TMM and ETS. The consistency compared the results of acoustic immittance eustachian tube test with the results of ETS was poor(kappa value was negative), and the difference was statistically significant.Conclusion The open pressure of acoustic immittance positive pressure balance method is a good predictor of the subjective scores of ETS, TMM and ETS. The smaller the open pressure is, the better the subjective scores of ETS, TMM and ETS may be. This two methods results are inconsistent and cannot be replaced. More consideration should be given to the middle ear. The open pressure, equilibrium pressure and the difference between them need to be paid attention to at the same time.
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表 1 声导抗开放压得分与ETS结果得分的Spearman相关分析
Spearman秩相关 ETS TMM ETS主观得分 AI分值 相关系数(r) -0.439 -0.425 -0.249 P值 < 0.001 < 0.001 0.005 
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表 2 声导抗结果正常与异常组的ETS、TMM、ETS主观得分的秩和检验
M(P25，P75) 声导抗 差值中位数(95% CI) Wilcoxon 两样本秩和检验 正常 异常 Z值 P值 ETS 6(4，8) 2(0，5) 3(2，4) 5.09 < 0.001 TMM 4(3，6) 1(0，3) 3(2，4) 5.29 < 0.001 ETS主观得分 2(0，3) 0(0，2) 1(0，2) 2.38 0.017 注：M代表中位数，P25代表下四分位数，P75代表上四分位数。
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表 3 声导抗与ETS结果的一致性检验
声导抗不同分组方法 ETS(< 5为异常；≥5为正常) 一致性检验 正常 异常 合计 一致率/% Kappa值 P值(χ2检验) ≤2 正常 9 1 10 46.77 -0.117 < 0.001 > 2 异常 65 49 114 合计 74 50 124 ≤3 正常 21 5 26 53.23 -0.199 0.004 > 3 异常 53 45 98 合计 74 50 124 ≤5 正常 64 27 91 70.16 -0.287 < 0.001 > 5 异常 10 23 33 合计 74 50 124
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| 引用本文: |
杨亚利, 王士杰, 韩曙光, 等. 声导抗及咽鼓管评分在咽鼓管功能测试中的相关性研究[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(8): 587-591. doi: 10.13201/j.issn.2096-7993.2022.08.004
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| Citation: |
YANG Yali, WANG Shijie, HAN Shuguang, et al. Correlation between acoustic immittance and TMM in eustachian tube function test[J]. J Clin Otorhinolaryngol Head Neck Surg, 2022, 36(8): 587-591. doi: 10.13201/j.issn.2096-7993.2022.08.004
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