Analysis of wideband acoustic immittance measurements in patients with unilateral Ménière's disease
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摘要: 目的 分析单侧梅尼埃病(Ménière's disease，MD)患者宽频声导抗(wideband acoustic immittance，WAI)测试参数特征，探讨其临床应用价值。方法 纳入30例眩晕发作间歇期的单侧MD患者(症状耳及非症状耳各30耳)及26例健康者(52耳)行WAI测试，分析与声能吸收率(energy absorbance，EA)相关的多个参数，包括吸收率鼓室图双峰起始频率、共振频率、峰压下EA峰值及EA相对面积、峰压下全频域EA。结果 ① 单侧MD症状耳组、非症状耳组中存在双峰EA鼓室图的均为27耳(84.4%)，对照组38耳(70.4%)，且三组间双峰起始频率差异均无统计学意义(P>0.05)；②MD症状耳组共振频率显著低于MD非症状耳组(t=-3.544，P=0.001)及对照组(t=2.084，P=0.041)，差异有统计学意义；共振频率于MD非症状耳组和对照组间差异无统计学意义(P>0.05)；③MD症状耳组及非症状耳组峰压下EA峰值均显著低于对照组(t=4.240，P < 0.001及t=4.202，P < 0.001)；④MD症状耳组及非症状耳组峰压下EA相对面积显著低于对照组(t=3.295，P=0.001及t=3.193，P=0.003)；⑤3组峰压下EA曲线比较：MD症状耳组在1 059~2 911 Hz的峰压下EA均低于对照组(P < 0.05)；MD症状耳组在1 000 Hz以内和1 834~2 119 Hz内的EA均低于MD非症状耳组(P < 0.05)；MD非症状耳组515~2 748 Hz内的EA均低于对照组(P < 0.05)。结论 单侧MD患者患耳的多个EA相关参数与正常人和(或)健耳比较存在差异，提示其可能与内淋巴积水导致的中耳机械功能改变有关，但WAI各参数在该疾病中的临床意义尚需深入探讨。Abstract: Objective To investigate the characteristics of wideband acoustic immittance(WAI) measurements in patients with unilateral Ménière's disease(MD) and evaluate the clinical value of WAI in diagnosis of MD.Methods WAI was performed in 30 patients with unilateral MD(30 ears for symptomatic and 30 ears for asymptomatic) and in 26 healthy individuals(52 ears)(control group). The WAI measurements, including the frequency first appearing two peaks in energy absorbance(EA) tympanogram, resonance frequency(RF), the peak value of absorbance(PVA), the integral area of absorbance(IAA), EA curve at peak pressure, were analyzed.Results ① The occurrence of two peaks in EA tympanogram in both the MD symptomatic and asymptomatic ear was observed in 27 ears(84.4%), and 38 ears(70.4%) in the control group, with no significant difference in the frequency of first appearing in two peaks onset between the groups(all P>0.05). ②The RF of the MD symptomatic ears was significantly lower than that of the asymptomatic ears(t=-3.544, P=0.001) and that of the control subjects(t=2.084, P=0.041); there was no difference of RF between the MD asymptomatic ears and the control group(P>0.05). ③The PVA were significantly lower in both MD symptomatic(t=4.240, P < 0.01) and asymptomatic ears(t=4.202, P=0.001) than in controls. ④The IAA in MD symptomatic(t=3.295, P=0.001) and asymptomatic ears(t=3.193, P=0.003) was significantly lower than in the control group. ⑤Comparison of the EA curve at peak pressure of the three groups: the EAs of MD symptomatic ears were lower than those of the control group at the range of 1 059-2 911 Hz(all P < 0.05); the EAs of MD symptomatic ears were lower than those of MD asymptomatic ears within 1 000 Hz and 1 834-2 119 Hz(all P < 0.05); the EAs of MD asymptomatic ears were lower than those of the control group at the range of 515-2 748 Hz(all P < 0.05).Conclusion Symptomatic ears in unilateral MD patients show alterations in some WAI measurements compared to asymptomatic ears and/or controls, suggesting that middle ear mechanical fuction of the affected side may be modified due to the endolymphatic hydrops. The clinical significance of WAI needs to be further explored in the context of evaluating MD.
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表 1 单侧MD患者与对照组EA鼓室图双峰起始频率
X±S 组别 耳数 双峰起始频率/Hz MD症状耳组 27 1 868.52±106.48 MD非症状耳组 27 2 016.67±83.66 对照组 38 2 282.20±134.70 
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表 2 单侧MD患者与对照组共振频率、峰值压力下EA峰值及相对面积
X±S 组别 耳数 共振频率/Hz EA峰值/% EA相对面积/% MD症状耳组 30 848.40±164.39 77.48±11.26 46.35±6.68 MD非症状耳组 30 952.20±186.39 76.82±12.36 45.70±7.75 对照组 52 936.23±213.26 87.49±8.39 50.81±5.41
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