低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用

Comparison of the low and high frequency tympanometries as diagnostic tests of middle ear function in infants

目的评价低频和高频探测音鼓室声导抗测试在诊断婴儿中耳功能异常中的作用。方法使用GSI Tympstar中耳分析仪，对年龄5—25周的听性脑干反应（auditory brainstem response，ABR）检查正常婴儿15例（30耳）和Ⅰ波潜伏期延长提示可能存在中耳功能异常婴儿17例（20耳），进行226、678、1000Hz探测音鼓室声导抗测试的比较。结果226Hz探测音鼓室声导纳图的静态声导纳值、图形、峰压和梯度在2组间的差异无统计学意义。678Hz探测音鼓室声导纳图、声纳图及声导图在2组中均可见无峰型、单峰型、双峰型、三峰型图形，其与ABR检查的一致率分别为70．0％、58．0％、64．0％，kappa值分别为0．324、0．234、0．118。1000Hz探测音鼓室声导纳图、声纳图及声导图在正常组中单峰型分别为28耳（93．3％）、25耳（83．3％）、26耳（86．7％），在异常组中无峰型分别为15耳（75％）、17耳（85％）、13耳（65％），其与ABR的一致率分别为90．0％、92．0％、86．0％，kappa值分别为0．783、0．831、0．690。结论1000Hz探测音鼓室声导抗测试是诊断小于25周婴儿中耳功能的较准确的检查方法，226、678Hz探测音鼓室声导抗测试则不能提供这些婴儿中耳功能的准确的信息。

Objective To evaluate the effect of low frequency and high frequency tympanometry in the diagnosis of middle ear function of infants. Methods Tympanometries with 226 Hz, 678 Hz and 1000 Hz probe tones were obtained from infants aged 5-25 weeks with normal ABR （15 infants, 30 ears） and those with prolonged Wave I latency suggesting middle ear dysfunction （ 17 infants, 20 ears） using GSI Tympstar middle ear analyzer. Results The type, peak pressure, peak compensated static acoustic admittance and gradient of 226 Hz tympanometry were of no significant differences between two groups. The pattern of 678Hz tympanograms for admittance,susceptance and conductance included non-peaked, single-peaked, W-shaped and three-peaked type in both groups. The consistency between auditory brainstem response （ABR） and 678Hz tympanometry for admittance ,susceptance and conductance were 70. 0%, 58.0%, 64.0% （kappa = 0. 324,0. 234,0. 118） respectively. A single peaked tympanogram was typical in normal infants for 1000 Hz admittance,susceptance and conductance tympanograms and there were 28 ears （93.3%）, 25 ears （83.3%） and 26 （86.7%） respectively. Tympanogram without any positive peak was the most characteristic for a probe frequency of 1000 Hz in infants with prolonged wave I latency and there were 15 ears （75%）, 17 ears（85%） and 13 ears （65%） respectively. For admittance, susceptance and conductance,the consistency between 1000 Hz tympanometry and ABR were 90. 0%, 92.0% and 86.0% and kappa were 0. 783,0. 831 and 0. 690, respectively. Conclusions 1000 Hz probe tone tympanometry was accurate diagnostic tests for middle ear function in infants younger than 25 weeks of age, while 226 Hz and 678 Hz probe tone tympanometries were not.