婴幼儿中耳异常分析

Analysis of abnormality of the middle ear in infant and young children

目的分析婴幼儿听力学测试和（或）颞骨薄层CT提示中耳异常的病例，探讨婴幼儿中耳异常的听力学和医学诊断。方法回顾性分析2005年12月至2008年6月在本院儿童听力诊断中心就诊的31例2个月到2岁6个月婴幼儿中耳异常病例的临床资料，比较了听力学和颞骨薄层CT检查的结果。结果ABR测试31例（62耳）中38耳表现了Ⅰ波潜伏期延迟，其中双耳延迟13例，单耳延迟12例；15耳ABR没有表现I波潜伏期延迟，但其中6耳CT显示中耳乳突有高密度影；9耳未引出Ⅰ波。16例完成鼓室导抗图测试，异常17耳，表现为11个月以下1000Hz导抗图无正峰，12个月以上226Hz导抗图B型或C型。15例ABR测试和（或）鼓室导抗图测试提示中耳病变者行CT检查，鼓室乳突有高密度影双侧12例，单侧3例。ABRⅠ波延迟，同时CT鼓室乳突有高密度影13耳，ABRⅠ波潜伏期正常，而CT鼓室乳突有高密度影的4耳。没有ABRⅠ波潜伏期延迟而CT无改变者，但ABR、鼓室导抗图和CT间存在不一致现象。结论婴幼儿声导抗测试和ABRⅠ波潜伏期检查可以检出绝大部分的中耳异常，但仍不能完全反映婴幼儿中耳状况，婴幼儿中耳异常诊治中存在着困惑，有待深入研究。

Objective To discuss the diagnosis of middle ear abnormity in infants and young children. Methods To analyze retrospectively the data of audiology （including ABR, tympanometry） and CT scanning in 31 infants and young children who presented middle ear abnormity. Results Wave Ⅰ latencies of ABR were delayed in 38 of 62 ears and not delayed in 15 ears, but CT scanning showed high density in 6 ears of these 15 ears. Wave Ⅰ could not be elicited in 9 ears. Tympanometries were tested in 16 cases and were abnormal in 17 ears. CT scanning was carried out in 15 cases who＇s ABR and tympanometries showed abnormal. High signal intensity was present in mastoids and middle ear cavities in both ears of 12 cases and unilateral ear of 3 cases. Wave Ⅰ latency of ABR was delayed and High signal intensity was present in mastoids and middle ear cavities in CT scanning of 13 ears. Wave Ⅰ latency of ABR was normal, but high signal intensity was present in mastoids and middle ear cavities in CT scanning of 4 ears, there was no any ear which Wave Ⅰ latency was delayed but CT scanning was normal. And disaccord among ABR, Tympanometry and CT scanning were showed. A typical case was reported. Condusions The most abnormity of the middle ear could be found used the tympanometry and Ⅰ latency of ABR in infant and young children, but still there were some abnormity of the middle ear could not be showed. Some quandaries were existed and more sensitivity tests were needed in the diagnosis of abnormity in middle ears of infant and young children.