摘要
目的探讨探测音频率及声导纳值测量方法对1~6月龄婴儿分泌性中耳炎诊断的价值。方法筛选1~6月龄正常婴儿71人(正常组142耳)、分泌性中耳炎患儿54人(中耳炎组90耳)(颞骨薄层CT证实),采用GSl2000Tympstar2型中耳分析仪分别对两组对象进行226、1000Hz探测音鼓室声导纳检测,并用Linder/Jerger法、Baldwin法、基线法测量1000Hz探测音鼓室声导纳,采用ROC曲线下面积(A)比较的方法分析四种方法对婴儿中耳炎的诊断准确性,取值范围:0≤A≤1,A〉0.5,且越接近1,诊断准确性越高;A—0.5,无诊断意义;A〈0.5则不符合实际情况。结果1~3月龄组的226Hz探测音鼓室声导纳值以及Linder/Jerger法、Baldwin法、基线法测得的1000Hz探测音鼓室声导纳值正常组分别为0.83±0.29、0.60±0.55、0.74±0.56、0.90±0.59mmho,中耳炎组分别为0.82±0.35、0.01±0.06、-0.24±0.15、~0.29±0.21mmho,ROC曲线下面积(正常组与中耳炎组同时检测,下同)分别为0.507、0.896、0.976、0.988。4~6月龄组四种方法测得鼓室声导纳值正常组分别为0.60±0.35、0.55±0.58、0.76±1.0、0.86却.72mmho,中耳炎组分别为0.36±0.24、0±0、-0.34±0.16、-0.44±0.28mmho;ROC曲线下面积分别为0.749、0.888、0.969、0.988。1000Hz探测音鼓室声导纳的ROE曲线下面积在两个年龄组均大于226Hz探测音鼓室声导纳值(P〈O.05);基线法测得1~3月龄组的1000Hz探测音鼓室声导纳的ROC曲线下面积大于其他三种方法(P〈0.05)。基线法测得4~6月龄组的1000Hz探测音鼓室声导纳的ROC曲线下面积大于其他三种方法,但与Baldwin法比较差异无统计学意义(P〉0.05)。结论1000Hz探测音声导纳对于1~6月龄分泌性中耳炎患儿的诊断意义高于226Hz探测音声导纳;1000Hz探测音鼓室声导纳的测量方法以基线法较为合适。
Objective To explore the effects of different probe tone and tympanometric admittance measurement methods on the diagnose of otitis media prediction,and to provide a clinical reference for the selection of probe tones and measurement method to apply to newborn infants. Methods Tympanograms with 226 Hz and 1 000 Hz probe tones were obtained from normal infants (142 ears) and infants with otitis media (90 ears) . Mean values, standard deviations, the 90% range and 95% mean confidence interval were recorded as the variable to observe po- tential impacts on tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods respectively according to Linder/Jerger classification, the Baldwin classification and baseline classification adapted from Baldwin. The four indexes were tested with compara- tive analysis. The area under ROC curve simultaneous detects the normal group and otitis media group, with refer- ences to the accuracy of the detection method to disease (including specificity and sensitivity). Results In 1--to--3month group,tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 0.83±0.29,0.60±0.55,0.74±0.56,0.90±0.59 in nomal infants and 0. 82±-0. 35,0. 01±0. 06,-0. 24±0.15,-0. 29±0. 21 in infants with OME,respectively. The areas under ROC curve of the four kinds of measurement methods were 0. 507,0. 896,0. 976,0. 988, respectively. In 4 to 6 month group, tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 01 60±0.35,0.55± 0.58,0.76 ±1.0,0.86±0.72 in nomal infants and 0.36±0.24,0.36±0.34±0. 16,-0.44 ±0.28 in infants with OME,respectively. The areas under ROC curve of the four kinds of measurement methods were 0. 749,0. 888,0. 969,0. 988 in 4 to 6 month infants,respectively. Tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were significantly better than that with 226 Hz probe tone. The areas under ROC curve of tympanometric peak admittance with 1 000 Hz probe tone by baseline classification adapted from Baldwin were bigger than others and the differences were significant(P〈0.05),but no difference between the Baldwin classification and baseline classification in 4 to 6 month infants(P〉0.05). Conclusion Tympanometric peak admittance with 1 000 Hz probe tone were better than that with 226 Hz probe tone to assess otitis media in 1-6 month infants. The baseline classification adapted from Baldwin was appropriate for the measurement of tympanometric peak admittance with 1 000 Hz probe tone.
出处
《听力学及言语疾病杂志》
CAS
CSCD
北大核心
2013年第6期585-590,共6页
Journal of Audiology and Speech Pathology