不同声阻抗试验对积液型分泌性中耳炎临床应用

Comparation of the clinical value and the differential diagnostic of otitis media with effusion between 226 Hz, 1000 Hz acoustic immittance and wideband immittance

目的对比分析226、1000Hz声导抗和宽频声导抗(wideband immittance,WBI)在积液型分泌性中耳炎(OME)鉴别诊断中的临床应用价值,探讨WBI的临床应用价值。方法检测中耳功能正常者12例(24耳)和2017年9月~2018年3月我科经耳内镜下鼓膜穿刺确诊为积液型OME患者64例(95耳),单侧33例(33耳),双侧31例(62耳)的226 Hz声导抗、1000 Hz声导抗和WBI检查,分析积液型OME在三种声导抗的敏感度、特异度和准确度。采用独立样本t检验分析中耳功能正常者和积液型OME患者,WBI在外耳道压力为0 da Pa和峰压值时9个频率的能量吸收率。结果①外耳道压力为0 da Pa和峰压值时,中耳功能正常者与积液型OME患者的能量吸收率在667、1000、1681、2669、3363、5339和8000 Hz比较,差异均有统计学意义(P<0.05),在226和408 Hz频率比较,无统计学意义(P>0.05);②对于积液型OM E诊断而言,226H z声导抗敏感度87.30%,特异度40.63%,准确度71.58%;1000Hz声导抗敏感度93.65%,特异度37.50%,准确度74.74%;WBI敏感度98.41%,特异度96.88%,准确度97.89%;③WBI敏感度、特异度和准确度最佳,1000 Hz声导抗敏感度和准确度优于226 Hz声导抗检查,226 Hz声导抗特异度优于1000 Hz声导抗检查。结论相较于226和1000 Hz声导抗检查,WBI检查在积液型OME的鉴别诊断中具有较高临床应用价值。

OBJECTIVE To compare the clinical value of 226 Hz acoustic immittance, 1000 Hz acoustic immittance and wideband and immittance on differential diagnosis of otitis media with effusion, andto investigate the clinical value of wideband immittance. METHODS 12 controls(24 ears) and 64 patients(95 ears) with otitis media with effusion, which has 33 patients on one side(33 ears) and 31 patients on both sides(62 ears) were examined for 226 Hz, 1000 Hz acoustic immittance and wideband immittance. All the patients with otitis media with effusion were examined by tympanocentes using endoscope, the sensitivity, specificity and accuracyof 226 Hz, 1000 Hz acoustic immittance and 226-8000 Hz wideb and immittance were analysed, the energy absorbance of the wideband immittance at 9 frequencies were also analysed by independent samples T Testbetween controls and the patients with otitis media with effusion when the pressure of external acoustic meatus was 0 da Pa and peak pressure. RESULTS 1. When the pressure of external acoustic meatus was 0 da Pa and peak pressure, there were significant differences in energy absorbance between controls and the patients with otitis media with effusion at 667, 1000, 1681, 2669, 3363, 5339 and 8000 Hz(P<0.05), but there was no significant difference at 226 and 408 Hz(P>0.05). 2. For the diagnosis of otitis media with effusion, the sensitivity, specificity and accuracy of 226 Hz acoustic immittance were 87.30%, 40.63%, 71.58%;the sensitivity, specificity and accuracy of 1000 Hz acoustic immittance were 93.65%, 37.50%, 74.74%;the sensitivity, specificity and accuracy of wideband immittance were 98.41%, 96.88%, 97.89%. 3. Wideband immittance has the best sensitivity, specificity and accuracy;the sensitivity, specificity of 1000 Hz acoustic immittance is better than 226 Hz;whereas the accuracy of 226 Hz acoustic immittance is better than 1000 Hz. CONCLUSION Compared with 226 Hz and 1000 Hz acoustic immittance, wideband immittance has higher clinical value on differential diagnosis of otitis media with effusion.