耳硬化症和中耳畸形患者的宽频声导抗研究

Wideband Acoustic Immittance in Otosclerosis and Middle Ear Malformation

目的探讨宽频声导抗测试对耳硬化症和中耳畸形辅助诊断中的应用价值。方法收集耳硬化症组45耳,先天性中耳畸形组13耳,另有正常组76耳作为对照,所有受试者均行宽频声导抗测试,对各组峰压下的声能吸收率进行分析比较。结果峰压下,耳硬化症组的声能吸收率在917/972~1029/1091~1297/1456/1731/2059~3462/4000~5339Hz比正常组的显著减小(P<0.05)。耳硬化症患者在1kHz以下较正常组无异常切迹。峰压下,先天性中耳畸形组的声能吸收率在408~749/7336~7772Hz比正常组的显著增大(P<0.05),在1059~1224/1297/1414~1456/4000~4490Hz比正常组的显著减小(P<0.05)。69%(9/13)的先天性中耳畸形患者在1kHz以下有一切迹。结论声能吸收率鼓室图在1kHz以下出现切迹提示患者存在镫骨畸形合并锤骨和/或砧骨畸形。仅镫骨固定患者1kHz以下无切迹。宽频声导抗对于术前评估耳硬化症和中耳畸形患者中耳听骨链情况具有现实意义,可作为辅助耳硬化症和中耳畸形诊断的听力学检查之一。

Objective To report the use of wideband acoustic immittance in diagnosing otosclerosis and congenital middle ear malformation.Methods We compared wideband acoustic energy absorbance under peak pressure in healthy volunteers(control,76 ears),in patients with otosclerosis(45 ears)and in patients with congenital middle ear malformation(13 ears).Results Acoustic energy absorbance was significantly different between the control and otosclerosis groups at 917/972-1029/1091-1297/1456/1731/2059-3462/4000~5339 Hz(P<0.05).Acoustic energy absorbance tympanometry in ears with otosclerosis did not show a notch below 1 kHz.Acoustic energy absorbance was significantly different between the control and congenital middle ear malformation groups at 408-749/7336-7772 Hz and 1059-1224/1297/1414-1456/4000-4490 Hz(P<0.05).Nine patients with congenital middle ear malformation(69%)showed a notch below 1 kHz.Conclusion A notch below 1 kHz in energy absorbance tympanometry suggests potentially abnormal incus,malleus or stapes,while ears with fixed stapes tend not to show a notch below 1 kHz.Wideband acoustic immittance may facilitate preoperative assessment of the ossicular chain in ears with otosclerosis or congenital middle ear malformations,and can be a useful audiological examination to evaluate middle ear anatomy.