3~6岁儿童鼓膜置管术后宽频声导抗变化

Changes of 0 daPa Wideband Acoustic Immittance after Tympanic Ventilation Tube in 3~6 Years Children

目的以环境压力(0 daPa)宽频声导抗声能吸收率(wideband acoustic immittance,WAI-0 daPa)曲线的变化探索3~6岁儿童分泌性中耳炎鼓膜置管术后中耳功能变化,为判断鼓膜置管术后通风管状态提供客观依据。方法对71例121耳3~6岁儿童进行0 daPa宽频声导抗测试,其中中耳功能正常组20耳,鼓室积液组20耳,分泌性中耳炎鼓膜置管术后组81耳,并根据鼓膜置管时长和通风管状态分为0~1月组(19耳)、3月组(19耳)、6月组(17耳)、≥12月组通风管通畅(19耳)和通风管堵塞组(7耳)。共获得107个频率的WAI-0 daPa。利用Kruskal-WallisH和Nemenyi统计法,分析中耳功能状态、鼓膜置管时长、通风管状态对WAI-0daPa的影响。结果(1)鼓室积液组除226 Hz和5339 Hz外,各频率WAI-0 daPa均显著低于中耳功能正常组;鼓膜置管术后0~1月组在226~667 Hz、1000~1297 Hz处WAI-0 daPa显著高于中耳功能正常组(P<0.05);鼓室积液组除4000~5339 Hz外,余各频率WAI-0 daPa显著低于鼓膜置管术后0~1月组(P<0.05)。(2)鼓膜置管术后0~1月组500 Hz和3664 Hz处WAI-0 daPa显著高于3月组(P<0.05);在1682 Hz处WAI-0 daPa显著低于6月组(P<0.05);在2670~3364 Hz WAI-0 daPa显著高于6月组(P<0.05);在226~324 Hz和2670~4000 Hz处WAI-0 daPa显著高于≥12月组(P<0.05);在1297~1682 Hz处WAI-0 daPa显著低于≥12月组(P<0.05);3月组在5339 Hz处WAI-0 daPa显著高于≥12月组(P<0.05)。(3)鼓膜置管术后≥12月组,在226~667 Hz处WAI-0 daPa显著高于中耳功能正常组(P<0.05);在2670~5339 Hz处显著低于中耳功能正常组(P<0.05)。通风管堵塞组在226~500 Hz和1297 Hz处WAI-0 daPa显著低于≥12月组(P<0.05)。结论鼓室积液儿童WAI-0 daPa显著低于中耳功能正常儿童,鼓膜置管术可显著提高鼓室积液儿童WAI-0 daPa。0 daPa宽频声导抗检测可为判断通风管状态提供客观依据。

Objective To investigate the changes of middle ear function and the status of tympanic ventilation tube after tympanic ventilation tube in chronic otitis media in 3~6 years old children. By studying the wideband acoustic immittance(WAI-0 daPa) curve. Methods A total of 71 children(121 ears) were included with 20 ears for normal middle ear function group, 20 ears for chronic otitis media group, 19 ears for 0~1 month after tympanic ventilation tube group, 19 ears for 3-month group, 17 ears for 6-month group, 19 ears for 12-month group, 7 ears for blocking tympanic ventilation tube group. Wideband acoustic immittance test was performed and recorded at 107 frequencies between 226 to 8 000 Hz under ambient pressure(0 daPa) conditions. Kruskal-WallisH and Nemenyi analysis were used to analyze the effects of middle ear functional status, tympanic ventilation tube placement cluration, and ventilation status on WAI-0 daPa. Results(1) Except 226 Hz and 5 339 Hz, WAI-0 daPa in tympanic effusion group was significantly lower than that in normal middle ear group. WAI-0 daPa at 226~667 Hz and 1 000~1 297 Hz in 0~1 month group was significantly higher than that in the group with normal middle ear function group. Except for 4 000~5 339 Hz, WAI-0 daPa at all frequencies in tympanic effusions group was significantly lower than that in the 0~1 month group.(2) WAI-0 daPa at 500 Hz and 3 664 Hz in the 0~1 month group was significantly higher than that in the 3-month group. WAI-0 daPa at 1 682 Hz was significantly lower than that at 6 months. WAI-0 daPa in 2 670~3 364 Hz was significantly higher than that in 6 months group. At 226~324 Hz and 2 670~4 000 Hz, WAI-0 daPa was significantly higher than 12 months. WAI-0 daPa at 1 297~1 682 Hz was significantly lower than that at 12 months. WAI-0 daPa at 5 339 Hz in 3 month group was significantly higher than that in 12 month group.(3) WAI-0 daPa at 226~667 Hz in 12 month group was significantly higher in the group with normal middle ear function. At 2 670~5 339 Hz, it was significantly lower than that of normal middle ear function group. At 226~500 Hz and 1 297 Hz, the WAI-0 daPa in blocking tympanic ventilation tube group was significantly lower than that in the 12 months group. Conclusion WAI-0 daPa in chronic otitis media children was significantly lower than normal middle ear function children. The tympanic ventilation tube significantly increase WAI-0 daPa in chronic otitis media children. Using WAI-0 daPa can provide objective reference for status of tympanic ventilation tube.