正常新生儿宽频声导抗能量吸收率及其可重复性研究

Test-Retest Reliability of the Wideband Absorbance in Mormal Hearing Neonates

郝文洋;商莹莹;倪道凤;高志强;徐春晓;李奉蓉;赵翠霞;王素菊;

1:中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科

摘要
目的探讨正常新生儿中耳宽频声导抗(wideband acoustic immittance,WAI)能量吸收率及其相关的影响因素,评价宽频声导抗测试的可重复性。方法选取通过瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)听力初筛的正常新生儿124例(193耳),在其出生4872小时进行WAI测试,分析不同频率能量吸收率的变化规律、两次测试的重复性及外耳道处于不同压力、性别、侧别、分娩方式对WAI能量吸收率的影响。结果正常新生儿宽频声导抗能量吸收率随频率增大呈"两峰两谷"形态,即在低频及3 363 Hz附近较低、在1 296Hz附近及高频较高;两次测试的重复性显示外耳道处于峰压时,1 000Hz和2 000Hz两次测试差值的绝对值较外耳道压力处于0daPa时小,且差异有统计学意义(P<0.05),而其余各频率差异无统计学意义(P>0.05)。外耳道压力处于0daPa时与峰压时相比,除1 000、6 727Hz外,其余各频率WAI能量吸收率的差异均有统计学意义(P<0.05);不同性别、侧别、分娩方式的新生儿WAI能量吸收率差异无统计学意义(P>0.05)。结论正常新生儿外耳道处于峰压时,两次WAI测试的重复性较好;外耳道处于不同压力对大部分频率WAI能量吸收率有一定影响;性别、侧别、分娩方式对WAI能量吸收率无明显影响。
关键词
新生儿;宽频声导抗;能量吸收率
基金项目(Foundation):
公益性卫生行业科研专项项目(201202005);; 国家科技部“十二·五”支撑项目(2012BAI12B00);; 国家临床重点专科基金资助
作者
郝文洋;商莹莹;倪道凤;高志强;徐春晓;李奉蓉;赵翠霞;王素菊;
参考文献

1黄孟捷,郑芸,王恺.宽频声导抗测试[J].临床耳鼻咽喉头颈外科杂志,2010,24:620.

2 Keefe DH,Folsom RC,Gorga MP,et al.Identification of neonatal hearing impairment Ear-canal measurements of acoustic admittance and reflectance in neonates[J].Ear Hear,2000,21:443.

3 Sanford CA,Keefe DH,Liu YW,et al.Sound-conduction effects on distortion-product otoacoustic emission screening outcomes in newborn infants:Test performance of wideband acoustic transfer functions and 1-kHz tympanometry[J].Ear Hear,2009,30:635.

4 中华医学会耳鼻咽喉头颈外科学分会听力学组,中华耳鼻咽喉头颈外科杂志编辑委员会.新生儿及婴幼儿早期听力检测及干预指南(草案)[J].中华耳鼻咽喉头颈外科杂志,2009,44:883.

5 Palva T,Northrop C,Ramsay H.Spread of amniotic fluid cellular content within the neonate middle ear[J].Int J Pediatr Otorhinolaryngol,1999,48:143.

6 韩德民,许时昂.听力学基础与临床[M].北京:科学技术文献出版社,2004.366~388.

7 Kei J,Sanford CA,Prieve BA,et al.Wideband acoustic immittance measures:developmental characteristics(0to 12months)[J].Ear and Hearing,2013,34:17.

8 Baldwin M.Choice of probe tone and classification of trace patterns in tympanometry undertaken in early infancy[J].International Journal of Audiology,2006,45:417.

9 Hunter LL,Schlauch RS.Safety and clinical performance of acoustic reflex tests[J].Ear Hear,1999,20:506.

10 韩德民,莫玲燕,卢伟,等.临床听力学[M].北京:人民卫生出版社,2006.141~149.

11 黄孟捷,郑芸,王恺.正常成人宽频声导抗能量反射的初步研究[J].听力学及言语疾病杂志,2010,18:433.

12 倪道凤.关注分泌性中耳炎的诊治研究[J].中华耳鼻咽喉头颈外科杂志,2008,43:881.

13 Hunter LL,Prieve BA,Kei J,et al.Pediatric applications of wideband acoustic immittance measures[J].Ear and Hearing,2013,34:36.

14 Sanford CA,Feeney MP.Effects of maturation on tympanometric wideband acoustic transfer functions in human infants[J].J Acoust Soc Am,2008,124:2106.

15 Shahnaz N,Feeney MP,Schairer KS.Wideband acoustic immittance normative data:ethnicity,gender,aging,and instrumentation[J].Ear and Hearing,2013,34:27.

16 商莹莹,倪道凤,刘世琳.低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用[J].中华耳鼻咽喉头颈外科杂志,2006,41:326.

17 雷一波,卢伟,莫玲燕.外中耳正常汉族婴幼儿宽频声导抗能量反射值的观察[J].中华耳鼻咽喉头颈外科杂志,2014,49:1.

18 Keefe DH,Bulen JC,Arehart KH,et al.Ear canal impedance and reflection coefficient in human infants and adults[J].J Acoust Soc Am,1993,94:2617.

19 Smolkin T,Mick O,Dabbah M,et al.Birth by cesarean delivery and failure on first otoacoustic emissions hearing test[J].Official Journal of the American Academy of Pediatrics,2012,130:e95.