检测婴儿中耳炎的听力学方法敏感性比较  

Comparison of sensitivity of audiological tests to identify otitis media with effusion in newborn infants

作　　者：黄丽辉[1] 马潇然[1] 王硕[1] 鲜军舫[1] 莫玲燕[1] 刘辉[1] 唐向荣[1] 杨宜林[1] 唐小青[1] 郭连生[1] 韩德民[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科北京市耳鼻咽喉科研究所耳鼻咽喉头颈科学教育部重点实验室,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2008年第12期886-890,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家“十五”科技攻关项目（2004BA720A18-02）;国家“十一五”科技支撑计划（2007BAI18B12）

摘　　要：目的探讨常规听力学检查中婴儿中耳炎诊断相关的的敏感因素。方法研究对象为听力筛查未通过的婴儿48例（96耳），男31例，女17例；年龄1．5—12个月（平均4．3个月）。所有受试者均接受了颞骨CT薄层扫描和常规听力学测试。听力学检查包括气导和骨导听性脑干反应（ABR）、40Hz-听觉相关电位（40Hz-auditory event related potential，40Hz—AERP）、畸变产物耳声发射（DPOAE）、声反射及226Hz、1000Hz探测音鼓室声导抗。统计软件采用SPSS14．0标准统计软件包。以颞骨CT结果作为诊断的依据，与以下9项因素进行Kappa一致性检验、单因素Х^2检验和多因素Logistic回归分析。分析因素包括：226Hz及1000Hz探测音鼓室声导抗、ABR气导反应阈值、ABR骨气导反应阈值差值、ABRI波潜伏期、ABRⅠ～Ⅴ波间期、40Hz-AERP反应阈值、DPOAE反应幅值及声反射阈值。结果96耳中，CT确诊中耳炎77耳，中耳正常19耳。以颞骨CT扫描结果作为金标准，Kappa一致性检验表明，1000Hz鼓室声导抗测试、ABR气导反应阈值、ABRI波潜伏期、40Hz—AERP反应阈值和DPOAE与颞骨CT具有较好一致性（Kappa值均〉0．04，P值均〈0．001）。单因素分析提示，有7个因素与婴儿中耳功能有关（P值均〈0．001）：1000Hz探测音鼓室声导抗、声反射阈值、ABR气导反应阈值、ABR气骨导反应阈值差值、ABRI波潜伏期、40Hz—AERP反应阈值和DPOAE。Logistic回归分析显示，1000Hz探测音鼓室声导抗（P〈0．001）和40Hz—AERP反应阈值（P=0．004）可以列入Logistic回归方程。结论1000Hz鼓室声导抗可作为婴儿中耳炎检出的敏感因素，ABR气导反应阈值、ABRI波潜伏期、40Hz-AERP反应阈值和DPOAE可较好地反映婴儿的中耳功能。Objective To investigate the sensitive factors which were used in routine audiological tests to find out otitis media with effusion （OME） in newborn infants. Methods Subjects of this study were 48 infants,including 31 males and 17 females, who failed in the universal newborn heating screening. The age ranged from 1.5 to 12 months with the average age of 4. 3 months. All subjects accepted temporal bone CT and routine audiological assessments, including air-conduction and bone-conduction auditory brainstem response（ABR）, 40 Hz-auditory event related potential （40 Hz-AERP）, distortion-product otoacoustic emission （DPOAE）, acoustic reflex, tympanometties using 226 Hz and 1000 Hz probe tone. Nine factors were statistically analyzed using Kappa test, Univatiate Х^2 test and multivariate condition Logistic stepwise regression analysis, which included the results of acoustic immitanee, the air-conduction and bone- conduction ABR thresholds,the difference between air-conduction and bone-conduction ABR thresholds, the latency of ABR wave Ⅰ , duration between ABR wave Ⅰ and Ⅴ, 40 Hz-AERP thresholds, amplitudes and thresholds of DPOAE, and acoustic reflex thresholds （ ART）. Results Seventy-seven ears were diagnosed with OME, and 19 ears were normal. CT scan of temporal bone was set as a comparative standard. Kappa test indicated that the results of tympanometry with 1000 Hz probe tone （ Kappa = 0. 745, P 〈 0. 001 ）, the air-conduction ABR threshold（ Kappa = 0. 453 ,P 〈 0. 001 ）, the latency of ABR wave Ⅰ （ Kappa = 0. 430, P 〈 0. 001 ）, the threshold of 40 Hz-AERP （ Kappa = 0. 582, P 〈 0. 001 ）, and DPOAE （ Kappa = 0. 495, P 〈 0. 001 ） had agreement with the results of temporal bone CT on evaluating the function of middle ear. Univariate analysis indicated that sensitive factors of middle ear function in newborn infants were tympanometry with 1000 Hz probe tone （P 〈 0. 001 ）, ART （P 〈 0. 001 ）, the air-conduction ABR threshold （P 〈0. 001 ）, the diffe

关 键 词：中耳炎 伴渗出液 婴儿 声阻抗试验 诱发电位 听觉 脑干 体层摄影术  X线计算机 

分 类 号：R686[医药卫生—骨科学]