低龄儿童分泌性中耳炎宽频声导抗特点及临床意义  

Characteristics and clinical significance of wideband tympanometry of otitis media with effusion in young children

作　　者：盛海斌[1,2,3] 周嵌 李海峰 任燕 韩琨 黄美萍 陈颖[1,2,3] 李孛[1,2,3] 李蕴 黄治物[1,2,3] Sheng Haibin;Zhou Qian;Li Haifeng;Ren Yan;Han Kun;Huang Meiping;Chen Ying;Li Bei;Li Yun;Huang Zhiwu(Department of Otorhinolaryngology Head and Neck Surgery,Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China;Ear Institute,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科,200011 [2]上海交通大学医学院耳科学研究所,200092 [3]上海市耳鼻疾病转化医学重点实验室,200092

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第6期579-585,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析低龄儿童分泌性中耳炎(OME)宽频声导抗(wideband tympanometry,WBT)声能吸收率(energy absorbance,EA)特点,探讨其在低龄儿童OME诊断中的应用价值。方法2018年1月至2020年6月在上海交通大学医学院附属第九人民医院诊断为OME且有完整WBT测试结果的95例(190耳)低龄患儿作为研究对象,其中男52例(104耳),女43例(86耳),年龄1~72月龄。另选取61名(121耳)行WBT测试且听力正常儿童作为对照组,其中男41名(81耳),女20名(40耳),年龄1~72月龄。两组儿童均按照月龄分为1~6月龄、7~36月龄和37~72月龄三个年龄段。应用SPSS 20.0统计软件分析比较不同月龄OME患儿和对照组儿童在WBT峰压下的EA参数特点,运用接受者操作特征(receiver operating characteristic,ROC)曲线分析WBT对OME的诊断价值。结果OME患儿500~2000 Hz的EA在不同月龄组间存在明显差异(P<0.05);与对照组相比,1~6月龄组OME患儿峰压下EA在4000 Hz以下频率明显下降(P<0.05),7~36月龄组OME患儿峰压下EA在545~1600 Hz频率显著低于对照组(P<0.05),37~72月龄组OME患儿峰压下EA在545 Hz以上频率明显下降(P<0.05)。OME组总体特征:ROC曲线显示EA在1000 Hz处诊断价值最高,曲线下面积(area under the curve,AUC)为0.890,其次为1500 Hz以及500~2000 Hz(AUC分别为0.883和0.881)。运用约登指数(Youden index)计算出截断值为0.56的1000 Hz处EA具有最佳的OME诊断敏感性(90.8%),高于传统单频声导抗诊断OME的敏感性(85.8%)。组合使用WBT的EA、峰压值以及226 Hz声导抗声顺值作为预测因子,可以获得最大的AUC(0.932)。结论OME患儿WBT的EA与听力正常儿童相比显著降低。与传统单频声导抗相比,WBT对低龄儿童OME的预测更为准确,且与226 Hz声导抗联合应用时,预测准确率更高。Objective To study the characteristics of wideband tympanometry(WBT)and its application value in the diagnosis of otitis media with effusion(OME)in young children.Methods We compared wideband acoustic energy absorbance(EA)under peak pressure in young children with OME(190 ears)and healthy control subjects(121 ears)from Ninth People′s Hospital of Shanghai Jiaotong University School of Medicine between January 2018 and June 2020.Both groups were divided into three groups,1-6 months,7-36 months and 37-72 months.SPSS 20.0 statistical software was used to analyze and compare the EA parameters between OME children of different months and the control group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of WBT in young children with OME.Results There were significant differences in EA among three OME groups from 500 Hz to 2000 Hz(P<0.05).Compared with the control groups,EA of 1-6 m OME group decreased significantly below 4000 Hz(P<0.05),EA of 7-36 m OME group decreased significantly at 545-1600 Hz(P<0.05),EA of 37-72 m OME group decreased significantly above 545 Hz(P<0.05).ROC curve indicated that EA at 1000 Hz had the greatest diagnostic value(AUC was 0.890),followed by 1500 Hz and the range of 500-2000 Hz(AUC was 0.883 and 0.881,respectively).EA at 1000 Hz with a cutoff value of 0.55 had the best diagnostic sensitivity of 90.8%,which was higher than conventional tympanometry(85.8%).The maximum AUC(0.932)could be obtained by combining EA,peak pressure and admittance amplitude of 226 Hz tympanometry as predictors.Conclusions EA is significantly decreased in young children with OME.Compared with the conventional single frequency tympanometry,WBT is more accurate in the diagnosis of OME in young children,and the prediction accuracy would be better if combined with 226 Hz tympanometry.

关 键 词：中耳炎 伴渗出液 声阻抗试验 宽频声导抗 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]