基于声能吸收率的鼓室图A型腺样体肥大儿童诊断价值初探  

Preliminary study of the diagnostic value of wideband absorbance in adenoid hypertrophy children with type A tympanogram

作　　者：李行 蒋雯 刘洁 林欢 刘稳 乔月华 LI Hang;JIANG Wen;LIU Jie;LIN Huan;LIU Wen;QIAO Yuehua(The First Clinical Medical College of Xuzhou Medical University,Xuzhou 221000,P.R.China;The Otolaryngology Department of the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,P.R.China;Jiangsu Artificial Hearing Engineering Laboratory,Xuzhou 221000,P.R.China)

机构地区：[1]徐州医科大学第一临床医学院,江苏徐州221000 [2]徐州医科大学附属医院耳鼻咽喉科,江苏徐州221000 [3]江苏省人工听觉工程实验室,江苏徐州221000

出　　处：《中国循证医学杂志》2024年第1期23-28,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的本研究旨在探讨鼓室图A型腺样体肥大(AH)儿童与正常儿童中耳功能差异,评估宽频声导抗(WAI)检查在诊断鼓室图A型AH儿童中耳功能障碍中的价值。方法采用回顾性队列研究设计,纳入96例(192耳)AH儿童,并收集40例(80耳)正常儿童作为对照组,所有儿童均完善纯音测听、226 Hz声导抗、宽频声导抗、耳内镜、电子鼻咽镜,将鼓室图A型AH儿童作为研究组(AH组),比较两组226 Hz声导抗指标,宽频声能吸收率,将有统计学意义的频率进行主成分分析降维后构建二元Logistic回归模型,并使用受试者工作特征(ROC)曲线评估模型诊断价值。结果两组226 Hz声导抗指标差异无统计学意义(P>0.05)。鼓室图A型AH儿童与正常儿童在WAI检查中存在统计学差异。在峰值压力下,AH组声能吸收率在226~630 Hz、3150~6000 Hz高于对照组;在环境压力下,AH组声能吸收率在1250~1600 Hz低于对照组,在4000~6000 Hz高于对照组(P<0.05)。将有统计学意义的15个频率进行主成分分析降维为3个主成分(包含原始信息的89.79%)构建二元Logistic回归模型,模型诊断价值ROC曲线下面积(AUC)为0.813,灵敏度为62.18%,特异度为87.50%,截断值为0.70。结论WAI可用于评估鼓室图A型AH儿童的中耳功能。Objective To investigate the differences in middle ear function between adenoid hypertrophy(AH)children with type A tympanogram and normal children,and to evaluate the value of wideband acoustic immittance(WAI)in diagnosing middle ear dysfunction in AH children with type A tympanogram.Methods This retrospective cohort study included 96 children(192 ears)with AH and 40 healthy children(80 ears)as the control group.All children underwent pure tone audiometry,226 Hz tympanometry,WAI,otoscopy,and electronic nasopharyngoscopy.Type A AH children were selected as the study group(AH group)to compare the 226 Hz tympanometry index and WAI between the two groups.A binary logistic regression model was constructed after dimensionality reduction by principal component analysis of the frequencies with statistical significance,and the diagnostic value of the model was evaluated by receiver operating characteristic(ROC)curve.Results There was no significant difference in 226 Hz tympanometry between the two groups(P>0.05).This study found that there were significant differences in WAI between children with AH and healthy children.Under tympanic peak pressure,the wideband absorbance(WBA)of the AH group was significantly higher than that of the control group at 226~630 Hz and 3150~6000 Hz;Under ambient pressure,the WBA of the AH group was significantly lower than that of the control group at 1250~1600 Hz and significantly higher than that of the control group at 4000~6000 Hz.The dimensionality of 15 statistically significant frequencies was reduced to 3 principal components(89.79%of the original information)by principal component analysis.The binary logistic regression model constructed after dimensionality reduction by principal component analysis had a high diagnostic value,with an AUC of 0.813,a sensitivity of 62.18%,and a specificity of 87.50%.Conclusion WAI can be used as an effective method for evaluating the middle ear function of AH children with type A tympanogram.

关 键 词：腺样体肥大 声能吸收率 中耳功能 主成分分析 回归模型 

分 类 号：R766[医药卫生—耳鼻咽喉科]