【作者】 江林杰；

【导师】 王海涛；

【作者基本信息】 广州医科大学 ， 耳鼻咽喉科学（专业学位）， 2023， 硕士

【摘要】 目的:1、明确宽频声导抗中226Hz鼓室导抗图与传统声导抗226Hz鼓室导抗图是否具有一致性和统一性。2、明确听力正常人、分泌性中耳炎及耳硬化症患者中耳共振频率(Middle ear resonant frequency,RF)和宽频声导抗能量吸收率(Wideband absorbance,WBA)曲线的数值和范围,分析年龄、性别、耳别对WBA及RF的影响。3、明确RF和WBA对听力正常人、分泌性中耳炎及耳硬化症患者的诊断和鉴别诊断价值。方法:1、选取2022年10月至2023年2月就诊于广州市第十二人民医院,经专科查体、纯音听阈测试、普通声导抗测试及耳声发射(OAE)检查,听力正常的受检者77例(共154耳)为正常对照组,包括男性32例,女性45例,年龄范围14-49岁,其中正常组按年龄将其划分为:少年组(14-17岁)16例,平均年龄15.75岁;青年组(18-29岁)39人,平均年龄22.56岁;中青年组(30-49岁)22例,平均年龄30.01岁。2、选取同期就诊于广州市第十二人民医院,临床诊断为分泌性中耳炎患者13例(男7例,女6例)及耳硬化症患者8例(男性3例,女性5例)作为研究对象。3、上述不同年龄组听力正常人和患者均用同一台宽频声导抗仪测试,得到其能量吸收率(WBA)曲线、中耳共振频率(RF)和226Hz鼓室导抗图测值,用统计学的方法,计算出各个测值的均数±标准差(x±S),绘制其WBA曲线,对比和分析听力正常人、分泌性中耳炎患者及耳硬化症患者的差异。结果:1、在听力正常人群中,宽频声导抗中226Hz鼓室导抗图与传统声导抗226Hz鼓室导抗图各测值两两比较,通过配对t检验分析并发现:声顺值有显著性差异(P<0.05),鼓室导抗图峰压点有显著性差异(P<0.05),但等效外耳道容积无显著性差异(P>0.05)。2、年龄、性别、耳别对中耳共振频率(RF)的影响:以听力正常组中少年组、青年组、中青年组为单因素行方差分析,结果显示满足方差齐性,中耳共振频率(RF)在少年、青年和中青年组之间不存在显著性差异(P>0.05)。在男女、左右耳RF测值的t检验中发现:男、女RF测值无显著性差异(P>0.05);左、右耳RF测值无显著性差异(P>0.05)。3、听力正常组、分泌性中耳炎组及耳硬化症组RF测值:听力正常组为924±173Hz、分泌性中耳炎组为405±64Hz、耳硬化症组为1312±131Hz。通过方差分析发现,各组间均P<0.05,提示各组的RF测值有显著差异。4、听力正常人WBA曲线测试结果:吸收率主要集中在1374-2911Hz。在226Hz为吸收率最低值0.152,随后陡峭上升,在1374Hz达第一个吸收率峰值0.696,随后形成一平台期,在2911Hz达第二个吸收率峰值0.712,随后迅速下降,在6350Hz达第二个吸收率低值0.394。整体呈“语频区高平M型状”。5、年龄、性别、耳别对听力正常人WBA曲线测试结果的影响:听力正常组中三个不同年龄组及不同性别间的WBA曲线基本一致,选取226Hz、500Hz、1000Hz、2000Hz、4000Hz、8000Hz下的吸收率,以年龄及性别为因素进行方差分析,各个频率下差异均无统计学意义(P>0.05)。左、右耳的WBA曲线基本一致,各个频率下差异均无统计学意义(P>0.05)。6、分泌性中耳炎组WBA曲线测试结果:整体呈“全频区低平M型状”。在226Hz为吸收率最低值0.14,在866Hz达第一个吸收率峰值0.277,在2828Hz达第二个吸收率峰值0.421。两个峰值点较听力正常组明显降低,且两个吸收率峰值点所对应的频率均向前移。在226～8000Hz内选10个频率分析峰压下分泌性中耳炎组与正常组能量吸收率的差异,提示在500Hz以上频率分泌性中耳炎组显著低于正常组,具有统计学差异(P<0.05)。进一步选取500～750Hz之间的515Hz、545Hz、561Hz进行比较分析,提示在515Hz处无显著差异(P>0.05),545Hz、561Hz具有显著差异(P<0.05),提示在545Hz以上频率分泌性中耳炎组能量吸收率显著低于正常组。7、耳硬化症WBA曲线测试结果:整体呈“中低频区低平状、高频区高峰状”,表现为低频区为“低平状”,到了高频区为“高峰状”。在226Hz吸收率为最低值0.067,在3268Hz达吸收率峰值0.727。在226～6000Hz内选7个频率(226Hz、500Hz、1000Hz、2000Hz、2997Hz、4000Hz、6000Hz)分析峰压下耳硬化症组与正常听力组能量吸收率的差异,提示除了2997Hz、4000Hz及6000Hz外其余4个频率具有显著差异(P<0.05),继续选取2997Hz的前两个频率即2828Hz及2911Hz进行分析,均具有显著差异(P<0.05),提示在226～2911Hz范围耳硬化症组能量吸收率显著低于正常组。结论:1、宽频声导抗中226Hz鼓室导抗图与传统226Hz鼓室导抗图中的声顺值、峰压值存在显著差异,其原因可能为两种测试技术之间存在系统误差所致。2、年龄(主要指少年、青年、中青年)、性别及耳别因素对中耳共振频率(RF)和能量吸收率(WBA)曲线测值的大小无明显影响。3、中耳共振频率(RF)在确定听力正常人、分泌性中耳炎和耳硬化症时有临床诊断和鉴别诊断价值。4、能量吸收率(WBA)曲线在确定听力正常人、分泌性中耳炎和耳硬化症时有诊断和鉴别诊断价值;WBA曲线对中耳积液量的多少亦有鉴别诊断价值。更多还原

【Abstract】 Objective:1.Clarify whether the 226 Hz tympanic chart in broadband acoustic reactance is consistent and unified with the 226 Hz tympanic chart in traditional acoustic reactance.2.Clear the value and range of Wideband absorbance(WBA)curve and Middle ear resonant frequency(RF)of hearing normal people,secretory otitis media and otosclerosis patients.The effects of age,sex and ear side on WBA and RF were analyzed.3.To clarify the diagnostic and differential diagnostic value of RF and WBA in hearing normal people,secretory otitis media and otosclerosis patients.Methods:1.A total of 77 subjects(154 ears in total)with normal hearing were selected from the Twelfth People’s Hospital of Guangzhou from October 2022 to February 2023 after specialist physical examination,pure tone threshold test,general acoustic reactance test and otoacoustic emission(OAE)examination,including 32 males and 45 females,aged14-49 years old,as the normal group.In the normal group,16 patients were divided into the juvenile group(14-17 years old)with an average age of 15.75 years.There were 39 students in the youth group(18-29 years old),with an average age of 22.56 years old.Twenty-two patients were in the young and middle-aged group(30-49 years old),with an average age of 30.01 years.2.A total of 13 cases(7 males and 6 females,aged 21-37 years)in the secretory otitis media group and 5 cases(2 males and 3 females)in the otosclerosis group were selected from the Twelfth People’s Hospital of Guangzhou during the same period.3.The above mentioned healthy people and patients in different age groups were all tested with the same wide-band acoustic reactance instrument to obtain the energy absorption rate(WBA)curve,middle ear resonance frequency(RF)and tympanum reactance map of 226 Hz.The mean and standard deviation of each measured value was calculated by statistical methods,and the WBA curve was drawn.Compare and analyze the difference of hearing normal people secretory otitis media patients and otosclerosis patients.Results:1.Pairwise comparison between the 226 Hz tympanic chart and the traditional 226 Hz tympanic chart in wide-band acoustic reactance was conducted through paired T-test analysis and it was found that there were significant differences in sound compliance value(P<0.05),significant differences in peak pressure points in tympanic chart(P<0.05),and no significant differences in equivalent external auditory canal volume(P>0.05).2.The influence of age,gender and ear measurement on middle ear resonance frequency(RF): The adolescent group,the youth group and the middle-aged and young people group in the normal hearing group were taken as the single factor,and the analysis of variance was performed,P>0.05,indicating that the homogeneity of variance was satisfied,indicating that there was no significant difference in middle ear resonance frequency(RF)between the teenagers,the young people and the middle-aged and young people.The paired T-test of RF measurements of male and female ear showed that there was no significant difference between male and female RF measurements(P>0.05).There was no significant difference between left ear RF and right ear RF(P>0.05).3.Normal hearing group,secretory otitis media group and otosclerosis group RF measurement values: normal hearing group was 924±173Hz,secretory otitis media group was 405±64Hz,otosclerosis group was 1312±131Hz.By variance analysis,P < 0.05 was found for all groups,suggesting significant differences in RF measurements among all groups.4.WBA curve test results of hearing normal people: absorption rate mainly concentrated in 1374～2911Hz.The lowest absorptance was 0.152 at 226 Hz,and then it rose steeply,reaching the first peak of 0.696 at 1374 Hz,then forming a plateau,reaching the second peak of 0.712 at 2911 Hz,and then falling rapidly,reaching the second low value of 0.394 at 6350 Hz.In the normal hearing group,the WBA curves of the three different age groups and different genders were basically consistent.The absorption rate at226 Hz,500Hz,1000 Hz,2000Hz,4000 Hz and 8000 Hz was selected,and age and gender were used as two factors for analysis of variance,and there was no statistical significance at each frequency(P>0.05).The WBA curves of the left and right ears were basically the same,and there was no statistical significance at each frequency(P > 0.05).5.Secretory otitis media group WBA curve test results: the whole was "low flat".The lowest absorption rate was 0.14 at 226 Hz,the first absorption rate was 0.277 at 866 Hz,and the second absorption rate was 0.421 at 2828 Hz.Compared with the normal hearing group,the two peak absorptivity points decreased significantly,and the corresponding frequencies of the two peak absorptivity points moved forward.The difference of energy absorption rate between the secretory otitis media group and the normal group was analyzed by selecting 10 frequency peaks within 226～8000Hz,suggesting that the energy absorption rate of secretory otitis media group with frequency above 500 Hz was significantly lower than that of the normal group,with statistical difference(P < 0.05).Further,515 Hz,545Hz and 561 Hz between 500 and 750 Hz were selected for comparative analysis,indicating that there was no significant difference at 515Hz(P > 0.05),while there was significant difference between 545 Hz and 561Hz(P < 0.05).The energy absorption rate of otitis media group with secretory frequency above 545 Hz was significantly lower than that of normal group.6.Otosclerosis WBA curve test results: the overall is "low flat-peak shape",the performance of the low frequency area is "low flat shape",to the high frequency area is "peak shape".The lowest absorptivity was 0.067 at 226 Hz,and the peak absorptivity was0.727 at 3268 Hz.Seven frequencies(226Hz,500 Hz,1000Hz,2000 Hz,2997Hz,4000 Hz,6000Hz)were selected from 226 to 6000 Hz to analyze the difference of energy absorption rate between otosclerosis group and normal hearing group under peak pressure.It indicates that except 2997 Hz,4000Hz and 6000 Hz,the other four frequencies have significant differences(P < 0.05).Continue to select the first two frequencies of 3000 Hz,namely 2828 Hz and 2911 Hz,for analysis,and both have significant differences(P < 0.05).The energy absorption rate of otosclerosis group was significantly lower than that of normal group in 226-2911 Hz range.Conclusion:1.There are significant differences in sound alignment value and peak pressure value between the 226 Hz tympanic reactance map and the traditional 226 Hz tympanic reactance map in broadband acoustic reactance,which may be caused by systematic errors between the two test techniques.2.There is no significant difference in the middle ear resonance frequency(RF)and WBA curves due to age(mainly adolescents,young adults and middle-aged and young adults),gender and ear type,and the influence of the above factors on RF and WBA curves should not be considered in clinical work.3.Middle ear resonance frequency(RF)has clinical diagnostic value in determining normal hearing,secretory otitis media and otosclerosis.4.The WBA curve of broadband acoustic transduction has differential diagnostic value in determining normal hearing persons,secretory otitis media and otosclerosis,and the WBA curve has diagnostic value in the amount of middle ear effusion.更多还原