听力学及言语疾病杂志
聽力學及言語疾病雜誌
은역학급언어질병잡지
JOURNAL OF AUDIOLOGY AND SPEECH PATHOLOGY
2013年
6期
585-589,590
,共6页
苏仁杰%许军%陈淑飞%郑周数%邵小飞%史波宁
囌仁傑%許軍%陳淑飛%鄭週數%邵小飛%史波寧
소인걸%허군%진숙비%정주수%소소비%사파저
鼓室导纳测试%婴儿%中耳炎
鼓室導納測試%嬰兒%中耳炎
고실도납측시%영인%중이염
Tympanometry%Infants%Otitis media
目的：探讨探测音频率及声导纳值测量方法对1～6月龄婴儿分泌性中耳炎诊断的价值。方法筛选1～6月龄正常婴儿71人（正常组142耳）、分泌性中耳炎患儿54人（中耳炎组90耳）（颞骨薄层CT证实），采用GSI2000Tympstar 2型中耳分析仪分别对两组对象进行226、1000 Hz探测音鼓室声导纳检测，并用Linder/Jerger法、Baldw in法、基线法测量1000 Hz探测音鼓室声导纳，采用ROC曲线下面积（A ）比较的方法分析四种方法对婴儿中耳炎的诊断准确性，取值范围：0≤A≤1，A＞0．5，且越接近1，诊断准确性越高；A＝0．5，无诊断意义；A＜0．5则不符合实际情况。结果1～3月龄组的226 Hz探测音鼓室声导纳值以及Linder/Jerger法、Baldwin法、基线法测得的1000 Hz探测音鼓室声导纳值正常组分别为0．83±0．29、0．60±0．55、0．74±0．56、0．90±0．59 mmho ，中耳炎组分别为0．82±0．35、0．01±0．06、-0．24±0．15、-0．29±0．21 mmho ，ROC曲线下面积（正常组与中耳炎组同时检测，下同）分别为0．507、0．896、0．976、0．988。4～6月龄组四种方法测得鼓室声导纳值正常组分别为0．60±0．35、0．55±0．58、0．76±1．0、0．86±0．72 mmho ，中耳炎组分别为0．36±0．24、0±0、-0．34±0．16、-0．44±0．28 mmho ；ROC曲线下面积分别为0．749、0．888、0．969、0．988。1000 Hz探测音鼓室声导纳的ROC曲线下面积在两个年龄组均大于226 Hz探测音鼓室声导纳值（ P＜0．05）；基线法测得1～3月龄组的1000 Hz探测音鼓室声导纳的ROC曲线下面积大于其他三种方法（ P＜0．05）。基线法测得4～6月龄组的1000 Hz探测音鼓室声导纳的 ROC曲线下面积大于其他三种方法，但与Baldw in法比较差异无统计学意义（ P＞0．05）。结论1000 Hz探测音声导纳对于1～6月龄分泌性中耳炎患儿的诊断意义高于226 Hz探测音声导纳；1000 Hz探测音鼓室声导纳的测量方法以基线法较为合适。
目的：探討探測音頻率及聲導納值測量方法對1～6月齡嬰兒分泌性中耳炎診斷的價值。方法篩選1～6月齡正常嬰兒71人（正常組142耳）、分泌性中耳炎患兒54人（中耳炎組90耳）（顳骨薄層CT證實），採用GSI2000Tympstar 2型中耳分析儀分彆對兩組對象進行226、1000 Hz探測音鼓室聲導納檢測，併用Linder/Jerger法、Baldw in法、基線法測量1000 Hz探測音鼓室聲導納，採用ROC麯線下麵積（A ）比較的方法分析四種方法對嬰兒中耳炎的診斷準確性，取值範圍：0≤A≤1，A＞0．5，且越接近1，診斷準確性越高；A＝0．5，無診斷意義；A＜0．5則不符閤實際情況。結果1～3月齡組的226 Hz探測音鼓室聲導納值以及Linder/Jerger法、Baldwin法、基線法測得的1000 Hz探測音鼓室聲導納值正常組分彆為0．83±0．29、0．60±0．55、0．74±0．56、0．90±0．59 mmho ，中耳炎組分彆為0．82±0．35、0．01±0．06、-0．24±0．15、-0．29±0．21 mmho ，ROC麯線下麵積（正常組與中耳炎組同時檢測，下同）分彆為0．507、0．896、0．976、0．988。4～6月齡組四種方法測得鼓室聲導納值正常組分彆為0．60±0．35、0．55±0．58、0．76±1．0、0．86±0．72 mmho ，中耳炎組分彆為0．36±0．24、0±0、-0．34±0．16、-0．44±0．28 mmho ；ROC麯線下麵積分彆為0．749、0．888、0．969、0．988。1000 Hz探測音鼓室聲導納的ROC麯線下麵積在兩箇年齡組均大于226 Hz探測音鼓室聲導納值（ P＜0．05）；基線法測得1～3月齡組的1000 Hz探測音鼓室聲導納的ROC麯線下麵積大于其他三種方法（ P＜0．05）。基線法測得4～6月齡組的1000 Hz探測音鼓室聲導納的 ROC麯線下麵積大于其他三種方法，但與Baldw in法比較差異無統計學意義（ P＞0．05）。結論1000 Hz探測音聲導納對于1～6月齡分泌性中耳炎患兒的診斷意義高于226 Hz探測音聲導納；1000 Hz探測音鼓室聲導納的測量方法以基線法較為閤適。
목적：탐토탐측음빈솔급성도납치측량방법대1～6월령영인분비성중이염진단적개치。방법사선1～6월령정상영인71인（정상조142이）、분비성중이염환인54인（중이염조90이）（섭골박층CT증실），채용GSI2000Tympstar 2형중이분석의분별대량조대상진행226、1000 Hz탐측음고실성도납검측，병용Linder/Jerger법、Baldw in법、기선법측량1000 Hz탐측음고실성도납，채용ROC곡선하면적（A ）비교적방법분석사충방법대영인중이염적진단준학성，취치범위：0≤A≤1，A＞0．5，차월접근1，진단준학성월고；A＝0．5，무진단의의；A＜0．5칙불부합실제정황。결과1～3월령조적226 Hz탐측음고실성도납치이급Linder/Jerger법、Baldwin법、기선법측득적1000 Hz탐측음고실성도납치정상조분별위0．83±0．29、0．60±0．55、0．74±0．56、0．90±0．59 mmho ，중이염조분별위0．82±0．35、0．01±0．06、-0．24±0．15、-0．29±0．21 mmho ，ROC곡선하면적（정상조여중이염조동시검측，하동）분별위0．507、0．896、0．976、0．988。4～6월령조사충방법측득고실성도납치정상조분별위0．60±0．35、0．55±0．58、0．76±1．0、0．86±0．72 mmho ，중이염조분별위0．36±0．24、0±0、-0．34±0．16、-0．44±0．28 mmho ；ROC곡선하면적분별위0．749、0．888、0．969、0．988。1000 Hz탐측음고실성도납적ROC곡선하면적재량개년령조균대우226 Hz탐측음고실성도납치（ P＜0．05）；기선법측득1～3월령조적1000 Hz탐측음고실성도납적ROC곡선하면적대우기타삼충방법（ P＜0．05）。기선법측득4～6월령조적1000 Hz탐측음고실성도납적 ROC곡선하면적대우기타삼충방법，단여Baldw in법비교차이무통계학의의（ P＞0．05）。결론1000 Hz탐측음성도납대우1～6월령분비성중이염환인적진단의의고우226 Hz탐측음성도납；1000 Hz탐측음고실성도납적측량방법이기선법교위합괄。
Objective To explore the effects of different probe tone and tympanometric admittance measure-ment methods on the diagnose of otitis media prediction ,and to provide a clinical reference for the selection of probe tones and measurement method to apply to newborn infants .Methods Tympanograms with 226 Hz and 1 000 Hz probe tones were obtained from normal infants (142 ears) and infants with otitis media (90 ears) .Mean values , standard deviations ,the 90% range and 95% mean confidence interval were recorded as the variable to observe po-tential impacts on tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods respectively according to Linder/Jerger classification ,the Baldwin classification and baseline classification adapted from Baldwin .The four indexes were tested with compara-tive analysis .The area under ROC curve simultaneous detects the normal group and otitis media group ,with refer-ences to the accuracy of the detection method to disease (including specificity and sensitivity ) .Results In 1-to -3 month group ,tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 0 .83 ± 0 .29 ,0 .60 ± 0 .55 ,0 .74 ± 0 .56 ,0 .90 ± 0 .59 in nom-al infants and 0 .82 ± 0 .35 ,0 .01 ± 0 .06 ,-0 .24 ± 0 .15 ,-0 .29 ± 0 .21 in infants with OME ,respectively .The areas under ROC curve of the four kinds of measurement methods were 0 .507 ,0 .896 ,0 .976 ,0 .988 ,respectively .In 4 to 6 month group ,tympanometric admittance with 226 Hz probe tone and tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were 0 .60 ± 0 .35 ,0 .55 ± 0 .58 ,0 .76 ± 1 .0 ,0 .86 ± 0 .72 in nomal infants and 0 .36 ± 0 .24 ,0 ± 0 ,-0 .34 ± 0 .16 ,-0 .44 ± 0 .28 in infants with OME ,respectively .The areas under ROC curve of the four kinds of measurement methods were 0 .749 ,0 .888 ,0 .969 ,0 .988 in 4 to 6 month infants ,re-spectively .Tympanometric peak admittance with 1 000 Hz probe tone by three different measurement methods were significantly better than that with 226 Hz probe tone .The areas under ROC curve of tympanometric peak admittance with 1 000 Hz probe tone by baseline classification adapted from Baldwin were bigger than others and the differences were significant(P<0 .05) ,but no difference between the Baldwin classification and baseline classification in 4 to 6 month infants(P>0 .05) .Conclusion Tympanometric peak admittance with 1 000 Hz probe tone were better than that with 226 Hz probe tone to assess otitis media in 1~6 month infants .The baseline classification adapted from Baldwin was appropriate for the measurement of tympanometric peak admittance with 1 000 Hz probe tone .
