科研之友
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摘要
Objective: The goal of the present study was to investigate the clinical utility of measurements of ear-canal reflectance (ECR) in a population of patients with conductive hearing loss in the presence of an intact, healthy tympanic membrane and an aerated middle ear. We also sought to compare the diagnostic accuracy of umbo velocity (V(U)) measurements and measurements of ECR in the same group of patients. Design: This prospective study comprised 31 adult patients with conductive hearing loss, of which 14 had surgically confirmed stapes fixation due to otosclerosis, 6 had surgically confirmed ossicular discontinuity, and 11 had computed tomography and vestibular evoked myogenic potential confirmed superior semicircular canal dehiscence (SCD). Measurements on all 31 ears included pure-tone audiometry for 0.25 to 8 kHz, ECR for 0.2 to 6 kHz using the Mimosa Acoustics HearID system, and V(U) for 0.3 to 6 kHz using the HLV-1000 laser Doppler vibrometer (Polytec Inc, Waldbronn, Germany). We analyzed power reflectance vertical bar ECR vertical bar(2) as well as the absorbance level = 10 x log(10)(1 - vertical bar ECR vertical bar(2)). All measurements were made before any surgical intervention. The V(U) and ECR data were plotted against normative data obtained in a companion study of 58 strictly defined normal ears (Rosowski et al., 2011). Results: Small increases in vertical bar ECR vertical bar(2) at low-to-mid frequencies (400-1000 Hz) were observed in cases with stapes fixation, while narrowband decreases were seen for both SCD and ossicular discontinuity. The SCD and ossicular discontinuity differed in that the SCD had smaller decreases at mid-frequency (similar to 1000 Hz), whereas ossicular discontinuity had larger decreases at lower frequencies (500-800 Hz). SCD tended to have less air-bone gap at high frequencies (1-4 kHz) compared with stapes fixation and ossicular discontinuity. The vertical bar ECR vertical bar(2) measurements, in conjunction with audiometry, could successfully separate 28 of the 31 cases into the three pathologies. By comparison, VU measurements, in conjunction with audiometry, could successfully separate various pathologies in 29 of 31 cases. Conclusions: The combination of vertical bar ECR vertical bar(2) with audiometry showed clinical utility in the differential diagnosis of conductive hearing loss in the presence of an intact tympanic membrane and an aerated middle ear and seems to be of similar sensitivity and specificity to measurements of V(U) plus audiometry. Additional research is needed to expand upon these promising preliminary results.
- 出版日期2012-2
