Wideband Reflectance in Normal Caucasian and Chinese School-Aged Children and in Children with Otitis Media with Effusion
Wideband Reflectance in Normal Caucasian and Chinese School-Aged Children and in Children with Otitis Media with Effusion
复制标题
DOI：
10.1097/aud.0b013e3181c00eae
复制
发表时间：
2010-04-01
期刊：
影响因子：
3.7
通讯作者：
Kozak, Frederick K.
中科院分区：
文献类型：
--
作者：
Beers, Alison N.;Shahnaz, Navid;Kozak, Frederick K.
目的：宽带反射率(WBR)是一种中耳分析技术，它可以在很宽的频率范围内量化特定频率的声传导。WBR的一个缺点是标准数据有限，特别是对于儿科人群和患有中耳病变的儿童。本研究的目的是建立早期学龄儿童的体重比标准化数据；确定白种人与中国儿童、男女儿童、儿童与成人之间的体重比是否存在显著差异(实验一)；并将儿童标准体重体重比数据与中耳异常儿童的体重比数据进行比较(实验二)。设计：测量78名平均年龄6.15岁的中耳正常儿童和平均年龄6.34岁的中耳状态异常儿童的体重比。对照组受试者和之前诊断为中耳病变的受试者从大温哥华地区的八所小学招募。已知中耳病变的受试者是通过不列颠哥伦比亚省儿童医院耳鼻喉科招募的。中耳积液(MEE)是两种方法中的一种。在不列颠哥伦比亚省儿童医院组，MEE由儿科耳鼻喉科医生(OTL)使用气动耳镜和视频耳镜诊断。这些病例(21耳)被归类为OTL确诊。在小学通过筛查评估并根据听力学测试组合结果怀疑患有MEE的受试者，包括气导阈值升高，低频和高频鼓室图平坦，以及没有瞬时诱发耳声发射，被归类为未确认OTL(21耳)。对性别、种族(高加索人与中国人)、年龄(儿童与成人)和中耳状况的影响进行了统计分析。本研究使用的WBR设备来自Mimosa Acoustics(RMS-System，版本4.03)。结果：对照组受试者的数据(实验1)没有显示性别和耳朵的影响，它们与频率的交互作用也不显著。种族(高加索人与中国人)和频率之间存在显著的交互作用。中国儿童在中频范围内的能量反射率(ER)值较低。儿科数据和以前收集的成人数据之间的ER显著不同。病变组ER在四种中耳状态(正常、轻度中耳负压、重度中耳负压和MEE)之间差异均有统计学意义(实验2)。使用接收器工作特征(ROC)曲线分析来客观地评估ER的整体测试性能；将其在三分之一倍频程内的平均频率上进行比较。对ROC下面积(AUROC)图的统计比较表明，800 Hz以上的ER(除6300 Hz的ER外)在区分正常中耳和MEE方面的测试表现优于630和800 Hz的ER。虽然ER与800~5000赫兹之间的其他频率没有统计学差异，但1250赫兹的ER具有最大的AUROC曲线(敏感性为96%，特异性为95%)，并被选作进一步分析。比较1250 Hz的WBR和226-HZ探头频率的静态导纳的AUROC曲线，WBR在区分健耳和MEE方面的测试表现明显更好。结论：初步建立了一套5~7岁儿童人群的标准化ER数据，这些数据与以前收集的标准成人ER数据有显著差异。在这项研究中，儿科标准数据被用于测试儿童，但种族特定的标准不被要求用于检测中耳病理和中耳状态的变化。WBR显示出作为一种临床诊断工具的前景，用于测量中耳的机械声学特性以及导致中耳负压或MEE的变化。
Objectives: Wideband reflectance (WBR) is a middle ear analysis technique that quantifies frequency-specific sound conduction over a wide range of frequencies. One shortcoming of WBR is that there is limited normative data, particularly for pediatric populations and children with middle ear pathology. The goals of this study were to establish normative WBR data for early school-aged children; to determine whether WBR differs significantly between Caucasian and Chinese children, male and female children, and children and adults (experiment 1); and to compare the normative pediatric WBR data with the WBR data obtained from children with abnormal middle ear conditions (experiment 2).Design: WBR was measured from 78 children with normal middle ear status with an average age of 6.15 yrs and 64 children with abnormal middle ear status with an average age of 6.34 yrs. Control group subjects and subjects without previously diagnosed middle ear pathology were recruited from eight elementary schools in the Greater Vancouver Area. Subjects with known middle ear pathology were recruited through the British Columbia Children's Hospital Otolaryngology department. Middle ear effusion (MEE) was identified in one of the two ways. In the British Columbia Children's Hospital group, MEE was diagnosed by a pediatric otolaryngologist (OTL) using pneumatic otoscopy and video otomicroscopy. These cases (21 ears) were classified as OTL confirmed. Subjects who were assessed through screenings at their elementary schools and suspected to have MEE based on audiological test battery results including elevated air conduction thresholds, flat low-and high-frequency tympanograms, and absent transient-evoked otoacoustic emissions were classified as not OTL confirmed (21 ears). Data were statistically analyzed for effects of gender, ethnicity (Caucasian versus Chinese), age (child versus adult), and middle ear condition. WBR equipment used for this study was from Mimosa Acoustics (RMS-system, version 4.03). Data were averaged in one-third octave bands collected from 248 frequencies ranging from 211 to 6000 Hz.Results: Control group subject data (experiment 1) revealed no effects of gender or ear, and their interactions with frequency were not significant. There was a significant interaction between ethnicity (Caucasian versus Chinese) and frequency. Chinese children had lower energy reflectance (ER) values over the mid-frequency range. ER was significantly different between pediatric data and previously collected adult data. Diseased group ER was significantly different among all four middle ear conditions (normal, mild negative middle ear pressure, severe negative middle ear pressure, and MEE) (experiment 2). The overall test performance of ER was objectively evaluated using receiver operating characteristic (ROC) curve analyses; it was compared across frequencies averaged in one-third octave bands. Statistical comparison of the area under ROC (AUROC) plots revealed that ER above 800 Hz (except for ER at 6300 Hz) had better test performance in distinguishing normal middle ear status from MEE compared with ER at 630 and 800 Hz. Althoughnot statistically different from other frequencies between 800 and 5000 Hz, ER at 1250 Hz had the largest AUROC curve ( sensitivity of 96% and specificity of 95%) and was selected for further analysis. Comparison of AUROC curves between WBR at 1250 Hz and static admittance at 226-Hz probe tone frequency revealed significantly better test performance for WBR in distinguishing between healthy ears and MEE.Conclusions: A preliminary set of normative ER data have been generated for a pediatric population between the ages of 5 and 7 yrs, which were significantly different from previously gathered normative adult ER data. In this study, pediatric normative data were warranted for testing children, but ethnic-specific norms were not required to detect middle ear pathology and changes in middle ear status. WBR shows promise as a clinical diagnostic tool for measuring the mechanoacoustic properties of the middle ear and the changes that result in the presence of negative middle ear pressure or MEE.