Pediatric Applications of Wideband Acoustic Immittance Measures
Pediatric Applications of Wideband Acoustic Immittance Measures
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DOI：
10.1097/aud.0b013e31829d5158
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发表时间：
2013-07-01
期刊：
影响因子：
3.7
通讯作者：
Sanford, Chris A.
中科院分区：
文献类型：
--
作者：
Hunter, Lisa L.;Prieve, Beth A.;Sanford, Chris A.
儿童人群听力问题的筛查和诊断对中耳问题检测的临床测试性能要求很高。所有听力学测试都受到传导性听力损失（CHL）的影响，因为听觉信号通过外耳和中耳传导，产生行为、生理或电生理反应。特别是，耳声发射（oae）受到中耳问题的高度影响，而筛选听性脑干反应（ABR）似乎受到的影响较小，但在中耳积液（MEE）存在时，诊断ABR的空气传导阈值可能升高。因此，儿科听力学家需要敏感的、具体的、用户友好的筛查和诊断工具，以便更好地解释所有年龄段的中耳状况。传统的单频鼓室测量和声反射测试在几个方面受到限制，特别是在新生儿和幼儿中。标准的单频鼓室测量法对新生儿MEE的敏感性较差，并且为了评估更高的频率，需要单独的探测音调，这是耗时的。标准的声反射测试灵敏度和特异性较差，并且由于需要高刺激水平，有医源性听力损失的风险（Hunter et al. 1999）。最近开发的外耳和中耳状态测量方法使用精心校准的探针来记录中耳对宽带信号的反应。使用这种技术可以测量许多不同的物理特性，本文将其称为宽带声阻抗（WAI）。WAI是一个包罗万象的术语，包括以阻抗（Za）或导纳（Ya）表示的物理测量，如反射率、吸光度以及潜在的相位和幅度（见Rosowski等人，本期，第9S-16S页）。宽带测试可以在环境压力下进行，也可以在鼓室测量中加压，也可以用来唤起和测量声反射。WAI测试通过测量中耳如何在广泛的频率范围内接收、吸收和传输声能，提供有关中耳功能的重要信息。在儿科临床人群中，WAI可能比单频鼓室测定仪提供更好的诊断能力。
Screening and diagnosis of hearing problems in the pediatric population demands a high degree of clinical test performance for detection of middle ear problems. All audiologic tests are affected by conductive hearing loss (CHL), because auditory signals are conducted through the outer and middle ear to produce a behavioral, physiologic, or electrophysiologic response. In particular, otoacoustic emissions (OAEs) are highly affected by middle ear problems, and while screening auditory brainstem responses (ABRs) appear to be less affected, air conduction thresholds for diagnostic ABR can be elevated in the presence of middle ear effusion (MEE). Pediatric audiologists therefore need sensitive, specific, and user-friendly screening and diagnostic tools that permit better interpretation of middle ear status at all ages. Traditional, single-frequency tympanometry and acoustic reflex tests have been limited in several respects, particularly in newborns and young infants. Standard single-frequency tympanometry has poor sensitivity to MEE in newborns, and to assess higher frequencies, individual probe tones are required, which is time consuming. Standard acoustic reflex tests have poor sensitivity and specificity, and have a risk of iatrogenic hearing loss due to the need for high stimulus levels (Hunter et al. 1999).A more recently developed measure of outer and middle ear status uses a carefully calibrated probe to record middle ear responses to broadband signals. Many different physical properties can be measured using this technique, which will be referred to as wideband acoustic immittance (WAI) in this article. WAI is a catch-all term that includes physical measures known as reflectance, absorbance, and the underlying phase and magnitude quantities expressed in impedance (Za) or admittance (Ya) terms (see Rosowski et al., this issue, pp. 9S–16S). Wideband tests can be conducted at ambient pressure, or with pressurization as in tympanometry, and can also be used to evoke and measure acoustic reflexes. WAI tests provide important information about middle ear function by measuring how the middle ear receives, absorbs, and transmits sound energy across a wide range of frequencies. WAI may provide improved diagnostic capability over single-frequency tympanometry in pediatric clinical populations.