OTOREFLECTANCE ASSESSMENT OF MIDDLE-EAR FUNCTIONING

描述(申请人提供)：耳反射(OR)是一种新的听力测试仪器，利用耳道中呈现和记录的声音信号。Or仪器解决了现有中耳功能筛查和诊断仪器的以下局限性：(1)中耳炎的检测，(2)传导性听力损失的预测，(3)在接受新生儿听力筛查检查或后续听力学评估的婴儿中检测中耳功能障碍，以及(4)在言语带宽的频率上评估中耳功能的一般用途。OR测试提供宽频带范围(约0.25至8 kHz)的传递函数测量，如反射和导纳，以及耳道和中耳吸收的功率。能量反射率和吸收功率是对耳道中探头位置相对不敏感的OR函数，因此非常适合在较高频率下解释中耳功能。一种类型的OR仪器可以与类似于耳声发射探头的探头一起使用，在周围耳道压力下在几秒钟内筛查中耳功能。该项目的第一阶段确定了在听力正常的成人和儿童以及经手术证实中耳积液的儿童中测量此类OR反应的可行性。第一阶段还实施了宽带OR测试来评估中耳肌肉反射的功能，并将婴儿和成年人的反射阈值与使用传统仪器测量的阈值进行了比较。在第二阶段，将安装宽带或鼓室导纳测定仪，增加一个泵来改变耳道静压，并将在成人中测量或鼓室导纳正常值。环境压力OR和传统226-HZ鼓室导纳的测试性能将在幼儿中进行比较，以检测中耳积液并预测与渗出性中耳炎相关的传导性听力损失。或者，鼓室导纳将成为一种新的客观有效的宽带测试的一部分，以测量中耳肌肉反射阈值，并将其与使用传统测试测量的成年人和婴儿的阈值进行比较。在接受标准新生儿听力筛查的婴儿中，将比较OR鼓室导纳、环境压力OR和常规1000赫兹鼓室导纳检测中耳功能障碍的能力的测试表现。第二阶段的结果将评估在重要的社会关注的临床应用中，OR是否比传统测试更准确地筛查和诊断中耳功能障碍。

DESCRIPTION (provided by applicant): Otoreflectance (OR) is a new class of hearing-test instruments utilizing acoustic signals presented and recorded in the ear canal. OR instruments address the following limitations in existing instruments to screen and diagnose middle-ear function: (1) detection of otitis media, (2) prediction of conductive hearing loss, (3) detection of middle-ear dysfunction in infants receiving a newborn hearing screening exam or follow-up audiologic assessment, and (4) general use to assess middle-ear function at frequencies in the bandwidth of speech. An OR test provides measurements over a wideband range (approximately 0.25 to 8 kHz) of such transfer functions as reflectance and admittance, and power absorbed by the ear canal and middle ear. Energy reflectance and absorbed power are OR functions that are relatively insensitive to probe position in the ear canal, and thus are well suited to interpreting middle-ear function at higher frequencies. One type of OR instrument can be used with probes similar to otoacoustic emission probes to screen middle-ear function in several seconds at ambient ear-canal pressure. Phase I of this project established the feasibility of measuring such OR responses in normal-hearing adults and children, as well as in children with surgically confirmed middle-ear fluid. Phase I also implemented a wideband OR test to assess the function of the middle-ear muscle reflex, and compared reflex thresholds in infants and adults with thresholds measured using conventional instruments. In Phase II, a wideband OR tympanometry instrument will be implemented, adding a pump to vary ear-canal static pressure, and OR tympanometry norms will be measured in adults. The test performance of ambient-pressure OR and conventional 226-Hz tympanometry will be compared in young children to detect middle-ear fluid and to predict a conductive hearing loss associated with otitis media with effusion. OR tympanometry will form part of a new objective and efficient wideband test to measure middle-ear muscle reflex thresholds, which will be compared to thresholds in adults and infants measured using a conventional test. The test performance of the ability of OR tympanometry, ambient-pressure OR, and conventional 1000-Hz tympanometry to detect middle-ear dysfunction will be compared in infants also receiving a standard newborn hearing screening exam. Outcomes from Phase II will evaluate whether OR is more accurate than conventional tests to screen and diagnose middle-ear dysfunction in clinical applications of important societal concern.