WIDEBAND CLINICAL DIAGNOSIS AND MONITORING OF MIDDLE-EAR AND COCHLEAR FUNCTION

宽带临床诊断和监测中耳和耳蜗功能宽带（WB）声学测试电池有可能提高中耳和耳蜗功能障碍的听力筛查和诊断。WB测试组解决了目前新生儿听力筛查（NHS）和诊断项目的局限性，并可能改善成人项目，以识别耳毒性听力损失和诊断中耳手术患者的中耳疾病。该测试测量耳道内声音的声学反应。电池中用于评估中耳功能的声阻抗测试包括声传递函数（ATF）测试和声反射阈值（ART）测试。ATF测试提供对语音感知重要频率（0.2-8 kHz）的导纳、吸光度和反射响应，可以在环境压力下进行，也可以作为WB鼓室图进行。环境压力ATF可能对新生儿在生命的头几个月有优势，而WB鼓室图可能对较大的婴儿和成人有优势。WB ART测试客观地测量婴儿的阈值，并可能提高新生儿听力筛查程序的准确性，以识别感音神经性听力损失（SNHL）和传导性听力损失（CHL）。电池中的WB点击诱发（CE）耳声发射（OAE）测试使用相对于临床CEOAE测试的扩展带宽来评估耳蜗功能。目的1评估在初始和后续NHS检查中加入WB测试组是否能提高SNHL和CHL检测的准确性。更准确的诊断将改善对听力障碍婴儿的后续临床护理。目的2评估NHS中WB测试电池检测到的中耳问题是否可以预测生命第一年持续的中耳功能障碍。由于缺乏与NHS转诊相关的CHL发病率、持续时间和重要性的证据，没有关于如何管理这些婴儿的临床指南。目的3评估WB阻抗试验是否可以检测颅面异常和发育迟缓的婴儿CHL。由于该人群的听力受认知状态的影响，迫切需要客观的生理测试来准确预测CHL。在成人Aim 4中，CEOAE的扩展带宽至少达到10 kHz，非常适合检测接受耳毒性药物治疗的囊性纤维化患者的早期听力损失。这种测试将作为医疗诊所使用行为听力学进行更广泛评估的补充。目的5将评估WB测试组是否能改善接受中耳手术的成人耳硬化和听骨不连续性的鉴别诊断。这些疾病很难用现有的诊断测试进行分类，准确的生理测试将改善患者中耳功能的临床管理和术后监测。

DESCRIPTION: Wideband Clinical Diagnosis and Monitoring of Middle-Ear and Cochlear Function A wideband (WB) acoustic test battery has the potential to improve hearing screening and diagnosis of middle-ear and cochlear dysfunction across the age range. The WB test battery addresses current limitations in newborn hearing screening (NHS) and diagnostic programs, and may improve adult programs to identify ototoxic hearing loss and diagnose middle-ear disease in patients receiving middle-ear surgery. The tests measure acoustic responses to sounds presented in the ear canal. The acoustic immittance tests in the battery to assess middle-ear function are an acoustic transfer function (ATF) test and an acoustic- reflex threshold (ART) test. The ATF test provides admittance, absorbance and reflectance responses over frequencies important for speech perception (0.2-8 kHz), and is performed either at ambient pressure or as a WB tympanogram. The ambient-pressure ATF may have advantages for testing newborns in the first months of life, whereas the WB tympanogram may have advantages for testing older infants and adults. The WB ART test objectively measures an infant's threshold and may improve the accuracy of newborn hearing screen programs to identify sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The WB click-evoked (CE) otoacoustic emission (OAE) test in the battery assesses cochlear function using an extended bandwidth relative to clinical CEOAE tests. Aim 1 assesses whether adding a WB test battery to the initial and follow-up NHS exams improves the accuracy of detecting SNHL and CHL. More accurate diagnoses would improve follow-up clinical care provided to infants with hearing disorders. Aim 2 evaluates whether middle-ear problems detected by the WB test battery in NHS can predict continued middle-ear dysfunction in the first year of life. No clinical guidelines exist on how to manage these infants, due to a lack of evidence regarding the incidence, duration and importance of CHL associated with NHS referrals. Aim 3 evaluates whether WB immittance tests can detect CHL in infants with cranial-facial anomalies and development delays. An objective physiological test to accurately predict CHL is urgently needed because audiometry in this group is affected by cognitive status. In Aim 4 with adults, the extended bandwidth of the CEOAE at least out to 10 kHz is well suited to detect early hearing loss in cystic fibrosis patients receiving ototoxic medications. Such a test would serve as a complement in medical clinics to a more extensive assessment using behavioral audiometry. Aim 5 would evaluate whether the WB test battery improves the differential diagnoses of otoscleroris and ossicular discontinuity in adults receiving middle-ear surgery. These disorders are difficult to classify using current diagnostic tests, and an accurate physiological test would improve clinical management and post-surgical monitoring of middle-ear function in patients. Public Health Relevance: Wideband Clinical Diagnosis and Monitoring of Middle-Ear and Cochlear Function A wideband test battery has translational potential to more accurately identify middle-ear and cochlear conditions in patients across the age range. The proposed research evaluates whether the use of this test battery improves the quality of newborn hearing screening programs to identify infants with hearing loss. The research also evaluates whether the test battery improves the accuracy of diagnosing middle-ear disease and of identifying hearing loss in adult patients who receive medications that may affect their hearing.