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

中耳和耳蜗功能的宽带临床诊断和监测

• 批准号: 8129473
• 负责人: Martin Patrick Feeney
• 金额: $ 72.35万
• 依托单位: FATHER FLANAGAN'S BOYS' HOME
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8129473
• 关键词: Acoustics; Address; Adult; Adverse effects; Affect; Age; Anxiety; Audiometry; Auditory; Auditory Brainstem Responses; Behavioral; Birth; Cephalic; Child; Clinic; Clinical; Clinical Management; Cognitive; Complement; Conductive hearing loss; Development; Diagnosis; Diagnostic; Diagnostic tests; Differential Diagnosis; Disease; Drug usage; Ear; Early identification; Eligibility Determination; Evaluation; External auditory canal; Face; Frequencies; Functional disorder; Goals; Guidelines; Hearing; Hearing problem; Incidence; Infant; Intellectual functioning disability; Life; Measures; Medical; Methods; Monitor; Newborn Infant; Operative Surgical Procedures; Otitis Media; Otologic Surgical Procedures; Otosclerosis; Pathology; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physiological; Population; Protocols documentation; Recurrence; Relative (related person); Research; Sensitivity and Specificity; Sensorineural Hearing Loss; Speech Perception; Testing; Time; Tobramycin; Tympanic membrane; Tympanometry; Visual; acoustic reflex; clinical Diagnosis; clinical care; cost; craniofacial; cystic fibrosis patients; diagnostic accuracy; follow-up; hearing impairment; hearing screening; high risk; improved; middle ear; middle ear disorder; otoacoustic emission; ototoxicity; performance tests; pressure; programs; public health relevance; relating to nervous system; repaired; response; sample fixation; sound; sound frequency; tool

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.

产品说明：中耳和耳蜗功能的宽带临床诊断和监测宽带（WB）声学测试组合具有改善听力筛查和诊断各年龄段中耳和耳蜗功能障碍的潜力。WB测试组合解决了目前新生儿听力筛查（NHS）和诊断程序的局限性，并可能改善成人程序，以识别耳毒性听力损失和诊断接受中耳手术的患者的中耳疾病。该测试测量对耳道中存在的声音的声学响应。用于评估中耳功能的组合中的声导抗测试是声传递函数（ATF）测试和声反射阈值（ART）测试。ATF测试在对语音感知重要的频率（0.2-8 kHz）上提供导纳、吸光度和反射率响应，并且在环境压力下或作为WB鼓室图进行。环境压力ATF可能具有测试新生儿在生命的最初几个月的优势，而WB鼓室图可能具有测试年龄较大的婴儿和成人的优势。WB ART测试客观地测量婴儿的阈值，并且可以提高新生儿听力筛查程序识别感音神经性听力损失（SNHL）和传导性听力损失（CHL）的准确性。WB点击诱发（CE）耳声发射（OAE）测试在电池中使用相对于临床CEOAE测试的扩展带宽评估耳蜗功能。目的1评估在初始和后续NHS检查中添加WB测试组合是否提高了检测SNHL和CHL的准确性。更准确的诊断将改善为听力障碍婴儿提供的后续临床护理。目的2评估在NHS中通过WB测试组合检测到的中耳问题是否可以预测生命第一年中持续的中耳功能障碍。没有临床指南存在如何管理这些婴儿，由于缺乏证据的发病率，持续时间和重要性的CHL与NHS转介。目的3评价WB导抗试验是否能检测出颅面部畸形和发育迟缓婴儿的CHL。客观的生理测试，以准确地预测CHL是迫切需要的，因为在这组听力受认知状态。在成人目标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。这样的测试将作为医疗诊所中使用行为测听法进行更广泛评估的补充。目的5：评估WB成套测试是否能提高接受中耳手术的成人耳硬化症和听骨不连续的鉴别诊断。这些疾病很难使用当前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。 公共卫生相关性：中耳和耳蜗功能的宽带临床诊断和监测宽带测试组合具有更准确地识别各个年龄段患者的中耳和耳蜗状况的转化潜力。拟议的研究评估使用这种测试组合是否可以提高新生儿听力筛查项目的质量，以识别听力损失的婴儿。该研究还评估了测试组合是否提高了诊断中耳疾病的准确性，以及识别接受可能影响听力的药物治疗的成年患者的听力损失的准确性。