Middle-ear reflex testing using wideband acoustic immittance

项目摘要/摘要 该项目的目标是建立和评估中耳肌肉反射(MEMR)测试系统，该系统 基于宽带声导抗(WAI)的测量。这个WAI-MEMR系统将是准确的， 科学技术健全、稳定、可靠、安全、临床医生友好。声学诱导的MEMR 在听力损失的临床评估中有着悠久的历史价值。虽然对中间人敏感，也受中间人的影响 与传导性听力损失有关的耳朵疾病，MEMR也表现出对突触的特殊敏感性 以及与第八神经和听觉脑干通路有关的突触后障碍 生理性中耳反应的同侧和对侧神经通路。MEMR是客观存在的 快速提供信息，而不需要患者的行为反应，并且这种客观性 便于在婴儿中使用。在WAI的背景下测量MEMR提供了明显的优势 方法基于在更广泛的频率范围内评估响应和引发响应的能力 强度较低的刺激。WAI的宽带特性在婴儿测试中是一个有据可查的优势。 然而，尽管MEMR是一种可靠和敏感的措施，但由于以下原因，它在临床上没有得到充分利用 关注的问题包括回答确定的主观性、受试者内部的差异、关于MEMR的不确定性 反应存在，以及临床医生在解释反应时缺乏信心。具体目标是 这一第二阶段的项目是：(1)建立一个双探头WAI-MEMR系统，该系统能够同侧、对侧、 和双耳刺激范例，并允许灵活和精确地处理测试参数；(2)开发 分析和量化WAI-MEMR反应的自动化过程，以提供一种客观的方法 测试解释；(3)开发和测试人工产物拒绝方法、用户友好的探头和校准 方法；(4)通过对婴儿的人体试验进一步定义刺激和获取参数， 儿童、听力正常的成年人和听力损失的成年人；以及(5)实施新的范式和评估 新的第二相双声道系统适用于听力正常的成人和婴儿。成就 在第一阶段完成后，双探头系统的原型已经在成年人身上进行了测试 听力正常和听力损失，结果令人振奋。自动化分析工作已经开始，以及 定义婴儿和成人的频率、幅度和阈值特征。持续的、高效的 Mimosa Acoustics的Jeng博士和Vanderbilt大学的Hood博士之间的合作将继续 在整个第二阶段项目期内，开发和评估WAI-MEMR方法。 创建使用这种方法的硬件和软件应该会减少临床医生解释的主观性 鼓励所有年龄段的患者增加临床利用和应用。此外，扩展后的 WAI和双探头系统提供的能力将促进对 在不同人群中的MEMR的特点，并促进在临床实践中的应用。

PROJECT SUMMARY/ABSTRACT The objective of this project is to build and evaluate a middle-ear muscle reflex (MEMR) test system that is based on measurement of wideband acoustic immittance (WAI). This WAI-MEMR system will be accurate, scientifically and technically sound, stable, reliable, safe, and clinician friendly. Acoustically elicited MEMRs have a long history of value in the clinical evaluation of hearing loss. While sensitive to and affected by middle- ear disorders linked to conductive hearing losses, MEMRs also demonstrate particular sensitivity to synaptic and postsynaptic disorders related to the eighth nerve and auditory brainstem pathways through activation of neural pathways ipsilateral and contralateral to the physiologic middle-ear response. MEMRs are objective in providing information rapidly without requiring behavioral responses from the patient, and this objectivity facilitates their use in infants. Measuring MEMRs in the context of WAI provides clear advantages over current methods based on the ability to evaluate responses over a broader frequency range and to elicit responses to lower-intensity stimuli. The broadband nature of WAI is a well-documented advantage in infant testing. However, even though MEMR is a robust and sensitive measure, it is underutilized clinically on account of concerns that include subjectivity in response determination, intrasubject variation, uncertainty about MEMR response presence, and lack of confidence among clinicians in interpreting responses. The specific aims for this Phase II project are to (1) build a dual-probe WAI-MEMR system that is capable of ipsilateral, contralateral, and binaural stimulus paradigms and allows flexible and precise manipulation of test parameters; (2) develop automated processes for analyzing and quantifying WAI-MEMR responses to provide a method for objective test interpretation; (3) develop and test artifact rejection methods, a user-friendly probe, and calibration methods; (4) define stimulus and acquisition parameters further through human-subject testing of infants, children, and adults with normal hearing and with hearing loss; and (5) implement new paradigms and evaluate the new Phase II dual-channel system in adults and infants with normal hearing. The accomplishments completed during Phase I have resulted in a prototype dual-probe system that has been tested in adults with normal hearing and hearing loss with promising results. Work has begun toward automated analysis as well as defining frequency, amplitude, and threshold characteristics in infants and adults. The ongoing, productive collaboration between Dr. Jeng at Mimosa Acoustics and Dr. Hood at Vanderbilt University will continue throughout the Phase II project period for the development and evaluation of the WAI-MEMR approach. Creating hardware and software that uses this approach should reduce subjectivity in clinician interpretation and encourage increased clinical utilization and application in patients of all ages. In addition, the expanded capabilities that both WAI and a dual-probe system provide will foster advancement in understanding the characteristics of the MEMR in various populations and facilitate applications in clinical practices.