OTOREFLECTANCE ASSESSMENT OF MIDDLE-EAR FUNCTIONING

描述（由申请人提供）：耳反射（OR）是一种新型听力测试仪器，利用耳道中呈现和记录的声信号。OR仪器解决了现有筛查和诊断仪器在以下领域的局限性：(1)检测中耳炎，(2)预测传导性听力损失，(3)增加新生儿听力筛查方案以测试中耳功能障碍，以及(4)对中耳功能在语音感知重要频率上的一般评估。OR在大约0.25至8 kHz的频率范围内提供诸如反射率和导纳等传递函数以及耳道和中耳吸收的功率的校准测量。能量反射率和吸收功率是OR函数，对探头在耳道中的位置相对不敏感。这一特性可能允许临床解释这些功能在中高频率，在鼓室导纳，这是敏感的探头位置，变得难以解释。一种建议的OR仪器可以与类似耳声发射探头的探头一起使用，在耳道内的环境压力下，在几秒钟内筛查中耳的功能。这种在环境压力下快速进行的测量可以为新生儿听力筛查项目提供中耳功能障碍的测试，也可以为有渗出性中耳炎风险的儿童提供传导性听力损失的测试。另一类拟议的OR仪器，将在探头系统中增加一个静压泵，用于测量反射率、导纳和吸收功率作为耳道中频率和静压的函数。由于能量反射鼓室图比仅基于导纳的多频鼓室图在中高频处具有更有序的模式，因此这种OR鼓室测量仪器在诊断中耳病理方面可能具有一般的听力学和筛查用途。第三类建议的OR仪器可以通过测量由对侧或同侧激活声引起的OR响应的宽带位移来提供声反射阈值的敏感测试。测量超阈反射衰减的方案可以提供临床反射测试中无法获得的额外宽带信息。

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 limitations in existing screening and diagnostic instruments in such areas as: (1) detecting otitis media, (2) predicting conductive hearing loss, (3) augmenting the newborn hearing screening protocol to test for middle-ear dysfunction, and (4) the general assessment of middle-ear functioning at frequencies important for speech perception. OR provides calibrated measurements over a frequency range from approximately 0.25 to 8 kHz of such transfer functions as reflectance and admittance, and the power absorbed by the ear canal and middle ear. Energy reflectance and absorbed power are OR functions that are relatively insensitive to the position of the probe in the ear canal. This property may allow clinical interpretation of these functions at moderate and high frequencies at which the tympanometric admittance, which is sensitive to probe position, becomes difficult to interpret. One proposed class of OR instruments can be used with probes similar to otoacoustic emission probes to screen middle-ear functioning in several seconds at ambient pressure in the ear canal. Such rapidly performed measurements at ambient pressure may provide a test of middle-ear dysfunction in newborn hearing screening programs, and a test to screen for conductive hearing loss in children at risk for otitis media with effusion. Another proposed class of OR instruments, for which a static pressure pump will be added to the probe system, will be used to measured reflectance, admittance and absorbed power as functions of both frequency and static pressure in the ear canal. Such OR tympanometry instruments may have general audiological and screening utility for diagnosing middle-ear pathology due to the fact that the energy reflectance tympanogram has more orderly patterns at moderate and high frequencies than multifrequency tympanometers based only on admittance. A third proposed class of OR instruments may provide a sensitive test of the acoustic reflex threshold by measuring the wideband shift in OR responses elicited by a contralateral or ipsilateral activator sound. A protocol to measure supra-threshold reflex decay may provide additional wideband information that is unavailable in clinical reflex testing.