Middle-ear reflex testing using wideband acoustic immittance

项目总结/摘要 本计画的目的是建立一套中耳肌反射测试系统， 基于宽带声导抗（WAI）的测量。这个WAI-MEMR系统会很准确 科学和技术合理，稳定，可靠，安全和临床医生友好。声诱发记忆效应 在听力损失的临床评估中具有悠久的历史价值。虽然敏感和受影响的中间- 与传导性听力损失有关的耳部疾病，MEMR也表现出对突触 以及通过激活第八神经和听觉脑干通路相关的突触后疾病， 生理中耳反应的同侧和对侧神经通路。MEMR客观， 快速提供信息，而不需要患者的行为反应，这种客观性 有利于它们在婴儿中的使用。在WAI的背景下测量MEMR提供了比当前更明显的优势。 基于在更宽频率范围内评估响应并引发响应的能力的方法 低强度刺激。WAI的宽带特性在婴儿测试中是一个有据可查的优势。 然而，即使MEMR是一种稳健和敏感的测量方法，但由于以下原因，它在临床上未得到充分利用： 包括反应确定的主观性、受试者内变异、MEMR的不确定性等问题 反应的存在，以及临床医生在解释反应时缺乏信心。具体目标为 该第二阶段项目是（1）建立一个双探头WAI-MEMR系统，能够同侧，对侧， 和双耳刺激范例，并允许灵活、精确地操纵测试参数;（2）开发 用于分析和量化WAI-MEMR响应的自动化过程， 测试解释;（3）开发和测试伪影抑制方法、用户友好的探针和校准 方法;（4）通过对婴儿的人类受试者测试进一步定义刺激和采集参数， 儿童和听力正常和听力损失的成年人;以及（5）实施新的范例并评估 新的第二阶段双通道系统适用于听力正常的成人和婴儿。的成就 在第一阶段完成的双探头系统原型已经在成人中进行了测试， 听力正常和听力损失，有希望的结果。自动化分析的工作已经开始， 定义婴儿和成人的频率、振幅和阈值特征。持续的、富有成效的 含羞草声学公司的郑博士和范德比尔特大学的胡德博士之间的合作将继续下去 在整个第二阶段项目期间，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减少临床医生解释的主观性 并鼓励在所有年龄段的患者中增加临床利用和应用。此外，扩大 WAI和双探头系统所提供的能力将促进对 MEMR在不同人群中的特征，并促进临床实践中的应用。

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.