Implications of Distortion Product Otoacoustic Emissions on Audiometry in Children with Otitis Media Effusion

兒童中耳積水之變頻耳聲傳射檢查和純音聽力檢查的相關性

蔡宗鎰(Tsung-Yi Tsai) ； 何坤瑤(Kuen-Yao Ho) ； 王凌峰(Ling-Feng Wang) ； 簡禎佑(Chen-Yu Chien) ； 張寧家(Ning-Chia Chang) ； 王遜模(Hsun-Mo Wang)

《台灣耳鼻喉頭頸外科雜誌》 52卷1期 (2017/03) Pp. 23-32

https://doi.org/10.6286/2017.52.1.23

摘要

OBJECTIVE: The aim of this study was to investigate implications of distortion product otoacoustic emissions (DPOAE) on pure tone average (PTA) in children with history of otitis media effusion (OME). MATERIALS AND METHODS: This retrospective study was conducted at the Otolaryngology Clinic of Kaohsiung Municipal Ta-Tung Hospital in Taiwan from December 2013 to June 2015, which included 26 children (10 females, 16 males; mean age 6 years; range 4 to 13 years) and a total of 51 ears with OME (in which 17 received medical therapy and 34 underwent grommet insertion). All children received pure tone audiometry, tympanometry and DPOAE examinations at the initial presentation and subsequent 1, 2 and 3 months followups. Correlations among initial PTA, initial average air-bone gap (ABG), OME duration and DPOAE were analyzed. RESULTS: There were significant differences between the initial PTA and DPOAE at baseline (initial presentation), 1month, and 3 months in all patients with OME ( p ＜ .05, p = .02, p = .01, respectively), and between initial average ABG and DPOAE ( p ＜ .05, p = .001, p = .03, respectively). However, there were no significant differences between OME duration and DPOAE at the same time points ( p = .512, p = .13, p = .18, respectively). CONCLUSION: Initial PTA and average ABG can predict DPOAE after grommet insertion, and the duration of OME is also related to DPOAE. We are the first to present objective data to demonstrate that poor initial PTA, high initial average ABG, a long duration of OME can predict DPOAE results, which reflects middle and inner ear function. Our findings may help clinicians, patients and their family members to decide whether or not to undergo grommet insertion for OME.

關鍵字

otitis media with effusion ； distortion product otoacoustic emission ； grommet insertion

並列摘要

背景：本研究目的在於探討中耳積水的病人，是否可以利用初次就診時的純音聽力檢查、變頻耳聲傳射檢查(distortion product otoacoustic emissions, DPOAE)、及病程時間長短來預測病人治療後的結果。方法：本研究收集高雄市立大同醫院耳鼻喉科在2013年11月到2015年1月間，由單一主治醫師對26位中耳積水病人進行治療的病例回顧。紀錄病程時間，和初次門診、第一、二、三個月回診時的純音聽力、變頻耳聲傳射及鼓室聽力檢查結果，並利用變頻耳聲傳射檢查結果來顯示治療後的中耳狀況，進一步統計初次門診純音聽力檢查、病程時間長短和治療後變頻耳聲傳射檢查的關係。結果：初次門診的聽力閾值和平均氣骨導差值，與第一、二、三個月回診時的變頻耳聲傳射檢查結果相關性是有達統計上的顯著意義；而病程時間長短與第一、二、三個月回診時的變頻耳聲傳射檢查結果相關性並未達統計上的顯著意義。結論：中耳積水病人的初次門診聽力閾值和氣骨導差值，可以用來預測病人經通氣管治療後的中耳預後，這有助於臨床醫師在治療中耳積水病人時，若一開始就出現聽力閾值較差、氣骨導差值較大、病程時間較久的情形，給予較積極的治療。

並列關鍵字

otitis media with effusion ； distortion product otoacoustic emission ； grommet insertion（中耳積水 ； 變頻耳聲傳射檢查 ； 通氣管置入）