鼓膜耳蜗电图诊断梅尼埃病的临床研究

发布时间：2018-06-05 11:51

本文选题：鼓膜耳蜗电图 + 梅尼埃病　；参考：《华中科技大学》2012年硕士论文

【摘要】：目的：探讨鼓膜耳蜗电图（Tympanic Electrocochleography TM—ECochG）在梅尼埃病（Meniere’s desease MD）诊断中的临床应用价值。方法：根据《1995年美国耳鼻咽喉头颈外科学会梅尼埃病分类指引》[6]将测试对象分为确诊（definite）、可能（probable）和疑似（possible）MD组，将可能和疑似MD组合并为可疑MD组（suspected）。对确诊MD组和可疑MD组患耳采用鼓膜耳蜗电图（TM—ECochG）进行测试。用短声（click）和500Hz、1000Hz、2000Hz、4000Hz四种频率短纯音（tone burst TB）分别测试，引出并记录和电位（summating potential SP）和动作电位（action potential AP）。规定SP与AP振幅的比值（SP/AP ratio）大于或等于0.40为阳性，表示诊断为MD。规定由click刺激声引出的动作电位疏波（condensation）和密波（rarefaction）潜伏期的差值（AP rar-con latency shift AP shift）大于0.30ms为阳性，表示诊断为MD。确诊MD组分别计算不同刺激声不同测试方法的诊断阳性率，比较诊断阳性率大小。比较确诊MD组和可疑MD组click SP/AP和AP shift数值大小，两组诊断阳性率大小。将确诊MD组患耳按照纯音测听结果分成四级，比较click SP/AP和AP shift阳性率与MD分级之间的关系。同时，将正常听力耳作为正常参考组，计算click SP/AP与AP shift的95%置信区间，得出正常临界参考值。最后，对所有进行耳蜗电图测试的测试耳采用交替极性（alternating），click刺激声进行听阈评估，，比较纯音测听结果与耳蜗电图听阈评估结果相关性。结果：确诊MD组患耳，click SP/AP阳性率为36.7%，TB500Hz、TB1000Hz、TB2000Hz、TB4000Hz阳性率分别为56.7%、83.3%、73.3%、53.3%，AP shift阳性率为50.0%。配对卡方检验结果显示，TB1000与click SP/AP（P0.01）、TB2000与click SP/AP(P0.01)阳性率差异具有显著统计学意义，其中TB1000诊断阳性率最高，即灵敏度（sensitivity）最高。确诊MD组与可疑MD组患耳click SP/AP阳性率分别为36.7%和5.3%，AP shift阳性率分比为50%和15.8%，四个表卡方检验显示两组之间click SP/AP和AP shift阳性率存在显著统计学差异（p0.05），独立样本t检验显示两组click SP/AP和AP shift数值具有显著统计学差异（p0.01，p0.05）。Fisher确切概率法检验显示，click SP/AP、AP shift阳性率在MD分级组之间无显著意义不同（p0.05）。正常参考耳click SP/AP95%置信区间为0.35，AP shift95%置信区间为0.30。采用线性相关分析显示，耳蜗电图听阈评估和纯音听阈测听具有良好相关性（r=0.925，p0.01）。结论：鼓膜耳蜗电图（TM—ECochG）在梅尼埃病诊断及鉴别诊断中作用显著，特别是采用1000Hz和2000Hz短纯音，其诊断灵敏度高达83.3%和73.3%。动作电位疏密波潜伏期差值（AP shift）也被证明是一种有效的测量方法，在辅助诊断MD中作用显著。最后，耳蜗电图能够有效进行听阈评估。
[Abstract]:Objective: To investigate the clinical value of tympanic Electrocochleography TM-ECochG in the diagnosis of Meniereres desease MDD. Methods: According to the 1995 American Academy of Otolaryngology and head and neck surgery Classification guidelines for Meniere's Disease [6], the subjects were divided into two groups: the confirmed definitesiform group and the suspected possibleMD group, which may be combined with suspected MD and be considered as suspicious MD group. The tympanic membrane electrocochogram (TM-ECochG) was used to test the affected ears in MD group and suspected MD group. The short tone (burst TBs) at four frequencies of 500Hz / 1000Hz and 500Hz / 1000Hz were measured, and the recording and potential summing potential (SPP) and action potential (APP) were obtained. If the ratio of SP / AP amplitude is greater than or equal to 0.40, the ratio of SP / AP amplitude is positive, indicating the diagnosis of MDM. The difference between the latency of action potential sparsely induced by click stimulation and that of dense wave rarefaction) is greater than that of 0.30ms, indicating that the difference between AP rar-con latency shift AP shift) and 0.30ms is positive, indicating that the diagnosis is MDD. The diagnostic positive rate of different stimuli and different test methods were calculated in MD group, and the diagnostic positive rate was compared. The values of click SP/AP and AP shift were compared between the confirmed MD group and the suspected MD group. The patients with MD were divided into four groups according to pure tone audiometry. The relationship between the positive rate of click SP/AP and AP shift and MD grade was compared. At the same time, the 95% confidence interval between click SP/AP and AP shift was calculated and the normal critical reference value was obtained by using the normal hearing ear as the normal reference group. Finally, the auditory threshold was evaluated by alternating polarity alternatingclick stimulation sound in all the tested ears, and the correlation between the results of pure tone audiometry and that of electrocochlear audiometry was compared. Results: In MD group, the positive rate of click SP/AP was 36.7% and TB500HzN TB1000HzN TB2000HzN TB4000Hz was 56.7%. The positive rate of 53.3AP shift was 50.0. The results of paired chi-square test showed that the positive rate of TB1000 was significantly different from that of click SPP / APP / TB2000 and that of click SPP / APP / P0.01), and the positive rate of TB1000 was the highest, that is, the sensitivity of TB1000 was the highest. The positive rate of click SP/AP was 36.7% in the confirmed MD group and 15.8% in the suspected MD group. The positive rate of AP shift was 50% and 15.8% in the confirmed MD group and suspected MD group, respectively. The positive rates of click SP/AP and AP shift in the two groups were significantly different from those in the two groups (p 0.05%), and the independent sample t-test showed that there was a significant difference in the positive rate of click SP/AP and AP shift between the two groups. The results showed that there was significant difference in click SP/AP and AP shift values between the two groups. The exact probability test showed that there was no significant difference in the positive rate of AP shift between the two groups (P 0.05). The normal reference ear click SPAP95% confidence interval is 0.35% AP shift95% confidence interval is 0.30. Linear correlation analysis showed that there was a good correlation between electrocochlear audiometry and pure tone audiometry. Conclusion: TM-ECochG plays an important role in the diagnosis and differential diagnosis of Meniere's disease, especially with 1000Hz and 2000Hz short tone. The diagnostic sensitivity of TM-ECochG is as high as 83.3% and 73.3%. The difference in the latency of action potential density wave (AP shift) has also been proved to be an effective measurement method, which plays an important role in the diagnosis of MD. Finally, electrocochocardiography can effectively evaluate the hearing threshold.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R764.33

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