本文選題：鼓膜耳蝸電圖 + 梅尼埃病�。� 參考：《華中科技大學(xué)》2012年碩士論文

【摘要】：目的： 探討鼓膜耳蝸電圖（Tympanic Electrocochleography TM—ECochG）在梅尼埃�。∕eniere’s desease MD）診斷中的臨床應(yīng)用價值。 方法： 根據(jù)《1995年美國耳鼻咽喉頭頸外科學(xué)會梅尼埃病分類指引》[6]將測試對象分為確診（definite）、可能（probable）和疑似（possible）MD組，將可能和疑似MD組合并為可疑MD組（suspected）。對確診MD組和可疑MD組患耳采用鼓膜耳蝸電圖（TM—ECochG）進(jìn)行測試。用短聲（click）和500Hz、1000Hz、2000Hz、4000Hz四種頻率短純音（tone burst TB）分別測試，引出并記錄和電位（summating potential SP）和動作電位（action potential AP）。規(guī)定SP與AP振幅的比值（SP/AP ratio）大于或等于0.40為陽性，表示診斷為MD。規(guī)定由click刺激聲引出的動作電位疏波（condensation）和密波（rarefaction）潛伏期的差值（AP rar-con latency shift AP shift）大于0.30ms為陽性，表示診斷為MD。確診MD組分別計算不同刺激聲不同測試方法的診斷陽性率，比較診斷陽性率大小。比較確診MD組和可疑MD組click SP/AP和AP shift數(shù)值大小，兩組診斷陽性率大小。將確診MD組患耳按照純音測聽結(jié)果分成四級，比較click SP/AP和AP shift陽性率與MD分級之間的關(guān)系。同時，將正常聽力耳作為正常參考組，計算click SP/AP與AP shift的95%置信區(qū)間，得出正常臨界參考值。最后，對所有進(jìn)行耳蝸電圖測試的測試耳采用交替極性（alternating），click刺激聲進(jìn)行聽閾評估，，比較純音測聽結(jié)果與耳蝸電圖聽閾評估結(jié)果相關(guān)性。 結(jié)果： 確診MD組患耳，click SP/AP陽性率為36.7%，TB500Hz、TB1000Hz、TB2000Hz、TB4000Hz陽性率分別為56.7%、83.3%、73.3%、53.3%，AP shift陽性率為50.0%。配對卡方檢驗(yàn)結(jié)果顯示，TB1000與click SP/AP（P0.01）、TB2000與click SP/AP(P0.01)陽性率差異具有顯著統(tǒng)計學(xué)意義，其中TB1000診斷陽性率最高，即靈敏度（sensitivity）最高。確診MD組與可疑MD組患耳click SP/AP陽性率分別為36.7%和5.3%，AP shift陽性率分比為50%和15.8%，四個表卡方檢驗(yàn)顯示兩組之間click SP/AP和AP shift陽性率存在顯著統(tǒng)計學(xué)差異（p0.05），獨(dú)立樣本t檢驗(yàn)顯示兩組click SP/AP和AP shift數(shù)值具有顯著統(tǒng)計學(xué)差異（p0.01，p0.05）。Fisher確切概率法檢驗(yàn)顯示，click SP/AP、AP shift陽性率在MD分級組之間無顯著意義不同（p0.05）。正常參考耳click SP/AP95%置信區(qū)間為0.35，AP shift95%置信區(qū)間為0.30。采用線性相關(guān)分析顯示，耳蝸電圖聽閾評估和純音聽閾測聽具有良好相關(guān)性（r=0.925，p0.01）。 結(jié)論： 鼓膜耳蝸電圖（TM—ECochG）在梅尼埃病診斷及鑒別診斷中作用顯著，特別是采用1000Hz和2000Hz短純音，其診斷靈敏度高達(dá)83.3%和73.3%。動作電位疏密波潛伏期差值（AP shift）也被證明是一種有效的測量方法，在輔助診斷MD中作用顯著。最后，耳蝸電圖能夠有效進(jìn)行聽閾評估。
[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.
【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R764.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 吳子明;張素珍;周娜;冀飛;陳艾婷;謝塑江;楊偉炎;韓東一;;幾項(xiàng)耳功能檢查在梅尼埃病診斷中的意義[J];臨床耳鼻咽喉科雜志;2006年10期

本文編號：1981897