| Objective To investigate whether compensation of middle ear pressure in patients with mild and moderate deafness in the presence of negative middle ear pressure(NMEP)can increase the rate of distortion product otoacoustic emission(DPOAE)elicitation,thereby reducing the incidence of misdiagnosis of conductive deafness(CHL)as sensorineural hearing loss(SNHL)or mixed hearing loss(MHL),which improves the scope of application of DPOAE in clinical hearing diagnosis.To investigate whether compensation of middle ear pressure DPOAE combined with electrocochleography(ECoch G)in patients with mild and moderate SNHL could provide more accurate localization of inner ear function and lesions,and thus provide more accurate clinical diagnosis and treatment for patients with NMEP combined with SNHL.Methods From October 2021 to October 2022,a total of 50 ears were collected from 45 patients,in the outpatient clinic of the ENT department,Inner Mongolia Autonomous Region People’s Hospital.The age range of those patients was 18～50 years old,the median age was 30.5 years,the pure tone audiometry was mild and moderate conductive hearing loss(CHL)or SNHL,and the clinical data of patients with C-type tympanometry on the 226Hz detection tympanic ventricular conduction diagram.According to the pure tone audiometry results,the CHL group and SNHL group were designed as DPOAE experimental group.And 24 healthy volunteers with A-type tympanometry on the 226Hz detection tympanic ventricular conduction diagram were recruited as the control group of the DPOAE experiment,with a total of 40 ears,the age range was between 18～50 years old,and the median age was 31 years old.The CHL group,SNHL group and control group were tested with DPOAE(traditional DPOAE)and compensated pressure DPOAE,and the elicitation rate and amplitude response of specific frequency points of DPOAE before and after the compensation of middle ear pressure were recorded in each group.Secondly,patients who failed the DPOAE and compensated pressure DPOAE tests in the SNHL group were selected as ECoch G experimental group,and then 20ears were selected from the DPOAE control group and designed as ECoch G control group.The two groups underwent ECoch G tests to record the amplitude of negative Summating Potential(SP)and the amplitude of Compound Action Potential(CAP or AP).-SP/AP amplitude ratio and SP/AP area ratio,the obtained data were clinically compared and statistically analyzed.Results(1)In the DPOAE experiment,the pass rate of DPOAE in the CHL group was 20.8%,the pass rate of compensated pressure DPOAE was 66.6%,and the pass rate of compensated pressure DPOAE was significantly higher than that of DPOAE,and the difference was statistically significant(χ~2=10.243,P<0.05);The pass rate of DPOAE and compensated pressure DPOAE in SNHL group was 0.The pass rate of DPOAE and compensated pressure DPOAE in the control group was 100.0%.(2)In the DPOAE experiment,the amplitude responses at 0.75,1.0,1.5 and 6.0 k Hz in the control group were higher than those in the CHL and SNHL groups in the DPOAE test before and after the compensation pressure,and the differences were statistically significant(P<0.05).(3)The compensated pressure DPOAE amplitude reaction and elicitation rate in the CHL group were higher than those at the three frequencies of 0.75,1.0 and 1.5k Hz,and the difference was statistically significant(P<0.05),while the compensated pressure DPOAE amplitude reaction and elicitation rate at the frequency of 6.0k Hz were not different from those of DPOAE(P>0.05).(4)Compared with DPOAE,the compensated pressure DPOAE elicitation rate at the four frequencies of 0.75,1.0,1.5 and6.0k Hz in the SNHL group was not statistically significant(P>0.05),but at the frequencies of0.75k Hz and 1.0k Hz,the amplitude response of the compensation pressure DPOAE was higher than that of DPOAE,the difference was statistically significant(P<0.05),and the amplitude reaction of the compensation pressure DPOAE at the frequencies of 1.5k Hz and 6.0k Hz was not statistically significant(P>0.05).(5)24 patients in the ECoch G experimental group had a total of 26 ears,all of which underwent ECoch G test,of which 8 had no waveform elicitation,9 had an SP/AP amplitude ratio greater than 0.39 and an SP/AP area ratio greater than 2.20,and the remaining 9 had no obvious abnormalities in the electrocochlear waveform.The amplitude value of SP in the SNHL group was significantly higher than that in the control group(P<0.05),while the difference in the amplitude value of AP was not statistically significant compared with the control group(P>0.05).Conclusion Patients with NMEP combined with mild and moderate CHL or SNHL can have a compensated pressure DPOAE combined with an ECoch G test for initial localization of inner ear function and lesions,so as to provide patients with more timely and accurate clinical diagnosis and treatment. |
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