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首页 声导抗基础知识

声导抗基础知识.ppt

声导抗基础知识

zhuimeng522008
2013-08-03 0人阅读 举报 0 0 0 暂无简介

简介:本文档为《声导抗基础知识ppt》,可适用于自然科学领域

声导抗基础知识培训声导抗基础知识培训TympanometryandAcousticReflexMeasurements鼓室声导抗和声反射测试Infanttestrecommendations婴儿测试的推荐方法Soundtravel声音传导Soundtravel声音传导Gettingsoundintoadifferentmedium声音在不同媒介中的传导Gettingsoundintoadifferentmedium声音在不同媒介中的传导Mostofthesoundenergyisreflectedwhenconfrontingaanothermedium大部分声能在临界面处被反射回来…becausedifferentmediaaremoreorlesseasytobringintomotion(impedance)因为不同媒介的声阻抗是不同的Theroleofthemiddleear中耳的作用Theroleofthemiddleear中耳的作用TheOssicles听小骨TheOssicles听小骨Malleus锤骨Incus砧骨Stapes镫骨Threesmallbonesformingachainbetweenthetympanicmembraneandtheinnerear听骨链位于鼓膜和内耳之间由块听小骨组成Airbornesoundwaveenergybecomesmechanicalvibration空气传导的声波能量转换为机械振动Compensatesfortheairfluidimpedancedifference补偿气液相不同媒介的导抗差TheMiddleearanatomy中耳解剖TheMiddleearanatomy中耳解剖Airpressuremustbenearequalonbothsidesoftheeardruminordertooptimisemobilityofthewholesystem应使鼓膜两侧气压接近从而保证中耳传声系统的最佳活动性TheEustachiantube(ET)ventilatesthemiddleearandallowspressureequalisation咽鼓管是中耳的通气管道可保证中耳气压平衡TheETopenswhenswallowingoryawning吞咽和打哈欠时咽鼓管开放Innerearfluids内淋巴Gettingsoundintoadifferentmedium声音在不同媒介中的传导Gettingsoundintoadifferentmedium声音在不同媒介中的传导The“stiletto”principle:圆锥效应Forceiscollectedoveralargerareaandfocusedonasmallerarea(B)作用力在锥底收集后聚焦到锥尖Howdowetestthemiddleear如何检测中耳功能Howdowetestthemiddleear如何检测中耳功能中耳测试中耳测试精密的中耳系统高精度的测试高质量控制系统Admittancelettingthesoundwavein声导纳-将声波导入Partoftheprobetoneisreflected,andsomeisadmittedintothemiddleear一部分探测音被反射回来另一部分则进入中耳Theadmittanceiscontinuouslymeasuredbyamicrophone声导纳通过麦克风持续测量计算出来Admittancelettingthesoundwavein声导纳-将声波导入鼓室图鼓室图中耳–劲度Tympanometry鼓室声导抗Tympanometry鼓室声导抗AdmittancedaPadaPaEarcanalpressure:Pressurestiffensthetympanicmembranesotheprobetonebouncesback,andthesoundlevelinthemiddleeardecreases和:大压强使鼓膜僵硬从而探测音多被反弹回来进入中耳的声能减少:Whenpressureisequalonbothsides,thesoundlevelinthemiddleearisatmaximum:鼓膜两侧压力相等时传入中耳的声能最大TheTympanogramcurve,ECVandTPP鼓室导抗图形等效外耳道容积和峰压点TheTympanogramcurve,ECVandTPP鼓室导抗图形等效外耳道容积和峰压点TheTPPapproximatesthemiddleearpressure峰压点近似于鼓膜内侧的中耳压力ECVTotalAdmittanceoftheearcanalandthemiddleear外耳道和中耳的声导纳总值TPPTheHzadmittanceoftheairintheearcanalisdirectlyproportionaltothevolumeofthatairThatgivesustheEquivalentEarCanalVolume,ECV以Hz为探测音测试探头与鼓膜之间的空气导纳值为外耳道容积即等效外耳道容积TheTympanogramcurveandbaselinecompensation鼓室导抗图形和基线补偿TheTympanogramcurveandbaselinecompensation鼓室导抗图形和基线补偿SubtractionoftheECVcontributiongivesusabaselinecompensatedtympanogram去除外耳道容积成分后的鼓室图称为基线补偿鼓室导抗图PeakadmittancebecomesStaticAdmittance,SA该图峰值处的声导纳称为静态声导纳(SA)TheSAistheadmittanceofthemiddleearaloneNowwecanusethenormativedata!SA等于中耳的声导纳值TheTympanogramcurveclassification,Type鼓室导抗图形分类TypeAd:OssiculardiscontinuityoragerelatedhypermobilityAd型:听骨链中断或鼓膜松弛TypeB:“Flat”EffusionorperforatedeardrumdependingonECVvalueB型:平坦型。鼓室积液或鼓膜穿孔根据ECV值区分TypeAs:PossibleeffusionorotosclerosisAs型:鼓室积液可能或耳硬化症TheTympanogramcurveclassification,Type鼓室导抗图形分类TheTympanogramcurveandTympanometricWidth鼓室导抗图形与鼓室图宽度(TW)PressureAdmittanceTheTympanogramcurveandTympanometricWidth鼓室导抗图形与鼓室图宽度(TW)TympanometricWidthquantifythesteepnessofthetympanogramTW决定鼓室导抗图的坡度Normativedataexistfordifferentagegroups不同年龄组标准化值不同TWandSAarethecriteriausedintheASHAtympanometricscreeningprotocol美国社会卫生学会的鼓室声导抗筛查方案把TW和SA作为诊断指标Hz:DifferentconfigurationsoftympanometricresultsHz鼓室声导抗测试结果与疾病的关系Hz:DifferentconfigurationsoftympanometricresultsHz鼓室声导抗测试结果与疾病的关系Tympanometryisaninvaluablediagnostictoolwhencombinedwithotheraudiologicaltests鼓室声导抗与其它听力学测试结合是不可替代的诊断工具Thetwomiddleearmuscles中耳肌Thetwomiddleearmuscles中耳肌:Tensormuscle鼓膜张肌:StapediusMuscle镫骨肌Themusclesarebelievedtostabilisethemechanicalsystemandprotectthecochleafromexcessivelowfrequencyvibration中耳肌可稳定中耳机械系统并保护耳蜗免受低频强声损伤TheAcousticReflex声反射TheAcousticReflex声反射LoudsoundsmakethestapediusmusclecontractThismakesthemiddleearsystemstiffer强声刺激可使镫骨肌收缩从而增加中耳传声系统的劲度…andlesslowfrequencysoundcangetthroughthemiddleear因而进入中耳的低频声波减少TheMiddleearImmittancetests中耳声导纳测试TheMiddleearImmittancetests中耳声导纳测试Stapediusmusclecontrolledbyfacialnerve(CNVII)镫骨肌由第七对颅神经-面神经支配Networkinbrainstemconsistsofipsilateralandcontralateralpaths脑干层面由同侧和对侧神经通路组成Reflexactivatedonbothears,evenwhenstimulationonlyoccursinoneear一侧耳受到刺激时双侧镫骨肌都会收缩Comparisonofipsilateralvscontralateralacousticreflexeshelpstodeterminesiteoflesion对比同侧和对侧声反射有助于判断病变部位Acousticreflexthreshold声反射阈声反射声反射蹬骨肌AcousticReflexThresholds声反射阈Deflectioncriterion声导纳偏移标准Itisusefultostudythegrowthwithintensitytoconfirmareflexthreshold继续增加声强观察偏移变化有助于进一步明确声反射阈!AcousticReflexThresholds声反射阈Loudstimuliarepresented,whilsttheadmittanceismeasured强声刺激出现时可测试出声导纳值的变化声反射测试–高精度的挑战声反射测试–高精度的挑战鼓膜处压力为TPP值时中耳蹬骨肌反射状况最佳正确的声反射是刺激音引起导纳在TPP处的变化耳道或中耳压力的改变导致错误的声反射对于鼓膜活动度过大可进行TPP补偿AcousticReflexDecay声反射衰减HalfLifeTime(HLT),thetimeafterstimulusonsetwhentheadmittancedeflectionhasdecreasedby半衰期是指声反射振幅减少%的时程Ahalflifetimevalue<secondsisindicativeoftumour半衰期小于秒提示蜗后病变常见的疾病是听神经瘤Noreflexdecaypresent阴性AdmittancechangeAcousticReflexDecay声反射衰减AcousticReflexfeatures声反射特征Thereflexshouldbeactivatedinbothearsevenifstimulatedinonlyoneear单耳刺激声可激活双耳声反射TheuppernormalintensitylimitforreflexthresholdsinadultsisdBHL正常成人声反射阈上限是-dBHLReflexthresholdscannotbedeterminedifthereisaproblemwiththemiddleear中耳疾病时不能测出声反射阈BroadBandNoiseprovokesareflexataboutdBlowerthanpuretonestimuli宽带噪声声反射阈较纯音刺激声低-dBDeterminestypeofhearinglosswhencomparedwiththeaudiogram声反射阈与听力图比较可帮助判断耳聋类型Decayswithneuralfatigue(typicallythnervetumour)衰减提示听神经疲劳是听神经肿瘤的典型表现AcousticReflexfeatures声反射特征DifferentconfigurationsofAcousticReflexresults声反射结果与疾病的关系DifferentconfigurationsofAcousticReflexresults声反射结果与疾病的关系Usingthiskindoftablemakesreflexinterpretationeasier使用该表格有助于判断声反射的临床意义Tympanometryininfantsyoungerthanmonths-个月以下婴儿的鼓室声导抗Hzprobetone:Normaltympanograminabnormalear!Hz探测音:异常中耳显示正常鼓室导抗图Tympanometryininfantsyoungerthanmonths-个月以下婴儿的鼓室声导抗HzprobetoneTheinfantouterandmiddleearsarestilldeveloping,anddonotvibratewithsoundthesamewayadultearsdo婴儿外耳和中耳正处于发育期与成人的声波振动方式不同UseHzprobetoneininfants推荐使用KHz探测音Tympanometryininfants婴儿鼓室声导抗Tympanometryininfants婴儿鼓室声导抗Hztympanometryclearlyindicatesabnormalmiddleearfunction!kHz鼓室声导抗明确显示中耳功能异常NormalHztympanogramsforbothears!Hz鼓室声导抗显示双耳正常Acousticreflexesconfirmahealthyrightsidemiddleear声反射证实右侧中耳功能正常Traditionaladmittancemagnitudetympanometry传统鼓室声导抗中声导纳的成分Traditionaladmittancemagnitudetympanometry传统鼓室声导抗中声导纳的成分BGcomponenttympanogram声纳声导成分鼓室导抗图BGcomponenttympanogram声纳声导成分鼓室导抗图B:Susceptance声纳G:Conductance声导SusceptanceandConductancemagnitudetympanometry声导与声纳SusceptanceandConductancemagnitudetympanometry声导与声纳ComponentCompensatedStaticAdmittance成分补偿声导纳CCSATraditionalbaselinecompensationCCSAisnotcalculatedthroughsimpleECVsubtraction,butthroughcompensatingtheBandGcomponentsindividuallybeforeputtingthemtogetherCCSA不是简单减去ECV得到的而是分别对声导和声纳补偿后再相加计算出来的ComponentCompensatedStaticAdmittance成分补偿声导纳CCSAMiddleearassessmentininfants,recommendations婴儿中耳评估的推荐方法Middleearassessmentininfants,recommendations婴儿中耳评估的推荐方法Lowfrequencyprobetonetympanometryisunreliableininfantsandshouldnotbeused低频探测音由于鼓室声导抗测试结果不可靠不推荐使用于婴儿HzprobetoneispreferabletoHzkHz探测音优于HzAlowpeak,belowHznormdatarange,ornopeakatallislikelyduetoeffusion低于kHz正常数据范围的低峰或无峰的测试结果提示中耳积液Reflextestingininfants:婴儿声反射测试HzprobetonekHz探测音ipsilateralstimulation同侧刺激音broadbandnoisestimulus宽带噪声刺激音CombineHztympanometryandreflextesting将kHz鼓室声导抗与声反射测试相结合综合判断

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