聲導抗是判斷耳部疾病主要手段之一,可以了解中耳的生理或病理狀況,初步客觀判斷是哪種類型的耳聾,如是不是精神性聾(有沒有真的聽力下降)、是不是偽聾(這是另一種假的聽力下降,經常出現在外傷后工傷鑒定中),又如聽力下降的原因是感音神經性聾還是傳導性聾(這決定了完全不同的治療方法)。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> <span style="box-sizing: border-box; background-repeat: no-repeat; margin: 0px; padding: 0px; border: 0px;"> 1.什么是聲導抗測試</span></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> 聲導抗測試指客觀測試中耳的聲導納和聲阻抗(聲波通過媒質及被阻不能通過媒質)以了解中耳傳音系統的功能狀態的檢查,又被稱作中耳分析儀,也可以部分反映腦干聽覺通路功能的方法。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> 常用以對中耳炎癥、咽鼓管功能及鐙骨肌反射的了解與診斷。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> <span style="box-sizing: border-box; background-repeat: no-repeat; margin: 0px; padding: 0px; border: 0px;">2.聲導抗測試方法及完整測試包括幾個部分:</span></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ①測試前準備:聲導抗測試是一種客觀測試,檢查前應囑咐患者,測試過程中不要說話、不要做咳嗽與吞咽等動作。對于成人告知測試時耳道將被耳塞塞住,并有一些壓力改變的感覺。測試者準備:電耳鏡檢查外耳道,防止有耵聹堵塞耳塞頭,或過多的耵聹阻擋探測音的傳入;防止有流膿或者水分或者血液被負壓吸進管道;同時也要檢查外耳道的大小和走行方向,以選擇合適的耳塞來快速、準確密封外耳道。對外耳道進行密封是做聲導抗測試的前提。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ②測試方法:測試者一般頭戴類似耳機的測試儀器,測試耳外耳道內塞入裝有合適耳塞的探頭,對側耳戴著耳機。探測音:常用226Hz探測音,還可以選用其他頻率探測音如1000Hz或者寬頻探測音,由探頭給聲。探頭:接3個管子,管3個功能給聲(包括探測聲及鐙骨肌聲反射測試時的同側給聲),變氣壓探測容積變化。耳機:負責鐙骨肌聲反射測試時的對側給聲。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ③測試類型:常用的有2種。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> 第1種是導抗圖(鼓室圖)測試:連續逐漸調節外耳道氣壓,正壓到負壓,鼓膜相應的連續移動產生的聲順動態變化,以壓力聲順函數曲線形式記錄下來,稱之為“導抗圖”。通過對鼓膜外側聲能傳遞過程變化的測量,了解中耳功能狀態。可以得到各種類型的鼓室圖,以及靜態聲順值,外耳道容積等數據。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> 第2種是鐙骨肌聲反射:當人耳受到足夠大強度的聲音刺激時,雙側鐙骨肌反射性收縮,此時中耳聲導抗發生變化,在平衡計上顯示并可畫出曲線,是一種強聲自我保護性反射。測試耳置放探頭可以同側給聲并觀察聲導抗的變化,對側耳給聲時測試對側耳給聲時鐙骨肌反射。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> <span style="box-sizing: border-box; background-repeat: no-repeat; margin: 0px; padding: 0px; border: 0px;">3.何時去查聲導抗?</span></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?耳悶,尤其是耳悶伴聽力下降時。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?全面了解中耳功能,判斷有無中耳炎。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?幫助判斷鼓膜穿孔是否愈合,比如鼓膜置管后。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?了解咽鼓管是否阻塞時。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?了解分泌性中耳炎是否好轉時。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?初步判斷偽聾或者精神性聾。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?初步判斷聽神經病。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?初步判斷耳硬化癥。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> <span style="box-sizing: border-box; background-repeat: no-repeat; margin: 0px; padding: 0px; border: 0px;">4.聲導抗可以知道什么?</span></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?鼓室是否有積液。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?咽鼓管是否解剖通暢。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?鼓膜是否穿孔。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?如果鐙骨肌反射完全正常,基本不考慮中重度耳聾。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"><br style="box-sizing: border-box; background-repeat: no-repeat;" /></p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; color: rgb(128, 128, 128);"> ?如果鐙骨肌反射完全正常,基本不考慮聽神經病。</p><p microsoft="" font-size:="" white-space:="" style="margin: 0px; font-family: sans-serif; font-size: 16px; box-sizing: border-box; background-repeat: no-repeat; padding: 0px; border: 0px; 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