JP4674229B2 - Acoustic pupillary reaction test system - Google Patents

Description

The present invention relates to an acoustic pupillary reaction inspection system that examines a pupillary reaction accompanied by an acoustic stimulus, and more particularly to an acoustic pupillary reaction inspection system that is effective in an autonomic nervous function test applicable in basic medicine and clinical medicine.

Conventionally, in clinical medicine, dizziness inspection among others autonomic function tests are cardiovascular examination mainly blood pressure test and ECG changes orthostatic operation, pupillary response due to acoustic stimuli for this type of autonomic function tests ( (Acoustic pupillary reaction) has hardly been clinically applied.
Regarding this type of acoustic pupillary reaction, it has already been confirmed that there is a pupillary reaction associated with acoustic stimulation using an ophthalmic infrared electronic pupillometer (Iriscorder) (for example, see Non-Patent Document 1). ).
In addition, a technology is provided in which an imaging camera is provided in goggles that can be worn on the subject's head, and the movement of the eyeball of the subject is imaged by the imaging camera, and eye movement data can be displayed based on the captured eyeball image. Has already been proposed (see, for example, Patent Document 1).

Oto-nose and Clinical 24, No. 2, March 1978 “Basic Problems of Acoustic Pupil Response as an Objective Hearing Test” pp. 171-181 Japanese Patent Laying-Open No. 2003-319907 (Embodiment of the Invention, FIG. 2)

By the way, when the autonomic nervous function test by the standing load described above is performed on subjects with strong symptoms, there is a possibility that consciousness loss and a fall accident accompanying it may sometimes occur, and it was difficult to perform on all subjects. Moreover, the examination time required 20 to 30 minutes per person, and it was not suitable for many subjects.
Further, when the above-described acoustic pupillary reaction is used for this type of autonomic nervous function test, if the Iriscoder of Non-Patent Document 1 or the goggles with an imaging camera of Patent Document 1 is used, the acoustic pupillary reaction is It may be possible to measure in real time how it is occurring.
However, it is impossible to measure and analyze acoustic pupillary response changes in association with acoustic stimulation, and it is not possible to collect sufficient information as a test result as an autonomic function test.

  The technical problem of the present invention is to provide an acoustic pupillary reaction inspection system capable of efficiently performing an acoustic pupillary reaction inspection without applying excessive stress to a subject.

As shown in FIG. 1, the present invention is an acoustic pupillary reaction inspection system for inspecting a pupil reaction associated with a predetermined acoustic stimulus, and includes an acoustic stimulus generation means 1 that generates a predetermined acoustic stimulus and the acoustic stimulus. The acoustic stimulus transmission means 2 for transmitting to the ear of the subject M, the positioning holder 7 in which the head of the subject M is positioned and held at a fixed position, and the movement of the eyeball of the subject M positioned by the positioning holder 7 are imaged. The eyeball imaging unit 3, the illuminance adjusting unit 9 that can adjust the illuminance of the eyeball position of the subject M positioned by the positioning holder 7, and the pupil change of the eyeball is analyzed based on the eyeball image from the eyeball imaging unit 3. A pupil change analyzing means 4 for recording, and a recording means 5 for recording the pupil change information analyzed by the pupil change analyzing means 4 and the acoustic stimulus information generated by the acoustic stimulus generating means 1 in association with each other. Acoustic stimulation information recorded by the recording means 5, the pupil changes information associated with the acoustic stimulation information, and includes a display unit 6 for displaying the test results of acoustic property pupillary Based on these, the The eyeball imaging means 3 is arranged so as not to face at least both eyes of the subject M, and can image both eyes of the subject M via the half mirror, and a white plate is provided at a transmission part of the half mirror facing both eyes. It is the arranged acoustic pupillary reaction inspection system.

In such technical means, the acoustic pupillary test includes a wide range of tests for examining the pupillary reaction associated with acoustic stimulation, and typically includes an autonomic function test (vertigo test) and an objective hearing test. And brainstem function evaluation tests.
The acoustic stimulus generation means 1 may be selected as appropriate as long as it generates a predetermined acoustic stimulus, may be fixedly set in advance, or the stimulus intensity and the number of times are variably set. You may do it.
Furthermore, examples of the acoustic stimulus transmission means 2 include headphones and earphones.
Furthermore, an imaging device such as a CCD is used as the eyeball imaging means 3. Further, the eyeball imaging means 3 may be installed on a movable table whose position can be adjusted in front of the eyeball of the subject M or in a goggle 8 that can be attached to the subject M.

Further, the pupil change analyzing means 4 may be anything that analyzes pupil changes (pupil diameter change, pupil area, etc.) with a predetermined algorithm.
Furthermore, the recording means 5 only needs to be associated with what is the pupil change information for the predetermined acoustic stimulus information, and may store both of them together, or each information may be stored separately. It is also possible to store the data in the storage location and associate the storage locations with each other.
Furthermore, the display means 6 may be appropriately selected such that the pupil change information associated with the acoustic stimulus information is continuously displayed in a graph or intermittently. In this case, the evaluation of the test result itself may be performed by a doctor by looking at the display result of the display means 6.

The half mirror and the eye imaging means 3, which faces both eyes of the subject M through the half mirror while being non-opposed with respect to both eyes of at least the subject M Ri imageable der, both eyeballs The aspect which arrange | positioned the white board in the permeation | transmission site | part is mentioned. According to this aspect, the eyeball imaging unit 3 is disposed so as not to face both eyes of the subject M, and the subject always sees the white plate in the transmission part of the half mirror facing the both eyes. Obstructs the field of view of the subject M, and does not apply excessive stress to the subject M during the examination period.
Further, the present system includes a positioning holder 7 for positioning and holding the head of the subject M at a fixed position . According to this aspect, it is possible to avoid a situation in which the head of the subject M moves unnecessarily, and to reduce the adverse effect on the acoustic pupillary reaction due to unnecessary shake of the head.
Furthermore, in the aspect in which the eyeball imaging means 3 is provided in the goggles 8 that can be worn in front of the eyeball of the subject M, the eyeball of the subject M and the eyeball imaging means 3 can be easily aligned. preferable.

In the present system, the illuminance of the eye position of the subject M is provided with an illuminance adjusting means 9 can be adjusted. According to this aspect, the inspection environment illuminance can be adjusted to a predetermined illuminance (for example, 100 to 1000 lux), and the pupil reaction can be stabilized.
Further, in the present system, an aspect including an eyeball image display unit 10 capable of displaying an eyeball image captured by the eyeball imaging unit 3 is preferable. According to this aspect, by making it possible to display an eyeball image, a doctor can visually check a pupil change of the eyeball directly, and an acoustic pupil reaction test can be more accurately evaluated.
Furthermore, in this system, it is preferable to include an evaluation unit 11 that can evaluate the test result of the acoustic pupillary reaction displayed on the display unit 6. Here, the evaluation unit 11 may have an evaluation determination algorithm for the acoustic pupillary reaction test and evaluates the display result of the display unit 6 based on the evaluation determination algorithm. According to this aspect, since the evaluation by the evaluation means 11 can be referred to, the evaluation work by the doctor can be performed more simply.

According to the present invention, the movement of the eyeball of the subject is imaged while applying a predetermined acoustic stimulus, the pupil change of the eyeball is analyzed based on the captured image, and the pupil change information is recorded in association with the acoustic stimulus information. Since the pupil change information associated with the acoustic stimulus information is displayed, the acoustic pupillary reaction test can be efficiently performed without applying excessive stress to the subject .
In particular, since the eyeball imaging means is arranged at a non-opposing position of both eyes by using a half mirror, and the white plate is arranged at the transmission part of the half mirror facing both eyes, the eyeball imaging means is used by the subject. Thus, there is no fear of subjecting the subject to excessive stress during the examination period, and the pupillary reaction of the eyeball can be stabilized by adjusting the illuminance on both eyes of the subject.

Hereinafter, the present invention will be described in detail based on embodiments shown in the accompanying drawings.
Embodiment 1
FIG. 2 shows the overall configuration of Embodiment 1 of the acoustic pupillary reaction inspection system to which the present invention is applied.
In this embodiment, the pupil change due to acoustic stimulation is an autonomic response called an acoustic pupil response, and this system is useful as an autonomic function test for vertigo patients such as Meniere's disease.
-Overall configuration of this system-
In this figure, the present system transmits the acoustic stimulus from the acoustic stimulus generator 20 to the subject M through the headphone 21, while wearing the goggles 30 in front of the eyeball of the subject M, An imaging device 40 (40a, 40b in this example) such as a CCD is arranged, and the imaging device 40 images the movement of the eyeball of the subject M.
The eyeball image signal from the image sensor 40 (40a, 40b) is converted into a digital signal via the image converter 50 and then transmitted to the monitor device 51 such as a liquid crystal display device, and on the other hand via the relay control device 52. To the computer 100 such as a personal computer.
Here, the acoustic stimulus generation device 20 is connected to the computer 100 via the relay control device 52, and generates a predetermined acoustic stimulus based on an acoustic stimulus control signal from the computer 100.
The image converter 50 combines the two eyeball image signals from the image sensor 40 (40a, 40b) into a single screen, and transmits it to the monitor device 51 and the relay control device 52.

-Inspection environment equipment-
FIG. 3 shows an example of a test environment facility for the subject M used in the present embodiment.
In the figure, the examination environment equipment includes a holding table 70 for positioning and holding the head of the subject M, and a chair 80 that is placed in front of the holding table 70 and seats the subject M.
Here, the holding table 70 has a fixed base 71 supported by four legs, and a pair of support columns 72 and 73 are provided on both sides of the fixed table 71 located on the chair 80 side. 73 is provided with a positioning holder on which the head of the subject M can be positioned and held.
In this example, the positioning holder is provided with guide bars 74, 76 that are movable in the vertical direction between the columns 72, 73 so as to be freely positioned at predetermined positions. Is disposed, and a frontal pad 77 on which the frontal head of the subject M can be pressed is disposed in the approximate center of the upper guide bar 76.
Reference numeral 78 denotes a white plate that covers the front side of the chin pad 75 and the forehead pad 77 in a curved shape between the support columns 72 and 73, and is considered so that the subject M can obtain a non-gaze state.
Further, in the present embodiment, the holding table 70 is provided with an illuminance adjustment mechanism 90 that can adjust the illuminance at the eyeball position of the subject M. The illuminance adjustment mechanism 90 includes a light source 91 that is provided on one column 72 and illuminates the vicinity of the eyeball position of the subject M, and an adjuster 92 that adjusts the illuminance of the light source 91. Note that an illuminance meter 95 is placed on the fixed base 71 of the holding table 70, and using the illuminance meter 95, for example, the illuminance near the eyeball position of the subject M is adjusted in advance to an appropriate illuminance (for example, 400 lux). do it.

-Test subject's condition-
FIG. 4A schematically shows the state of the subject M during the examination.
In the figure, the subject M is positioned and held in a predetermined posture by placing his / her chin on the chin pad 75 of the positioning holder and pressing the forehead against the forehead pad 77.
Furthermore, the subject M wears a headphone 21 for transmitting acoustic stimulation and wears a goggle 30 incorporating the image pickup device 40 in front of the eyeball with a headband 31.
In particular, in the present embodiment, the goggles 30 have an opening 33 formed in front of the goggles main body 32 as shown in FIGS. 4 (a) and 4 (b). The imaging element 40 (40a, 40b) such as a CCD is fixed to a position that is not opposed to the eyeball, for example, the upper inner wall of the goggle main body 32, and a half mirror 41 is disposed at the line-of-sight position forward of the eyeball. The binocular images are guided to the respective image sensors 40 (40a, 40b) through the half mirror 41.
Therefore, in the present embodiment, the subject M that is positioned and held by the positioning holder always sees the front white plate 78 through the opening 33 of the half mirror 41 and the goggle main body 32, and an obstacle such as the image sensor 40. This effectively avoids the situation in which the field of view in front of you is obstructed.

-Computer configuration-
FIG. 5 shows a configuration example of the computer 100 used in this embodiment.
In the figure, a computer 100 is a CPU 101 for performing arithmetic processing, an image analysis program for analyzing and displaying pupil diameter changes from an eyeball image of a subject M, an acoustic stimulus setting program for setting various acoustic stimuli, and the like. Is input in advance to the ROM 102, the RAM 103 in which the eyeball image data, pupil diameter change data, acoustic stimulus data, etc. of the subject M are stored, and the CPU 101, and the output signal from the CPU 101 is output. I / O port 104 is provided.
The computer 100 captures the eyeball image signal from the relay control device 52 and the input information from the operation unit 106 into the CPU 101 through the I / O port 104, and the CPU 101 stores the image analysis program and the acoustic stimulus setting stored in the ROM 102. The program is executed, eyeball image data and pupil diameter change data are stored in the RAM 103, necessary information is displayed on the display screen 105 via the I / O port 104, and acoustic stimulation is generated via the relay control device 52 The acoustic stimulation control signal set in the device 20 is sent out.

-Autonomic nerve function test-
Next, the autonomic nervous function test using this system will be described.
FIG. 6 is a flowchart showing the process of the autonomic nervous function test.
<Subject specific>
First, in order to specify the subject M, the examiner (physician) inputs the ID number of the subject M, the name, and other necessary information using the operation unit 106 of the computer 100.
<Acoustic stimulation setting>
Next, the examiner displays an acoustic stimulus setting screen (see, for example, FIG. 8) on the display screen 105 of the computer 100, sets the frequency of the sound desired to be output from the acoustic stimulus generator 20, and the stimulation time (a ), Determine the overall measurement time (b) and rest time (c).
In FIG. 8, the frequency of the sound is 10 Hz, (a) the time for producing the sound is 1.0 second, (b) the measurement time is 5.0 seconds, and (c) the rest time is 5.0 seconds.
Here, the sound for acoustic stimulation is selected so as to significantly affect the pupil change when performing the autonomic nervous function test.
Further, the examiner appropriately selects the number of times of sound repetition set for the acoustic stimulation, and designates and saves the set data with a number. The stored data can be called by specifying a number.

<Calibration>
Then, as shown in FIG. 4 (a), after mounting the headphones 21 and goggles 30 to the subject M, at positioning the holder of the holding table 70 (the chin pad 75, forehead pad 77) of the subject M head Positioning.
In this state, the position is adjusted so that the pupil of the eyeball comes to the center of the monitor screen of the monitor device 51.
In the present embodiment, the monitor screen of the monitor device 51 is also displayed on a part of the display screen 105 of the computer 100.
<Alignment>
Thereafter, when an “alignment” button (not shown) is pressed, the pupil diameter change based on the eyeball image of the subject M is analyzed under a condition without acoustic stimulation, and a pupil diameter change graph is displayed on the display screen 105.
In such alignment, it is possible to grasp the basic diameter of the pupil in a non-stimulated state without acoustic stimulation.

<Measurement>
This measurement is processed along the steps shown in FIG. 7, for example.
That is, when the examiner presses a “measurement start” button (not shown), the computer 100 causes the set acoustic stimulus No. (Storage number) is selected, and based on this, a sound for acoustic stimulation is generated from the acoustic stimulation generator 20 as set.
Then, the acoustic stimulus from the acoustic stimulus generator 20 is transmitted to the subject M via the headphone 21.
The movement of the eyeball of the subject M at this time is picked up by the image pickup device 40 (40a, 40b), and is input as an eyeball image to the CPU 101 of the computer 100 via the image converter 50 and the relay control device 52.
In this state, the CPU 101 analyzes the pupil diameter of the eyeball based on the eyeball image, and stores the pupil diameter change in the acoustic stimulus No. Record in association with. That is, the acoustic stimulus information and the pupil diameter change information are recorded in synchronization.

Here, in the pupil diameter analysis, for example, the longest diameter of the pupil diameter is measured a plurality of times, and the average pupil diameter is determined as the pupil diameter. Note that the pupil diameter analysis is not limited to this, and any analysis method for specifying the pupil diameter may be selected as appropriate.
While the pupil diameter analysis is being performed, the acoustic stimulus and the pupil diameter change are displayed on the display screen 105 in real time.
For example, as shown in FIG. 9, the display screen 105 at this time is a graph display column on the lower side, a monitor small screen corresponding to the monitor device 51 on the upper left column, an examination date, and the ID of the subject M on the upper right column. Number, name, left eye, right eye pupil diameter change characteristic values.
Here, the characteristic values of the pupil diameter change of the left eye and the right eye will be briefly described as follows.
-Rising I: Time of the first starting point of the biphasic waveform-Rising II: Time of the second starting point of the biphasic waveform-Peak I: First of the biphasic waveform Peak point time / peak II: The second peak point time / rise speed I of the biphasic waveform I: Change speed / rise speed II: biphasic waveform at the first start point of the biphasic waveform Speed of change at the second starting point of the waveform Note that a measurement bar K that is adjusted to an arbitrary point by operating a position designator (so-called mouse) that is one of the operation units 106 to determine the above six items. It is provided in the graph display column.
In FIG. 9, the graph display column of the display screen 105 displays a graph of pupil diameter changes of the left eye and the right eye when a single acoustic stimulus S (indicated by a dashed line in the figure) is given. Not limited to this, all data for multiple acoustic stimuli can be displayed in a graph, or the data for multiple acoustic stimuli can be averaged or displayed, or the time variation of acoustic stimulation can be combined. The graph can be displayed according to various display modes such as display.
The vertical axis of the graph display column of the display screen 105 indicates the pupil diameter dimension (unit: mm). For example, the basic diameter of the pupil is within the display area of the graph display column in the above-described alignment. It is possible to change the vertical axis display range of the display area.

After this, the final acoustic stimulus No. If it is not final after checking whether or not the next acoustic stimulus No. Is selected and the same measurement process is performed, and the final acoustic stimulus No. is selected. Continue until the measurement process for.
<Graph display>
When the measurement process ends, the eyeball image of the subject M and the pupil diameter change information are stored in the acoustic stimulus No. When the “graph display” button (not shown) is pressed on the computer 100, the pupil diameter change pattern associated with various acoustic stimuli for the predetermined subject M is displayed in a graph. .

<Inspection evaluation>
The examiner looks at this graph display, determines the relationship between the acoustic stimulation and the pupil diameter change, and evaluates the result of the autonomic nerve function test.
Here, the measurement data about the pupil diameter change of the subject M is recorded in the predetermined RAM 103, but is converted into a file format of, for example, an existing spreadsheet software (for example, Microsoft Excel (trademark of Microsoft Corporation)). Then, the data may be stored. In this way, it is possible to more easily analyze the result of the autonomic nervous function test of the subject M using existing spreadsheet software or the like.
Further, in this embodiment, the examiner evaluates the result of the autonomic nervous function test by looking at the graph display shown in FIG. 6, but is not limited to this, for example, acoustic stimulation and pupil diameter change In the case where a large number of clinical cases are obtained for the relationship, the evaluation program including the evaluation judgment algorithm for the autonomic nerve function test is created based on the results of these clinical cases, and this evaluation program is stored in the ROM 102. It is preferable that the display result of the pupil diameter change pattern accompanying the acoustic stimulation is evaluated based on the evaluation determination algorithm by storing in advance and executing the evaluation program in the CPU 101.
In this case, the examiner can evaluate the pupil diameter change pattern accompanying the acoustic stimulation while referring to the evaluation by the evaluation determination algorithm.

<Deformation>
Further, in the present embodiment, the pupil diameter analysis is performed in the measurement process. However, the present invention is not limited to this. For example, the pupil area analysis is replaced, and an acoustic pupil reaction test is realized based on this. You may do it.
Furthermore, in this embodiment, the examiner performs the acoustic pupillary reaction test while operating the computer 100, but is not limited to this. For example, as shown in FIG. The central management computer 200 is installed in the examination management center, and centralized management is performed by the computer 100 (specifically, 100 (1), 100 (2), 100 (3)... 100 (n)) of each clinic. The inspection program downloaded from the computer 200 is executed, and the result data of the pupil change (pupil diameter change, pupil area change) accompanied by the acoustic stimulation obtained there is uploaded to the central management computer 200 via the network 150. You may do it. In FIG. 10, reference numeral 210 denotes a storage device attached to the central management computer 200, in which various data of the subject M is stored.

It is explanatory drawing which shows the outline | summary of the acoustic pupillary reaction test | inspection system based on this invention. It is explanatory drawing which shows Embodiment 1 of the acoustic pupillary reaction inspection system to which this invention was applied. It is explanatory drawing which shows an example of the test | inspection environment installation of a test subject used by this Embodiment. (A) is explanatory drawing which shows the state at the time of the test | inspection of the test subject in this Embodiment, (b) is explanatory drawing which shows the structural example in goggles. It is explanatory drawing which shows the structural example of the computer of FIG. It is a flowchart which shows the process of the autonomic- nerve function test | inspection performed in this Embodiment. It is a flowchart which shows the detail of the measurement process of FIG. It is explanatory drawing which shows the example of an operation screen for performing "acoustic stimulus setting" of FIG. It is explanatory drawing which shows the example of a display screen at the time of "measurement" of FIG. It is explanatory drawing which shows the modification which implement | achieves the acoustic pupillary reaction test | inspection system which concerns on Embodiment 1 via a network.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Acoustic stimulus production | generation means, 2 ... Acoustic stimulus transmission means, 3 ... Eyeball imaging means, 4 ... Pupil change analysis means, 5 ... Recording means, 6 ... Display means, 7 ... Positioning holder, 8 ... Goggles, 9 ... Illuminance adjustment Means 10 ... Eyeball image display means 11 ... Evaluation means M ... Subject

Claims (4)

An acoustic pupillary response test system for examining a pupillary response associated with a predetermined acoustic stimulus,
Acoustic stimulus generation means for generating a predetermined acoustic stimulus;
Acoustic stimulus transmission means for transmitting the acoustic stimulus to the ear of the subject;
A positioning holder in which the head of the subject is positioned and held at a fixed position;
Eyeball imaging means for imaging the movement of the eyeball of the subject positioned by the positioning holder ;
Illuminance adjusting means capable of adjusting the illuminance of the eyeball position of the subject positioned by the positioning holder;
And pupil change analysis means for analyzing the pupil changes in the eyeball on the basis of the eyeball image from the eye image pickup means,
Recording means for recording the pupil change information analyzed by the pupil change analyzing means and the acoustic stimulus information generated by the acoustic stimulus generating means in association with each other;
Acoustic stimulus information recorded by the recording means, pupil change information associated with the acoustic stimulus information , and display means for displaying the test result of the acoustic pupil reaction based on these ,
The eyeball imaging means is arranged so as not to face at least both eyes of the subject and can image both eyes of the subject via a half mirror, and a white plate is arranged at a transmission part of the half mirror facing both eyes An acoustic pupillary reaction inspection system characterized by the above. The acoustic pupillary response examination system according to claim 1,
An acoustic pupillary reaction inspection system, wherein the eyeball imaging means is provided in goggles that can be worn in front of the eyeball of the subject. The acoustic pupillary response examination system according to claim 1,
An acoustic pupillary reaction inspection system comprising eyeball image display means capable of displaying an eyeball image captured by an eyeball imaging means. The acoustic pupillary response examination system according to claim 1,
An acoustic pupillary reaction system comprising an evaluation unit capable of evaluating a test result of the acoustic pupillary response displayed on the display unit.

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