钻井工人畸变产物耳声发射的检测

目的：了解畸变产物耳声发射（ＤＰＯＡＥ）在监测噪声性聋方面的应用价值。方法：检测１０２例（１９５耳）钻井工人ＤＰＯＡＥ的幅值和引出率。结果：钻井工人ＤＰＯＡＥ的幅值和引出率均较对照组明显下降;随着接触噪声工龄的延长,ＤＰＯＡＥ的引出率逐渐下降;纯音测听正常的接触噪声者与正常人相比,ＤＰＯＡＥ的幅值及引出率亦明显降低;ＤＰＯＡＥ高频段引出率与相应频段的纯音听阈存在着负相关。结论：ＤＰＯＡＥ能较好地反     

耳鸣与耳声发射

为探讨耳鸣的产生原因和客观检测手段以及耳鸣与耳声发射（ＯＡＥ）的关系，报道耳鸣患者的２７３例（３０６耳）畸变产物耳声发射（ＤＰＯＡＥ），自发性耳声发射（ＳＯＡＥ）和瞬态诱发性耳声发射（ＴＥＯＡＥ）的特点，结果提示：（１）耳鸣频率与ＳＯＡＥ频率不一致，（２）９４．８％感音神经性聋性耳鸣患者ＤＰＯＡＥ图在相应频率有振幅下降或缺失，５９％听力正常耳鸣耳出现某些频率ＤＰＯＡＥ振幅下降和反应缺失，且不能记录     

耳鸣与耳声发射

为探讨耳鸣的产生原因和客观检测手段以及耳鸣与耳声发射（ＯＡＥ）的关系，报道耳鸣患者２７３例（３０６耳）畸变产物耳声发射（ＤＰＯＡＥ）、自发性耳声发射（ＳＯＡＥ）和瞬态诱发性耳声发射（ＴＥＯＡＥ）的特点。结果提示：①耳鸣频率与ＳＯＡＥ频率不一致；②９４．８％感音神经性聋伴耳鸣患者ＤＰＯＡＥ图在相应频率有振幅下降或缺失，５９％听力正常耳鸣耳出现某些频率ＤＰＯＡＥ振幅下降和反应缺失，且不能记录到ＳＯＡＥ，而在ＳＯＡＥ频率附近ＤＰＯＡＥ有良好反应高峰。耳声发射可望用于发现早期耳蜗病变。     

内耳血流对ABR波I与畸变产物耳声发射的影响

为研究在耳蜗血流（ＣＢＦ）障碍时ＡＢＲ波Ｉ振幅,潜伏期及畸变产物耳声发射（ＤＰＯＡＥ）的振幅和时相的变化,进行了试验研究。用５只２～４ｋｇ重的雄性幼兔,经后颅窝手术．在内听动脉（ＩＡＡ）放入探极,测量术前术中和术后ＡＢＲ波Ｉ振幅潜伏期及ＤＰＯＡＥ的振...     

畸变产物耳声发射对侧抑制效应的临床应用价值

目的：为观察畸变产物耳声发射（ＤＰＯＡＥ）对侧抑制效应的临床应用价值。方法：研究以白噪声为对侧声刺激,对１７例正常人（３４耳）,１３例蜗性聋（１３耳）,９例蜗后聋（９耳）进行了ＤＰＯＡＥ及其对偶抑制效应测试。结果：蜗性聋耳的ＤＰＯＡＥ幅值较正常耳显著下降（Ｐ〈０．０１）,对偶抑制效应减弱,但与正常人差异无统计学意义（Ｐ〉０．０５）,蜗后聋耳ＤＰＯＡＥ幅值高于正常耳（Ｐ〉０．０５）,对侧抑制效应显著     

甲状腺功能低下对ABR和DPOAE的影响

为了探讨甲状腺功能低下（甲低）时听觉功能损害的部位及可能的致病机理，用含甲硫咪唑（０．１５ｇ／Ｌ）的饮用水喂养大鼠制造甲低模型，对甲低前后的大鼠进行听性脑干反应（ＡＢＲ）和畸变产物耳声发射（ＤＰＯＡＥ）的检测。结果发现：甲低后ＡＢＲ阈值明显升高；而ＡＢＲ各波潜伏期及波间期无明显变化。ＤＰＯＡＥ“听力图”显示甲低后ＤＰＯＡＥ振幅明显下降；ＤＰＯＡＥ阈值明显上升。提示耳蜗是甲低时听觉功能损害的主要部位，文中对可能的发病机理进行了讨论。     

畸变产物耳声发射在突发性聋在突发性聋恢复过程中的变化

目的：探讨畸变产物耳声发射（ＤＰＯＡＥ）测试对于耳蜗功能损害的检测价值。方法：ＧＳＩ－６０型耳声发射检测２仪,对３０例（６０耳）突发性聋（突聋）患者进行ＤＰＯＡＥ测试,观察其发病和恢复过程中的耳声发射（ＯＡＥｓ）变化,及其与纯间听阈变化的关系。并对患者进行治疗与随访。结果：患耳的ＤＰＯＡＥ检出率、幅值低于健耳,检出阈升高;在恢复过程中,ＤＰＯＡＥ的幅值、检出阈也随听阈一起改善;听阈的恢复率高于幅值     

外耳道压力改变对耳声发射幅值的影响

目的了解外耳道压力改变对耳声发射幅值的影响，进而探讨外耳道压力因素对耳功能状态的影响。方法用ＧＳＩ３３型声导抗仪和ＩＬ０９２型耳声发射仪，对２３例（４６耳）正常人进行不同外耳道压力状态下的ＴＥＯＡＥ和ＤＰＯＡＥ测试。结果外耳道正、负压越大，ＴＥＯＡＥ的平均反应幅值越低，低频区频谱幅值下降明显，高频区无明显改变，Ｆ２在６９６～２００２Ｈｚ之间时，ＤＰＯＡＥ幅值降低明显，Ｆ２为３００３、５００５、６００６Ｈｚ时，ＤＰＯＡＥ幅值无明显改变，Ｆ２为４００４Ｈｚ时，ＤＰＯＡＥ幅值增高。结论正常的耳声发射幅值依赖于正常的耳功能状态。外耳道压力改变可使中耳和内耳的传音功能发生改变，主要表现为低频声的传导被阻滞。     

畸变产物耳声发射临床应用价值的探讨

研究了７３例（１３９耳）纯音听阈正常耳及各种感音神经性聋耳的ＤＰＯＡＥ，发现ＤＰＯＡＥ对耳蜗功能异常的改变早于纯音测听，并可精确地反映耳蜗毛细胞在相关频率上的功能状态；ＤＰＯＡＥ幅值及引出率随纯音听阈的提高而下降，当纯音听阈＞５０ｄＢ（ＨＬ）时，ＤＰＯＡＥ幅值明显降低或缺失；蜗后病变耳ＤＰＯＡＥ正常，当蜗后病变累及耳蜗时，ＤＰＯＡＥ幅值可异常，其异常程度与纯音听阈不平行。认为ＤＰＯＡＥ有广泛临床应用价值。     

豚鼠外淋巴瘘对畸变产物耳声发射的影响

为观察豚鼠外淋巴瘘造模后畸变产物耳声发射（ＤＰＯＡＥ）的变化，选用１１只豚鼠右耳为实验耳，手术建立蜗窗外淋巴瘘。在实验前、打开听泡、蜗窗膜造瘘、缝合伤口及外淋巴瘘造后１８天，均以２ｆ１－ｆ２ＤＰＯＡＥ的幅值记录其变化。测试完毕后豚鼠耳蜗行火棉胶包埋切片，观察形态学改变。结果发现在形成蜗窗膜外淋巴瘘前后ＤＰＯＡＥ幅值变化差异有显著性（Ｐ＜０．０１），１８天后蜗窗膜愈合者ＤＰＯＡＥ幅值明显提高，接近实验前，而未愈合者则下降明显。病理检查见Ｃｏｒｔｉ器正常，愈合的蜗窗膜有上皮增生，肉芽及纤维母细胞。豚鼠形成外淋巴瘘后ＤＰＯＡＥ幅值明显下降，愈合后又上升，提示ＤＰＯＡＥ可作为外淋巴瘘辅助诊断的手段之一。     

豚鼠畸变产物耳声发射潜伏期的对侧抑制效应现象

目的 通过观察对侧抑制效应中畸变产物耳发射（distortion productotoacousticemissions,DPOAE)各指标的改变,探讨耳蜗生理机制及传出神经的调节机能。方法 12只健康杂色豚鼠分A、B2组,在对侧耳无声刺激及给予70dB SPL宽带噪声条件下,分别使用不同的原始纯音强度组合测定在f2＝2、4、6kHz时测试耳DPOAE之幅值及潜伏期。次日,A组动物背侧径路开放右耳听泡,圆窗膜给予60mmol/L卡因酸1μL,作用3h后拭去。给药后6h测试右耳无声刺激和给予70dB SPL宽带噪声刺激下,左耳的DPOAE幅值、潜伏期等指标。结果 ①用药前,A组对侧耳给声时以等强度原始音诱发的测试耳DPOAE各频率幅值与给声前基本无变化,而潜伏期显著延长;②用药前,B组对侧耳给声以差强度原始音（L2＝L1－10dB)诱发的测试耳DPOAE在2、4kHz的幅值与给声前相比有显著减小,潜伏期也显著延长;③A组用药后,对侧耳给声对测试耳DPOAE幅值和潜伏期均无显著影响。结论 潜伏期亦是对侧抑制研究中的敏感指标。对侧抑制效应在调制耳蜗转导机制中发挥负反馈作用。     

ABR and DPOAE indices of normal loudness in children and adults

Loudness growth prediction using normal templates of loudness derived with ABR and DPOAE measures was investigated in 20 children 4 to 12 years and 20 adults with normal hearing. An ABR click latency-intensity function (LIF), ABR 2 kHz tone LIF, and DPOAE 2 kHz amplitude-intensity function (AIF) were recorded from each listener. A loudness-intensity function was also measured for each electrophysiologic stimulus. Children and adults exhibited similar intensity functions of ABR latency, DPOAE amplitude, and loudness. A statistically significant relationship was found between loudness and ABR latency and DPOAE amplitude. Loudness estimation equations derived with ABR latency and DPOAE amplitude accurately and reliably predicted the loudness-intensity functions of the listeners. Normative ABR and DPOAE templates of predicted loudness growth may have clinical application in site-of-lesion assessment or hearing aid fitting by distinguishing abnormal rates of loudness growth for individuals who cannot provide reliable behavioral measures.     

Normal values for distortion product otoacoustic emissions in children: a study using primary levels previously demonstrated to be optimum for identification of hearing loss.

No published data exist for normal values of distortion product otoacoustic emissions (DPOAE) in children at primary levels f1 = 65 dB and f2 = 55 dB SPL. These primary levels have been previously demonstrated to be optimal for identification of hearing impaired ears in adults. A total of 102 normal children underwent audiological assessment, including exclusion of middle ear disease, pure tone audiometry and DPOAE DP-grams (primaries L1/L2 = 65/55 dB SPL, f1:f2 = 1.22). There was a statistically significant decrease in DPOAE amplitude with increasing age. DPOAE amplitude was also dependent on the frequency of f2. However, there was wide inter- and intra-individual variation in DPOAE amplitude at different frequencies of f2. There was also a large overlap between the range of values of DPOAE amplitude between the adjacent age groups. Detailed assessment of DPOAE in children is feasible in the clinical setting. These normal values should prove invaluable in future studies; however, the large range of normal values means that cross-sectional studies may not be able to detect small variations in cochlear function.     

自身免疫性听神经病动物模型的建立及听性脑干反应和畸变产物耳声发射的变化

目的建立自身免疫性听神经病动物模型，探讨其听性脑干反应（auditory brainstem response ABR）和畸变产物耳声发射（distortion product otoacoustic emission DPOAE）的变化特征。方法选取耳廓反射正常的白色豚鼠250只，分离、电泳与纯化豚鼠螺旋神经节及蜗轴内的耳蜗神经纤维抗原，然后与等量完全弗氏佐剂免疫同种豚鼠，其中正常组10只，对照组10只，试验组50只。观察ABR、DPOAE、血清IgG水平、螺旋神经节和耳蜗核团形态学的改变、听神经抗原蛋白在螺旋神经节和耳蜗神经的表达、听神经纤维超微结构的变化。结果免疫后16只动物（32／100耳）出现听性脑干反应阈提高10～25dB，Ⅰ、Ⅲ波潜伏期延长，到免疫后第3周最为明显，随后有逐渐恢复的趋势，其中Ⅲ波潜伏期到第6周恢复正常；该组豚鼠DPOAE没有变化，动物血清IgG显著性升高，与对照组相比差异有统计学意义（F=10．03，P〈0．05）；均有不同程度的螺旋神经节细胞变性、数目减少，螺旋神经节和小血管周围有淋巴细胞浸润；听神经纤维出现脱髓鞘、髓鞘断裂等现象。豚鼠耳蜗核各亚核团平均细胞密度和细胞平均面积各组差异比较没有统计学意义；听神经蛋白完全分布于耳蜗螺旋神经节和听神经纤维组织。免疫后34只动物（68／100耳）没有出现ABR反应阈升高，血清IgG没有升高，与对照组相比差异没有统计学意义，螺旋神经节、耳蜗核团、听神经纤维超微结构没有变化。结论建立了豚鼠自身免疫性听神经病动物模型，该动物模型的ABR反应阈轻中度提高，Ⅰ、Ⅲ波有自然恢复的趋势。DPOAE没有变化。     

Latencies of the 2f1-f2 distortion product otoacoustic emissions measured using a phase-gradient method in young people, in the elderly and in people exposed to noise

Distortion product otoacoustic emissions (DPOAE) are generally accepted as a good tool for investigating the micromechanics of the cochlea. The 2f1-f2 DPOAE latencies provide significant data regarding travelling waves. In this study the 2f1-f2 DPOAE latencies were measured using a phase-gradient method, with a swept-f2 procedure, for three groups: Group I comprised 60 healthy young people, aged 17-32 years; Group II comprised elderly patients, aged 56-72 years, with presbyacusis; and Group III consisted of 74 miners, aged 19-35 years, who had been exposed to noise for 2-15 years. Measurements were performed for frequencies between 1.0 and 6.0 kHz. In all groups the latencies were fitted using a non-linear regression model. The aim of the study was to compare the latency and amplitude of 2f1-f2 DPOAE in different inner ear pathologies. The highest DPOAE amplitudes were recorded in Group I and in miners with 2-4 years noise exposure (Group IIIa), and the latencies showed a similar pattern. The lowest DPOAE amplitudes were recorded in the elderly and in miners with 8-15 years noise exposure (Group IIIc), but in contrast the longest latencies were measured in miners and the shortest in the elderly. The latency analysis significantly reinforces opinions on the micromechanics of the cochlea, mostly in terms of the cochlear functioning as a filter and amplifier and with regard to the elasticity of the basilar membrane.     

小儿蜗后听觉神经损害的临床与听力学特征及定位

目的 探讨包含了听神经病在内的ABR严重异常、DPOAE正常为特征的蜗后听觉神经功能障碍小儿的临床与听力学特征及其可能的病损部位.方法 选取2002至2006年听力专科中ABR严重异常、DPOAE正常,排除中耳传导功能异常的患儿86例(165耳),年龄8 d～7岁,平均1岁1个月,入选为本研究对象.选择ABR严重异常、DPOAE异常、排除中耳病变的听功能障碍26例(29耳)患儿作为蜗性病变对照组,选择健康同龄儿童86例(166耳)作为正常对照组,比较蜗后病变、蜗性病变、正常听力3组间ABR波Ⅰ、波Ⅲ、波Ⅴ潜伏期和振幅,以及Ⅰ～Ⅲ波间期等参数的异同.所有数据采用SPSS11.0统计软件包进行t检验.结果 86例蜗后听神经损害患儿中,51例(59.3%)的病例新生儿期有高胆红素血症史,其中40例血中间接胆红素水平达重度标准,11例为轻中度;在首次就诊的原因中,主诉运动障碍者40例(46.5%),听力言语障碍者10例(11.6%);在伴随的疾病中,32例(37.2%)确诊伴随有脑性瘫痪.在86例165耳蜗后听觉神经功能障碍患耳中,103耳最大强度声刺激(103 dB)ABR无波分化,27耳仅见波Ⅰ分化,19耳仅见波Ⅴ分化,13耳见波Ⅰ+Ⅲ分化,3耳见波Ⅰ+Ⅴ分化.仅见波Ⅰ分化耳,其波Ⅰ潜伏期较正常听力耳延长,振幅较正常听力耳低矮(t值分别为-6.75和2.58,P值均<0.05);有波Ⅰ+Ⅲ分化耳,波Ⅰ潜伏期和振幅与正常听力耳差异无统计学意义,波Ⅲ潜伏期则较正常听力耳延长,振幅较正常听力耳低矮(t值分别为-2.77和3.63,P值均<0.05),Ⅰ～Ⅲ波间期较正常听力耳Ⅰ～Ⅲ波间期延长(t=-2.99,P<0.05).结论 在蜗后听觉神经功能损害类型中,最常见的类型为ABR从波Ⅰ开始就严重异常,即听神经病,其病变主要在第Ⅷ颅神经听支;仅见波Ⅰ分化耳,其病变部位主要在第Ⅷ颅神经听支以后;ABR有波Ⅰ+波Ⅲ分化耳,主要病变部位在波Ⅲ的发源神经核团,即上橄榄核以后的听觉神经通路.振幅低矮的波Ⅴ不是听神经病独有的特征.高胆红素血症导致的蜗后听觉神经系统病变的病例中,其受侵害部位的先后次序可能为大脑皮层、腩干听觉神经核团、第Ⅷ对颅神经听支.     

Assessment criteria for rotated stereociliary bundles in the guinea pig cochlea.

OBJECTIVE: Our study examined the relationship between variant stereociliary bundles of cochlear outer hair cells (OHCs) and auditory function to analyze assessment criteria for rotated stereociliary bundles in the guinea pig cochlea. METHODS: Auditory brainstem response and distortion product otoacoustic emission (DPOAE) were recorded on 100 guinea pigs. Variant hair cells were identified and counted by scanning electron and light microscopy. RESULTS: The most common variation observed was rotation of stereociliary bundles in the first-row OHCs (OHC1), with most 13.3% variant OHC1 rotated 90 degrees and a few 2.5% rotated 180 degrees. Occasionally, the length and angle of the 2 arms of an OHC deviated from the norm. The auditory brainstem response threshold of affected animals increased only slightly, 20- to 30-dB sound pressure level. More importantly, amplitude of DPOAE increased significantly (40.5 dB sound pressure level). CONCLUSION: Our study suggests that rotation of stereociliary bundles in the cochlear OHC was found to be prevalent in 28% of the animals. We established the assessment criteria for rotated stereociliary bundles that were more than 10% OHC1 rotated. This hair bundle seemed to be rotated by 90 degrees from the normal orientation and was accompanied with changes of auditory function. Increased amplitude of DPOAE is associated with the variation of rotated OHC that might result in hearing loss.