多频稳态诱发反应应用于中度以上聋儿听力评估的临床分析

目的 探讨多频稳态诱发反应(auditory steady-state response,ASSR)在中度以上聋儿残余听力检测中应用的可能性.方法 检测64例(128耳)听性脑干反应(auditory brainstem response,ABR)阈值＞60 dBnHL的中度以上聋儿在睡眠状态下的ASSR阈值.按ABR阈值将聋儿分为2组:第1组84耳,ABR阈值为61～100 dB nHL;第2组44耳,ABR阚值＞100 dB nHL.将第1组中ASSR在0.5,1.0,2.0,4.0 kHz频度处的阈值分别与ABR阈值作比较,统计分析两者的相关性;计算第2组中ASSR在各个频率的引出率.结果 第1组中,ASSR在O.5,1.0,2.0,4.0 kHz频率处阈值分别与ABR阈值比较,经各相关系数的t检验,P均＜0.01,ASSR阈值与纯音听阈呈线性相关.第2组中,ASSR在0.5,1.0,2.0,4.0 kHz频率处的引出率分别为25.0%,43.1%,34.1%和31.8%,且差异无统计学意义(x2=3.33,P＞0.05).结论 ASSR具有刺激强度大、频率特异性好、测试不受睡眠影响等特点,作为一种客观的测试方法,能够早期快速检测中度以上聋儿的听力水平.     

儿童多频听性稳态诱发反应阈值与纯音测听阈值的相关性

目的 分析多频听性稳态诱发反应阈值与纯音测听阚值间是否具有相关性,明确能否应用多频听性稳态诱发反应评估纯音测听.方法 选择60例5～6岁儿童,包括正常听力组20例和听力异常组40例.所有患者先行纯听测听检查,然后口服10%水合氯醛镇静睡眠后行多频听性稳态诱发反应检测.根据纯音测听结果,将听力异常组的患儿分为轻度聋组、中度聋组和重度聋组,并将结果分别与其多频听性稳态诱发反应阈值进行比较,分析不同频率处的听力阈值情况及其相关性.结果 听力正常组及轻度聋、中度聋患儿纯音测听阈值与多频听性稳态诱发反应阈值差异均有统汁学意义(P＜0.05),听力正常儿童多频听性稳态诱发反应阈值比纯音测听阚值高20～25 dB HL,轻度聋组约高10 dB HL,中度聋组高10～20 dB HL;重度聋组两者基本一致,且两者成正相关(r=0.837,P＜0.05).结论 多频听性稳态诱发反应阈值与纯音测听阈值之间具有相关性,可以用多频听性稳态诱发反应评估纯音测听.(中国眼耳鼻喉科杂志,2008,8:362-363)     

骨导听性脑干反应和骨导多频听觉稳态反应在传导性听力损失检测中的应用 △

目的 研究骨导分频率听性脑干反应(BC-chirp-ABR)和骨导多频听觉稳态反应(BC-ASSR)与骨导纯音听阈(BC-PTA)在传导性听力损失患者中的差异和相关性,为临床客观听力诊断及预估主观测听阈值提供参考。方法 对40例单侧传导性听力损失患者分别行掩蔽后的BC-chirp-ABR和BC-ASSR测试,获得反应阈,并与BC-PTA阈值进行相关性分析。结果 在0.5、1、2、4kHz频率,BC-chirp-ABR反应阈分别为(25.0±8.2)、(22.3±6.1)、(18.2±7.6)、(19.7±6.9)dB nHL,BC-ASSR反应阈分别为(30.7±10.1)、(28.3±9.7)、(27.7±9.1)、(27.1±8.6)dB nHL。在上述4个频率,BC-PTA阈值分别为(9.5±6.3)、(10.7±5.7)、(12.8±9.1)、(15.3±4.5)dB HL。Pearson相关性分析显示,BC-chirp-ABR和BC-ASSR反应阈与同频率BC-PTA阈值均具有显著相关性,频率越高相关性越强。结论 BC-chirp-ABR和BC-ASSR能够反映同频率BC-PTA阈值,BC-chirp-ABR和BC-ASSR是较好的评估主观听阈的频率特异性客观测听技术。     

噪声影响下纯音诱发听性脑干反应的改变

目的 观察噪声影响下纯音诱发听性脑干反应(ABR)的改变.方法 将10只成年南美栗鼠随机平均分为两组,分别暴露强度为105 dB SPL窄带噪声,中心频率4 kHz,2h或5h.噪声暴露前、后1h、2周及4周,测试动物对短纯音声音刺激(1、2、4、8、12以及16 kHz)诱发的听神经复合动作电位(CAP)和ABR,并结合耳蜗毛细胞的损害程度和范围进行分析.结果 2h和5h的窄带噪声暴露造成南美栗鼠不同程度和范围的耳蜗毛细胞损害.与毛细胞损害部位相对应频率的CAP及ABR阈值在暴露噪声后均出现不同程度的提高.噪声暴露后4周,尽管某些动物的CAP已经发生了不可逆性永久阈移,但在某些短纯音频率诱发的ABR阈值却呈现部分恢复,甚至在个别动物的CAP测试波形中引出了低于CAP阈值的ABR波形成分.结论 中枢听觉功能的重组在一定条件下可能促进脑干听觉神经元提高感知因周边耳蜗损害而引起微弱听觉输入信号的敏感性.     

老年性耳聋患者应否进行眼科检查以早期诊断假性剥脱综合征？

目的：探讨老年性耳聋是否为早期诊断假性剥脱综合征(pseudoexfoliation syndrome,PES)的临床预测参数。 方法：这是一项前瞻性病例对照研究。单眼或双眼PES患者组成研究组,另有30例老年性耳聋患者。测量0.5,1,2和4kHz纯音听阈水平。同时记录鼓室测压高峰值和瞬态诱发耳声发射测试结果。所有受试者进行了详细的眼科检查。 结果：PES组与老年性耳聋的听力水平分布不同。轻度听力丧失（21~40分贝）第2组高于第1组。对PES和老年性耳聋患者各检查频率之平均听力阈值进行直接比较。比较PES和老年性耳聋患者的平均纯音听阈可发现两耳之间存在显著性差异。然而高频率（4kHz）时, 两耳之间无统计学意义。 结论：所有在耳鼻喉科诊断为老年性耳聋的患者不应该进行眼科检查。在临床实践中,此种检查是时间和金钱的巨大浪费。     

听神经病纯音听阈与病程的关系

目的探讨听神经病患者在不同病变时期纯音听阈的特点及其与病程的关系。方法收集37例（60耳）听神经病患者的纯音测听资料，按病程长短分为3组：A组14例（17耳）。病程〈6个月；B组12例（21耳），病程为6个月至2年；C组11例（22耳），病程〉2年。分析各组纯音听阈特点，并统计分析纯音听阈与病程的关系。结果A组听力图表现为低频（125～1000Hz）听力下降的勺型曲线，B组为以低频（125-2000Hz，8000Hz）听力下降为主的S型曲线，而C组为低频、高频（125-8000Hz）听力均有下降的S型曲线，且C组的听阈提高幅度最大。A组和B组在1000Hz以下频率听阈差异有统计学意义，B组和C组在1～4kHz频率区域听阈差异有统计学意义，A组和C组在所有频率的听阈差异均有统计学意义。结论随着病程的进展，听神经病的听阈提高由低频区逐渐向高频区扩展，后期可表现为全频听力下降。     

梅尼埃病畸变产物耳声发射的临床听力学特征

目的探讨梅尼埃病畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)听力学表现,明确梅尼埃病DPOAE临床听力学特征.方法收治梅尼埃病336例,行纯音听阈与DPOAE测试,并绘出纯音听力图与DPOAE图.结果纯音听力测试,297名为感音神经性耳聋,39名听力正常;在DPOAE测试中,患耳检出率均较健耳低;对刺激频率组的几何平均频率(Fm)及它们所对应的DPOAE幅值,均显著低于健耳,且幅值重复性差;患耳检出阈显著高于健耳.纯音听阈均值(Pure tone average,PTA)≥40 dB的145例,DPOAE反应缺失;PTA≤35 dB,伴低频下降的98例,DPOAE低频或低、中频振幅下降或反应消失;DPOAE图与纯音听力图的病损频率范围一致,曲线基本吻合.39例听阈正常的梅尼埃病患者,DPOAE测试显示有程度不同的高频或高、中频或低频振幅下降或缺失.结论 DPOAE能鉴别出亚临床的病理改变,对梅尼埃病的早期诊断、动态监测与预后等有指导意义.     

耳鸣与畸变产物耳声发射的关系

目的探讨畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)对耳鸣的临床应用价值.方法测试86例(125耳)耳鸣患者DPOAE听力图与纯音测听,比较二者关系.结果99耳耳鸣伴听力下降耳DPOAE图在相关频率有振幅下降或缺失,二者有高度相关性;21耳耳鸣但听力正常耳DPOAE图都出现振幅下降;5例耳鸣,听力下降,但DPOAE图引出正常.结论DPOAE对耳鸣蜗性,蜗后性的定位及定性有一定参考意义;对纯音测听正常耳鸣患者,DPOAE可用于发现早期耳蜗病变.     

儿童阻塞性睡眠呼吸暂停低通气综合征中耳功能的观察

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对中耳功能的影响.方法 对32例(64耳)OSAHS患儿及26例(52耳)健康儿童行声导抗和纯音测听检查.结果 32例OSAHS患儿中,鼓室导抗图A型16耳,B型24耳,c型18耳,Ad型4耳,As型2耳;正常听阈12耳,轻度聋48耳,中度聋4耳.患儿组各频率气导听阈均值与对照组比较,差异有统计学意义,峰压值与对照组比较差异亦有统计学意义.结论 儿童OSAHS患者异常导抗图增加,镫骨肌反射消失增多,峰压值偏向负压,出现气导听阈的提高.     

卡哈切迹在儿童分泌性中耳炎诊断中的意义

目的探讨纯音听阈图中卡哈切迹(CN)在儿童分泌性中耳炎(OME)诊断中的意义。方法回顾分析81例(153耳)OME住院患儿的临床资料。收集术前纯音测听图结果,根据CN存在与否、平均气导听阈以25 dB为界、骨气导差以30 dB为界分组,分析CN、平均气导听阈及骨气导差在推测中耳积液性质中的意义。结果 CN存在率为32.7%(50耳),其中47耳证实为黏液,与无CN耳相比积液明显黏稠,差异有统计学意义(P=0.006)。平均气导听阈>25 dB较≤25 dB组积液黏度高,差异有统计学意义(P=0.001)。骨气导差>30 dB组积液黏稠,差异有统计学意义(P=0.008)。结论 CN存在耳积液黏稠。OME患儿术前行纯音测听,同时结合CN存在与否,可以帮助推断积液性质,进行早期手术干预。     

Exfoliation syndrome related to sensorineural hearing loss

Background: To investigate the relationship between exfoliation syndrome and sensorineural hearing loss. Methods: A prospective study was designed. Patients with evidence of ocular exfoliation syndrome (study group) and individuals without any clinical signs of exfoliation syndrome (control group) were selected. Cases and controls were chosen to have similar demographic characteristics. Study and control group subjects with a history of conditions affecting hearing function were excluded. Pure‐tone audiometry was performed in all participants in both groups and hearing thresholds were measured at frequencies of 0.25, 0.5, 1, 2, 4 and 8 kHz (kilohertz) for each ear. Results: A total of 69 subjects participated in the study. The study group included 47 subjects and the control group 22. There was no significant difference in mean age (P = 0.985) and gender (P = 0.378) between groups. Mean pure‐tone hearing thresholds were significantly higher in study group at frequencies of 4 kHz (P = 0.004) and 8 kHz (P = 0.001), but not at frequencies of 0.25, 0.5, 1 and 2 kHz. The greatest difference in the comparison of mean hearing thresholds between study and control group was noted at 8 kHz. Conclusions: The above results are in accordance with previous studies and provide additional evidence of the association between exfoliation syndrome and sensorineural hearing loss at high frequencies. Particular effect was shown on the highest frequency of 8 kHz. These findings may support the systemic nature of exfoliation syndrome.     

突发性耳聋与血糖、血脂水平紊乱的相关性分析

目的 分析突发性耳聋患者血糖、血脂代谢特点,探讨其与突发性耳聋发病的相关性。方法 选取2018年6月~2019年12月确诊并收治于我科的突发性耳聋患者155例为研究对象(病例组),另选取同时期性别、年龄相匹配的155例健康体检者作为对照组,收集受试者的一般资料及血糖、血脂水平。根据突发性耳聋诊断和治疗指南将病例组分为低频型、平坦型、高频型、全聋型。比较各组间血糖及血脂代谢差异以及不同类型间血糖、血脂水平与受损频率听阈的相关性;运用多因素logistic回归确定突发性耳聋的独立危险因子。结果 病例组血糖异常比例及血糖水平显著高于对照组(P<0.05),2组间血脂水平差异无统计学意义。低频型和高频型的受损听阈与血糖水平显著相关。logistic回归分析显示,在矫正年龄、性别、血脂水平后,与血糖正常者相比,血糖异常者患突发性耳聋的风险明显增加(P<0.01)。结论 血脂紊乱与突发性耳聋发病无明显相关性,而血糖异常是突发性耳聋的独立危险因素。     

Evaluation of the acoustic function in pseudoexfoliation syndrome and exfoliation glaucoma: audiometric and tympanometric findings

PURPOSE: Previous studies have reported increased audiometric thresholds in patients with pseudoexfoliation syndrome (XFS), compared with normative data. This study examines mean audiometric thresholds and tympanometric peak values in patients with XFS and in a control group. METHODS: This is a prospective, nonrandomized control case study. Patients with XFS in one or both eyes constituted the study group (SG). Patients without XFS in either eye constituted the control group (CG). Patients with a history of conditions affecting hearing function were excluded. The SG and the CG included 54 and 48 patients, respectively. Pure tone hearing thresholds levels were measured at 0.25, 1, 2, 3, and 8 kHz. Tympanometric peak values were also recorded. Differences in audiometric mean threshold values and tympanometric peak values between SG and CG, as well as between glaucomatous and nonglaucomatous eyes, were examined. RESULTS: Bone and air audiometric thresholds were significantly increased in SG for 3 kHz and 8 kHz but not for 0.25 kHz, 1 kHz, and 2 kHz. Tympanometric peak values were significantly lower in SG compared with CG. In SG, glaucomatous patients had significantly higher air-conduction thresholds for 3 kHz and 8 kHz. Differences in bone and air audiometric findings as well as tympanometric findings between glaucomatous and nonglaucomatous patients were statistically not significant in CG. CONCLUSIONS: The results agree with previous reports on sensorineural hearing loss in XFS. The reduced tympanometric peak values in SG imply impairment in the elastic properties of the middle ear in XFS. The findings provide additional evidence for the systemic nature of XFS.     

上鼓室根治术及鼓室成形术40耳治疗体会△

目的 观察经外耳道入路上鼓室根治术(上鼓室切除术)联合上鼓室重建、鼓室成形术治疗中耳胆脂瘤和慢性中耳炎的临床疗效。方法 回顾分析2016年1月~2018年12月随访完整的38例40耳临床资料,包括中耳胆脂瘤22耳、慢性活动期中耳炎18耳。采用外耳道入路上鼓室切开术清除病灶,通畅引流;以自体耳屏或耳甲腔软骨重建上鼓室。行单纯鼓膜成形术10耳,人工部分听骨赝复物(PORP)植入28耳,全听骨赝复物(TORP)植入2耳;显微镜手术27耳,全耳内镜手术13耳。术后随访0.5~3.5年,观察术腔愈合、听力改善及复发情况。结果 上鼓室自清洁内陷袋形成伴气导听力下降1耳,其余病例上鼓室、鼓膜和外耳道形态结构均恢复良好,随访未见复发。纯音测听:0.5、1、2、3 kHz频率区域的气骨导差(ABG)由术前(28.78±10.78)dB 缩小到术后(15.40±9.51)dB,差异有统计学意义(t=6.886, P<0.001);1、2、4 kHz高频骨导水平,术前(24.04±14.97)dB、术后(19.76±8.75)dB,差异无统计学意义(t=1.985,P>0.05),提示手术未造成高频骨导恶化。结论 外耳道入路上鼓室根治术,有利于清除局部病灶,改善引流,可避免不必要的乳突气房开放,联合上鼓室重建及鼓室成形术,可较好恢复鼓膜和外耳道的形态、结构,术后恢复快,复发率低,可有效提高听力。耳内镜下操作有助于清除隐匿病灶,减少去骨。     

咽喉反流对嗅觉功能的影响

目的 研究咽喉反流(LPR)对嗅觉功能的影响。方法 选取我院2017 年 1月~2018 年 5 月门诊确诊的LPR患者50例作为LPR组,选取年龄、性别构成比相匹配的无吸烟、饮酒史健康志愿者50例作为对照组。所有入选者均行嗅觉功能测试、RSI和RFS量表评分、鼻内镜检查及Lund-Kennedy评分。对比2组患者的嗅觉功能和Lund-Kennedy评分,分析LPR患者RSI和RFS量表评分、鼻内镜下Lund-Kennedy评分与嗅觉功能的相关性。结果 Sniffin’ Sticks试验3项测试中,LPR组的气味阈值得分、气味辨别得分、气味识别得分和嗅觉总分(TDI)均低于健康对照组(P值均<0.05)。LPR患者症状中,痰多或涕后流评分与Sniffin’ Sticks试验中的气味阈值、气味识别、TDI 值呈负相关(P值均<0.05);反酸、胃灼热评分与气味阈值、气味辨别、TDI 值呈负相关(P值均<0.05)。LPR患者体征中,喉水肿评分与TDI 值呈负相关(P<0.05);喉黏膜增厚评分与气味阈值、TDI值呈负相关(P值均<0.05)。LPR组Lund-Kennedy 评分高于对照组(P<0.05),Lund-Kennedy 评分与嗅觉评分TDI 值呈负相关(P<0.05)。结论 LPR可导致患者嗅觉功能降低,在气味阈值、气味辨别、气味识别上均低于同龄正常人群。     

Visual evoked cortical potentials and psychophysical determination of color contrast thresholds along different chromatic axes

Color vision can be assessed by examining the color contrast threshold along various color axes. We in vestigated the possibility of determining these thresholds objectively by means of visual evoked cortical potentials. A color-calibrated flicker-free (112-Hz) monitor and a 14-bit-per-gun board allowed visualization of colors with specified xyY CIE 1931 coordinates. Horizontal grating, 1 c/deg were sinusoidally alternated at 8 Hz for both visual evoked cortical potential recordings and psychophysical determinations. Two healthy emmetropic 35 year-old subjects performed color brightness matching along each color axis, before any recording and reduction in color contrast. For each color axis, extrapolation to zero voltage of the visual evoked cortical potential amplitude versus log color contrast response allowed determination of the color contrast threshold. The visual evoked cortical potential-derived threshold changed considerably with the color axis, with evident intersubject differences. These differences were similar to those observed in the psychophysically determined thresholds. Visual evoked cortical potential responses to suitable chromatic stimuli allow determination of color contrast thresholds that correspond well to those determined psychophysically. Hence, with the visual evoked cortical potential, accurate objective assessment of color vision is feasible and may be useful in both research and clinical settings.