200例主观性耳鸣患者听力损失临床分析

目的:对耳鸣患者的听力损失进行分析,为进一步探讨耳鸣的发病原因、检查方法提供临床依据。方法:对以主观性耳鸣为主诉的200例患者进行耳科专科检查、声导抗检测、常频纯音听阈测听和高频扩展听阈测听检查。结果:200例耳鸣患者中,单侧耳鸣123例(61.5%),双侧耳鸣77例(38.5%);46例(23.0%)听力正常。单侧耳鸣中,患侧与对侧听阈比较0.125～8kHz差异有统计学意义(P<0.05),10kHz及其以上频率差异无统计学意义(P>0.05)。常频听力正常组与听力异常组比较各频率阈值差异均具有统计学意义(均P<0.05),听力异常组扩展高频检出率低于听力正常组。结论:耳鸣可以存在听力正常的人群中,扩展高频测听能否为耳鸣患者提供早期听力损失的依据,尚需对更多的临床资料进一步研究。     

82例耳鸣患者半倍频程频率纯音测听的特征及意义

目的 :观察常规倍频程纯音测听听阈无异常的耳鸣患者的半倍频程频率测试结果并探讨其特征及临床意义。方法 :应用纯音听力计对 82例 (14 0耳 )倍频程纯音测听听阈无异常的耳鸣组患者和 30例 (6 0耳 )正常对照组进行半倍频程频率测试。结果 :耳鸣组 14 0耳中 ,发现 37.14 %存在听力下降 ;主要为高频下降 ;大多为轻度下降 ;下降的频率与耳鸣频率有高度一致性 ;耳鸣的强度 (dBSL)与听力下降与否无关。结论 :半倍频程频率测试方法可为倍频程纯音测听听阈无异常的耳鸣患者早期听力损害的检出提供直接参考依据 ,对临床早期发现其潜在的耳蜗病变有积极意义     

自觉听力正常耳鸣患者纯音听力及畸变产物耳声发射临床分析

目的分析自觉听力正常耳鸣患者的纯音听力特征,并探讨自觉听力正常耳鸣患者畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)测定值与纯音听阈值之间的相关性及其意义。方法 2010—2011年在我科就诊的以耳鸣为第一主诉但无明显自觉听力障碍患者114例(190耳),对所有入组患者进行纯音测听及DPOAE检测。分析DPOAE测定值与纯音听阈值之间的相关性,并结合其发病的可能危险因素进行相关分析。结果自觉听力正常的耳鸣患者中,听力异常可达76.84%(146/190)。纯音测听表现为:高频下降型46.31%(88/190);低频下降型14.73%(28/190);正常23.15%(44/190);其它类型15.78%(30/190)。其危险因素主要为:噪声接触,疲劳和/或精神压力、其他基础疾病等。所有频率(f0)的DPOAE幅值与各频率纯音听阈间存在负相关,且有明显的频率对应关系。结论自觉听力正常的耳鸣患者存在一定程度的听力损失,尤其以高频听力下降为多见。DPOAE测定值与其纯音听阈之间呈明显的负相关关系,且DPOAE测试频率与纯音听阈频率间存在明显的对应关系,DPOAE检测作为一种客观指标,可以在一定程度上反映自觉听力正常耳鸣患者的听力损失程度,有一定的临床应用价值。     

伴乙肝的耳鸣患者心理声学特征初探

目的：初步探讨伴乙肝的耳鸣患者的心理声学特征,为此类人群制订更为个性化的耳鸣治疗方案提供临床依据。方法使用听尼特TM1000A耳鸣综合诊断治疗仪对35例伴乙肝的耳鸣患者进行纯音测听和耳鸣心理声学测试,对结果进行统计分析。结果35例患者中,听力正常组12例,听力损失组23例;耳鸣音调匹配失败5耳;耳鸣音调匹配类型以纯音为主（占68.6%）;耳鸣频率以高频居多（占70.0%）;耳鸣响度不大,以10 dB SL以内为主（占80.0%）;耳鸣佛德曼曲线在听力正常组与听力损失组均以汇聚型最多;残余抑制试验阳性率听力损失组（占70.0%）高于听力正常组（占50.0%）。结论伴乙肝的耳鸣患者,听力损失人数居多;汇聚型佛德曼曲线且伴听力下降的患者残余抑制试验阳性率最高,耳鸣更易被掩蔽。     

煤矿井下噪声暴露工人扩展高频测听

目的 探讨扩展高频纯音听阈在听力监测及早期发现噪声性听力损害中的价值.方法 对73名(142耳)耳科正常者(对照组)和78名(154耳)煤矿井下噪声暴露工人(实验组,其中常频纯音听阈正常组45名90耳,常频纯音听阈异常组33名64耳),行常频纯音测听、扩展高频纯音(0.5～16kHz)测听,将两组结果进行比较.结果实验组纯音听阈在4.0、6.0 kHz及扩展高频区与对照组比较明显升高,扩展高频未检出率逐渐增加,差异有显著意义(P＜0.05);常频纯音听阈正常的实验组与对照组比较,其扩展高频听阈升高,未检出率在14 kHz开始升高,差异有显著意义(P＜0.05);常频听阈异常的实验组与对照组比较,扩展高频听阈升高,未检出率在11.2 kHz开始增加,差异均有显著意义(P＜0.01).结论 扩展高频测听可用于噪声性聋的早期诊断和听力监测.     

纯音听力正常的颅后窝病变患者的ABR结果

本文分析了16名患侧纯音测听正常(500～4000Hz损失不过25dB)经手术证实为颅后窝肿瘤患者的ABR的结果。研究表明:(1)虽然颅后窝病变的患者自觉有听力困难或耳鸣,但与其纯音测听结果不符合,这说明患者的听力自我评价比纯音测听更值得注意。(2)累及听神经的病变体积大,但纯音听力可不受影响。(3)年青人的听力系统对Ⅷ神经及低位     

瞬态耳声发射的高频分析

目的：研究瞬态耳声发射(TEOAE)在高频区域的临床应用价值及与纯音测听听力检查的相关性。方法：应用耳声发射测试仪检测正常组和高频听力损失组高频区域的TEOAE各频段平均强度；应用纯音听力计检测各频率点的纯音听阈值，比较两者的变化趋势。结果：TEOAE在1．5～4．5kHz高频范围内，正常组与高频听力损失组的耳声发射平均强度差异有统计学意义，与纯音听阈检查结果有一定的相关性。两种检查中，高频听力损失组的两个指标变化趋势相一致。结论：临床上，结合纯音电测听结果，可使TEOAE更为准确客观地判断患者高频区域听力损失的程度和范围。     

高频测听在语频听力正常的耳鸣患者中的应用及其意义

目的 观察语频听力正常的耳鸣患者的高频测听结果并探讨其临床意义。方法 应用8－20kHz的纯音听力计对语频听力正常（≤25dB HL）的耳鸣组患者35例（60耳）和相同年龄段的正常对照组人群30例（60耳）进行高频测听。结果 耳鸣组患者的高频听阈检测结果显示，随频率增高，听阈逐渐提高，听阈检出率逐渐下降。相同频率耳鸣组患者与对照组人群移的差异有显著性意义（P＜0.05），14－20kHz范围内两组听阈检出率差异也有显著性意义（P＜0.01）。结论 耳鸣组患者高频听阈明显高于正常对照组，在14kHz以上听阈检出低于正常对照组。高频测听能够在早期为耳鸣患者提供听力受损的直接参考依据，患者的高频听务损失，可能在最初的耳鸣发生中起一定的作用。     

急性主观性耳鸣发病机制及治疗进展

随着隐性听力损失深入研究,常频纯音测听无法发现的听力损失逐渐引起重视,临床上部分患者以“耳鸣(短时间内),但无听力下降”为主诉就诊。关于急性主观性耳鸣发生机制的研究屡见报道,但尚不明确。已有研究显示,急性主观性耳鸣的治疗方案与发生机制相关。耳鸣的病程可能影响急性主观性耳鸣的康复效果。因此及时鉴别急性主观性耳鸣的发生机制并予相应治疗,对耳鸣的改善具有重要意义。本文旨在介绍急性主观性耳鸣(acute subjective tinnitus)发病与治疗进展,为急性主观性耳鸣的诊断及治疗提供理论基础。     

耳鸣患者的畸变产物耳声发射测试

目的探讨耳鸣患者畸变产物耳声发射（DPOAE）的临床特征，了解畸变耳声发射检测在耳鸣患者中的临床应用价值。方法对42例耳鸣患者进行DPOAE测试及纯音听阈检测，并进行对比。结果耳鸣伴听力下降患者的畸变产物耳声发射在相关频率幅值下降或未引出，二者有相关性；耳鸣伴听力正常患者畸变产物耳声发射均出现高频段幅值下降或缺失。结论对纯音听阈正常的耳鸣患者DPOAE可用于发现早期耳蜗病变，对听力损失者可有助于客观预估听力损失程度。     

Course of hearing loss and occurrence of tinnitus

Chronic tinnitus is often accompanied by a hearing impairment, but it is still unknown whether hearing loss can actually cause tinnitus. The association between the pitch of the tinnitus sensation and the audiogram edge in patients with high-frequency hearing loss suggests a functional relation, but a large fraction of patients with hearing loss does not present symptoms of tinnitus. We therefore, investigated how the occurrence of tinnitus is related to the shape of the audiogram. We analyzed a sample where all patients had noise-induced hearing loss, containing 30 patients without tinnitus, 24 patients with tone-like tinnitus, and 17 patients with noise-like tinnitus. All patients had moderate to severe high-frequency hearing loss, and only minor to moderate hearing loss at low frequencies. We found that tinnitus patients had less overall hearing loss than patients without tinnitus. Moreover, the maximum steepness of the audiogram was higher in patients with tinnitus (-52.9+/-1.9 dB/octave) compared to patients without tinnitus (-43.1+/-2.4 dB/octave). Differences in overall hearing loss and maximum steepness between tone-like and noise-like tinnitus were not significant. For tone-like tinnitus, there was a clear association between the tinnitus pitch and the edge of the audiogram, with tinnitus pitch being on average 1.48+/-0.12 octaves above the audiogram edge frequency, and 0.81+/-0.1 octaves above the frequency with the steepest slope. Our results suggest that the occurrence of tinnitus is promoted by a steep audiogram slope. A steep slope leads to abrupt discontinuities in the activity along the tonotopic axis of the auditory system, which could be misinterpreted as sound.     

正常听力耳鸣患者的耳鸣音调

目的通过观察正常听力耳鸣患者的耳鸣音调分布状况,探讨耳鸣的听力下降相关机理。方法总结美国Iowa大学医院2000—2007年耳鸣患者数据库,根据听力图筛选196例耳鸣患者中的听力正常者,对他们的耳鸣音调进行观察。结果耳鸣患者中有34.69%为正常听力者,听力正常耳鸣患者的耳鸣音调分布从500Hz至8kHz频率范围,8kHz耳鸣音调患者占55.88%。最大听阈提高频率与耳鸣音调之间不存在相关性。结论耳鸣可以存在于正常听力人群中,耳鸣音调分布范围较广,耳鸣起源于听力损失的理论不适用于解释正常听力耳鸣人群,耳鸣产生的机理不能用单一的理论来解释。     

DPOAE in tinnitus patients with cochlear hearing loss considering hyperacusis and misophonia

The most probable place generating tinnitus in auditory pathway are outer hair cells (OHC) inside cochlea. To asses their activity otoacoustic emission is used. The goal of the investigation was estimation the features of otoemission DPOAE in groups with tinnitus patients with cochlear hearing loss, estimation of diagnostic value of DPOAE parameters for analysis of function of the cochlea in investigated patients emphasizing DPOAE parameters most useful in localizing tinnitus generators and estimation of hypothetic influence of hyperacusis and misophony on parameters of DPOAE in tinnitus patients with cochlear hearing loss. The material of the study were 42 tinnitus patients with cochlear hearing loss. In the control group there were 21 patients without tinnitus with the same type of hearing loss. Then tinnitus patients were divided into three subgroups--with hyperacusis, misophony and without both of them, based on audiologic findings. METHOD: after taking view on tinnitus and physical examination in all the patients pure tone and impedance audiometry, supratreshold tests, ABR and audiometric average and discomfort level were evaluated. Then otoemission DPOAE was measured in three procedures. First the amplitudes of two points per octave were assessed, in second--"fine structure" method-- 16-20 points per octave (f2/f1 = 1.2, L1 = L2 = 70 dB). Third procedure included recording of growth rate function in three series for input tones of value f2 = 2002, 4004, 6006 Hz (f2/f1= 1.22) and levels L1=L2, growing by degrees of 5dB in each series. RESULTS: DPOAE amplitudes in recording of 2 points per octave and fine structure method are very valuable parameters for estimation of cochlear function in tinnitus patients with cochlear hearing loss. Decreasing of DPOAE amplitudes in patients with cochlear hearing loss and tinnitus suggests significant role of OHC pathology, unbalanced by IHC injury in generation of tinnitus in patients with hearing loss of cochlear localization. DPOAE fine structure provides us the additional information about DPOAE amplitude recorded in two points per octave, spreading the amount of frequencies f2, where differences are noticed in comparison of two groups--tinnitus patients and control. Function growth rate cannot be the only parameter in estimation of DPOAE in tinnitus patients with cochlear hearing loss, also including subjects with hyperacusis and misophony. Hyperacusis has important influence on DPOAE amplitude, increases essentially amplitude of DPOAE in the examined group of tinnitus patients.     

中文版老年听力障碍筛查量表评分与纯音听阈测试的比较研究

目的探讨中文版老年听力障碍筛查量表(hearing handicap inventory for the elderly-screening,HHIE-S)评分与纯音听阈测试的关联性与差异性,为该量表的临床应用提供依据。方法275例老年受试者(听力正常者47例、不同程度听力损失者228例)填写中文版HHIE-S量表获得评分,并进行纯音听阈测试,比较受试者中文版HHIE-S量表评分与较好耳500、1000、2000、4000 Hz纯音气导听阈平均值(PTA)之间的关联性与差异性。结果275例受试者中,PTA正常组47例,HHIE-S评分为无听力障碍者占80.85%(38/47);PTA轻度听力损失组101例,HHIE-S评分为轻中度听障者占38.61%(39/101);PTA中度听力损失组110例,HHIE-S评分为轻中度听障者占40.0%(44/110);PTA重度听力损失组17例,HHIE-S评分为重度听障者占82.35%(14/17)。HHIE-S与纯音听阈测试结果的Kappa系数为0.210(P<0.001)。HHIE-S评分与PTA的Pearson相关系数r为0.722(P<0.001)。以PTA≤25 dB HL为听力正常、HHIE-S评分≤8分表示无听力障碍,HHIE-S量表的敏感性为61.0%,特异性为80.9%,阳性预测值为93.9%,阴性预测值为29.9%。结论HHIE-S量表与纯音听阈测试既有较好的关联性,又有差异性,二者联合应用可以全面评估老年人的听力状况。     

Spontaneous Otoacoustic Emissions in Tinnitus Patients

IntroductionOtoacoustic emissions (OAEs) are believed to bethe products of active cochlear mechanics. The activityprocess in the cochlea is important for hearing sensitivi-ty, fine-tuning and maybe self-protection. Compromiseof this process is usually accompanied by hearing loss,auditory distortion and often tinnitus. It is now generallyagreed that OAEs are associated with relatively intactouter hair cell function. The relations between the cen-tral and peripheral auditory systems can be co…     

Effect of inflation of the eustachian tube on tinnitus]

The purposes of this study were to evaluate the effect of inflating the Eustachian tube in patients with tinnitus, and to identify diseases in which tubal inflation is indicated. Fifty-four ears of as many patients complaining of tinnitus were examined by pure tone audiometry and decreases in pitch and loudness associated with tinnitus were also evaluated by tinnitus audiometry (Danac-100, DanaJapan). Tinnitus was associated with sensorineural hearing loss (SNHL) in 44 ears and not associated in the remaining 10. The subjects were classified further into two groups: the higher tone group showed a pitch range with tinnitus of 1000 Hz or higher, and the lower tone group showed a pitch range of less than 1000 Hz. In the higher tone tinnitus group with SNLH, the tubal inflation was effective in 3 of 31 ears (10%), and in the lower tone group, 10 of 13 ears (77%). On the other hand, in the tinnitus group with no hearing loss, the method relieved tinnitus in 6 of 10 ears (60%). In the higher tone tinnitus group with no hearing loss, the tubal inflation was effective in 3 of 6 ears (50%), and in the lower tone group, 3 of 4 ears (75%). In this study, however, no ears were permanently relieved of tinnitus with tubal inflation. In the higher tone group, the duration of the reduced tinnitus was less than 10 minutes. In 69% of the lower tone group, the reduction was from 20 minutes to 2 hours. The effect did not continue for more than 2 hours at the longest. In conclusion, Eustachian tubal inflation is indicated in diseases with tinnitus as follows: 1. Lower tone tinnitus with SNHL, particularly in Meniere's disease and acute onset low-tone type SNHL, may be temporarily relieved with tubal inflation. 2. Tinnitus in an ear without SNHL that may gain transitory relief from ringing with the tubal inflation.     

伴感音神经性聋耳鸣的心理声学和听力学特征

目的:研究伴感音神经性聋耳鸣的心理声学特征测试及听力学的特征。方法:选取感音神经性聋耳鸣患者61例(79耳)作为实验组,选取25例(50耳)听力正常且无耳鸣的志愿者作对照组,分别检测2组对象的纯音测听、声导抗测试、耳鸣检测、畸变产物耳声发射(DPOAE),并进行统计学分析。结果:实验组平均后效抑制阳性率为51.3%,其中耳鸣掩蔽曲线为汇聚型者掩蔽效果较好;实验组与对照组DPOAE的通过率差异有统计学意义,实验组(15.2%)低于对照组(96.0%);在500～8 000Hz各个频率点实验组DPOAE幅值低于对照组有统计学意义。结论:耳鸣心理声学测试能够更全面了解耳鸣详细的心理声学特征资料,对耳鸣康复指导提供更加详尽量化指标依据,DPOAE测试可以辅助对耳鸣患者耳蜗病变的诊断。     

Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

Objective

A few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125 Hz to 8000 Hz (≤20 dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.