Logon诱发听性脑干反应

为了解Logon诱发听性脑干反应的频率特异性,在文中以2～8kHz Logon及短声作为刺激声信号,来观察0.25～8kHz纯音听力正常青年人及听力曲线表现为4kHz“V”型下降,而2kHz及8kHz听阈正常青年人的听性脑干反应.结果示听力正常青年人高强度各频率Logon刺激均可引出分化很好的包括5个反应波的波形,其中I、Ⅲ波检出率最高为100%,Ⅳ、Ⅴ波常融合为一个波;听性脑干反应阈4kHz及8kHz较2kHz略低,Ⅰ波潜伏期随频率升高而缩短,Ⅲ波潜伏期缩短轻微,Ⅴ波潜伏期各频率差异无显著性意义,各波波间期随频率升高而延长.听力曲线表现为4kHz“Ⅴ”型下降,而2kHz及8kHz听阈正常的青年人,短声听性脑干反应阈、各波潜伏期、波间期均无明显异常,而4kHz Logon刺激听性脑干反应阈显著升高,2、8kHz Logon刺激听性脑干反应阈基本正常,Logon刺激听性脑干反应阈与纯音听阈线性相关.因此可以认为2～8kHz Logon刺激诱发听性脑干反应具有频率特异性,可做为相应频率听觉敏度测试的客观指标.     

3～4月龄及5～6月龄婴儿听性脑干反应的正常值分析

目的观察正常婴儿听性脑干反应(ABR)潜伏期及阈值正常值范围,为早期干预治疗提供依据。方法应用美国ICS CHARTR诱发电位仪对40例(80耳)听力正常的婴儿和20例听力正常成人进行ABR检测,根据年龄分为A组(3~4月龄)、B组(5~6月龄)、对照组。建立不同月龄婴儿ABR正常值范围,讨论性别、耳别、月龄对测试结果的影响及阈值测定的临床应用。结果80dB nHL短声刺激下,A组A easeBR波Ⅰ、Ⅲ、Ⅴ潜伏期的正常值范围分别是:(1.52±0.19)m s、(4.20±0.20)m s、(6.34±0.26)m s;B组ABR波Ⅰ、Ⅲ、Ⅴ潜伏期的正常值范围分别是:(1.50±0.09)m s、(4.05±0.16)m s、(6.16±0.25)m s;对照组ABR波Ⅰ、Ⅲ、Ⅴ潜伏期的正常值范围分别是:(1.43±0.10)m s、(3.63±0.15)m s、(5.50±0.16)m s。随着月龄的增长,婴儿各波的潜伏期(PL)和波间期(IPL)均缩短;但6月龄时仍未达成人水平。A、B两组各波的潜伏期及波间期与对照组比较差异均有统计学意义(P0.05);A组与B组比较Ⅲ、Ⅴ波潜伏期及Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期差异具有统计学意义(P0.05)。女婴潜伏期和波间期短于男婴(A组内Ⅰ-Ⅲ波间期除外),A组内男女间Ⅴ波潜伏期差异具有统计学意义(P0.05);B组内男女Ⅲ、Ⅴ波潜伏期及Ⅰ-Ⅴ波间期差异有统计学意义(P0.05);各组内左右耳差异无统计学意义(P0.05)。各月龄组及正常成人ABR反应阈差异无统计学意义。结论建立不同月龄婴儿ABR潜伏期及阈值正常值标准,为听损伤的早期诊断和随访监测提供可靠依据。     

不同月龄婴儿的ABR正常值分析

目的 获取6月龄内婴儿的听性脑干反应(auditory brainstem response,ABR)正常值范围并分析其特点.方法 2006年5月至2008年5月对听力正常、出生40天～7月龄的60例婴儿进行ABR检测,根据平均年龄分为A(6周龄)、B(3月龄)、C(6月龄)组,每组20例(40耳);对照组为听力正常的成人20例(40耳),平均年龄25.2岁.对各组的ABR结果进行统计分析.结果 各组100 dB nHL ABR的波Ⅰ、Ⅲ、Ⅴ潜伏期的正常值范围分别为:A组:1.49±0.08、4.42±0.16、6.61±0.25 ms;B组:1.47±0.07、4.35±0.20、6.50±0.25 ms;C组:1.45±0.07、4.17±0.15、6.32±0.22 ms;对照组:1.45±0.07、3.79±0.11、5.49±0.20 ms;三组婴儿80 dB nHL ABR的波Ⅰ、Ⅲ、Ⅴ潜伏期的正常值范围分别为:A组:1.63±0.08、4.52±0.17、6.74±0.26 ms;B组:1.64±0.11、4.44±0.20、6.67±0.26 ms;C组:1.60±0.11、4.27±0.16、6.43±0.24 ms.随刺激声强度降低,ABR各波潜伏期延长.各月龄组婴儿的波Ⅲ、Ⅴ潜伏期、Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期均比成人延长,且随婴儿月龄增加逐渐缩短,但6月龄时仍未达到成人水平.各月龄组ABR反应阈差异无统计学意义.结论 不同月龄婴儿的波Ⅰ潜伏期与成人相近;各月龄婴儿的ABR反应阈无明显差异,且与成人相近.     

中耳功能异常婴儿听性脑干反应特点及应用

目的探讨中耳功能异常婴儿的听性脑干反应(ABR)特点及临床应用价值。方法分析比较85例(170耳)中耳功能异常、ABR反应阈≤60dB nHL的婴儿(A组)和83例(166耳)中耳功能正常、ABR反应阈40～60dB HL的婴儿(B组)以及41例(82耳)正常婴儿(C组)的ABR波Ⅰ、Ⅲ、Ⅴ潜伏期、波间期和波Ⅴ反应阈值。结果 A组中24耳(14.11%)为ABR反应阈≤30dB nHL、73耳(42.94%)为40dB nHL、54耳(31.76%)为50dBnHL、19耳(11.18%)为60dB nHL;B组中83耳(50%)ABR反应阈为40dB nHL、52耳(31.33%)为50dB nHL、31耳(18.67%)为60dB nHL;C组婴儿ABR反应阈均≤30dB nHL。刺激声为80dB nHL时三组间波Ⅰ、Ⅲ、Ⅴ潜伏期的关系分别为:A组波Ⅰ、Ⅲ、Ⅴ潜伏期明显长于B组和C组(P<0.01),而Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期则较B组和C组短(P<0.01),Ⅲ-Ⅴ波间期则与B组和C组差异无统计学意义(P>0.05);B组各波潜伏期、波间期与C组比较差异均无统计学意义(P>0.05)。三组中反应阈相同者波潜伏期比较:A组波Ⅰ、Ⅲ、Ⅴ潜伏期仍明显长于B组和C组(P<0.05)。结论婴儿中耳功能异常时大部分ABR反应阈升高,以轻中度异常为主,均有波Ⅰ潜伏期延长;波Ⅰ潜伏期明显延长对判断婴儿中耳功能异常有意义。     

气骨导短音ABR在听力正常成年人中的特性

目的 研究耳科正常成年人气导和骨导短音诱发的听性脑干反应(auditory brain stem response,ABR)的特点,探讨短音ABR反应阈与纯音听阈的关系及骨导短音ABR对于鉴别听力损失类型的作用.方法 对耳科正常成年人(20例,男/女=10/10)应用SmartEP听觉诱发电位仪记录受试者短音气导和骨导ABR.结果 气导0.5 kHz、1 kHz、2 kHz、4 kHz短音诱发的ABR反应阈分别为(24.8±7.3)dB nHL、(16.1±6.5)dB nHL、(13.5±5.5)dB nHL、(11.9±5.8)dB nHL,分别较对应频率气导纯音听阈高(19.5±9.3)dB、(13.4±6.6)dB、(12.2±6.0)dB、(12.2±7.2)dB,骨导0.5 kHz、1 kHz、2 kHz、4 kHz短音诱发的ABR反应阈为(28.4±9.2)dB nHL、(19.0±7.4)dB nHL、(15.1±7.7)dB nHL、(13.6±6.4)dB nHL,分别较对应频率骨导纯音听阈高(32.0 10.3)dB、(19.4±10.0)dB、(14.2±8.2)dB、(16.1±6.9)dB.各频率气导与骨导短音ABR反应阈无显著性差异.短音ABR的波形与短声ABR相似,随刺激声频率降低,Ⅰ、Ⅲ波引出率降低.短音ABR各波潜伏期均较短声长,且随频率降低,各波潜伏期延长.反应阈强度骨导短音ABR的Ⅴ波潜伏期比气导短音Ⅴ波潜伏期长,其中0.5 kHz和1 kHz该差异具显著性.结论 短音ABR的反应阈可以用于预测纯音听阈,骨导短音ABR的反应阈及短音ABR反应阈的气骨导差有助于鉴别听力损失的类型.     

听性稳态诱发反应在听力异常婴儿的诊断意义

目的听性稳态诱发反应（auditory steady—statere sponse，ASSR）新技术与视觉强化测听（vision reinforcement audiometry，VRA）阈值的相关性分析研究，探讨听神经病症侯群及其鉴别诊断。方法10例（20耳）对照组，年龄6～12个月，测得ASSR和VRA的正常阈值。16例（26耳）异常听力组患儿（年龄在3～6个月），根据其所患疾病分为3个亚组：Ⅰ组为早孕感染组5例（8耳），Ⅱ组为窒息缺氧组5例（10耳），Ⅲ组为高胆红素血症组6例（8耳），检测畸变产物耳声发射（DPOAE）、听性脑干反应（ABR）潜伏期、肌反射值与ASSR和VRA及其相关性结果对照。结果Ⅰ组中2例次（2耳次）为单纯疱疹病毒感染。5例次（8耳次）DPOAE消失，4例次（6耳次）ABR波Ⅰ潜伏期延长、Ⅰ—Ⅴ波间潜伏期缩短，3例次（6耳次）500Hz和1000Hz的镫骨肌反射正常，2例次（2耳次）镫骨肌反射阈偏高，初步推测单纯耳蜗性病变，排除听神经病可能，测得ASSR平均估计阈值与VRA平均阈值具有很好的相关性（r=0．95～0．98）。Ⅱ组中4例次（8耳次）畸变产物耳声发射消失，其中1例次（2耳次）ABR波Ⅰ、波Ⅲ、波Ⅴ消失和肌反射消失，3例次（5耳次）ABR波Ⅰ消失和波Ⅲ及波Ⅴ潜伏期延长，以及肌反射消失。2例次（3耳次）Ⅰ-Ⅲ波间潜伏期延长，肌反射也消失。推测可能为听神经病症侯群（耳蜗至脑干下听觉传导通路受损）伴有耳蜗功能障碍，测得ASSR平均估计阈值与VRA平均阈值具有较好的相关性（r=0．72～0．84）。Ⅲ组中6例次（8耳次）DPOAE存在，4例次（5耳次）ABR波Ⅰ、Ⅲ、Ⅴ和肌反射消失，2例次（3耳次）Ⅰ—Ⅴ波间潜伏期延长，镫骨肌反射阈正常偏高，初步分析推测为听神经病症侯群病损在脑干以上，测得ASSR平均估计阈值与VRA平均阈值具有很弱的相关性（r=0．43～0．64），ASSR阈值和VRA阈值不一致，进一步说明这组的病损应该在脑干或皮层。3个亚组的每个频率（0．25、0．5、1、2,4kHz）平均ASSR和VRA阈值差值比较，差异都具有统计学意义（F检验，P〈0．05、P〈0．01、P〈0．01、P〈0．05、P〈0．05）。结论通过ASSR阈值和VRA阈值相关性技术研究或许可提供诊断及鉴别诊断在各种频率听力障碍婴儿的听神经病症侯群（病变高位）、听神经病症侯群伴有耳蜗功能障碍（病变低位）以及单纯耳蜗性病（非听神经病）。     

不同周龄早产儿听性脑干反应的初步研究

目的了解不同周龄早产儿及同龄足月儿听性脑干反应(ABR)的发展变化,探讨早产儿听力损失的早期诊断时机和诊断标准。方法按照周龄的不同将听功能正常的早产儿分成3组(34~37周龄儿为A组,37 1~44周龄儿为B组,50~54周龄儿为C组),3月龄健康足月儿为D组,分别进行ABR测试,比较各组ABR的各波潜伏期和波间期的变化,并进行统计学分析。结果与足月儿相比,早产儿ABR波形较为简单,波间期较长;随着周龄的增加,波Ⅰ引出率逐渐增加,波Ⅰ、Ⅲ、Ⅴ潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期逐渐缩短。70dB nHL短声刺激下,A组与C、D两组比较,B组与C组比较各波潜伏期及波间期的差异有统计学意义;A组与B组的波Ⅲ潜伏期的差异有统计学意义。50~54周龄(相当于足月儿3月龄)的早产儿,与同龄健康足月儿相比,ABR各波潜伏期和波间期均无统计学差异。30dB nHL短声刺激下各组ABR波Ⅴ潜伏期随周龄增加而缩短,其差异有统计学意义。结论①早产儿听力损失的早期诊断,可以在推算周龄为50~54周时进行,诊断标准可参考同龄健康足月儿;②ABR阈值正常,但潜伏期和波间期异常的早产儿要定期随访。     

听力正常孤独症谱系障碍儿童的听性脑干反应波形特征分析

目的 探究听力正常孤独症谱系障碍(autism spectrum disorder, ASD)儿童的听性脑干反应(ABR)特征及各波潜伏期和波间期与ASD严重程度分级的关系。方法 (1)将55例(110耳)听力正常ASD儿童和月龄、性别相匹配的55例(110耳)典型发育(typical development, TD)儿童,按月龄分为≤24月龄(22耳)、25～36月龄(40耳)、37～48月龄(28耳)及>48月龄(20耳)四个亚组。比较听力正常ASD儿童与TD儿童的ABR潜伏期和波间期是否存在差异。(2)根据第五版精神障碍诊断与统计手册(DSM-V)将ASD儿童按照严重程度分级,探究听力正常ASD儿童ABR各波潜伏期和波间期与其严重程度分级是否相关。结果 (1)≤24月龄时,ASD与TD儿童ABR各波潜伏期及波间期差异均无统计学意义(P>0.05);(2)25～36月龄时,与TD儿童相比,听力正常ASD儿童波Ⅲ潜伏期及Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期显著延长;37～48月龄时波Ⅲ、Ⅴ潜伏期及Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期显著延长;>48月龄时波Ⅴ潜伏期及Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期显著...     

不同月龄婴幼儿听性稳态反应和听性脑干反应的相关性分析

目的 了解不同月龄婴幼儿听性稳态反应和听性脑干反应反应阈的相关性.方法 对象为299例(497耳)1～36月龄的婴幼儿,分为1～月龄组208耳,4～月龄组81耳,7～月龄组47耳,13～月龄组53耳,19～36月龄组108耳,将各组ABR反应阈均值分别与ASSR的2、4 kHz反应阈及2、4 kHz反应阈的平均值进行相关性分析.结果 1～月龄组ABR反应阈与ASSR的2、4 kHz反应阈及2、4 kHz反应阈平均值相关系数分别为0.499、0.541、0.531;4～月龄组分别为0.678、0.705、0.726;7～月龄组分别为0.792、0.717、0.777;13～月龄组分别为0.934、0.880、0.915;19～36月龄组分别为0.817、0.810、0.867.结论 1～18月龄婴幼儿听性稳态反应和听性脑干反应反应阈的相关性随月龄增加而增加,12月龄以上均为高度相关.     

不同病因致婴幼儿听力障碍的听力学分析

目的 探讨不同病因致婴幼儿听力障碍的特点及其鉴别诊断。方法 30例（60耳）正常听力婴幼儿为对照组，年龄6～24个月，行ABR、ASSR、视觉强化测听（vision reinforcement audiometry，VRA）和声导抗检查。20例（36耳）异常听力患儿（年龄6～24个月）根据其所患疾病分为3个组：Ⅰ组7例为围产期缺氧缺血，Ⅱ组7例为出生时核黄胆，Ⅲ组6例为出生时高胆红素血症，对各组患儿分别行畸变产物耳声发射（distortion-product otoacouslic emission，DPOAE）、耳蜗微音电位（CM）、ABR、ASSR、声导抗和VRA检查，并采用F检验进行数据统计学处理。结果①Ⅰ组所有病例DPOAE和CM存在、鼓室导抗图为A型，ABR异常，其中一部份患儿的Ⅲ-Ⅴ波间期延长，另外1例（2耳）ABR的波Ⅳ与波Ⅴ消失，各频率（0．25、0．5、1、2．4kHz）ASSR平均反应阈明显高于VRA平均阈值，其平均相关系数为r=0．41～0．65。②Ⅱ、Ⅲ组一部份患儿（7耳）CM存在，而DPOAE消失（Ⅱ组6耳、Ⅲ组1耳），ABR的波Ⅴ潜伏期和Ⅰ-Ⅲ波间期延长，其中Ⅱ组的ASSR反应阈较接近VRA阈值，其平均相关系数为r=0．92～0．97，而Ⅲ组两者平均阈值的相关系数为r=0．69～0．86。③3组各频率平均ASSR／VRA阈值差值的差异均有统计学意义。结论 不同病因致婴幼儿听力障碍的听力学检测结果不同，应综合分析，这对于采用何种干预方法以及预测干预效果都有非常重要的意义。     

不同病因引起的新生儿高胆红素血症听性脑干反应的特点

目的 探讨不同病因引起的新生儿高胆红素血症的听性脑干反应(ABR)特点及其与临床的关系.方法 将88例(176耳)高胆红素血症患儿按病因分为6组,同时选取15名(30耳)健康新生儿作为正常对照,均进行ABR测试,并比较各组间的差异,42 d后患儿复查ABR.结果 不同病因中,葡萄糖6-磷酸脱氢酶(glucose-6-phosphate dehydrogenase,G-6-PD)缺乏症所致的高胆红素血症ABR反应阈增高最明显,异常率最高.不同病因组之间及与对照组间ABR的Ⅲ波、Ⅴ波潜伏期及Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期差异均具有统计学意义(P值均＜0.05).高胆红素血症患儿ABR各波潜伏期及波间期均较对照组延长,其中新生儿感染最容易引起ABR各波潜伏期及波间期延长,其次是ABO溶血与其他不明原因组,母乳性黄疸组潜伏期与波间期相对要短.多病因组ABR反应阈的异常率明显高于单病因组(P＜0.05);单种病因与多种病因引起的高胆红素血症组间比较,ABR各波潜伏期及波间期差异无统计学意义(P值均＞0.05).30例患儿进行了复查,复查前后除Ⅰ-Ⅲ波间期外,各波潜伏期及波间期差异均具有统计学意义(P值均＜0.05).结论 高胆红素血症对听觉系统的损害与病因的种类及数量有关.由G-6-PD缺乏、新生儿感染、ABO溶血、多病因以及不明原因引起的高胆红素血症与母乳性黄疸相比,更易导致听觉功能损害.高胆红素血症对听觉的损害存在一定的可逆性.

Abstract：

Objective To explore the characteristics of auditory brainstem response (ABR) in neonatal hyperbilirubinemia induced by different causes. Methods A total of 88 neonates ( 176 ears) with hyperbilirubinemia were divided into several groups according to the causes and followed up after 42 d, and 15 nomal neontes (30 ears) were measured ABR and analyzed the results. Results The thresholds of ABR in glucose-6-phosphate dehydrogenase were the highest in all the groups and had the lowdest incidence rate.The wave Ⅲ, Ⅴ latencies and Ⅲ-Ⅴ, Ⅰ -Ⅴ interwave intervals of the ABR were significantly difference and prolonged during test in comparison to the latencies in the control group ( P ＜ 0. 05 ). The neonatal infections group had the longest wave and interwave intervals, followed by ABO incompatibility hemolytic diseases and the unknown cause groups, while the breastfeeding jaundice were the shortest in the groups of neonatal hyperbilirubinemia. The thresholds of ABR in the hyperbilirubinemia caused by several etiologies were significant abnomality when compared with the single etiology. However, they were similar in the wave latencies and interwave intervals of ABR. During the follow up, the ABR wave latencies and interwave intervals except for interwave latency Ⅰ-Ⅲ were significantly shorter. Conclusions The toxicity of hyperbilirubinemia to the auditory nervous system are related to the species and number of etiologies. The neonate hyperbilirubinemia cuased by glucose-6-phosphate dehydrogenase, infections, ABO incompatibility hemolytic diseases and many etiologies are much more dangerous to the auditory system than the breastfeeding jaundice. The damages of hyperbilirubinemia to the auditory nervous system are reversible probably.     

Establishing normal hearing with the dichotic multiple-frequency auditory steady-state response compared to an auditory brainstem response protocol

OBJECTIVE: To determine the clinical usefulness of the dichotic multiple-frequency (MF) auditory steady-state response (ASSR) technique for estimating normal hearing compared to a 0.5-kHz tone burst and broadband click auditory brainstem response (ABR) protocol in a sample of adults. MATERIAL AND METHODS: A comparative experimental research design was selected in order to compare estimations of normal hearing obtained with the dichotic ASSR technique at 0.5, 1, 2 and 4 kHz with a 0.5-kHz tone burst and broadband click ABR protocol. The recording times required for each procedure were also compared. Normal-hearing subjects (n = 28) were selected according to immittance values within normal limits and pure-tone behavioural thresholds of < 25 dB HL across frequencies. RESULTS: The dichotic MF ASSR estimated normal hearing to be, on average, 30-34 dB HL across the range 0.5-4 kHz. The mean estimate of normal hearing for 0.5 kHz using tone burst ABRs was 30 dB nHL and the mean click ABR threshold was 16 dB nHL, i.e. 14-18 dB better than the ASSR thresholds. The dichotic MFASSR technique recorded 8 thresholds (4 in each ear) in a mean time of 23 min. The ABR protocol recorded 4 thresholds (2 in each ear) in a mean time of 25 min. CONCLUSION: Both the dichotic MF ASSR and ABR protocols provided a time-efficient estimation of normal hearing. There was no significant difference between the tone burst ABR and MF ASSR techniques in terms of estimation of normal hearing at 0.5 kHz. The dichotic MF ASSR technique proved more time-efficient by determining more thresholds in a shorter time compared to the ABR protocol.     

早产极低出生体重儿听性脑干诱发电位特征分析

目的：探讨早产极低出生体重儿（VLBW）听性脑干诱发电位（ABR）的特征,及其与患儿生理特征的关系。方法：选取本院新生儿病区、新生儿重症监护室及听力专科就诊接受检查的早产VLBW儿纳入研究,共59例（118耳）,登记围产期高危因素;选取30例（60耳）同期足月正常出生体重儿作为对照组。对所有患儿进行中耳分析,畸变产物耳声发射和ABR。结果：早产VLBW儿中听力异常的构成比明显大于正常人群,伴有其他高危因素的患儿（42例）阈值高于不伴有其他高危因素者（17例）;相关分析显示,ABR阈值与出生体重、孕周、评估时年龄和调整年龄之间没有相关性（P〉0．05）;ABRI、Ⅲ、Ⅴ波潜伏期和Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ—Ⅴ波间期等特征参数与患儿评估时年龄和调整年龄呈负相关（P〈0．05）;早产VLBW儿与足月儿在ABR Ⅰ、Ⅴ波潜伏期及Ⅰ-Ⅲ、Ⅲ-Ⅴ波间期等参数间存在差异。结论：早产VLBW儿导致听力损失的根本原因可能并不是胎龄和体重本身,而是与并发症有关;早产VLBW儿中,外周听觉功能异常率高;对于VLBW儿需建立耳声发射与自动ABR两者结合的听力筛查方式并定期随访。     

听性稳态反应与听性脑干反应阈值的比较

目的:通过比较同一组聋儿听性脑干反应(ABR)和听性稳态反应(ASSR)的反应阈值,对ASSR的临床应用价值作出评价。方法:分别记录65例年龄在2.5个月~5.5岁聋儿的ABR及ASSR结果并进行比较及相关分析。结果:本组聋儿ABR反应阈值左右耳分别为(85.82±12.39)和(82.70±14.93)dB nHL;ASSR 4个测试频率的反应阈值左耳为(86.91±16.70)(、90.32±16.11)、(91.02±16.58)、(89.80±17.08)dB HL,右耳为(85.15±18.16)(、89.32±17.76)(、90.41±18.87)(、85.15±17.03)dB HL。ASSR 4个测试频率的反应阈值与ABR结果的相关系数分别为左耳0.622、0.721、0.757、0.714和右耳0.613、0.732、0.795、0.739。结论:ASSR与ABR测试结果有显著的相关性,而ASSR所获得的是分频资料,因此这种测试方法有较高的临床应用价值。     

Comparison of auditory steady-state response and auditory brainstem response thresholds in children

Recently, auditory steady-state responses (ASSRs) have been proposed as an alternative to the auditory brainstem response (ABR) for threshold estimation. The goal of this study was to investigate the degree to which ASSR thresholds correlate with ABR thresholds for a group of sedated children with a range of hearing losses. Thirty-two children from the University of Iowa Hospitals and Clinics ranging in age from 2 months to 3 years and presenting with a range of ABR thresholds participated. Strong correlations were found between the 2000-Hz ASSR thresholds and click ABR thresholds (r = .96), the average of the 2000- and 4000-Hz ASSR thresholds and click ABR thresholds (r = .97), and the 500-Hz ASSR and 500-Hz toneburst ABR thresholds (r = .86). Additionally, it was possible to measure ASSR thresholds for several children with hearing loss that was great enough to result in no ABR at the limits of the equipment. The results of this study indicate that the ASSR may provide a reasonable alternative to the ABR for estimating audiometric thresholds in very young children.     

Auditory sensitivity in children using the auditory steady-state response

OBJECTIVE: To determine the effectiveness of auditory steady-state response (ASSR) as a measure of hearing sensitivity in young children suspect for significant hearing loss. DESIGN: Within-subject comparisons of click auditory brainstem response (ABR) thresholds and ASSR thresholds. SUBJECTS: The study population comprised 42 children suspect for hearing loss and subsequently referred for hearing assessment using electrophysiologic techniques. MAIN OUTCOME MEASURES: Electrophysiologic threshold responses for click ABR and ASSR stimuli (0.5, 1, 2, and 4 kHz) for right and left ears. RESULTS: Based on ABR and ASSR thresholds, 50% of the subjects demonstrated significant hearing loss in the severe to profound range. In some subjects, ASSRs were present at higher stimulus levels when click ABRs were absent. Significant correlations (P<.05) were found between high-frequency ASSR and click ABR thresholds for this study sample. For some subjects, ASSR findings suggested differences between ears that were not observable from the no-response click ABR results. CONCLUSIONS: Auditory steady-state response testing may provide additional information for children who demonstrate hearing levels in the severe to profound range. This information may be helpful when selecting the ear for cochlear implantation for a young hearing-impaired child. Multiple objective methods, such as ABR and ASSR testing, may be needed to determine accurate hearing sensitivity for young children being considered for sensory devices, and in particular, cochlear implants.     

同步多频听觉稳态诱发反应与听性脑干诱发电位相关性研究

目的探讨同步多频听觉稳态诱发反应(auditory steady-state responses to multiple simultaneous stimuli,MSS-ASSR)与听性脑干诱发电位(auditory brainstem response audiometry,ABR)的关系。方法受试者为不同程度听力损失的儿童70名(140耳),年龄范围为3月龄～6岁。测试状态为水合氯醛镇静睡眠。仪器采用美国INTELLEGENT HEARING的诱发电位仪,MSS-ASSR及ABR测试的软件分别为SMART ASSR和SMART EP,刺激声信号的载波频率为0．5kHz、1kHz、2kHz及4kHz。左耳上述各个载波频率的调制频率分别为77Hz、85Hz、93Hz、101Hz,右耳为79Hz、87Hz、95Hz、103Hz。测试时,双耳八个调幅调制声信号经ER-3A标准插入式耳机同时给出。ABR的刺激声为短声,极性为交替波,刺激速率为19．3次／分,耳机也是ER-3A插入式耳机。受试儿先进行ABR测试、然后进行MSS-ASSR的测试,分别以降10升5法得出二者的反应阈。将MSS-ASSR 0．5kHz、1kHz、2kHz和4kHz的反应阈与ABR反应阈比较,以SPSS 10．0软件进行相关性分析。结果除去58耳ABR无反应外,剩余82耳ABR反应阈与MSS-ASSR 0．5kHz、1kHz、2kHz、4kHz的反应阈相关性具有显著性意义(P=0．000)。Pearson相关系数分别为0．757,0．854,0．906,0．912。结论MSS-ASSR作为儿童听力定量诊断的客观方法有很大的临床应用价值。     

儿童OSAHS不同刺激重复率听性脑干反应的临床研究

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)的脑干听觉诱发电位反应(Brain Auditory Evoked Potention,BAEP)的特征。方法 对经多导睡眠检测确诊的儿童OSAHS患者87例,经声阻抗检查呈A型曲线,4～7岁,分别以11.1、33.1?Hz的不同刺激重复率进行BAEP测试,比较不同病变程度对两种刺激重复率听觉阈值、潜伏期及波间期差的影响。结果 与对照组比较,OSAHS轻度组：两种刺激重复率的 BAEPⅠ、Ⅲ、Ⅴ波的潜伏期及波间期差均在正常范围,Ⅴ波听阈为25dBnHL;中度组：刺激重复率33.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及波间期差无异常,Ⅴ波听阈25dBnHL;刺激重复率11.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期延长,差异具有统计学意义（P＜0.05）,Ⅰ～Ⅲ、Ⅰ～Ⅴ波间期延长,Ⅲ～Ⅴ间期在正常范围,Ⅴ波听阈28dBnHL;重度组：刺激重复率33.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及各波间期差均延长,Ⅴ波听阈35dBnHL;刺激重复率11.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及波间期差均延长,Ⅴ波听阈40dBnHL。重度OSAHS患者两种刺激重复率各波潜伏期、波间期差听阈改变均具有统计学意义。结论 低频短声刺激能较早反映OSAHS患儿脑干功能的改变;重度OSAHS患儿的BAEP测试结果异常,提示OSAHS对听阈及听觉脑干传导功能都存在影响。     

听力筛查转诊婴幼儿不同滤波条件短纯音诱发听性脑干反应的比较

目的 短纯音诱发听性脑干反应(ABR)是听力筛查转诊婴幼儿听力评估的重要方法,本研究比较滤波分别为30～1500 Hz与30～3000 Hz时不同频率短纯音ABR阈值之间的差异,总结两种滤波条件下ABR波形特点及对阈值判断的影响,以选择更优化的频率特异性ABR测试参数.方法 应用美国IHS公司SmartEP听觉诱发电位仪记录18例(22耳)2～33月龄婴幼儿短声、滤波为30～1500 Hz与30～3000 Hz短纯音ABR各频率反应阈.结果 0.5 kHz、1 kHz、2 kHz、4 kHz滤波为30～3000 Hz短纯音ABR反应阈比滤波为30～1500 Hz短纯音ABR反应阈高.0.5 kHz及2.0 kHz两种滤波条件下短纯音ABR反应阈之间差异具有统计学意义(t值分别为2.238及2.217,P值均＜0.05),其他频率两种滤波条件下反应阈之间差异无统计学意义(P值均＞0.05).同等刺激强度下,滤波为30～3000 Hz的ABR波形与30～1500 Hz相比不平滑,反应波曲线上会出现锯齿状细小的干扰波.结论 在用短纯音ABR反应阈评估婴幼儿听力时,30～1500 Hz可以作为更优化的滤波设置参数.

Abstract：

Objective Auditory brainstem responses (ABR) evoked by tone burst is an important method of hearing assessment in referral infants after hearing screening. The present study was to compare the thresholds of tone burst ABR with filter settings of 30 - 1500 Hz and 30 - 3000 Hz at each frequency,figure out the characteristics of ABR thresholds with the two filter settings and the effect of the waveform judgement, so as to select a more optimal frequency specific ABR test parameter. Methods Thresholds with filter settings of 30 - 1500 Hz and 30 -3000 Hz in children aged 2 -33 months were recorded by click,tone burst ABR. A total of 18 patients ( 8 male / 10 female), 22 ears were included. Results The thresholds of tone burst ABR with filter settings of 30 - 3000 Hz were higher than that with filter settings of 30 - 1500 Hz. Significant difference was detected for that at 0. 5 kHz and 2.0 kHz ( t values were 2.238 and 2. 217, P ＜ 0. 05 ), no significant difference between the two filter settings was detected at the rest frequencies tone evoked ABR thresholds. The waveform of ABR with filter settings of 30 - 1500 Hz was smoother than that with filter settings of 30 - 3000 Hz at the same stimulus intensity. Response curve of the latter appeared jagged small interfering wave. Conclusions The filter setting of 30 - 1500 Hz may be a more optimal parameter of frequency specific ABR to improve the accuracy of frequency specificity ABR for infants' hearing assessment.