外伤性鼓膜穿孔患者常频与扩展高频测听结果分析

目的探讨外伤性鼓膜穿孔对扩展高频听力的影响。方法对55例（55耳）外伤性鼓膜穿孔患者在鼓膜愈合前后行常频纯音测听及扩展高频测听,骨导频率范围0.25～4kHz,气导频率范围0.125～16kHz,并与30例（60耳）健康对照组比较。结果在常频段,外伤性鼓膜穿孔患者鼓膜穿孔时所有频率气、骨导阈值均高于对照组,差异有统计学意义（P〈0.05）,鼓膜愈合后气、骨导阈值与对照组比较差异无统计学意义（P〉0.05）,骨、气导差距明显减小。在扩展高频段,鼓膜愈合前后所有频率气导阈值均高于对照组,差异有统计学意义（P〈0.05）,且穿孔愈合后有随着频率增高气导改善逐渐减少的趋势。结论外伤性鼓膜穿孔患者鼓膜愈合后常频段纯音气、骨导听阈恢复较好,但扩展高频区恢复较慢,甚至不可逆。     

耳硬化症术后骨导听力改善的探讨

目的　探讨耳硬化症镫骨术后听力尤其是骨导听力改善情况，比较分析镫骨手术不同术式及长短期手术效果，为临床治疗策略选择提供依据。方法　回顾性分析耳硬化症行镫骨手术患者临床资料共56耳，重点关注听力情况。术后6周～6个月和术后1年复查听力。结果　术前气导阈值（56.2±11.1）dB，骨导阈值（22.2±7.9）dB，骨气导差（34.0±8.9）dB；术后气导阈值（33.1±10.9）dB，骨导阈值（19.9±8.3）dB，骨气导差（13.2±7.9）dB。23例（41.1%）术后骨气导差≤10 dB，45例（80.4%）骨气导差≤20 dB。术后0.5、1和2 kHz频率的骨导阈值分别下降了1.0、3.1和3.9 dB，而4 kHz频率的骨导阈值提高了0.6 dB。1和2 kHz频率的术后听力改善具有统计学意义（t 1 kHz=2.536，t 2 kHz=2.666，P 均＜0.05）。结论　镫骨手术可明显改善耳硬化症患者1和2 kHz频率的骨导阈值，缩小骨气导差。不同镫骨手术技术对于改善术后听力无明显区别，术后长期听力可以获得较好保持。     

儿童与成人分泌性中耳炎的临床分析

目的：探讨儿童与成人分泌性中耳炎（SOM）在病因、病程、临床特征和听力学等方面的异同。方法：对42例（74耳）儿童和34例（43耳）成人SOM患者术前临床资料及听力学检查资料进行对比分析。结果：儿童SOM平均病程较成人短,以腺样体肥大多见,成人以中耳乳突炎多见。C型鼓室导抗图的成人患者鼓室负压大于儿童（P〈0．05）。儿童与成人SOM各频率气导听阈均提高,并且都可出现骨导听阈提高,以高频2、4kHz为主,且成人高频4kHz骨导听阈提高较儿童明显（P〈0．05）。结论：儿童病程一般较成人短,以腺样体肥大多见,易引起中耳积液。儿童SOM与成人一样都可以引起感音神经性聋,以高频损害为主,但高频下降没有成人明显,但由于可造成儿童学语与认知方面的不良后果,应及时干预和诊治。     

慢性化脓性中耳炎与感音神经性聋的相关性分析

目的：探讨慢性化脓性中耳炎与感音神经性聋之间的相关性。方法：回顾分析174例单侧慢性化脓性中耳炎患者的骨导阈值改变。采用配对t检验分析0．5kHz，1．0kHz，2．0kHz，4．0kHz患耳与健耳骨导阈值的差异，单因素方差分析法分析胆脂瘤存在及听骨链破坏对语频(0．5kHz，1．0kHz，2．0kHz)和4．0kHz骨导阈值的影响，直线回归法讨论了语频和4．0kHz骨导阈值改变与年龄和病程之间的相关性。结果：患耳与健耳各频率骨导阈值之间差异有统计学意义。语频骨导听力损失程度随着患者年龄的增加而逐渐加重。胆脂瘤的存在以及听骨链破坏亦未增加感音神经性聋的发生概率。结论：慢性化脓性中耳炎可引起感音神经性聋。高频骨导听阈较低频更易受到影响。     

正常青年人气骨导听性脑干反应的比较研究

目的 比较气、骨导听性脑干反应（ABR）测试结果的差异，为骨导听性脑干反应的临床应用提供参考依据。方法 利用Nicolet spirit诱发电位仪，TDH－39P和Radioear B-71换能器，对一组听力正常青年人（男31耳，女30耳）进行短声气，骨导测试。结果 在阈值及阈上强度下，骨导ABR波形与气导类似，但各波引出率较气导低。听力正常青年男女之骨导短声ABR阈值间无差异（P＞0．05）；阈上60dB三声刺激下Ⅰ、Ⅲ、Ⅴ波潜伏期及Ⅰ-Ⅴ波间期亦无差异（P＞0．05）。骨导短声ABR与气导短声ABR比较显示：前者阈值高于后者（P＜0．01），两者间呈显著的正相关（r=0.7740)；短声阈上60dB强度刺激下，前者Ⅰ、Ⅲ、Ⅴ波潜伏期均大于后者（P＜0．01），但两者Ⅰ-Ⅲ，Ⅲ-Ⅴ，Ⅰ-Ⅴ波间期无差异（P＞0．05）。结论 骨导听性脑干反应测试的应用具有一定的局限性，但对部份不适于气导ABR检测的患者，仍有其临床使用价值。     

鼓室硬化镫骨固定的手术疗效分析

目的分析不同手术方法治疗鼓室硬化镫骨固定的疗效。方法回顾性分析1992～2004年于我科手术且资料完整的鼓室硬化镫骨固定病例56例（62耳）,按Wielinga分型Ⅲ型40耳;Ⅳ型22耳,其中镫骨撼动术15耳（Ⅲ型12耳、Ⅳ型3耳）、全人工听骨赝复物（tatolossicular replacement prosthesis,TORP）重建听骨链25耳（Ⅲ型16耳、Ⅳ型9耳）、自制Teflon小柱活塞型人工镫骨（Piston）重建听骨链22耳（Ⅲ型14耳、Ⅳ型8耳）。术后随访1～5年,分析患者言语频率（0.5、1、2kHz）平均纯音气导阈值及气骨导差,应用SPSS13.0软件包进行统计分析。结果鼓室硬化Ⅲ型、Ⅳ型患者术前言语频率平均纯音气导阈值及气骨导差差异无统计学意义（P〉0.05）;镫骨撼动组、TORP组、Piston组术前3组病例平均纯音气导阈值及气骨导差差异无统计学意义（P〉0.05）;术后1、3、5年3组病例平均纯音气导阈值及气骨导差差异有统计学意义（P〈0.01）;术后5年Piston组在纯音气导阈值及气骨导差方面疗效优于TORP组,差异有统计学意义（P〈0.01）。结论鼓室硬化镫骨固定无论锤、砧骨固定与否,最好去除锤骨头及砧骨,予人工听骨重建听骨链,镫骨足板造孔术是安全的,而且疗效稳定。     

社区老年人群纯音听阈测试结果分析

目的获得社区老年人群纯音听阈的正常值，为选取敏感频率测试老年人听阈提供参考依据。方法采用整群随机抽样方法，选取60岁以上社区老年人845例，按平均听阈（0．5、1、2和4kHz听阈平均值）≤40dBHL为正常或轻微损失，筛选205人，按60～65岁、66～70岁、71～75岁和76岁以上分组，计算各年龄组在0．5、1、2、3、4和8kHz的听阈及听阈检出率，采用SPSSl3．0软件进行）x^x检验和方差分析。结果听力正常老年人群不同年龄组听阈值存在显著差异（P〈0．01），随着年龄增长，听阈值呈增高趋势；不同频率听力测试显示不同频率组听阈值存在显著差异（P〈0．01）。各年龄组的听阈随频率的增高而增高，随频率、年龄增高，听阈检出率呈下降趋势。结论高频较低频测听能够早诊断老年人听力损失，可作为检测老年人早期听力损失的客观手段。     

扩展高频气导纯音测听与年龄的关系

纯音测听中常以125Hz-8kHz频率为基础的听力检测。C 将8kHz-20kHz的超高频测听命名为扩展频率纯音阈值测听法(EFPTTA),过去文献中已有超高频骨导昕阈测听用于临床的报道,但尚无气导超高频听阈检测记载。     

分泌性中耳炎骨导听阈改变的临床观察

目的 证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳为,尤其是顽固的分泌性中耳炎提供依据。方法 115例（164耳）分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0．5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数。分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组。结果 在164耳中,出现骨导听阈提高的共94耳（57．3％）。双侧组与单侧组骨导听力损失程度差异均无显著性（P＞0．05）;单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大。结论 半数以上分泌性中耳为可以导致感音神经性耳聋。在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势。     

中耳胆脂瘤并发迷路瘘管的术后听力回顾性研究

目的探讨手术治疗对中耳胆脂瘤并发迷路瘘管患者听力的影响。方法回顾性分析35例（35耳）中耳胆脂瘤并发迷路瘘管患者的临床资料;其中21例（21耳）患者随访术后听力情况。结果21例（21耳）术后随访纯音测听3个月～5年,12例平均骨导阈值（0．5、1、2,N4kHz）与术前差别小于5dBHL,较术前听力提高者3例,较术前下降者5例,1例于术后3个月成功植入人工耳蜗。21例患者中11例行开放式乳突切开＋鼓室成形术,其手术前后骨气导各频率间（0．5、1、2、4～118kHz）听力阈值未见明显差异（配对样本t检验,P值均大于0．05）。结论中耳胆脂瘤并发迷路瘘管的术后骨导听力阈值无明显变化,有条件者仍可行鼓室成形术保存听力。     

Clinical validation of the AMTAS automated audiometer

Abstract

Objective: To validate the air- and bone-conduction AMTAS automated audiometry system. Design: Prospective study. Test-retest reliability was determined by assessing adults with AMTAS air- and bone-conduction audiometry. Accuracy was determined by comparing AMTAS and manual audiometry conducted on adults. AMTAS testing was conducted in a quiet room and manual audiometry in a sound booth. Study sample: Ten participants for test-retest reliability tests and 44 participants to determine accuracy were included. Participants had varying degrees of hearing loss. Results: For test-retest reliability the overall difference in air-conduction hearing thresholds (n = 119) was 0.5 dB. The spread of differences (standard deviation of absolute differences) was 4.9 dB. For bone-conduction thresholds (n = 99) the overall difference was ? 0.2 dB, and the spread of differences 4.5 dB. For accuracy the overall difference in air-conduction hearing thresholds (n = 509) between the two techniques was 0.1 dB. The spread of differences was 6.4 dB. For bone-conduction thresholds (n = 295) the overall difference was 0 dB, and the spread of differences 7.7 dB. Conclusions: Variations between air- and bone-conduction audiometry for automated and manual audiometry were within normally accepted limits for audiometry. However, AMTAS thresholds were elevated but not significantly different compared to other contemporary studies that included an automated audiometer.     

Benefit of a new hearing device utilizing cartilage conduction

Objective

Our previous study demonstrated that sound was effectively transmitted by attaching a transducer to the aural cartilage even without fixation pressure. This new method for sound transmission was found by Hosoi in 2004, and was termed cartilage conduction (CC). CC can be utilized even in hearing-impaired patients who cannot use air-conduction hearing aids owing to continuous otorrhea or aural atresia. A prototype hearing aid employing CC was investigated in this study.

Methods

Four patients with conditions such as continuous otorrhea and acquired aural atresia after surgery participated in this study. The CC hearing aid was fitted, and its benefits were assessed by audiometric tests and interview.

Results

Thresholds and speech recognition scores improved in all subjects. However, in subjects with continuous otorrhea, it was difficult to obtain the gains according to the target gains owing to their severe hearing loss and the limitation of the output level. On the other hand, unexpectedly large gains were obtained below 2 kHz in the patient with acquired aural atresia. These large gains were probably caused by soft tissue filling the postoperative space. No subjects complained of pain associated with the attachment of the transducer, although such problems are usually observed for a bone-conduction (BC) hearing aid. This feature is considered one of the advantages of the CC hearing aid.

Conclusion

The results of the audiometric tests and interview suggest that the CC hearing aid has potential as a useful amplification device for hearing disability. Unfortunately, if the soft tissue pathway is not involved, the current device is insufficient for the patients with severe hearing loss. The improvement of the output level will lead to develop a reliable CC hearing aid as an alternative to BC hearing aids or bone anchored hearing aids.     

Relative Effective Frequency Response of Bone versus Air Conduction Stimulation Examined via Masking

An adaptation of the sensorineural acuity level procedure was employed to obtain thresholds under bone- (BC) vs. air-conducted (AC) white noise masking. For the BC masking condition, a Radioear B71 was placed on one mastoid. An Etymotic ER3 with a foam tip placed in the ear on the same side was used to deliver the pure-tone probe stimulus. This transducer was chosen to approximate the Telephonies TDH-39 earphone response characteristic while reducing occlusion effect. For the AC masking condition, the masker and probe were mixed electrically and delivered to the earphone. Masked threshold data, transformed into frequency response curves, demonstrated greater variance of BC vs. AC response across frequency but less high-frequency roll-off than expected from coupler measurements obtained using an artificial mastoid and 6-cm³ cavity, respectively.     

慢性化脓性中耳炎患者听骨链病变与听力变化的关系

目的探讨慢性化脓性中耳炎(chronic suppurative otitis media,CSOM)患者听骨链病变特点及其与听力受损的关系。方法对146例CSOM患者术前行纯音测听、检查鼓膜穿孔部位,术中显微镜观察听骨链病变。结果 7 9例鼓膜紧张部穿孔患者听骨链完好3 6例(45.6%)、受破坏(中断或固定)43例(54.4%);67例松弛部穿孔患者听骨链完好13例(19.4%)、受破坏54例(80.6%),两组差异显著(P<0.01)。听骨链破坏组与完好组比较,各语音频道(0.5、1、2、4 kHz)气导听阈均升高(P<0.01),骨导听阈仅在2 kHz有明显升高(P<0.05),语音频道总气骨导差增大(P<0.01)。结论①CSOM紧张部穿孔者听骨链受损程度低于松弛部穿孔者。②听骨链破坏主要影响CSOM患者的气导听阈,骨导阈值仅在听骨链共振频率2 kHz处有影响。     

Sound lateralization ability of patients with bilateral microtia and atresia after bilateral reconstruction of auricles and external auditory canals and fitting of new canal-type hearing aids to replace a bone conduction hearing aid

Abstract

Conclusion: Each of eight patients with bilateral microtia and atresia underwent bilateral reconstruction of the auricles and external auditory canals and were fitted bilateral canal-type hearing aids in the operated ears to replace a bone conduction hearing aid. The ability to discriminate inter-aural intensity difference (IID) and even inter-aural time difference (ITD) was retained in all these patients.

Objective: This study studied the post-operative sound lateralization ability of patients with bilateral microtia and atresia after total reconstruction of both auricles and external auditory canals, followed by fitting of bilateral canal-type hearing aids.

Methods: Eight patients with bilateral microtia and atresia ranging in age from 13–43 years were recruited in this study. Each of them underwent bilateral reconstruction of the auricles and external auditory canals and were fitted canal-type hearing aids in both the operated ears to replace a bone conduction hearing aid. A sound lateralization test was conducted to determine IID and ITD discrimination ability thresholds.

Results: In all the patients, the IID discrimination ability thresholds of the patients were more than 3-fold those of the controls, the ITD discrimination ability threshold was more than 5-fold those of controls, and binaural hearing was retained.     

Clinical Implications in Calibration Requirements in Bone Conduction Standardisation

Although international agreement has long been reached on a standard threshold for air conduction audiometry, no similar standard exists for bone conduction audiometry. It is argued that the techniques applied to the determination of the air conduction thresholds are not applicable to those for bone conduction which should instead be brought into line with ISO 1964 and not established independently. A pilot study has been carried out which shows that by adopting the new approach now advocated international agreement could be attained with the expenditure of minimal time and effort.

Nous n'oublions pas qu'il a fallu attendre bien longtemps pour qu'un agrement international soit obtenu concernant le seuil standard par voie aérienne. En ce qui concerne la détermination d'un seuil standard par voie osseuse, nous pensons que des techniques différentes doivent ětre utilisées; le seuil ne doit pas ětre établi indépendamment, mais plutO't en rapport avec l'ISO 1964. Nous avons entrepris une étude pilote qui montre qu'avec cette nouvelle approche du problème, un agrément international pourrait ětre obtenu avec un minimum de temps et d'effort.     

镫骨小窗技术对耳硬化症患者频率特异性骨导超闭合的影响

目的评估镫骨小窗技术对耳硬化症患者频率特异性骨导超闭合的影响。方法回顾性分析我院130例诊断为耳硬化症并进行镫骨小窗技术的患者。收集患者术前及术后的纯音测听资料,按照术前骨导(BC)是否≤25 dB HL,把患者分为骨导正常组(normal BC, N-BC)及骨导阈值升高组(increased threshold BC, IT-BC);并根据各频率是否有骨导阈值升高分为亚组。比较术后各频率亚组之间,骨导的超闭合率(Overclosure rate,OR),显著超闭合率(Significant overclosure rate, SOR),骨导恶化率(Deterioration rate,DR),显著恶化率(Significant deterioration rate, SDR)以及相应的阈值的差异是否有统计学意义。结果 5例缺乏随访资料被剔除,共纳入125例病人,其中76例为N-BC组,49例为IT-BC组。所有IT-BC亚组的OR、SOR、超闭合阈值、显著超闭合阈值(除外1kHz)优于N-BC亚组(P<0.05)。DR,SDR及相应的阈值在平均(PTA)水平差异无统计学意义。...     

骨导ABR测试信号经气放射对结果的影响

为了解骨导听性脑干反应(ABR)测试中骨导振荡器测试信号经气放射对结果的影响,本组用Dantec-Evolution诱发电位系统测试了正常听力年青人20名38耳和传导性聋13例21耳的骨导ABR.两组结果比较,在较高刺激强度正常组有较大的刺激伪迹,对Ⅰ波干扰较大.两组反应阈、Ⅰ、Ⅲ和Ⅴ波潜伏期、Ⅰ-Ⅲ和Ⅲ-Ⅴ波间期无显著差异,但Ⅰ-Ⅴ波间期的差异有统计学意义.这是由于正常组骨导振荡器经气放射的刺激伪迹对波Ⅰ的影响使Ⅰ-Ⅴ波间期缩短.本结果提示在用骨导ABR确定反应阈时可不考虑这个影响,但在用于蜗后病变定位诊断时要考虑经气放射的影响问题,     

AMTAS®: Automated method for testing auditory sensitivity: III. Sensorineural hearing loss and air-bone gaps

Abstract

Objective: The objectives were to measure the occlusion effect produced by three earphones—circumaural, supra-aural, and insert—and to compare air- and bone-conduction thresholds obtained with manual and automated methods for subjects with sensorineural hearing loss. Design: Acoustic and psychoacoustic occlusion effects were measured with each earphone. Manual and automated, air- and bone-conduction thresholds were compared. Study sample: Occlusion effects were measured for six adult subjects with normal external and middle ears. Pure-tone thresholds were measured for nineteen ears of thirteen subjects with sensorineural hearing loss. Results: The supra-aural earphone produced the largest occlusion effects, followed by the insert and circumaural earphones. Some systematic differences in air-conduction thresholds were found for the two procedures that may be attributable to earphone differences. A large air-bone gap at 4 kHz, reported in a previous study, was replicated. Conclusions: From 0.5 to 8.0 kHz, occlusion effects produced by the circumaural earphone are sufficiently small that covering the ear does not appreciably alter bone-conduction thresholds. Air-conduction threshold differences warrant further study to determine if reference equivalent threshold sound pressure levels for the two earphones produce equivalent thresholds. The large air-bone gap at 4 kHz suggests the possibility of an incorrect reference equivalent threshold force level at that frequency.

Sumario

Objetivo: Los objetivos fueron medir el efecto de oclusión producido por tres auriculares – circumaural, supra-aural y de inserción – y comparar umbrales de conducción aérea y ósea obtenidos con métodos manuales y automatizados para sujetos con hipoacusia sensorineural. Diseño: Se midieron los efectos de oclusión acústicos y psicoacústicos con cada auricular. Se compararon los umbrales de conducción aérea y ósea manuales y automatizados. Muestra del Estudio: Se midieron los efectos de oclusión para seis sujetos adultos con oídos externos y medios normales. Resultados: Los auriculares supra-aurales produjeron los mayores efectos de oclusión, seguidos de los auriculares de inserción y los circumaurales. Se encontraron algunas diferencias sistemáticas en los umbrales de conducción aérea para los dos procedimientos que pueden atribuirse a las diferencias en los auriculares. Una gran brecha aéreo-ósea en 4 kHz que se reportó en un estudio previo, fue replicada. Conclusiones: De 0.5 a 8 kHz, los efectos de oclusión producidos por los auriculares circumaurales son lo suficientemente pequeños por lo que cubrir el cubrir el oído no altera apreciablemente los umbrales de conducción ósea. Las diferencias en los umbrales de conducción aérea exigen estudios adicionales para determinar si los niveles umbrales equivalentes de referencia de presión sonora para los dos auriculares producen umbrales equivalentes. La mayor brecha aéreo-ósea en 4 kHz sugiere la posibilidad de un nivel de referencia equivalente de fuerza umbral en esa frecuencia.