多频稳态诱发电位和听性脑干反应对感音神经性聋儿童客观听阈的评估

目的比较多频稳态诱发电位(MASSR)与短纯音听性脑干反应(Tb-ABR)对感音神经性聋儿童客观听阈的评估。方法对37名感音神经性聋儿童分别测试MASSR反应阈、Tb-ABR反应阈和行为听阈,参照行为听阈,比较MASSR反应阈和Tb ABR反应阈对行为听阈评估的准确性。结果MASSR反应阈、Tb-ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时,对行为听阈的评估具有相似的准确性;但在频率为0.5、1kHz时,MASSR的准确性较Tb ABR的准确性高。结论MASSR和Tb-ABR均可用作感音神经性聋儿童言语频率客观听阈的评估,但MASSR在低频(0.5、1kHz)时较Tb-ABR的准确性高。     

多频稳态反应阈与听性脑干反应阈的相关性

目的用多频稳态反应(auditory steady-state response,ASSR)与听性脑干反应(auditory brainstemre-sponse audiometry,ABR)测试聋儿残余听力,观察两者反应阈之间的相关性,对测试结果的准确性做出初步评价。方法对300例(600耳)感音神经性聋儿和30例(60耳)听力正常儿童(对照组)在睡眠状态下进行ASSR与ABR测试,得到不同阈值分布范围,并进行两者反应阈的相关性分析。结果30例(60耳)正常儿童ASSR各频率结果与ABR测试结果进行配对t检验,两者差异无统计学意义(P>0.05)。600例聋儿ASSR高频与ABR测试结果:Pearson统计高频相关系数为0.992,两者有显著相关性。结论ASSR和ABR两者高频反应阈之间有相关性,ASSR频率特性好,对聋儿听力检测及助听器验配具有临床价值。     

多频听觉稳态反应与40Hz听相关电位对儿童客观听阈评估的比较

目的通过对感音神经性聋患儿的多频听觉稳态反应（multiple frequency auditory steady--state response，MFASSR）测试结果进行分析，并比较其在0．5 kHz处与40 Hz听相关电位（40Hz auditory event related potential，40 Hz AERP）对客观听阈评估的准确性，为MFASSR临床应用提供指导。方法对感音神经性聋儿进行纯音测听、ABR、40 Hz AERP和MFASSR测试。MFASSR与ABR、40 Hz AERP测试均在睡眠状态下进行。按照测试结果分为ABR未引出组与ABR引出组。结果①MFASSR在0．5 kHz处引出率比40 Hz AERP低。②0．5 kHz MFASSR反应阈对纯音听阈的评估较1、2、4 kHz MFASSR反应阈对纯音听阈的评估差。③以纯音听阈为标准，在0．5 kHz处MFASSR与40 Hz AERP对纯音听阈的评估差别具有统计学意义（P=0．001），说明，在0．5 kHz处MFASSR对纯音听阈评估的准确性不如40 Hz AERP。结论MFASSR反应阈对0．5 kHz处纯音听阈的预测需要结合40 Hz AERP来判断。     

听性稳态反应和短声诱发的听性脑干反应在客观听阈评估中的作用

目的探讨听性稳态反应(auditory steady-state responses,ASSR)和短声诱发听性脑干反应(ABR)在感音神经性聋人群客观听阈评估中的作用及其在耳聋鉴定中的价值。方法对感音神经性聋组(35耳)及正常组(22耳)分别进行纯音听阈、ABR及ASSR测试,并记录0.5、1、2及4kHz ASSR反应阈(dBHL)、纯音听阈(dBHL)及ABR反应阈(dBnHL)。结果正常组在0.5、1、2、4kHz的ASSR反应阈与纯音听阈相比差异无统计学意义(P>0.05),ABR反应阈与各频率纯音听阈差异有显著统计学意义(P<0.05);耳聋组各频率ASSR反应阈与纯音听阈差异无统计学意义(P>0.05),ABR反应阈与0.5kHz纯音听阈差异有统计学意义(P<0.05),与1、2、4kHz纯音听阈差异无统计学意义(P>0.05)。结论ASSR与ABR联合测试是临床工作中用于客观听阈评估的有效方法。     

感音神经性聋儿童听性稳态反应与行为听阈相关性分析

目的：分析感音神经性聋儿童听性稳态反应（auditory steady－state response,ASSR）与行为听阈的相关性。方法63例（126耳）重度或极重度感音神经性听力损失儿童,年龄0．5～6岁,按年龄分为 A 组（0．5～1．0岁,21例）,B 组（1．1～3．0岁,21例）,C 组（3．1～6．0岁,21例）;分别进行 ASSR 及小儿行为听阈测试,A 组采用行为观察测听（BOA）,B 组采用视觉强化测听（VRA）,C 组采用游戏测听（PA）,采用 SPSS17．0统计软件分析二种检查结果的相关性。结果①ASSR 反应阈与行为听阈在0．5、1、2和4 kHz 处的相关系数分别为0．75、0．76、0．76、0．83,呈极显著相关（P ＜0．01）。②小儿行为听阈值通常比 ASSR 反应阈值低,随着频率的增高,两者间差距缩小。③A 组（相关系数0．70）各频率 ABR 反应阈与行为听阈相关性均较 B（相关系数0．78）、C（相关系数0．83）组低。结论0．5～6．0岁感音神经性聋儿童 ASSR 与行为听阈值均有良好的相关性,ASSR 可预测感音神经性聋儿言语频率的客观听阈,为低龄儿童及难以检测行为听力的患儿验配助听器提供参考。     

多频听性稳态反应评估听力正常青年人纯音听阈的探讨

目的　探讨多频听性稳态反应(multipleauditorysteadystateresponse ,MASSR)评估听力正常青年人纯音听阈的可靠性。方法　对2 8名( 5 6耳)听力正常青年人进行MASSR及纯音听阈检查,记录0 .5、1、2、4kHz反应阈及行为听阈,比较二者间的相关性。结果　MASSR反应阈左右耳间无显著性差异;各频率间MASSR反应阈比较,0 .5kHz较其他各频率有显著性差异(P <0 .0 0 1) ,1、2、4kHz三个频率间均无显著性差异(P >0 .0 5 )。MASSR反应阈与纯音听阈在0 .5、1、2、4kHz相关系数分别为0 .71、0 .83、0 .86、0 .87。结论　MASSR反应阈与纯音听阈间有较好的相关性,MASSR可用于评估纯音听阈     

聋儿听力评估中听性脑干反应和听性稳态反应引出率的比较

目的 通过比较感音神经性聋患儿听性脑干反应(ABR)和听性稳态反应(ASsR)的引出率,探讨ABR和ASSR对聋儿听力评估的意义.方法对54例(108耳)感音神经性聋患儿分别进行ABR和ASSR测试,比较ABR和ASSR在0.5、1、2、4 kHz各频率的引出率.结果 ASSR在0.5、1、2 kHz引出率都显著高于ABR的引出率(P＜0.01),4 kHzASSR的引出率与ABR引出率比较,差异无统计学意义(P＞0.05).在ABR无反应的65耳中,ASSR 1 kHz引出率达76.9%.结论 在聋儿听力评估中,ASSR较ABR有更高的检出率,对于ABR无反应的患儿还应进行ASSR测试.     

成人频率特异性chirp听性稳态反应与纯音听阈测试的相关性研究

目的采用chirp信号作为声刺激进行听性稳态反应(auditory steady-state response,ASSR)测试,观察chirp-ASSR反应阈值与纯音听阈的相关性,探讨chirp-ASSR客观听力检测在成人临床听力评估中的价值。方法研究对象包括正常成人组(年龄20～60岁,共计151耳)和感音神经性听力损失组(年龄22～82岁,共计83耳)。在500Hz、1000Hz、2000Hz和4000Hz处进行Chirp-ASSR和纯音听阈测试,并对结果进行统计学分析。结果 0.5～4kHz频率听力正常组Chirp-ASSR反应阈与纯音听阈的相关系数r分别为0.19、0.43、0.58、068;0.5-4.0kHz频率感音神经性听力障碍者的相关系数r分别为0.68、0.84、0.87、0.84;校正后0.5～4kHz各听力组预估听力阈值与纯音听阈的差值较校正前明显缩小。结论在0.5～4.0kHz频率,Chirp-ASSR反应阈与纯音听阈之间存在明显的相关性,在听力损失组中两者的相关性更加显著,而在500Hz处两者的相关性较其它频率低。Chirp-ASSR在客观听力评价中有较好的准确率。     

成人感音神经性聋的听觉稳态反应反应阈与纯音听阈

目的探讨成人感音神经性聋的听觉稳态反应（auditory steady-state responses,ASSR）反应阈与纯音听阈的关系。方法选择中国医科大学附属一院耳鼻咽喉科门诊感音神经性聋的成人患者,分别进行纯音听力测试、ASSR检查,比较ASSR在0.5、1、2、4 kHz频率处的反应阈与纯音听阈的相关性及按听力损失程度比较两者的差值。结果 ASSR反应阈与纯音听阈在各频率处的相关系数分别为0.840、0.905、0.886、0.924;随着感音神经性听力损失的加重二者的差值明显缩小。随着频率的增加,两者的差值明显缩小。结论成人感音神经性聋ASSR反应阈与纯音听阈有显著相关性,随着听力损失的加重,ASSR反应阈愈接近纯音听阈,ASSR作为成人感音神经性聋听力定量诊断的客观方法有很大的临床应用价值。     

短音诱发听性脑干反应的特性观察

目的 了解短音（tone pip）诱发的听性脑干反应（TP－ABR）的特征及其各频率反应阈与纯音听阈的关系。方法 对正常听力青年人30耳分别采用短声（click）、短音（0.5、1、2、4、6、8kHz）测试，记录各自不同强度下ABR的波形，观察V波潜伏期的改变。结果 tone pip与常规click声诱发的ABR极为相似，均有很高的可重复性和可靠性；ABR反应阈均较其主观听阈高，尤其是频率越低，反应阈越高，低频个体差异较大；随频率（0.5-8kHz）和强度（40－120dB peSPL）增加Ⅰ波Ⅴ潜伏期递减；各频率的反应阈与音听阈均有较好的相关性。结论 短音刺激记录的TP－ABR具有频率特性，其反应阈在相应频率的客观听力评估中有应用价值。     

Multiple auditory steady-state responses in children and adults with normal hearing, sensorineural hearing loss, or auditory neuropathy

OBJECTIVES: We tested the clinical effectiveness of multiple auditory steady-state responses (ASSRs) for the objective assessment of hearing thresholds in patients with and without hearing loss, candidates for cochlear implants, and children with auditory neuropathy. METHODS: The study sample included 29 subjects with sensorineural hearing loss (SNHL), 18 candidates for cochlear implants, 11 subjects with auditory neuropathy, and 18 subjects with normal hearing thresholds. Behavioral hearing thresholds and ASSRs to carrier frequencies of 0.5, 1, 2, and 4 kHz were obtained. Special care was taken to minimize possible aliasing and high-intensity multiple stimulation effects. Differences and correlations between the ASSRs and the behavioral thresholds were determined. RESULTS: The ASSR estimation of behavioral thresholds in the normal-hearing group was elevated, whereas very close predictions were found for the SNHL group. The correlations between the two measures ranged from 0.86 at 0.5 kHz carrier frequency to 0.94 at 2 kHz. In the cochlear implant candidates and the auditory neuropathy group, the ASSR thresholds generally overestimated the behavioral audiogram. In these groups the number of detected ASSRs was higher than the number of behavioral responses, especially for the high-frequency carrier stimuli. CONCLUSIONS: Multiple ASSRs may reliably predict the behavioral threshold in subjects with SNHL and may serve as a valuable objective measure for assessing the hearing threshold across different frequencies in candidates for cochlear implants and children with auditory neuropathy.     

Auditory steady-state response and auditory brainstem response thresholds in children

The inclusion of the auditory steady-state response (ASSR) into test-batteries for objective audiometry has allowed for clinical comparisons with the most widely used procedure, the auditory brainstem response (ABR). The current study describes ASSR and ABR thresholds for a group of infants and young children with various types and degrees of hearing loss. A sample of 48 subjects (23 female) with a mean age of 2.8 ± 1.9 years SD were assessed with a comprehensive test-battery and classified according to type and degree of hearing loss. Thresholds were determined with a broadband click-evoked ABR and single frequency ASSR evoked with continuous tones (0.25–4 kHz) amplitude modulated (67–95 Hz). Mean difference scores (±SD) between the ABR and high frequency ASSR thresholds were 9.8 (±11), 3.6 (±12) and 10.5 (±12) dB at 1, 2 and 4 kHz, respectively. An ASSR mean threshold for 2–4 and 1–4 kHz compared to the ABR threshold revealed an average difference of 7 (±9) and 7.9 (±8) dB, respectively. The overall correlation between the ABR and ASSR thresholds was highest for the mean ASSR thresholds of 2–4 and 1–4 kHz (r = 0.92 for both conditions). Correlations between the ABR and individual ASSR frequencies were slightly less (0.82–0.86). The average of the 2–4 kHz ASSR thresholds correlated best with the click-evoked ABR for all categories of hearing loss except for the sensorineural hearing loss category for which the 1–4 kHz ASSR average was better correlated to ABR thresholds. Findings demonstrate the reliability of verifying high frequency ASSR thresholds with a click-evoked ABR as an important cross-check in infants for whom behavioural audiometry may not be possible.     

Auditory steady-state responses and clinical applications

The auditory steady-state responses to single continuous tones modulated in amplitude have been proposed as an alternative to objective frequency-specific audiometry. The aim of this study was to compare thresholds obtained by pure-tone audiometry (PTA) and by auditory steady-state responses in normal hearing or affected by hearing loss in adults and in order to evaluate the applicability of this objective test in no collaborative hearing-impaired subjects. Eleven people, 6 normal hearing and 5 with hearing loss, underwent PTA and multiple frequency auditory steady-state responses; simultaneous carrier tones (0.5, 1, 2 and 4 KHz) modulated in amplitude at different rates (77–105 Hz) were presented monaurally (TDH 49 earphones) at variable intensities (110–20 dB SPL). The mean threshold difference between PTA and multiple frequency auditory steady-state responses was 28 dB (standard deviation=14.2) and R correlation value at 0.5-1-2-4 kHz was 0.71 (P=0.0012) at the Pearson’s test. These differences were significantly smaller considering the hearing-impaired separately (11.7 dB, standard deviation=2.9). The results of this study confirm previous reports showing that the multiple auditory steady-state response method is an accurate predictor of the behavioural audiogram in patients with sensory-neural hearing impairments and can be used as a valid support for behavioural evaluations.     

Correlations between audiogram and objective hearing tests in sensorineural hearing loss

Owing to its subjective nature, behavioral pure-tone audiometry often is an unreliable testing method in uncooperative subjects, and assessing the true hearing threshold becomes difficult. In such cases, objective tests are used for hearing-threshold determination (i.e., auditory brainstem evoked potentials [ABEP] and frequency-specific auditory evoked potentials: slow negative response at 10 msec [SN-10]). The purpose of this study was to evaluate the correlation between pure-tone audiogram shape and the predictive accuracy of SN-10 and ABEP in normal controls and in patients suffering from sensorineural hearing loss (SNHL). One-hundred-and-fifty subjects aged 15 to 70, some with normal hearing and the remainder with SNHL, were tested prospectively in a double-blind design. The battery of tests included pure-tone audiometry (air and bone conduction), speech reception threshold, ABEP, and SN-10. Patients with SNHL were divided into four categories according to audiogram shape (i.e., flat, ascending, descending, and all other shapes). The results showed that ABEP predicts behavioral thresholds at 3 kHz and 4 kHz in cases of high-frequency hearing loss. Also demonstrated was that ABEP threshold estimation at 3 kHz was not affected significantly by audiogram contour. A good correlation was observed between SN-10 and psychoacoustic thresholds at 1 kHz, the only exception being the group of subjects with ascending audiogram, in which SN-10 overestimated the hearing threshold.     

骨导多频听觉稳态诱发反应的测试

目的：了解多频听觉稳态诱发反应（MASSR）对骨导客观听阈及对传导性聋评估的准确性。方法：对30例传导性聋患者进行气、骨导MASSR及纯音测听,并将MASSR反应阈和纯音听阈进行比较。结果：气、骨导MASSR反应阈和纯音听阈之间具有较好的相关性,MASSR对传导性聋评估的准确性和纯音测听相似。结论：MASSR可用作传导性聋患者客观听阈的评估。     

不同程度感音神经性听力损失儿童ASSR、click-ABR反应阈与行为听阈的相关性

目的 探讨不同程度感音神经性听力损失儿童听性稳态反应(ASSR)、短声听性脑干反应(click-ABR)与行为阈值的相关性及在听障儿童听力评估中的价值.方法 回顾性分析2019年1月至2019年12月确诊的46例(92耳)感音神经性听力损失儿童的ASSR、click-ABR及行为听阈结果,其中,轻度听力损失4耳,中度听...     

Prediction of hearing thresholds: Comparison of cortical evoked response audiometry and auditory steady state response audiometry techniques

The present study evaluated how well auditory steady state response (ASSR) and tone burst cortical evoked response audiometry (CERA) thresholds predict behavioral thresholds in the same participants. A total of 63 ears were evaluated. For ASSR testing, 100% amplitude modulated and 10% frequency modulated tone stimuli at a modulation frequency of 40Hz were used. Behavioral thresholds were closer to CERA thresholds than ASSR thresholds. ASSR and CERA thresholds were closer to behavioral thresholds at higher frequencies than at lower frequencies. Although predictions based on CERA thresholds are slightly more accurate than ASSR thresholds, the differences may not be clinically significant, particularly when the degree of individual variations is considered. Prediction of hearing thresholds became more accurate when hearing loss increased. Due to variations in prediction across participants, a single correction factor cannot be used. Other factors must be considered in selecting whether to use CERA or ASSR in predicting behavioral thresholds.     

Hearing threshold estimation in infants using auditory steady-state responses

Successful early intervention in children with permanent hearing loss requires assessment techniques that can accurately reflect the behavioral audiogram in infancy. This retrospective study compared auditory steady-state response (ASSR) findings from subjects tested in the first three months of life with subsequently obtained behavioral hearing levels. ASSR audiograms were established using amplitude and frequency modulated tones at octave frequencies (500 Hz to 4 kHz). Results obtained from 575 subjects including 285 with normal hearing, 271 with sensorineural hearing loss, and 19 with auditory neuropathy-type hearing loss are presented. ASSR and behavioral hearing thresholds for subjects in the normal and sensorineural groups were highly correlated, with Pearson r values exceeding 0.95 at each of the test frequencies. In contrast, ASSR thresholds in children with AN-type hearing loss did not accurately reflect the behavioral audiogram. Overall, the findings indicate that ASSR testing can offer useful insights into the hearing acuity of children tested in infancy.     

多频稳态诱发电位评估中度感音神经性聋儿童的应用

目的探讨多频稳态听觉诱发电位评估儿童中度感音神经性聋的可靠性。方法所有患者经纯音测听（PTA）检查筛选出中度感音神经性聋30例5～6岁儿童（共40耳），然后口服10％水合氯醛镇静睡眠后，行多频稳态听觉诱发电位（ASSR）检测，其阈值与纯音听阂阈值进行比较，分析不同频率处听力阈值分布情况及其相关性。结果分别比较语言频率ASSR阂值与纯音听闽阈值，结果显示，0．5kHz处相关性较差，其差值为2-18dB，而在4kHz处相关性最好。结论可以应用多频稳态听觉诱发电位评估中度感音神经性聋儿童的听力阈值，但需要注意0．5kHz处的相关性差异。