听觉多频稳态诱发反应对儿童感音神经性聋听力评估的应用

目的探讨听觉多频稳态诱发反应(ASSR)在感音神经性聋患儿听力评估中的应用价值及ASSR相对其他测听方法的特点和优势。方法选取2015年1~10月我院耳鼻喉科收治的40例感音神经性聋患儿。对所有患儿进行常规耳科检查,ABR(听性脑干反应)、ASSR(听觉多频稳态诱发反应)和40Hz AERP(听觉相关电位)测试。对比不同频率下ASSR引出率与ABR之间的关系,对比不同频率下ASSR与ABR V波反应阈、40Hz AERP反应阈之间的关系。结果不同频率下ASSR反应阈引出率与40Hz AERP反应阈引出率与ABR反应阈引出率相比明显较高(P0.05)。0.5、1.0k Hz时ASSR反应阈与40Hz AERP反应阈呈正相关(P0.05)。2.0、4.0k Hz时ASSR反应阈与ABR反应阈呈正相关。结论听觉多频稳态诱发反应在感音神经性聋患儿听力评估中具有良好的应用价值。     

CE-Chirp刺激声诱发的听性稳态反应阈与行为测听阈值的相关性

目的:比较CE-Chirp刺激声诱发的听性稳态反应(ASSR)阈与行为测听阈的差值,探讨不同性质和不同程度听力损失患者的CE-Chirp ASSR反应阈与行为听阈之间的相关性.方法:根据电测听结果分为听力正常组(15例,30耳)和听力异常组(99例,144耳).听力异常组根据不同性质听力损失分为传导性(25耳)、混合性(42耳)和感音神经性聋(77耳),根据不同程度听力损失分为轻度(53耳)、中度(45耳)、重度(21耳)及极重度(25耳).分别测试正常和异常听力者CE-Chirp ASSR的反应阈,与在频率0.5、1、2和4kHz的行为听阈进行相关性分析;两阈值差分别在同一频率不同听力组间、同一听力组内不同频率间进行比较.结果:听力正常和异常组的CE-Chirp ASSR反应阈与行为听阈之间关系密切(P＜ 0.01);CE-Chirp ASSR反应阈与行为听阈差值在同一频率各听力异常组间及4个不同频率同一听力异常组内差异均无统计学意义(P＞0.05).结论:CE-Chirp ASSR反应阈与行为测听阈有显著相关性;CE-Chirp ASSR是一种快速、具有频率特异性的新型听力检测方法,可对不同性质、不同程度听力损失患者进行客观听力评估.     

多频稳态听觉反应与听性脑干反应测定成人感音神经性聋听阈的相关性

背景：多频稳态听觉反应是近年兴起的一种听觉电生理学检测方法,在儿童客观听阈评估方面应用很多,而在成人耳聋患者应用较少。目的：探讨成人感音神经性聋患者听性脑干反应和多频稳态听觉反应的关系,明确多频稳态听觉反应临床应用价值。设计、时间及地点：单一样本观察,对比分析,于2006-01/2008-03在南京医科大学附属南京第一医院耳鼻喉科听力研究室完成。对象：感音神经性耳聋患者30例（60耳）,磁共振检查排除内听道占位病变。方法：所有受试者采用美国Intelligent Hearing诱发电位仪先行听性脑干反应,再行多频稳态听觉反应测试,分别以降10升5法得出二者的反应阈。多频稳态听觉反应和听性脑干反应测试软件分别为Smart ASSR和Smart EP。主要观察指标：比较多频稳态听觉反应阈值和传统听性脑干反应方法检测所得阈值及波形引出情况。结果：多频稳态听觉反应的1,2,4kHz阈值和听性脑干反应短声反应阈之间有较好的相关性,相关系数分别为0.894,0.912和0.901,同时多频稳态听觉反应能检测到听性脑干反应不能引出的波形。结论：多频稳态听觉反应和听性脑干反应有很大的相关性,在波形引出方面优于听性脑干反应,因此多频稳态听觉反应在成人感音神经性聋的诊断中有重要应用价值。     

40Hz听觉相关电位结合听性脑干反应在婴幼儿助听器验配中的应用

目的：为双耳感音神经性聋的婴幼儿及小龄儿童客观验配助听器。方法：采用40Hz听觉相关电位(AERP)结合听性脑干反应(ABR)来客观评估聋儿听力，获得等效于成人的纯音听阈曲线并用于助听器验配。结果：36例中有32例配戴助听器半年后验证聋儿的行为听阈均进入“言语香蕉图”，聆听行为较验配前有改善。结论：ABR及40HzAERP可用于婴幼儿和小龄儿童助听器的客观验配，为他们尽快进入正常听觉康复训练赢得宝贵时间。     

听性脑干反应和听觉多频稳态诱发电位在伤残鉴定中的应用

目的探讨听脑干反应(ABR)和听觉多频稳态诱发电位(ASSR)与纯音听阈测定(PTA)之间的相关性及在伤残鉴定中的应用,总结在测试过程中的护理要点。方法选取我院2016年6月至2017年3月162例(324耳)接受检测者同时作ABR和ASSR、PTA检测。结果 ABR和ASSR听阈阈值均较PTA高。在刺激信号频率为80、90、99? KHz时(包括平均听力),受试者ABR值和PTA的相关性系数分别为0. 5212、0. 6281、0. 9299、0. 9156和0. 7271;在刺激信号频率为0. 5、1. 0、2. 0、4. 0? Hz时,ASSR值和PTA的相关系数分别为0. 6362、0. 7343、0. 8538、0. 9343和0. 7852。两者与PTA均具有明显的正相关(P 0. 05),有统计学意义。结论 ABR和ASSR配合PTA测听较准确的评估患者的听力,对于不能配合行为听力测试或行为测试结果不可靠的患者可提供较准确的依据,两者应用于临床互不可取代。     

多频听性稳态诱发反应在5～10岁听力障碍患儿中的应用

目的分析5～10岁儿童多频听性稳态诱发反应阈值与纯音测听阈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5～10岁听力障碍患儿的听力水平。方法选择95例5～10岁儿童,包括听力正常组35例和听力异常组60例。所有患儿先行纯音测听检查,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有统计学意义(P0.05),听力正常儿童多频听性稳态诱发反应阈值比纯音测听阈值高20～25dBHL,比轻度聋组约高10dBHL,比中度聋组高10～20dBHL;与重度聋组基本一致,且二者呈正相关。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5～10岁患儿听力水平。     

宁波市听力筛查阳性婴幼儿客观听力检测

目的　探讨听性脑干反应（auditory brain stem response, ABR）和多频稳态诱发电位（auditory steady state response,ASSR）在听力筛查阳性婴幼儿听力诊断中的应用价值。方法　2005年8月至2007年10月期间宁波市新生儿畸变产物耳声发射（distortion product otoacoustic emission, DPOAE）听力筛查阳性者70例转诊至宁波市儿童听力诊断治疗中心进行听性脑干反应及多频稳态诱发电位测试,综合分析ABR及ASSR的测试结果。结果　70例婴幼儿（140耳）中ABR正常37耳, 轻度聋18耳, 中度聋21耳, 重度聋31耳和极重度聋33耳; 非极重度聋ASSR的2 kHz和4 kHz反应阈与ABR反应阈之间呈直线正相关关系（IP/I0.05）, 而ASSR的0.5 kHz和1 kHz反应阈与ABR反应阈之间无直线关系（IP/I0.05）。极重度聋0.5 kHz、1 kHz、2 kHz和4 kHz ASSR引出率分别为42.4%、57.6%、45.5%和48.5%,高于ABR的引出率21.2％（I/Isup2/sup=9.7408,IP/I=0.0450）。结论　听力筛查阳性婴幼儿的高载波频率ASSR与ABR存在良好的相关性,且ASSR具有频率特性及较高反应引出率而更适用于极重度聋婴幼儿残余听力的评估。     

感音神经性聋患者助听前后言语测试分析

目的:探索能真实反应感音神经性聋患者助听后效果的检验方法及指标。方法:选择中至重度感音神经性聋患者32例,分别测试其助听前听阈(hearinglevel,HL),以言语察觉阈(speechperceptionthreshed,sPT),言语识别阈(speechrecognitionthreshed,SRT)等指标,然后按照NAL助听器选配处方公式进行助听器验配,并在声场中测试HL,SPT,SRT。对助听前后各项指标进行比较。结果:64耳250,500,1000,2000,4000Hz听阈平均值分别为57.84±10.15,59.83±6.75,64.27±6.21,69.32±8.15,72.78±8.36。听力损失犤(500Hz+1000Hz+2000Hz)/3犦,平均为64.70±13.08。HL,SPT,SRT分别为54.23±13.94,67.93±12.96,76.70±78.59。助听前后SPT稍低于HL,SRT稍高于HL,差异有显著性意义。结论:可以用言语测听指标来较真实地反应听力障碍者助听后的实际受益情况。     

纯音听阈和声导抗测试在听神经病诊断中的应用

目的:总结听神经病患者的纯音听阙和声导抗测试特征.探讨纯音听阈和声导抗测试在听神经病诊断中的应用.方法:对确诊听神经病37例(74耳)患者的临床资料、纯音听阁和声导抗测试结果进行总结,并与一般感音神经性耳聋患者30例(49耳)的听力学测试结果比较.结果:听神经病组37例(74耳)纯音听力图上升型53耳(71.6%).听神经病组纯音听力图左、右耳对称.37例听神经病患者左、右耳的气导纯音听阈升高程度在0.25～4.0 kHz.两耳间差异无统计学意义(P>0.10).镫骨肌声反射21例同侧及交叉声反射均未引出,16例28耳的单项或多项频率镫骨肌声反射可引出,但镫骨肌声反射阈值均升高.听神经病组所有患耳均无响度重振现象.感音神经性聋组9耳重振现象阳性.结论:听神经病表现为双侧对称性、渐进性听力减退,辨不清言语,部分可伴有耳鸣或头晕.纯音听闻多为双侧对称性、低频上升型听力图;言语听力明显差于纯音听力;声导抗测试双耳鼓压导抗图为"A"型曲线;镫骨肌声反射闽值升高或引不出,无响度重振现象.     

响度优势联合纯音听阈在患者听功能检测中的应用

【目的】评价响度优势测试与纯音听阈检测相结合用于患者听功能检测的效果。【方法】对2011年1月至2014年12月于本院耳科就诊的386例听力下降患者,在标准环境条件下进行纯音听阈检测与响度优势测试,观察伪聋检测效果。对于伪聋测试阳性患者进一步行听性脑干诱发电位（ABR）阈值检查,验证伪聋测试结果。【结果】386例患者接受了纯音听阈检测提示听功能异常,同时进行响度优势测试,结果提示46例（11．92％）患者因较强的主观意愿、配合不佳、心理或精神疾患、各种因素涉及保险或赔偿等原因影响纯音检测结果,46例患者ABR验证伪聋测试结果准确率达到100％。【结论】响度优势测试能够在一定程度上区分影响听功能检测的因素,将其用于评价主观意愿较强或纯音听阈测试配合不佳人群听功能的可靠性具有一定价值。     

Towards an optimal paradigm for intraoperative auditory nerve monitoring with auditory steady state responses

Auditory steady state responses (ASSR) may offer an alternative to brainstem auditory evoked potentials for monitoring of the auditory nerve during surgical procedures. In the current study, we evaluated the influence of noise on ASSR characteristics in total intravenous anesthesia (TIVA). Simulated ASSR in real noise recorded during surgery under TIVA were constructed with known parameters. Influence of amplitude, modulation frequency, averaging sweeps and detection threshold on ASSR were evaluated. High amplitude, more sweeps and a liberal threshold facilitated detection. High amplitude ASSR (80 nV) were detected in up to 45 % with 16 s of data, in 80–90 % with 112 s. Near-threshold ASSR were detected in 0.8–25 %. False positives ranged between 0.3 and 10.3 %. Number of sweeps did not influence false positives. Amplitude errors varied between ?61 and +39 % and improved with more averages but not with different thresholds. Modulation rate demonstrated the strongest influence on all parameters. 110 Hz yielded best, 90 Hz the worst results. Choice of parameters strongly influences detection and characteristics of ASSR. Optimal parameters enabled detection after 16 s in 45 %. Due to specific noise characteristics, modulation has a critical impact, which is currently not sufficiently recognized in ASSR studies.     

Ouabain诱导沙鼠蜗外电诱发听性脑干反应变化研究

目的沙鼠耳蜗圆窗应用毒毛旋花甙G(Ouabain),观察沙鼠蜗外电诱发听性脑干反应(EABR)的变化。方法显微镜下将浸有50μl Ouabain(1 mM)的明胶海绵置于沙鼠耳蜗圆窗膜表面,观察应用Ouabain 24 h、96 h后听觉脑干反应(ABR)、耳蜗微音电位(CM)、蜗外电诱发听性脑干反应(EABR)阈值变化。结果沙鼠圆窗应用Ouabain 24h、96 h后ABR、EABR阈值明显升高,差异具有统计学意义(P<0.05),CM阈值无明显变化,差异无统计学意义(P>0.05)。结论沙鼠圆窗膜表面应用50μl Ouabain(1 mM)24 h、96 h后可导致沙鼠ABR、EABR阈值明显升高,而CM阈值无明显变化。     

Neural responses to auditory stimulus deviance under threat of electric shock revealed by spatially-filtered magnetoencephalography

Stimulus novelty or deviance may be especially salient in anxiety-related states due to sensitization to environmental change, a key symptom of anxiety disorders such as posttraumatic stress disorder (PTSD). We aimed to identify human brain regions that show potentiated responses to stimulus deviance during anticipatory anxiety. Twenty participants (14 men) were presented a passive oddball auditory task in which they were exposed to uniform auditory stimulation of tones with occasional deviations in tone frequency, a procedure that elicits the mismatch negativity (MMN) and its magnetic counterpart (MMNm). These stimuli were presented during threat periods when participants anticipated unpleasant electric shocks, and safe periods when no shocks were anticipated. Neuromagnetic data were collected with a 275-channel whole-head MEG system and event-related beamformer analyses were conducted to estimate source power across the brain in response to stimulus deviance. Source analyses revealed greater right auditory and inferior parietal activity to stimulus deviance under threat relative to safe conditions, consistent with locations of MMN and MMNm sources identified in other studies. Structures related to evaluation of threat, left amygdala and right insula, also showed increased activity to stimulus deviance under threat. As anxiety level increased across participants, right and left auditory cortical as well as right amygdala activity increased to stimulus deviance. These findings fit with evidence of a potentiated MMN in PTSD relative to healthy controls, and warrant closer evaluation of how these structures might form a functional network mediating sensitization to stimulus deviance during anticipatory anxiety.     

Detection and localization of occult lesions with brainstem auditory responses

Seven vertex-positive potentials--the brainstem auditory response--can be recorded from the human scalp within 10 milliseconds of an appropriate acoustic stimulus. The first of these potentials is generated in the acoustic nerve, the third in the pons, and the fifth in the midbrain. Measurement of the relative latencies and amplitudes of these potentials allowed detection of subclinical lesions in 37 (53 percent) of 70 patients with suspected multiple sclerosis who had no signs or symptoms of brainstem involvement by the disease. Abnormalities in the brainstem auditory response provided the first evidence of the pressence of multiple lesions in 14 (35 percent) of 40 patients with suspected multiple sclerosis who had clinical evidence of only a single spinal or cerebral lesion. Response abnormalities also suggested the presence of tumors of the posterior fossa in three patients with nonspecific symptoms and normal neurologic examinations, the test indicated the need for contrast studies, which then led to the correct diagnosis of infratentorial neoplasm.     

Problems in interpreting abnormal auditory brainstem responses in comatose patients

Auditory brainstem responses (ABRs) provide a way to evaluate central nervous system function in young, confused, uncooperative or comatose patients. Auditory brainstem responses represent activity in or around the vestibulocochlear (VIII) cranial nerve, cochlear nucleus, superior olivary complex, lateral lemniscus, and inferior colliculus. Many factors affect recording of the auditory brainstem response. These factors include technical factors, chronic alcoholism, demyelinating diseases, ototoxic drugs, barbiturates, hearing loss, otitis media, and hypothermia.     

The spatiotemporal pattern of auditory cortical responses during verbal hallucinations

Functional magnetic resonance imaging (fMRI) studies can provide insight into the neural correlates of hallucinations. Commonly, such studies require self-reports about the timing of the hallucination events. While many studies have found activity in higher-order sensory cortical areas, only a few have demonstrated activity of the primary auditory cortex during auditory verbal hallucinations. In this case, using self-reports as a model of brain activity may not be sensitive enough to capture all neurophysiological signals related to hallucinations. We used spatial independent component analysis (sICA) to extract the activity patterns associated with auditory verbal hallucinations in six schizophrenia patients. SICA decomposes the functional data set into a set of spatial maps without the use of any input function. The resulting activity patterns from auditory and sensorimotor components were further analyzed in a single-subject fashion using a visualization tool that allows for easy inspection of the variability of regional brain responses. We found bilateral auditory cortex activity, including Heschl's gyrus, during hallucinations of one patient, and unilateral auditory cortex activity in two more patients. The associated time courses showed a large variability in the shape, amplitude, and time of onset relative to the self-reports. However, the average of the time courses during hallucinations showed a clear association with this clinical phenomenon. We suggest that detection of this activity may be facilitated by examining hallucination epochs of sufficient length, in combination with a data-driven approach.     

Gamma band pitch responses in human auditory cortex measured with magnetoencephalography

We have previously used direct electrode recordings in two human subjects to identify neural correlates of the perception of pitch (Griffiths, Kumar, Sedley et al., Direct recordings of pitch responses from human auditory cortex, Curr. Biol. 22 (2010), pp. 1128-1132). The present study was carried out to assess virtual-electrode measures of pitch perception based on non-invasive magnetoencephalography (MEG). We recorded pitch responses in 13 healthy volunteers using a passive listening paradigm and the same pitch-evoking stimuli (regular interval noise; RIN) as in the previous study. Source activity was reconstructed using a beamformer approach, which was used to place virtual electrodes in auditory cortex. Time-frequency decomposition of these data revealed oscillatory responses to pitch in the gamma frequency band to occur, in Heschl's gyrus, from 60 Hz upwards. Direct comparison of these pitch responses to the previous depth electrode recordings shows a striking congruence in terms of spectrotemporal profile and anatomical distribution. These findings provide further support that auditory high gamma oscillations occur in association with RIN pitch stimuli, and validate the use of MEG to assess neural correlates of normal and abnormal pitch perception.     

Brainstem auditory evoked responses in rats with experimental chronic renal failure

1. Chronic renal failure was induced in rats by five-sixths nephrectomy. Brainstem auditory evoked response (BAER) was recorded after 3 months. 2. In the uraemic rats latency of the first wave was delayed, while the interpeak I-V latency was similar to that of the controls. 3. These results suggest a delayed neural conduction along the acoustic nerve or cochlear changes in uraemic rats.