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。     

Measurement of Hearing Level in Occupational Noise-Induced Hearing Loss

Research on the hearing loss at 2 000 and 4 000 Hz which enabled us to estimate the loss at 3 000 Hz would appear to be the best measure of occupational noise-induced hearing loss: this measure is the most specific and the most discriminating of the suggested formulas. Calculation of the social handicap must take into consideration the same frequencies and the probability of error of identification at the various levels of hearing impairment. Its coefficient is that of the disability in relation to total deafness.

Notre recherche montre que seules les fréquences de 2 000 et 4 000 Hz, approximation de la fréquence 3 000 Hz, sont acceptables pour estimer une perte auditive professionnelle. La moyenne à ces deux fréquences est plus spécifique et plus discriminative. Le calcul de la perte sociale peut se faire à partir de la probabilité d'erreur de la discrimination phonétique, ou ces memes fréquences sont également les plus importantes.     

不同人群高频听力测试结果分析

目的 通过测试不同年龄段常频听力正常受试者的高频听阈，从而获得高频听力的正常值。方法 2002年2月～2003年12月，对常频听力正常的受试者进行了高频测听。按国际标准将符合条件的受试者分为青年组和成年组，青年组160名，年龄在18-25岁之间，平均21．7岁，其中男96名，女64名；成年组192名，并按照10岁为一个年龄段分为25～岁，35～岁，45～岁．55～岁和65～岁5个小组，每组均行双耳常频和高频听阈测试，计算高频各频率的检出率，并对检查结果运用SPSS10．0统计软件分别进行方差分析和x^2检验。结果 青年组常频听力测试在各频率均〈25dB HL，在4000，6000和8000Hz处的听阈略高（P〈0．05）；成年组常频区的听力测试在各频率均≤25dB HL，但随着年龄的增长，听阈值有逐渐提高的趋势（P〈0．05）。将青年组和成年组受试者按照性别分类，发现女性受试者的听力比男性的好（P〈0．05）。高频听力测试显示正常青年组的听阈随频率的增高而增高（P〈0．05），同时对于各个频率，随年龄的增长听阈也逐渐提高（P〈0．05）。结论 本研究获得了青年人以及不同年龄段成年人的常频和高频听阈均值及其性别差异。     

梅尼埃病的高频测听观察

本文报告34例30～40岁梅尼埃病患者常规测听(0.25～8kHz)和高频测听(9～20kHz)与相同年龄组正常人比较的结果.发现梅尼埃病早期常规测听低频听力下降的同时,也存在高频听力下降,并非到病变后期才出现高频下降,若能及时行高频测听检查,有利于梅尼埃病的早期诊断.本文还对高频听力下降的机理进行初步探讨.     

Acoustic Reflex Amplitude and Noise-Induced Hearing Loss

Acoustic reflex maximum amplitude measurements elicited both contralaterally and ipsilaterally were obtained from subjects with noise-induced hearing loss and compared with those obtained from normal-hearing subjects. The eliciting signal was a pure tone of 1 kHz presented for 1 000 ms. The groups were matched on age, sex, static immittance and ear canal volume. Acoustic reflex amplitudes were clearly reduced in noise-impaired subjects compared with normal-hearing subjects at a frequency where their hearing thresholds were normal.     

Hearing loss and middle ear involvement in patients with juvenile idiopathic arthritis

OBJECTIVE: Evaluation of the hearing status and middle ear function of patients with juvenile idiopathic arthritis. METHODS: The study group was comprised of 38 ears of 19 patients (6 males, 13 females) aged between 5 and 23 years. The control group was comprised of 30 ears of 15 healthy subjects (5 males, 10 females) aged between 5 and 22 years. All subjects were examined audiologically using tympanometry, stapedial reflex, acoustic reflex decay, pure-tone audiometry, high frequency audiometry and transient evoked otoacoustic emission tests. RESULTS: There were statistically significant (p<0.05) number of ears (32%) with abnormal tympanograms in the patient population while all tympanograms were normal, type A in the control group. Seven type As, 2 type Ad, and 3 type C tympanograms were seen in the patient population. In pure tone audiometry tests there was no subject having neither a conductive nor sensorineural hearing loss individually in both groups. But as a group, patients with juvenile idiopathic arthritis showed statistically significant elevation of air conduction thresholds at frequencies of 250, 500, 6000, 14,000 and 16,000 Hz for right ears; and at 500, 2000, 12,500 and 16,000 Hz for left ears; and larger air-bone gaps at 500 and 2000 Hz for right ears; and at 500 Hz for left ears (p<0.05). Comparison of bone conduction thresholds and otoacoustic emission tests between both groups did not reveal any statistically significant difference (p>0.05). CONCLUSION: This study suggests a dual effect of disease on both the middle and inner ear of patients with juvenile idiopathic arthritis. Presence of abnormal tympanograms together with worse air conduction thresholds at lower frequencies as well as larger air bone gaps at frequencies of 500 and 2000 Hz suggest subclinical middle ear involvement; while hearing losses at 6000 Hz and very high frequencies of 12,500, 14,000 and 16,000 Hz suggest inner involvement at an early stage.     

Hearing loss after noise exposure

The higher field strength magnetic resonance imaging (MRI) such as 3 Tesla (T) and above generates noise that has potential detrimental effects on the hearing. Temporary threshold shifts following MRI examination have been reported for MRI with lower field strength. Such effect, however, have not been reported so far for a 3 T MRI. We report a case that exemplifies the possible detrimental effects of a 3 T MRI generated noise on the auditory system. Our patient underwent investigation of his chronic backache in a 3 T MRI unit and developed hearing loss and tinnitus post-MRI examination. Hearing assessment was done using pure tone audiogram, distortion product otoacoustic emission (DPOAE) and brainstem electrical response audiometry (BERA) which revealed a unilateral sensorineural hearing loss which recovered within 3 days. However the tinnitus persisted. This is possibly a case of temporary threshold shift following noise exposure. However a sudden sensorineural hearing loss remains the other possibility.     

122例听神经瘤患者听力受损相关因素分析

目的分析听神经瘤患者听力受损相关因素。方法回顾性分析122例单侧听神经瘤患者MRI,颞骨CT及听力学检查结果(纯音听阈及言语识别率),根据术前纯音听阈≤50dB、言语识别率≥50%的标准将患者分为实用听力组和无实用听力组,比较两组患者肿瘤大小、肿瘤囊变、脑干受压移位、瘤周有无水肿、内听道宽度、内听道长度、内听道底有无脑脊液等因素。结果内听道扩大程度与听力受损明显相关(P<0.001),肿瘤大小(P=0.25)、脑干受压移位(P=0.38)、瘤周有无水肿(P=0.91)、内听道长度(P=0.75)、内听道底有无脑脊液与听力受损无明显相关(P=0.18);肿瘤囊变可能有相关,但两组患者无统计学意义(P=0.08)。结论内听道扩大的程度与听神经瘤患者听力受损明显相关,其在一定程度上反应了内听道内耳蜗神经长时间受压情况。     

不同听力检测方法对早期发现噪声性隐性听力损失的意义

目的探讨扩展高频纯音测听、畸变产物耳声发射(DPOAE)及噪声下言语识别能力测试对早期发现噪声性隐性听力损失的意义。方法选取20例常频纯音听阈正常、有噪声接触史的工人(接噪组,年龄20~41岁)与20例无噪声接触史、常频听阈正常的青年人(对照组,年龄19~35岁),分别行扩展高频纯音测听、扩展高频DPOAE及噪声下言语识别能力测试(汉化版噪声下BKB语句测试),记录并比较两组各项测试结果。结果接噪组扩展高频纯音听阈检出率低于对照组,在16 kHz差异有统计学意义(P<0.05),在18、20 kHz差异有显著统计学意义(P<0.01);接噪组8~20 kHz扩展高频纯音听阈平均值高于对照组,在9、18 kHz差异有统计学意义(P<0.05),在14 kHz差异有显著统计学意义(P<0.01);接噪组扩展高频DPOAE的信噪比及幅值均较对照组降低,在10 kHz差异有统计学意义(P<0.05),在8、9 kHz差异均有显著统计学意义(P<0.01);噪声下言语识别能力测试显示接噪组信噪比损失平均值为4.6±2.19 dB,高于对照组(3.00±2.08 dB)(P<0.01)。结论接噪组相较对照组,扩展高频纯音听阈值升高或引不出,扩展高频DPOAE信噪比及幅值降低,噪声下言语识别能力显著下降,以上三种检测方法对早期发现噪声性隐性听力损失有一定的参考价值。     

The Increase in Prevalence of High Frequency Hearing Impairment Among College Students

There are numerous intense sounds in the environment to which regularity. To assess the effect of such noise exposure upon the hearing of persons under 21, a 2-part study was conducted. In the Fall of 1968, 2 769 Freshman entering the University of Tennessee were given a modified screening test for hearing. The failure level was established to be 15 dB (ISO, 1964 standard). If a student failed at any frequency, his threshold for hearing was measured for that frequency and recorded on a printed form. It was found that 4.6% of the students failed to respond to a 2 000 Hz stimulus. Failure levels were found to be 6.8, 10.5 and 29.4% for 3 000, 4 000 and 6 000 Hz, respectively. The procedure was repeated in testing 1 410 students in the Fall of 1969. It was discovered, however, that the prevalence of high frequency hearing impairment rose dramatically in this group. Failure rates were found to be 6.3, 13, 14.3 and 54.9% for the 2 000, 3 000, 4 000 and 6 000 Hz signals, respectively. Of the students tested, 7.4% had a hearing threshold of 40 dB or greater for the 6 000 Hz signal. Additional data are presented which indicate that the occurrence of measurable high frequency hearing impairment in young persons is tangible evidence of the toll being exacted by high intensity recreational and environmental sounds. The results of these studies are related to previous incidence studies and to histologic evidence of sensory cell damage observed in laboratory experiments.     

Otoacoustic emissions recorded in people with chronic migraine

Migraine, a moderate to severe chronic headache occurring on one or both sides, is a common disease affects young people. Although hearing loss in subjects with migraine is not rare, the correlation of migraine with hearing loss is not clear. In this study, we examined hearing loss in young migraine subjects to determine if migraine may be a factor in causing cochlear dysfunction. Seven college students with migraine and three age matched subjects without history of migraine were assessed using extended high frequency audiometry and distortion product otoacoustic emissions (DPOAEs). There was no significant difference in regular audiometry threshold between the migraine group and the control group. However, high frequency audiometry (9–16 kHz) showed thresholds at 25 dB nHL or higher in six out of twenty ears in the migraine group. The amplitude of DPOAEs were reduced for more than 10 dB in the migraine group in comparison with the control group. These data suggest that migraine may affect cochlear dysfunction evidenced by the reduced amplitude of DPOAE and high frequency pure-tone audiometry.     

185名中国民航飞行员听力状况调查

目的了解中国民航飞行员听力状况在一定时间内的变化趋势。方法将185名民航飞行员按照初访时年龄分为A(20～岁,101人)、B(30～岁,49人)、C(40～49岁,35人)三组,分别测试其纯音听阈,10年后随访复查纯音听阈,比较随访前后各组听力损失发生率及纯音听阈变化情况。结果 185名飞行员中共有126名随访成功,随访率为68.11%(126/185)。126名飞行员初访及随访时语频听力损失发生率分别为0.79%(1/126)和4.76%(6/126),高频听力损失发生率分别为14.29%(18/126)和30.95%(39/126),随访时听力损失发生率显著高于初访时(P<0.05);各年龄组10年后随访时的纯音听阈较初访时明显提高(P<0.01),且高频较语频提高明显(P<0.05),经年龄修正后,仅A组10年后测得的纯音听阈明显高于初访时(P<0.01),其它年龄组差异无显著统计学意义。结论民航飞行员听力损失的发生和发展以高频为主,进而影响语频,主要与噪声和年龄因素有关。     

职业性噪声性聋发病工龄的调查分析

目的了解职业性噪声暴露人员的听力状况及其剂量-效应关系,为修订国家职业性噪声性聋诊断标准提供数据支持。方法选择8小时等效连续噪声暴露人员,运用横断面调查的方法,由经过培训合格的调查人员进行问卷调查和纯音听力检查。结果排除非噪声性听力损失的影响,有效调查1001人,高频听力损失检出率为65.1%(651/1001),显著高于语频听力损失检出率(3.0%,30/1001)。言语频率平均听力损失≥26dB的阳性检出率在工龄<10年组为0.0%;高频及语频听力损失率在10年及以上各工龄组间差异无统计学意义。结论10年以下噪声暴露基本不会影响作业人员的言语频率听力;在诊断是否"职业性噪声性聋"或"听力损伤"时应考虑剂量-效应关系;建议职业性噪声性聋诊断标准中增加噪声作业工龄≥5年的要求。     

Detection of Hearing Loss with Ipsilateral Acoustic Reflex Thresholds

This study consisted of two experiments both of which involved measurement of the ipsilateral acoustic reflex threshold (ART). In Experiment I, ipsilateral ARTs were measured in normal-hearing adults for a 2 000-Hz tone and computer-generated complex stimuli of varying bandwidth. Results of this experiment revealed that the bandwidth effect for the ipsilateral ART was similar to the contralateral effect. The ART decreased monotonically as a function of bandwidth of the reflex-eliciting stimulus. Results of Experiment II indicated that ipsilateral ARTs successfully differentiated between normal hearing and significant hearing loss, in difficult-to-test groups of young children, when used with the bivariate plotting procedure. In addition, obtaining reflexes ipsilaterally, rather than contralaterally, appeared to have advantages with this population. The ipsilateral test apparatus is less cumbersome, the possibility of calibration error from a malpositioned contralateral earphone is eliminated and the children were generally more accepting of the ipsilateral assembly.     

Hearing Impairment in 2008: A compilation of available epidemiological studies

A data bank of prevalence of hearing impairment for monitoring and implementation of programmes at national or global level and for the estimate of the global burden has been established. A systematic search was conducted of random-sample population-based studies of bilateral hearing impairment with clearly defined hearing threshold levels. Fifty-three studies from 31 countries from all WHO regions were found to meet the selection criteria. The prevalence of mild and disabling hearing impairment and other details from the studies are reported by WHO region. Although a large number of studies were found, only a small number among them were suitable surveys of prevalence of bilateral hearing impairment in the general population. Hearing impairment is a major disability that should be monitored at all ages: more population-based surveys are needed in all regions of the world. Utilization of the WHO protocol is recommended for collection and analysis of data in standard ways; especially recommended is the use of WHO threshold levels and to report the prevalence of bilateral impairment, both of which required to calculate burden.     

急性低频感音神经性聋镫骨肌声反射消失的病因及临床意义探讨

目的 探讨部分急性低频感音神经性聋(acute low-tone sensorineural hearing loss,ALHL)镫骨肌声反射(acoustic stapedius reflex,AR)消失的原因及临床意义.方法 分析21例(21耳)镫骨肌声反射消失的ALHL患者患耳的声顺值、共振频率、耳蜗电图、DPOAE及ABR的改变,与其健耳以及镫骨肌声反射正常的ALHL患者相应观察值进行对照,并比较患耳上述观察值治疗前后的变化.结果 ALHL镫骨肌声反射消失耳的病变在内耳,其共振频率略高于健耳及对照组,但无显著性差异.患耳耳蜗电图-SP/AP值高于健耳及对照组,差异显著.糖皮质激素及利尿剂治疗后,听力恢复正常16耳,其中仅4耳AR可引出,12耳仍不能引出;其余5耳听力仅部分恢复,AR仍不能引出.结论 膜迷路积水导致镫骨底板活动受限是AR消失的重要原因之一,膜迷路积水同时引起传声系统质量及劲度的改变,其对共振频率的影响取决于积水对镫骨底板活动度的影响程度.     

常频听阈正常的民航飞行学员扩展高频听阈分析

目的 探讨扩展高频(extended highfrequency,EHF)测听对于早期发现民航飞行学员听力损失的意义.方法 对中国民航某飞行学院尚处于理论学习阶段的175例飞行学员(均为男性,18~25岁,平均20.2±0.92岁)进行问卷调查和EHF测听,所有受试者常频(0.25~8 kHz)听阈≤25 dB HL,将结果与国外相应推荐标准比较;将其中173例听力资料完整的学员(除外中耳疾病和有听力损失家族史各1例)按照随身听使用情况分为低风险组(不使用,121例)和高风险组(使用时间>1年,每天>1小时,52例),比较两组间EHF听阈及检出率的差异.结果 173例飞行学员9~20 kHz各频率听阈值均略高于美国国家标准化协会规定的声压级参考阈值和国外文献推荐的同年龄段标准;高风险组9、12.5、16、18 kHz阈值显著高于低风险组(P<0.05或0.01),随着频率增高,高风险组听阈检出率逐渐下降,在18、20 kHz的检出率显著低于低风险组(P<0.01).结论 EHF测听有助于早期发现飞行学员噪声性听力损失,应当重视民航飞行学员听力保健,建议避免使用或减少随身听使用时间.     

Hearing assessment by recording multiple auditory steady-state responses: the influence of test duration

The influence of test duration on the precision of hearing thresholds estimated by recording multiple auditory steady-state responses (ASSRs) was investigated. ASSR thresholds at four frequencies in both ears were assessed in 10 normal-hearing and 10 hearing-impaired subjects. The precision of the estimated hearing thresholds was compared for ASSR recordings of 5, 10 and 15 min per intensity level, corresponding to total test durations of approximately 30, 55 and 70 min for hearing-impaired ears. Furthermore, an intensity step size of 10 dB was compared to a step size of 5 dB. The mean difference scores averaged over the four frequencies were 15±10, 12±9 and 11±8 dB after recordings of 5, 10 and 15 min respectively. The corresponding Pearson correlation coefficients were 0.93, 0.95 and 0.96. Increasing the length of the separate recordings increases the precision of the estimates, independent of tested frequency. A compromise between both will have to be made. With a total test duration of approximately 1 h, four hearing thresholds in both ears can be estimated with a standard error of the estimate of 8dB.     

噪声性听觉损害的声反射增长函数

目的　探讨噪声暴露对声反射增长函数 (acousticreflexgrowthfunction ,ARGF )的影响。方法　对有长期噪声暴露史的工人 5 7例 (10 6耳 )及正常听力青年人 2 5例 (5 0耳 )进行ARGF测试 ,观察受试耳对 10 0 0Hz纯音刺激级由声反射阈 (acousticreflexthreshold ,ART)水平增加至 12 5dBHL时声抗量值变化的函数关系。根据纯音平均听阈 (pure-tonethresholdaverage ,PTA)将噪声暴露耳分为三组。结果　噪声暴露组的声反射 (acousticreflex ,AR)动态范围变窄 ,声抗增长量值减小 ,ARGF曲线坡度变缓 ,反射振幅及声抗增长量值与正常青年组相比有显著下降 (P <0 .0 1) ,而听力损失程度不同的三个病变组间的差异不显著 (P >0 .0 5 )。分别用声抗量值及声抗量增幅比随AR刺激级的增加而变化两种方法分析所得数据 ,发现噪声暴露组的ARGF与正常耳有明显差别 (P <0 .0 5 ,P <0 .0 1)。结论　噪声暴露对ARGF有显著影响。ARGF可用作监测早期噪声性听觉损害 (noiseinducedhearingloss,NIHL)的敏感指标