听觉及言语发育观察表可用性初探

目的分析婴幼儿听性脑干反应（ABR）结果与听觉及言语发育评估的相关性,探讨听觉及言语发育观察表在农村地区婴幼儿听力保健中的可用性。方法采用听觉及言语发育观察表和听性脑干反应对136例受试者（年龄3～18个月,平均5个月）进行测试,分析两种测试结果的相关性。结果①ABR测试结果：136例中双耳听力正常76人,单耳听力损失27人,双耳听力损失33人（轻度13人,中度2人,重度13人,极重度5人）。②听觉及言语发育观察结果：听力损失程度不同听觉及言语发育观察表的通过率亦不同,双耳昕力正常组、单耳听力损失组、双耳轻度听力损失组、双耳中度听力损失组、双耳重度听力损失组、双耳极重度听力损失组通过率分别为98。68％、92．59％、92．31％、50％、15．38％和0％。结论听力正常的婴幼儿能很好地做到与其月龄相对应的听觉及言语发育观察表中的项目,通过率高;随着听力损失程度的加重,通过率逐渐降低。在农村地区应用听觉及言语发育观察表作为听力监测的一种方法,可弥补现阶段听力筛查中的不足。     

高压氧对不同听力损失程度与听力曲线突发性聋患者的疗效观察

目的:探讨不同听力损失程度与不同听力曲线的突发性聋(突聋)患者对高压氧治疗疗效的影响,为制订个性化的治疗方案提供理论依据.方法:120例突聋患者被分成2组,每组60例.A组单纯药物治疗,B组在A组的基础上同时加用高压氧治疗;疗程2周.分析不同听力损失程度与不同听力曲线的突聋患者两种治疗方案疗效的差异.结果:A、B两组总有效率分别为60.00%(36/60)和83.33%(50/60),差异有统计学意义(χ2 =8.044,P<0.01).轻度和极重度聋时,两种治疗方案疗效差异无统计学意义;中度和重度聋时,两组疗效差异有统计学意义,其χ2分别为4.969和5.560,均P<0.05.在A组中,轻度与极重度疗效差异有统计学意义(χ2 =6.739,P<0.05),其他不同程度耳聋之间的疗效均未显示出统计差异(χ2 <3.910,P>0.05).B组中,轻度与极重度、中度与极重度、重度与极重度疗效差异均有统计学意义,其χ2分别为11.500、15.058、10.221,均P<0.01,其他不同程度耳聋之间的疗效未显示出统计差异(χ2<1.313,P>0.05).在上升型和全聋型听力曲线中,A、B两种治疗方案疗效差异均无统计学意义.而下降型和平坦型听力曲线中,A、B两种治疗方案疗效差异有统计学意义,其χ2分别为5.144和5.969,均P<0.05.在A组中,上升-下降、上升-平坦、上升-全聋型听力曲线间疗效差异均有统计学意义,其χ2分别为6.188、7.247、8.082,均P<0.05.而其他各型听力曲线间差异无统计学意义(χ2<0.566,P>0.05).在B组中,各型听力曲线间疗效差异均无统计学意义(χ2<4.200,P>0.05).结论:高压氧治疗疗效在不同的听力损失程度与不同听力曲线的突聋患者中有一定的差异,对中、重度听力损失及下降型与平坦型听力曲线者,药物联合高压氧治疗显示出一定的优势.     

紫杉醇对豚鼠听阈的影响

目的：探讨紫杉醇对豚鼠听阈的影响。方法：将30只雌性豚鼠随机分为6组（1个对照组和5个实验组,每组5只）,实验组分别予以不同剂量紫杉醇腹腔内注射,检测用药前、后各组动物ABR阈值。结果：实验组听力水平用药后均显著减低,相关分析显示,总药量与听力损失程度之间无显著相关性。结论：紫杉醇可导致轻到中度听力损失。     

耳声发射在重症监护新生儿听力筛查中的应用

目的 探讨重症监护新生儿(NICU)的合适听力筛查方法.方法 用瞬态诱发耳声发射仪(TEOAE),对263例重症监护新生儿进行听力筛查,未通过者1个月后进行复查,仍未通过者将接受脑干诱发电位(ABR)检查,以确定有无听力损失.结果 263例NICU新生儿中,209例通过了第一次OAE筛查,1个月后43例通过了OAE复查,最后11例行ABR检查,5例确诊有不同程度的听力损失.结论 TEOAE和 ABR联合应用的两步筛查法是NICU新生儿听力筛查的可行方法.     

听力筛查未通过婴幼儿的客观听力评估

目的 分析听力筛查未通过婴幼儿的客观听力学特征,为早期干预提供科学依据。方法 对听力筛查未通过患儿286例进行听力诊断性检查。采用听性脑干反应(ABR)、40Hz听觉相关电位(40Hz-AERP)、畸变产物耳声发射(DPOAE)、声导抗进行评估。结果 286例婴幼儿中双耳听力正常95例(33.22%);听力损失者191例(66.78％),其中单耳听力损失70例(24.47％),双耳听力损失121(42.31％);传导性听力损失59例(20.63%),感音神经性听力损失132例(46.15%);轻度听力损失91例(31.82%),中度43例(15.03%),重度20例(6.99％),极重度37例(12.94％)。191例听力异常者只有16例复查,占8.38％,复查结果：听力正常2例,双耳听力损失10例,单耳听力损失4例。结论 部分听力筛查未通过婴幼儿的听力可随着听觉神经系统发育的完善恢复正常;同时中耳病变也是部分婴幼儿听力筛查未通过的影响因素;客观听力学组合测试可有效评估听力筛查未通过患儿的听力特征,为听力损失的早期诊断、早期干预提供科学依据;听力异常患儿的复查率低和失访率高仍是目前亟需解决的问题。     

伴黄疸早产儿的听力损失相关因素分析

目的：探讨伴黄疸早产儿的听力损失及损失程度与胎龄、出生体重等因素的关系。方法：应用听性脑干诱发电位对不同出生体重、不同胎龄,并排除颅内出血、缺血缺氧性脑病及神经系统疾病等28例伴黄疸早产儿进行测试。设置同年龄段早产儿组及足月儿组,以单侧耳Ⅴ波反应阈〉40dBnHL作为听力损失指标．分析听力损失情况及损失程度,并分析Ⅰ、Ⅲ、Ⅴ波潜伏期及各波波间期情况。结果：伴黄疸早产儿组、早产儿组、足月儿组单耳听力损失发生率分别为55．4％、43．5％和19．6％（P〈0．01）;伴黄疸早产儿组中,出生体重越低,听力损失发生率越高、程度越重;出生胎龄越小,听力损失程度越重,但胎龄≤30周者与≤34周者,听力损失发生率无明显差异（P〉O．05）;伴黄疸早产儿组的Ⅴ波阈值高于足月儿组（P〈0．01）,与早产儿组Ⅴ波阈值及Ⅰ波潜伏期比较无明显差异,但伴黄疸早产儿组Ⅴ波潜伏期及各波波间期均高于早产儿组及足月儿组（P〈0．01）。伴黄疸早产儿组与早产儿组波Ⅰ潜伏期均较足月儿组延长（P〈0．01）。结论：伴黄疸早产儿是听力损失的高危人群,其听力损失程度与出生体重、胎龄呈负相关。     

听力损失儿童倍频程CE-Chirp听性脑干反应与行为测听相关性分析

目的　通过比较听力损失儿童倍频程CEChirp听性脑干反应（ABR）反应阈与行为测听阈值的结果差异,探讨倍频程CE-Chirp ABR临床应用的价值。方法  选择21例（共40耳）听力损失儿童,在安静环境下分别测试裸耳倍频程CE-Chirp ABR反应阈与行为测听听阈,将两种不同的测试方法的测试结果进行比较。结果　听力损失儿童倍频程CE-Chirp ABR反应阈与行为测听阈值结果进行统计分析,各频率相关系数r 分别为0.693、0.830、0.836和0.845,P 均<0.05。结论 两种测试方法存在较好的相关性,倍频程CE-Chirp ABR作为一种客观测听技术,对听力损失儿童客观反应具有良好的稳定性和可靠性,能够较好的反映听力水平。     

听觉功能重建的回顾与展望

听觉功能重建是指运用听力重建、听觉助听和听觉植入技术恢复或提高各种类型听力损失患者听觉能力的技术手段.纵观近10年来听觉功能重建技术的发展历程,毋容置疑的是,我们既取得了有目共睹的成就,又面临前着所未有的困难与挑战.     

轻中度听力损失对老年人水平方位声源定位的影响

目的 探讨轻中度听力损失对60岁及以上老年人水平方位声源定位能力的影响。方法 纳入45例60～85周岁双耳听力对称老年人,根据平均纯音听阈（pure-tone average,PTA）分为老年听力正常组（PTA<20 dB HL）、老年轻度听损组（20≤PTA<35 dB HL）、老年中度听损组（35≤PTA<50 dB HL）,每组15人,并匹配15例听力正常青年人作对照。采用角度偏差法对所有受试者进行水平方位声源定位能力测试,刺激声为白噪声,持续时间为500ms,声强为65 dB SPL,扬声器位置包括±90°、±45°和0°共5个方位。刺激声随机播放30次,要求受试者指出播放声源的扬声器编号,计算均方根误差（root-mean-square error, RMSE）作为结果。采用单因素方差分析比较各组受试者声源定位能力差异,重复测量方差分析对比不同位置声源定位表现差异,Pearson相关性分析检验声源定位与听力损失的关系。结果 老年人声源定位RMSE与听力损失程度显著相关（r=0.76, P<0.001）。老年三组和青年组受试者声源定位RMSE比较差异具有...     

听觉口语法的关键在于家长深度参与

听力损失是常见的新生儿先天性异常。据调查,我国每年因遗传、药物中毒和意外伤害等原因新产生听力损失儿童近3万名。这些儿童大多有残余听力,如及早进行听力补偿或重建,给予科学、系统的听力语言康复训练,是可以开口     

Dichotic sentence identification test in Portuguese: a study in young adults

IntroductionAmong the currently-applied auditory processing tests, dichotic listening tests have been widely used, since they allow investigating the hemispheric and inter-hemispheric function and their respective skills to process the received auditory information.ObjectiveTo obtain normality reference measures with the new dichotic sentence identification test in right-handed adults with normal hearing.MethodsQuantitative, observational, cross-sectional study. 72 subjects were assessed, aged 19–44 years, right-handed, with normal hearing, without hearing complaints. The dichotic sentence identification test consists of different lists of sentences, which were combined two by two and presented at the same time, using earphones in both ears, at 50 dB Sensation Level. The test was applied in four stages: training of the 3 stages, free attention, right and left directed attention, thus evaluating different auditory skills.ResultsIn the free attention task, the average percentage of correct answers in the right ear was 93.59% and in the left ear 86.06%, with a statistically significant difference between the ears, with an advantage for the right ear. In the directed attention task, the average percentage of correct answers was 99.37% in the right ear and 98.8% in the left ear, with no statistical difference between the ears.ConclusionIt is suggested, as a normality reference for the stage of free attention, 90%–100% for correct answers for the right ear and for the left ear, from 80% to 100%. When there is asymmetry between the ears, differences of up to 20% are expected, with an advantage for the right ear For the directed attention stage, the expected normality reference values ??are 100% for the right ear and for the left ear, with no asymmetry between the ears; however, if it occurs, a difference of 10% is expected between the ears, with an advantage for the right ear.     

Effects of Cadmium on the Hearing System

The functional resemblance between kidney proximal tubular and inner ear epithelial cells which has often been pointed out in the literature led us to hypothesize that nephrotoxic agents that cause renal tubular injury might also impair the function of inner ear cells. As one of the most toxic environmental nephrotoxic agents is cadmium, we aimed to study its effects on hearing experimentally in rats. In this study, increased blood and renal cortical cadmium levels were associated with high cadmium accumulation in ear ossicles and labyrinth in rats exposed to cadmium. The changes in auditory brainstem response (ABR) and otoacoustic emission in 2-month-old male rats exposed to drinking water containing 5 and 15 ppm CdCl₂ for 30 days showed that cadmium-induced nephrotoxicity was associated with signs of defective hearing at a concentration of 15 ppm CdCl₂ but that 5 ppm CdCl₂     

Ein Vorschlag zur gemeinsamen Genese von Hörverlust,Rekruitment und Ohrgeräuschen bei akuten Innenohrveränderungen

Summary Pathological changes on the stereocilia of cochlear hair cells observed by Bredberg et al. (1972) after noise exposure and in the early stages of antibiotic intoxication are suggested to cause a mechanical decoupling between the tectorial membrane and the hair cells. During acute episodes of endolymphatic hydrops a similar decoupling is suggested to occur, although for different reasons. Harris (1968) calculated the noise generated at the input to the hair cells on account of the Brownian motion of air particles in front of the tympanic membrane. For tight coupling, he obtained a level of (–)22 dB re auditory threshold. For loose coupling this noise was found to increase to +33 dB, i.e., for 55 dB. These two independent findings are used to account for the combination of hearing loss, recruitment, and tinnitus observed with the inner-ear pathologies mentioned. The proposed hypothesis is in good agreement with clinical observations.

Diese Arbeit wurde durch eine Reihe von N.I.H. grants unterstützt     

正常新生儿听性脑干反应测试结果分析

目的　分析新生儿听性脑干反应(auditorybrainstemresponses,ABR)的基本特征,为国内开展新生儿ABR检测及听力筛选提供依据。方法　对80名正常新生儿(160耳)的ABR测试结果进行分析,并与正常听力青年人测试结果进行比较。结果　130dBpeSPL强度短声刺激下,正常新生儿波Ⅰ、波Ⅲ、波Ⅴ的检出率均为100%。波Ⅴ反应阈为61.94±6.87dBpeSPL,显著高于正常听力青年人。新生儿波潜伏期和波间期均较正常听力青年人延长,波间期Ⅲ-Ⅴ/Ⅰ-Ⅲ比值显著低于正常听力青年人。结论　70dBpeSPL短声是较为适宜的新生儿ABR听力筛选的声刺激;性别及左、右耳差异不影响新生儿ABR筛选;新生儿听觉通路存在一个不断完善的成熟过程,但其脑干上、下部的发育并不是完全同步的。     

腭裂儿童ABR表现的初步研究

目的探索腭裂儿童听力受损情况及其听性脑干反应(ABR)异常特征。方法对94例腭裂儿童进行ABR测试,并与正常对照组进行比较。结果94例患儿(188耳)中,不同程度的听力下降共150耳。患儿左耳ABR波Ⅰ、Ⅲ、Ⅴ的峰潜伏期(PL)分别为2.14±0.38、4.30±0.41、6.20±0.53ms;右耳分别为2.12±0.39、4.29±0.44、6.21±0.53。对照组左耳波Ⅰ、Ⅲ、Ⅴ的峰潜伏期分别为1.50±0.13、3.74±0.12、5.60±0.15ms;右耳分别为1.60±0.16、3.72±0.13、5.62±0.17ms。上述所有数据,患儿组与对照组比较,差异均有显著性(P<0.05)。＜3岁的28例听力下降的发生率为94.6%(53/56耳),中重度异常占66.7%;3～6岁的发生率为77.0%(57/74耳),6岁以上至12岁的发生率为69.0%(40/58耳),3岁以后听力中重度异常仅占33.3%。结论腭裂组听力下降发生率高达79.8%;其ABR的特点为波Ⅰ、Ⅲ、Ⅴ波的峰潜伏期均延长;腭裂组年龄越小的,听力损害发生率越高,听力损害程度越重。     

Auditory neuropathy: endocochlear lesion or temporal processing impairment? Implications for diagnosis and management

BACKGROUND/OBJECTIVE: Auditory neuropathy/dys-synchrony, characterized by absent auditory brainstem responses, normal otoacoustic emissions or cochlear microphonics, and word discrimination disproportional to the pure-tone audiogram, may be accompanied by perceptual consequences that could jeopardize language acquisition in affected children. However, the related evidence is constantly changing leading to a serious debate. The aim of the present paper is to review the current knowledge on auditory neuropathy/dys-synchrony, and to present the therapeutic strategies that can be employed in its management, taking into account the potentially underlying pathophysiology. MATERIALS/METHODS: Literature review from Medline and database sources. Related books were also included. STUDY SELECTION: Controlled clinical trials, prospective and retrospective cohort studies, nested-based case-control and analytical family studies, laboratory and electrophysiological studies, animal models, case-reports, joint statements and review articles. DATA SYNTHESIS: Auditory neuropathy/dys-synchrony, in contrast to what is widely believed, is a very frequent disease, responsible for approximately 8% of newly diagnosed cases of hearing loss in children per year. Hyperbilirubinemia and hypoxia represent major risk factors, whereas generalized neuropathic disorders, or a genetic substrate involving the otoferlin gene, are responsible for the phenotype of auditory neuropathy/dys-synchrony in certain cases. Auditory nerve myelinopathy and/or desynchrony of neural discharges are the most probable underlying pathophysiologic mechanisms. Genetic testing may be helpful in cases of non-syndromic prelingual children. Auditory neuropathy/dys-synchrony management aims at restoring the compromised processing of auditory information, either through conventional amplification and/or alternative forms of communication, or by cochlear implantation (combined with intensive speech and language therapy). CONCLUSION: Auditory neuropathy/dys-synchrony is more frequent than considered in the past, especially amongst hearing-impaired children. Accurate diagnosis, based on subjective and objective hearing assessment techniques (including the various electrophysiological assessment measures), and timely treatment of the affected children is of paramount importance, with hearing aids, intensive speech and language therapy (and sign language when indicated) providing the mainstay of habilitation, and cochlear implantation representing a valid therapeutic alternative.     

听力损失与突发性聋预后的关系

目的：探索听力损失对突发性聋预后的影响。方法:对146例（167耳）突聋患者的临床资料进行回顾性分析，应用SAS 统计软件对纯音听阈情况与预后的关系进行统计学处理。结果:单因素分析显示，初诊时听力损失曲线为全聋型，纯音高频听阈（4?000?Hz及8?000?Hz）损失较重，高频听阈（4?000?Hz+8?000?Hz）大于低频(250?Hz+500?Hz)听阈的患者预后不佳；多因素分析显示，8?000?Hz的听阈水平与预后关系最为密切，其次为4?000?Hz听阈及听力损失类型。结论：从单、多因素分析的结果可以看出，对突聋应采用多因素逐步分析的方法进行研究，以使预后和疗效评估更具准确性和客观性；高频听力损失程度是突发性聋预后的一个可靠评估因素。     

Case report: "auditory neuropathy" in a newborn caused by a cerebellopontine angle arachnoid cyst

We present a 6-week-old girl, referred because of failed newborn hearing screening in the right ear. Click-evoked oto-acoustic emissions were present in both ears, auditory brainstem responses (ABR) were present in the left but totally absent in the right ear. A magnetic resonance imaging (MRI) study revealed a large arachnoid cyst in the right cerebellopontine angle (CPA) and a diagnosis of “auditory neuropathy/auditory dyssynchrony” was established. A microsurgical resection of the cyst wall and fenestration was performed by a retro sigmoid approach. This is the first case in the literature of auditory neuropathy (AN) in an infant caused by a cerebellopontine angle arachnoid cyst.     

Threshold changes of ABR results in toddlers and children

IntroductionAuditory brainstem response (ABR) is a clinically established method to identify the hearing threshold in young children and is regularly performed after hearing screening has failed. Some studies have shown that, after the first diagnosis of hearing impairment in ABR, further development takes place in a spectrum between progression of hearing loss and, surprisingly, hearing improvement.ObjectiveThe aim of this study is to evaluate changes over time of auditory thresholds measured by ABR among young children.Material and MethodsFor this retrospective study, 459 auditory brainstem measurements were performed and analyzed between 2010 and 2014. Hearing loss was detected and assessed according to national guidelines. 104 right ears and 101 left ears of 116 children aged between 0 and 3 years with multiple ABR measurements were included. The auditory threshold was identified using click and/or NB-chirp-stimuli in natural sleep or in general anesthesia. The frequency of differences of at least more than 10 dB between the measurements was identified.ResultsIn 37 (35%) measurements of right ears and 38 (38%) of left ears there was an improvement of the auditory threshold of more than 10 dB; in 27 of those measurements more than 20 dB improvement was found. Deterioration was seen in 12% of the right ears and 10% of the left ears. Only half of the children had stable hearing thresholds in repeated measurements. The time between the measurements was on average 5 months (0 to 31 months).ConclusionHearing threshold changes are often seen in repeated ABR measurements. Therefore multiple measurements are necessary when ABR yields abnormal. Hearing threshold changes should be taken into account for hearing aid provision.