天麻素对噪声性耳蜗损伤防护作用的实验研究

目的观察天麻提取液-天麻素对噪声性耳蜗损伤的防护作用.方法豚鼠28只随机分成3组,正常组8只、噪声组10只和天麻素组10只,暴露于噪声的同时加用天麻素.所有豚鼠均作ABR、耳蜗基底膜铺片和扫描电镜观察.结果噪声组(64.37dB)和天麻素组(31.25dB)ABR阈值均显著高于正常组(20dB),但天麻素组显著低于噪声组(P＜0.01).天麻素组耳蜗毛细胞和静纤毛损害均轻于噪声组.结论天麻素能降低豚鼠噪声暴露后的ABR阈值,减轻毛细胞损害,对噪声性耳蜗损伤有防护作用.     

氢气对噪声性聋的有效防护时间及机制研究

目的 近年研究表明氢气对噪声性聋具有良好的预防作用,但其对噪声性聋预防作用持续时间尚不明确,本实验通过建立豚鼠噪声性聋模型探索氢气预防作用持续时间及防护机制.方法 选用听力正常的豚鼠30只,随机等分为氢气组和噪声组,氢气组在首次脉冲噪声暴露前给予1h氢气吸入,两组动物随后每隔两小时重复施加脉冲噪声(峰值声强为163dB...     

噪声引起的耳蜗显微和超微结构损伤

噪声引起的听力损伤是部队常见的职业性伤害和致残因素,为探索噪声引起的病理机理。应用光学显微镜、透射和扫描电子显微镜观察技术,从显微、超微水平系统观察和研究噪声引起的耳蜗损伤。实验结果发现噪声暴露后对耳蜗螺旋器的影响,首先引起机械性损伤,继而引起代谢性损伤。噪声可以引起耳蜗内、外毛细胞静纤毛倒伏、散乱、部分或全部脱落。代谢性变化可见内、外毛细胞静纤毛融合、气球样改变、团状改变及静纤毛缺失等。噪声引起的耳蜗毛细胞变化,是以外毛细胞改变为主,可见细胞体变形、肿胀、细胞质均质化。细胞核位移、核固缩、核碎裂、核溶解,细胞消失,数量减少。强噪声和连续噪声暴露也可引起内毛细胞的病理改变和消失。透射电镜下观察到毛细胞质的多泡体,Hensen体和溶酶体增多,细胞质空泡形成引起细胞肿胀。强噪声暴露后不但引起耳蜗螺旋器内、外毛细胞的缺失,而且还可以引起Deiters细胞和内、外柱细胞的缺失,网状板破裂、Corti器塌陷、崩解、立方上皮或扁平上皮细胞移行替代毛细胞等。进一步的损伤可以引起耳蜗神经纤维逆行退行性变,耳蜗螺旋神经节细胞变性和缺失。文章就噪声损伤的程度、范围和分级及定量分析进行了描述,讨论了耳蜗组织细胞显微和超微结构的变化,以及它们与听力变化的关系,进一步探讨了噪声损伤的早期变化及其发生机制。探索军事噪声引起的耳聋机理,为防聋治聋提供了实验和理论依据。     

耳蜗性聋患者在噪声竞争下言语测听的探讨

为了观察耳蜗性聋患者噪声竞争下言语清晰度曲线与正常听力者的区别，不同噪声对清晰度曲线的不同影响，以及该测试方法对听力障碍的评价能力。文中报道了２９名耳蜗性聋，在３种不同噪声竞争下测得的言经结果。     

噪声对耳蜗损伤机理

噪声性耳聋是常见的后天获得性感音神经性耳聋之一,其主要损害部位是耳蜗,但噪声对耳蜗的损害机理仍不清楚。本文就目前噪声对耳蜗损伤的有关机理的研究进展作一简要阐述。     

噪声对耳蜗损伤机理

噪声性耳聋是常见的后天获得性感音神经性耳聋之一，其主要损害部位是耳蜗，但噪声对耳蜗的损害机理仍不清楚。本文就目前噪声对耳蜗损伤的有关机理的研究进展作一简要阐述。     

噪声性耳聋与耳蜗血管纹萎缩关系的研究

耳蜗血管纹萎缩可能对噪声有易感性，为探索耳蜗血管纹萎缩与噪声性耳聋之间的关系，利用耳蜗血管纹萎缩的豚鼠模型，进行噪声暴露后观察：①用ＡＢＲ检测耳蜗听觉功能的损害；②利用耳蜗铺片观察Ｃｏｒｔｉ器毛细胞的缺失。结果发现：①耳蜗血管纹萎缩较长组听阈升高；②耳蜗血管纹萎缩较长组噪声对耳蜗听功能损害加重，毛细胞的缺失也明显加重。提示：耳蜗血管纹萎缩较长者对噪声的损害有易感性，正是噪声对耳蜗损害个体差异的原因。通过听阈检测，有可能筛选出对噪声易感的个体。     

氢气选择性抗氧化作用在内耳急性损伤防治中的作用

氧化应激产生的活性氧(Reactive Oxygen Species,ROS)过量参与了包括噪声性听力损伤、药物性聋在内的内耳急性损伤过程。近年来研究表明,氢气是一种安全有效的抗氧化剂,可以迅速到达患处与氧化性较强活性氧进行反应,并有效对抗氧化应激。氢气的选择性抗氧化作用可能与降低氧化应激,减轻细胞凋亡,以及调节细胞信号通路相关。研究氢气的抗氧化作用为治疗内耳急性损伤性疾病提供了新思路。本文就氢气在选择性抗氧化作用及其可能的作用机制,以及氢气在内耳急性损伤防治中的研究进展等方面进行综述。     

神经营养因子对噪声引起豚鼠耳蜗外毛细胞损伤的防护作用

目的 定量观察胶质细胞源性神经营养因子(glial cell ine-derived neurotrophic factor,GDNF)和神经营养-3(neurotrophin-3,NT-3)对噪声引起豚鼠耳蜗外毛细胞损伤的防护作用。方法 将微渗透压泵埋置于豚鼠背部,经固定于耳蜗底回鼓阶内的改良微导管将GDNF(100ng/ml)和NT-3(2.5μg/ml)的混合液缓慢注入12只豚鼠左侧内耳,以左侧内耳灌注人工外淋巴液的9只豚鼠为对照,检测噪声暴露后豚鼠听功能和耳蜗外毛细胞形态、数量的变化。结果 噪声暴露10天后,实验组手术耳和非手术耳的脑干诱发电反应阈值低于对照组(P<0.05,p<0.01)。毛细胞表皮板和纤毛肌动蛋白荧光染色计数发现,实验组手术耳和非手术耳的外毛细胞缺失率低于对照组(p<0.001,p<0.01)。毛细胞核荧光染色计数发现,实验组手术耳和非手术耳的外毛细胞核肿胀率低于对照组(p<0.01,p<0.01)。结论 GDNF和NT-3对噪声引起豚鼠耳蜗外毛细胞损伤具有较好的防护作用。     

JNK抑制剂CEP-1347对噪声损伤耳蜗的保护作用及意义

目的 探讨JNK抑制剂CEP-1347对噪声损伤耳蜗的保护作用及意义。方法 27只wistar大鼠随机分成3大组,A组：噪声组,B组：噪声＋CEP 1347组,C组：噪声＋盐水组,分别给予噪声暴露,B组在噪声暴露前给予皮下注射CEP-1347;C组同时间皮下注射等量生理盐水。在噪声暴露后的1、4及14d分别测试各组的ABR阈值,同时检测外毛细胞的凋亡情况。结果 ABR阈值及外毛细胞凋亡数显示B组在1d时与A组比较差异无统计学意义（P>0.05）,4d时听力较A组差异有统计学意义（P<0.05）,用药后第14d听力与A组比较差异有统计学意义（P<0.01）;C组在各时间点与A组比较差异无统计学意义（P>0.05）。结论 应用JNK抑制剂CEP-1347进行干涉,可以减轻噪声造成的听力损失,JNK抑制剂的开发可能会成为NIHL防治的一个新的靶点和方向。     

Detailed Analysis of Auditory Brainstem Responses in Patients with Noise-induced Tinnitus

The role of the auditory brainstem in tinnitus is questionable. This study aimed comprehensively to assess auditory brainstem responses (ABRs) in patients suffering from noise-induced tinnitus (NIT). ABRs were recorded from 13 chronic NIT patients (21 ears) and 11 (21 ears) age and hearing matched control subjects without tinnitus. ABRs were recorded with scalp electrodes placed ipsilateral and contralateral to the stimulated ear, and in three orthonormal differential configurations. The ABRs were analyzed as a function of time, frequency and voltage space. A significantly enhanced ipsilaterally recorded, time domain wave III amplitude was observed for the tinnitus patients. This finding was not confirmed by any of the other ABR measures, which were indistinguishable between subject groups. Although this may be a spurious result, it nonetheless may point to an alteration in the functioning of the putative wave III auditory brainstem generator, which deserves further study.     

不同噪声暴露次数对C57小鼠听功能影响的研究

目的通过噪声暴露构建C57小鼠不同程度的耳聋模型。方法听力正常小鼠随机分成对照组A,一次噪声暴露组B,二次暴露组C和三次暴露组D,白噪声100dBSPL持续2小时,二次和三次噪声暴露为隔日给声。噪声暴露组分别在噪声暴露前,和最后一次噪声暴露后的第1天,第7天和第14天进行ABR阈值测试,第14天Ⅰ波振幅测试和耳蜗组织切片,HE染色进行毛细胞和螺旋神经节细胞计数。结果噪声暴露后第1天和第7天ABR阈值有明显升高,但B组第7天已经呈现恢复状态,而C、D组则呈现渐进性加重趋势。第14天时,B组阈值已经完全恢复,而C、D组小鼠未能完全恢复正常。ABRI波振幅在B、C、D组均有不同程度的降低。各组小鼠耳蜗内毛细胞和螺旋神经节细胞计数无明显差异,单次噪声暴露外毛细胞无明显损失,但随暴露次数增多,损失逐渐加重。结论通过不同次数的噪声暴露,可以构建稳定的C57小鼠的隐匿性听力损失和噪声性耳聋动物模型。     

A longitudinal study of changes in evoked otoacoustic emissions and pure-tone thresholds as measured in a hearing conservation program

Non-linear transient-evoked otoacoustic emissions (TEOAEs) at 74 dB pSPL, distortion-product otoacoustic emissions (DPOAEs) at 65/45 dB SPL and pure-tone audiometry were used to detect noise-induced, inner ear changes in a longitudinal study. Repeated-measures ANOVAs were made on the Noise (n=69) and Quiet (n=42) groups. The Noise group's hearing thresholds increased by 1.2 dB and DPOAE amplitude decreased by ?0.9 dB. For both groups, TEOAE amplitude decreased by approximately ?0.6 dB. Eight of 12 ears with permanent threshold shift (PTS) and 10 of 13 ears with temporary threshold shift (TTS) showed TEOAE decrements or low baseline TEOAE amplitudes. Fewer TTS and PTS ears also showed DPOAE decrements, and there was never a DPOAE decrement without a corresponding TEOAE decrement or low TEOAE baseline. Some TTS ears showed permanent emission decrements. Although otoacoustic emissions show promise in detecting noise-induced inner ear changes, it is premature to use them in hearing conservation programs.     

NLRP3炎性小体在变应性鼻炎中的作用

变应性鼻炎（AR）是一种以免疫球蛋白E （IgE）介导的多种免疫细胞、细胞因子和炎症介质等参与的鼻黏膜非感染性炎性反应性疾病,鼻腔黏膜炎症反应是AR的重要病理机制之一。核苷酸结合寡聚化结构域（NOD）样受体蛋白3（NLRP3）炎性小体活化诱导半胱氨酸蛋白酶1（caspase-1）前体转化,促进炎症细胞因子白介素1β（IL-1β）和白介素18（IL-18）表达,参与AR的炎性级联反应过程,对AR的发生发展起促进作用,应用NLRP3炎性小体相关通路抑制剂可抑制下游炎性细胞因子表达,减轻AR症状。本文围绕NLRP3炎性小体在AR中的作用及调控机制,和适用于AR治疗的NLRP3炎性小体相关通路抑制剂的研究进行综述如下。     

Effect of Hearing Rehabilitation Therapy Program in Hearing Aid Users: A Prospective Randomized Controlled Study

ObjectivesDespite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement.MethodsIn this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups.ResultsAfter completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (P<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups.ConclusionEven after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.     

Surgical and Audiologic Comparison Between Sophono and Bone-Anchored Hearing Aids Implantation

Objectives Bone-anchored hearing aids (BAHA) occasionally cause soft tissue problems due to abutment. Because Sophono does not have abutment penetrating skin, it is thought that Sophono has no soft tissue problem relating to abutment. On the other hand, transcutaneous device’s output is reported to be 10 to 15 dB lower than percutaneous device. Therefore, in this study, Sophono and BAHA were compared to each other from surgical and audiological points of view.Methods We retrospectively reviewed the medical records of 9 Sophono patients and 10 BAHA patients. In BAHA cases, single vertical incision without skin thinning technique was done. We compared Sophono to BAHA by operation time, wound healing time, postoperative complications, postoperative hearing gain after switch on, and postoperative air-bone gap.Results The mean operation time was 60 minutes for Sophono and 25 minutes for BAHA. The wound healing time was 14 days for Sophono and 28 days for BAHA. No major intraoperative complication was observed. Skin problem was not observed in the 2 devices for the follow-up period. Postoperative hearing gain of bilateral aural atresia patients was 39.4 dB for BAHA (n=4) and 25.5 dB for Sophono (n=5). However, the difference was not statistically significant. In all patients included in this study, the difference of air-bone gap between two groups was 16.6 dB at 0.5 kHz and 18.2 dB at 4 kHz. BAHA was statistically significantly better than Sophono.Conclusion Considering the audiologic outcome, BAHA users were thought to have more audiologic benefit than Sophono users. However, Sophono had advantages over BAHA with abutment in cosmetic outcome. Sophono needed no daily skin maintenance and soft tissue complication due to abutment would not happen in Sophono. Therefore, a full explanation about each device is necessary before deciding implantation.     

儿童突发性感音神经性听力损失的诊治体会

对18例20耳8～14岁突发性感音神经性听力损失患儿的临床资料进行了总结和分析,结果表明儿童突发性感音神经性听力损失发病与首诊之间病程较长,部分患儿有上感、流行性腮腺炎病史,可能和听力损失发生有关.儿童突发性感音神经性听力损失治疗效果类似于成人患者,而全聋者疗效差.东菱克栓酶同样适于治疗儿童突发性感音神经性听力损失且疗效和安全性较好,无明显的出血倾向和其它并发症.     

Noise-induced hearing loss in young adults: The role of personal listening devices and other sources of leisure noise

Concept: No consensus exists regarding the magnitude of the risk of noise-induced hearing loss (NIHL) associated with leisure noise, in particular, personal listening devices in young adults. Objective: Examine the magnitude of hearing loss associated with personal listening devices and other sources of leisure noise in causing NIHL in young adults. Study Design: Prospective auditory testing of college student volunteers with retrospective history exposure to home stereos, personal listening devices, firearms, and other sources of recreational noise. Methods: Subjects underwent audiologic examination consisting of estimation of pure-tone thresholds, speech reception thresholds, and word recognition at 45 dB HL. Results: Fifty subjects aged 18 to 30 years were tested. All hearing thresholds of all subjects (save one—a unilateral 30 dB HL threshold at 6 kHz) were normal, (i.e., 25 dB HL or better). A 10 dB threshold elevation (notch) in either ear at 3 to 6 kHz as compared with neighboring frequencies was noted in 11 (22%) subjects and an unequivocal notch (15 dB or greater) in either ear was noted in 14 (28%) of subjects. The presence or absence of any notch (small or large) did not correlate with any single or cumulative source of noise exposure. No difference in pure-tone threshold, speech reception threshold, or speech discrimination was found among subjects when segregated by noise exposure level. Conclusion: The majority of young users of personal listening devices are at low risk for substantive NIHL. Interpretation of the significance of these findings in relation to noise exposure must be made with caution. NIHL is an additive process and even subtle deficits may contribute to unequivocal hearing loss with continued exposure. The low prevalence of measurable deficits in this study group may not exclude more substantive deficits in other popu lations with greater exposures. Continued education of young people about the risk to hearing from recreational noise exposure is warranted.