老年性聋患者普通话快速噪声下言语测试及评估

目的评估老年性聋患者噪声下言语识别能力,探讨年龄、听力损失程度、认知功能对其噪声下言语识别能力的影响。方法选取2018年10月~2020年4月就诊的70例60岁及以上老年性聋患者为研究对象,按年龄分为60~69岁(20例40耳)、70~79岁(28例56耳)、≥80岁(22例44耳)三组,各组分别进行纯音听阈测试、简易智能精神状态量表(mini-mental state examination,MMSE)评估及普通话快速噪声下言语测试(Mandarin quick speech-in-noise test,M-Quick SIN),分别获得双耳0.5、1、2、4 kHz纯音平均听阈(pure-tone audiometry,PTA)、MMSE量表总得分及双耳信噪比损失(signal-to-noise ratio loss,SNR loss);分析年龄、平均听阈、MMSE量表得分对信噪比损失的影响。结果①60~69岁组SNR loss(5.25±5.42)dB明显小于70~79岁组(11.54±6.05)dB和≥80岁组(11.86±6.06)dB(P<0.01);70~79岁组和≥80岁组间SNR loss差异无统计学意义(P>0.05)。②SNR loss随PTA提高而升高,各组间差异均有显著统计学意义(P<0.01)。③MMSE量表得分对SNR loss的主效应不显著(P>0.05)。结论年龄、听力损失程度为老年性聋患者噪声下言语识别的主要影响因素;在一定范围内随着年龄增加,听力损失加重,其噪声下言语识别能力降低。     

老年性聋患者认知功能障碍初探

目的 分析老年性聋患者认知功能障碍情况,初步探讨老年性聋患者认知功能障碍的干预措施。方法 以2018年10月-2020年4月于空军特色医学中心行听力测试及言语识别能力调查的55例60岁及以上老年性聋患者为研究对象,其中男27例,女28例;年龄60~95岁。所有研究对象完成纯音听阈测试（PTA）、简易智能精神状态量表（MMSE）评估及普通话快速噪声下言语测试（M-Quick SIN）,分析不同年龄、不同听力损失程度和信噪比损失（SNR loss）程度下老年性聋患者的MMSE得分情况。结果 ①60~69岁组MMSE得分（27.89±1.82）分,高于70~79岁组（26.35±2.03）分和≥ 80岁组（25.19±2.07）分的得分,差异具有统计学意义（P<0.05）;70~79岁组和≥ 80岁组间MMSE量表得分的差异不具有统计学意义（P>0.05）;②不同听力损失组间MMSE量表得分的差异不具有统计学意义（P>0.05）;③轻度SNR loss组的MMSE量表得分（27.13±1.80）分高于重度SNR loss组（24.20±1.64）分（P<0.05）;轻度SNR loss组和中度SNR loss组、中度SNR loss组和重度SNR loss组间MMSE量表得分的差异不具有统计学意义（P>0.05）。结论 老年性聋患者认知功能障碍以SNR loss为主要特征,在听力损失早期进行干预是最佳时机。     

老年性聋患者噪声下言语识别能力的评估

目的 评估老年性聋患者噪声下言语识别能力,探讨年龄、听力损失程度、认知功能对噪声下言语识别能力的影响。方法 以90例60岁以上老年性聋者为受试者,按年龄分为三组,60~69岁(44例88耳)、70~79岁(32例64耳)、>79岁(14例28耳),完成纯音听阈测试、普通话噪声下言语测试(Mandarin hearing in noise test,MHINT)及简易智能精神状态量表(mini-mental state examination,MMSE)评估,分别获得0.5、1、2、4kHz平均听阈、MHINT自适应信噪比及MMSE量表总得分;分析年龄、平均听阈、自适应信噪比及MMSE量表得分之间的相关性。结果 1平均听阈、MHINT信噪比随年龄增长而提高,不同年龄组间的平均听阈、MHINT信噪比差异有统计学意义(P<0.01);2不同程度听力损失组间的MHINT信噪比差异显著(P<0.01),控制认知得分的情况下其差异仍然有统计学意义(P<0.01),且平均听阈与MHINT信噪比具有显著的直线相关性(r=0.326,P<0.01),随着受试者平均听阈提高,MMSE得分下降,二者有直线相关性(r=-0.187,P<0.05);3MHINT信噪比与MMSE量表得分具有相关性(r=-0.201,P<0.01),认知功能减退组(<27分)的MHINT信噪比平均值较认知功能正常组(27~30分)显著增加(P<0.01);不同听力损失程度组中,认知功能正常组与减退组之间MHINT信噪比差异无统计学意义(P>0.05)。结论 噪声下言语测试可用于老年人听觉功能评估,老年性聋者的年龄、听力损失程度、认知功能与噪声下言语识别能力之间相互影响,评估老年人听觉功能时应考虑认知功能的影响。     

中文版老年听力障碍筛查量表评分与纯音听阈测试的比较研究

目的探讨中文版老年听力障碍筛查量表(hearing handicap inventory for the elderly-screening,HHIE-S)评分与纯音听阈测试的关联性与差异性,为该量表的临床应用提供依据。方法275例老年受试者(听力正常者47例、不同程度听力损失者228例)填写中文版HHIE-S量表获得评分,并进行纯音听阈测试,比较受试者中文版HHIE-S量表评分与较好耳500、1000、2000、4000 Hz纯音气导听阈平均值(PTA)之间的关联性与差异性。结果275例受试者中,PTA正常组47例,HHIE-S评分为无听力障碍者占80.85%(38/47);PTA轻度听力损失组101例,HHIE-S评分为轻中度听障者占38.61%(39/101);PTA中度听力损失组110例,HHIE-S评分为轻中度听障者占40.0%(44/110);PTA重度听力损失组17例,HHIE-S评分为重度听障者占82.35%(14/17)。HHIE-S与纯音听阈测试结果的Kappa系数为0.210(P<0.001)。HHIE-S评分与PTA的Pearson相关系数r为0.722(P<0.001)。以PTA≤25 dB HL为听力正常、HHIE-S评分≤8分表示无听力障碍,HHIE-S量表的敏感性为61.0%,特异性为80.9%,阳性预测值为93.9%,阴性预测值为29.9%。结论HHIE-S量表与纯音听阈测试既有较好的关联性,又有差异性,二者联合应用可以全面评估老年人的听力状况。     

周围听功能障碍与认知障碍程度的相关性研究

目的探讨周围性听功能障碍程度与认知障碍程度之间的关系。方法利用临床痴呆量表(clinicdementiarating, CDR)检测轻度认知障碍(mildcognitiveimpairment,MCI)患者24例,轻度老年性痴呆(Alzheimer′sdisease, AD)患者31例,健康老年人50例,评定受试者测听可信度,统计测试结果,并将其得分同受试者的纯音测听、言语测听、声导抗、听觉脑干反应(auditorybrainstemresponse, ABR)结果进行对照分析,寻找二者之间的关系。并进一步将受试者按其听力损失程度分成4级(纯音听阈<25dB为0分, 25~30dB为1分, 31~35dB为2分, >35dB为3分),分别依其CDR得分不同(正常人0分,MCI患者0 5分,轻度AD患者1分),应用Kendalls等级相关法分析。结果受试者2耳间听力差异无统计学意义,以右耳听力结果进行统计,发现MCI组周围听功能检查结果与对照组之间的差异无统计学意义(P>0 05),轻度AD组听力障碍与其他两组相比差异有统计学意义,且发现随着听力损失的加重,轻度AD患者的CDR得分也明显增加(Kendallstaub=-0 285, P=0 018)。而测听可信度、声导抗和ABR阈值两组间差异无统计学意义(P>0 05 )。结论MCI患者与正常老年聋纯音测听、言语测听结果相似,轻度AD患者与MCI及正常对照组相比差异有显著性,受试者听力障碍程度与其CDR量表得分呈正相关(     

成人听力障碍筛查量表和噪声下数字言语测试在听力损失患者中的应用[论著]

目的　研究成人听力障碍筛查量表（hearing handicap inventory for adult-screening,HHIA-S）、噪声下数字言语测试（digits in noise,DIN）与听力损失的相关性,分析HHIA-S与DIN在听力损失诊断中的灵敏度和特异度。方法　本研究招募听力正常者29名、感音神经性听力损失患者38例,按双耳纯音听阈平均值PTA0.5～4 kHz分为轻度组19例,中度组10例,重度组9例,依次完成纯音听阈测试、声导抗测试、听力损失自我报告、HHIA-S量表以及DIN测试。采用线性相关分析HHIA-S得分、DIN阈值与纯音听阈平均值的相关性,采用受试者工作特性曲线（receiver operating characteristic,ROC）及曲线下面积（area under the curve,AUC）确定DIN在最佳诊断截点下的灵敏度和特异度。结果  ①本组受试者HHIA-S得分、DIN阈值与纯音平均听阈PTA0.5～4 kHz之间均呈显著相关性（P <0.01）;②将HHIA-S得分＞8分定义为存在听力障碍,结果显示HHIA-S量表发现听力损失的灵敏度为0.684,特异度为0.967;③DIN的最佳诊断截点（cut-off）为-16.1 dB,判断听力损失的灵敏度为0.894,特异度为1,均高于HHIA-S量表及听力损失自我报告。结论　DIN作为一种快速、有效且经济、便捷的听力筛查手段,其灵敏度和特异度均高于成人听力障碍筛查量表及听力损失自我报告。     

不同程度感音神经性听力损失儿童的Chirp-ASSR测试结果分析

目的 观察不同程度感音神经性听力损失儿童Chirp声听性稳态反应(Chirp auditory steady-state responses,Chirp-ASSR)的特点,探讨Chirp-ASSR测试的临床意义.方法 对136例(272耳)5～10岁不同程度感音神经性听力损失儿童进行纯音听阈测试(pure tone audiometry,PTA)和Chirp-ASSR测试,根据500、1 000、2 000和4 000 Hz的平均听阈,将受试者分为四组,即20～dB HL组、40～dB HL组、60～dB HL组和≥80dB HL组,比较不同程度感音神经性听力损失儿童各频率纯音听阈与Chirp-ASSR反应阈的相关性.结果 ①纯音听阈≥80 dB HL组的Chirp-ASSR反应阈值比纯音听阈值高,差异有统计学意义(P＜0.05).②PTA和Chirp-ASSR的相关系数γ随着听力损失程度加重而逐渐降低,随着测试频率的增加有增大的趋势,在500 Hz和4 000 Hz之间差异有统计学意义(P＜0.05).结论 Chirp-ASSR有频率特异性,能够较好的反映听力水平,特别在轻度、中度和重度感音神经性听力损失患者中更明显.     

驾驶人员畸变产物耳声发射检测与纯音听力测试相关性

目的 探讨畸变产物耳声发射(DPOAE)在检测驾驶人员听力损失的可行性和运用价值.方法 选择纯音听力测试听阈提高的驾驶人员作为检查组30例(60耳);正常体检人员作为对照组20例(40耳),分别进行纯音听力测试和DPOAE测试,比较两组结果.结果 检查组纯音听力测试2、4、8 kHz频率明显提高,与对照组比较差异有统计...     

老年听力障碍筛查量表在老年性聋调查中的应用与相关性分析

目的　探讨老年听力障碍筛查（h e a r i n g handicap inventory for the elderly-screening,HHIE-S）量表在老年人听力筛查中的应用价值,并分析其敏感性和特 异性。方法　对400例60岁以上老年人进行HHIE-S问卷调查及纯音听阈测试,以纯音测听较好耳的平均听阈,计算听力下降水平,分析HHIE-S在老年人听力筛查中的应用价值;依据世界卫生组织（WHO1997）听力障碍分级标准,并参照美国言语听力协会听力筛查指南标准,将HHIE-S量表得分＞８分定义为存在听力障碍,探讨HHIE-S量表对不同程度听力损失老年人听力筛查的敏感性和特异性及与纯音测听的相关性。结果　HHIE-S量表可以对老年人的听力障碍进行筛查,反映了听力下降对受试者生理和言语交流的影响。①HHIE-S量表敏感性分别是轻度听力损失65.70%、中度听力损失78.40%、重度听力损失98.90%。②HHIE-S量表特异性分别为轻度听力损失94.00%、中度听力损失82.80%、重度听力损失65.60%。③对听力损失阳性预测值分别为轻度98.70%、中度94.80%和重度51.10%;假阳性率分别为轻度6.00%、中度17.20%和重度34.40%;假阴性率分别为轻度34.30%、中度21.60%和重度1.10%。④HHIE-S量表与老年人听力损失程度相关系数分别为0.215、0.586和0.391（P 均<0.001）,有统计学意义。结论　HHIE-S量表简单易行,对于评估听力损失程度具有较高敏感性和特异性,与纯音测听有很好相关性,在老年人听力筛查中具有实 用性和有效性。     

单耳听力损失患者听力障碍量表评分与纯音听阈相关性研究

目的 探讨单耳听力损失(unilateral hearing loss, UHL)患者听力障碍量表(hearing handicap inventory, HHI)评分与纯音听阈的相关性及影响因素。方法 纳入本院门诊就诊未行助听干预的UHL患者56例，听力减退病程超过1个月，好耳气导听阈<20 dB HL,差耳听阈≥35 dB HL。采用病史调查表、视觉模拟量表(visual analog scale, VAS)及听力障碍量表了解患者听力、交流障碍程度，并与纯音听阈比较，分析其特征。结果 56例患者中，伴耳鸣患者27例(48.21%),自觉伴睡眠障碍者23例(41.07%),同时患有其他慢性病者26例(46.43%)。56例好耳平均听阈为10.99±4.31 dB HL,差耳平均听阈为66.32±26.21 dB HL,HHI平均得分20.36±15.41分，VAS平均得分3.64±2.34分。纯音听阈与HHI评分、VAS评分无明显相关性(P>0.05),HHI量表得分与VAS评分的相关系数为0.77(P<0.01)。HHI量表<17分(无听力障碍)者30例占5...     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.