ABR、40Hz-AERP和ASSR与主观纯音听阈测定的相关性研究

目的分析听性脑干反应(ABR)、40 Hz听觉相关电位(40 Hz-AERP)、多频稳态听觉诱发电位(ASSR)电反应阈与纯音测听各频率主观听阈的相关性。方法运用纯音测听、ABR、40 Hz-AERP、ASSR为一组测试组合,对55例(84耳)患者进行检测,分析ABR、40 Hz-AERP(500 Hz、1 kHz)、ASSR(500 Hz、1 kHz、2 kHz、4 kHz)客观电反应阈与纯音测听500 Hz、1 kHz、2k Hz、4 kHz的主观听阈的差值及相关性。结果 ABR与纯音测听2 kHz+4 kHz均值的相关系数最高,为0.829。40 Hz-AERP的500 Hz、1 kHz电反应阈与纯音测听500 Hz、1 kHz听阈的相关系数分别为0.507和0.667。ASSR 500 Hz、1 kHz、2 kHz、4 kHz的电反应阈与纯音相应频率听阈的相关系数分别为0.507、0.715、0.793和0.816。以上相关性均有统计学意义(P0.01)。84耳纯音测听听阈均值为39.8±22.9 dB HL, ABR、ASSR电反应阈均值分别为41.1±18.0 dB nHL和42.4±22.9 dB nHL,40 Hz-AERP/500Hz和1 kHz均值分别为39.5±18.0dB nHL和40.2±19.4 dB nHL。结论 ABR、40 Hz-AERP、ASSR电反应阈与纯音测听各频率主观听阈显著相关,测试结果准确可靠。测试组合可以推断听力曲线的形态,对不能主动配合完成主观测听的婴幼儿及伪聋患者的听力学的辅助诊断非常有价值。     

感音神经性聋儿多频稳态诱发电位及短纯音听性脑干反应与行为测听的相关性

目的 比较多频稳态诱发电位（MASSR）、短纯音听性脑干反应（Tb—ABR）与感音神经性聋儿行为测试听阈的差值．研究MASSR和Tb—ABR反应阈与行为听阈之间是否存在相关性以及在不同听力损失聋儿、不同的频率之间的差异。方法 对60名感音神经性聋儿分别测试MASSR和Tb—ABR反应阈和行为听阈，评价MASSR反应阈、Tb—ABR反应阈与行为听阈的相关性。结果 MASSR反应阈、Tb—ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时，对行为听阈的预测具有相似的、较高的准确性；但在频率为0．5、1kHz时，MASSR的准确性较Tb—ABR高。结论 MASSR和Tb—ABR均可用作感音神经性聋儿言语频率客观听阈的预测，为低龄儿童及难以检测行为听力的患儿提供诊断依据。     

正常青年人短纯音ABR和ASSR的相关性研究

目的比较正常青年人短纯音听性脑干反应（auditory brainstem response，ABR）和听性稳态反应（auditory steady-state response，ASSR）反应阈的差异及相关性。方法对10名（20耳）听力正常青年人进行短纯音ABR和ASSR反应阈测试，分别记录0．5．1、2和4 kHz的反应阈，比较这两种不同测试方法所得反应阈的特点及相关性。结果短纯音ABR和ASSR反应阈无显著性差异（P〉O．05），两者在0．5、1、2和4 kHz处的相关系数分别为0．49、0．52．0．64和0．76。结论正常青年人短纯音ABR反应阈和ASSR反应阈存在一定的相关性，高频处的相关性较低频好。     

多频听觉稳态反应与40Hz听相关电位对儿童客观听阈评估的比较

目的通过对感音神经性聋患儿的多频听觉稳态反应（multiple frequency auditory steady--state response，MFASSR）测试结果进行分析，并比较其在0．5 kHz处与40 Hz听相关电位（40Hz auditory event related potential，40 Hz AERP）对客观听阈评估的准确性，为MFASSR临床应用提供指导。方法对感音神经性聋儿进行纯音测听、ABR、40 Hz AERP和MFASSR测试。MFASSR与ABR、40 Hz AERP测试均在睡眠状态下进行。按照测试结果分为ABR未引出组与ABR引出组。结果①MFASSR在0．5 kHz处引出率比40 Hz AERP低。②0．5 kHz MFASSR反应阈对纯音听阈的评估较1、2、4 kHz MFASSR反应阈对纯音听阈的评估差。③以纯音听阈为标准，在0．5 kHz处MFASSR与40 Hz AERP对纯音听阈的评估差别具有统计学意义（P=0．001），说明，在0．5 kHz处MFASSR对纯音听阈评估的准确性不如40 Hz AERP。结论MFASSR反应阈对0．5 kHz处纯音听阈的预测需要结合40 Hz AERP来判断。     

游戏测听与听觉诱发脑干反应评估小儿听力

目的 通过对60例3～6岁感音神经性耳聋小儿听性脑干反应(auditory brainstem response,ABR)与小儿游戏测听(play audiometry,PA)测试结果比较,综合评估小儿听力.方法 选择60例3～6岁门诊患儿,均经声导抗测试及耳声发射测试排除传导性耳聋及听神经病,将60例3～6岁小儿120耳分别进行ABR测试.根据ABR测试结果.选择ABR波V反应阈为50～90 dB nHL的小儿30例为A组,ABR最大输出97 dB nHL未引出波V反应阚的小儿30例为B组;之后两组小儿分别进行游戏测听,将两组的ABR反应阈与游戏测听测试结果进行比较.结果 A组ABR的波V反应阈与小儿游戏测听中2 kHz～4 kHz最小听闻相差均无显著差异:B组ABR最大输出97 dB nHL未引出波V的小儿,游戏测听绝大部分均能获得行为听阈.结论 ABR的波V反应阈与小儿行为测听的高频听阈一致性较好;ABR最大输出97 dB nHL未引出波V的不等于无听力.     

听性稳态反应和短声诱发的听性脑干反应在客观听阈评估中的作用

目的探讨听性稳态反应(auditory steady-state responses,ASSR)和短声诱发听性脑干反应(ABR)在感音神经性聋人群客观听阈评估中的作用及其在耳聋鉴定中的价值。方法对感音神经性聋组(35耳)及正常组(22耳)分别进行纯音听阈、ABR及ASSR测试,并记录0.5、1、2及4kHz ASSR反应阈(dBHL)、纯音听阈(dBHL)及ABR反应阈(dBnHL)。结果正常组在0.5、1、2、4kHz的ASSR反应阈与纯音听阈相比差异无统计学意义(P>0.05),ABR反应阈与各频率纯音听阈差异有显著统计学意义(P<0.05);耳聋组各频率ASSR反应阈与纯音听阈差异无统计学意义(P>0.05),ABR反应阈与0.5kHz纯音听阈差异有统计学意义(P<0.05),与1、2、4kHz纯音听阈差异无统计学意义(P>0.05)。结论ASSR与ABR联合测试是临床工作中用于客观听阈评估的有效方法。     

感音神经性聋患儿的听功能综合评估

目的探讨听力测试组合（ABR＋ASSR＋声场环境中的行为测听）在感音神经性聋患儿残余听力评估中的应用价值。方法48名（96耳）感音神经性聋患儿中能配合纯音测听的患儿19人（38耳）设为PTA组,进行纯音测听及ASSR检测;不能配合纯音测听的患儿29人（58耳）设为BA组,进行声场环境中的行为测听（behavior audiometry,BA）、ABR及ASSR检测。结果①PTA组0．5、1、2、4kHz各频率ASSR反应阈与纯音听阈显著相关（P〈0．01）,各频率相关系数分别为0．75、0．76、0．76、0．83,建立本实验室的ASSR—PTA直线回归方程;②BA组23耳ABR无反应但仍可引出ASSR,而ASSR无反应耳ABR均未能引出;BA组29例患儿中ASSR检测反应较好耳（29耳）在0．5～4kHz四个频率上,ASSR可测得83个反应阈值,行为测听可测得89个反应阈值,综合ASSR和行为测听可以得到96个反应阈值。结论与单项听力测试方法相比,听力测试组合（行为测听＋ABR＋ASSR）能为更小年龄、听力损失更重的患儿进行残余听力的评估,同时能对双侧耳间听力差异、各频率的听力损失程度进行评估,为听力损失病变的定位判断提供参考。     

多频稳态诱发电位和听性脑干反应对感音神经性聋儿童客观听阈的评估

目的比较多频稳态诱发电位(MASSR)与短纯音听性脑干反应(Tb-ABR)对感音神经性聋儿童客观听阈的评估。方法对37名感音神经性聋儿童分别测试MASSR反应阈、Tb-ABR反应阈和行为听阈,参照行为听阈,比较MASSR反应阈和Tb ABR反应阈对行为听阈评估的准确性。结果MASSR反应阈、Tb-ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时,对行为听阈的评估具有相似的准确性;但在频率为0.5、1kHz时,MASSR的准确性较Tb ABR的准确性高。结论MASSR和Tb-ABR均可用作感音神经性聋儿童言语频率客观听阈的评估,但MASSR在低频(0.5、1kHz)时较Tb-ABR的准确性高。     

儿童有无平台短纯音诱发听性脑干反应研究

目的 比较有平台与无平台短纯音诱发的儿童听性脑干反应(Auditory Brain Stem Response,ABR)反应阈之间的相关性,选择更优化的频率特异性ABR刺激信号.方法 应用SmartEP听觉诱发电位仪(美国IHS公司)记录0～4岁儿童短声、有平台及无平台短纯音诱发ABR各频率反应阈,共26例(17男/9女)41耳.结果 0.5 kHz、1 kHz、2 kHz、4 kHz有平台短纯音ABR反应阈与无平台短纯音ABR反应阈的线性相关系数分别为0.949、0.968、0.979、0.936,前者比后者反应阈分别高(5.0±7.6)、(9.4±5.8)、(8.2±5.2)、(7.6±10.3)dB,差异有统计学意义(t值分别为3.397、8.060、7.915、3.682,P值均<0.01).极重度听力损失耳有平台短纯音各频率ABR反应阈值引出率均高于无平台短纯音.结论 本实验室应用SmartEP听觉诱发电位仪评估儿童听力时.总体上,在测试非极重度听力损失患儿时,无平台短纯音诱发ABR优于有平台短纯音;但本仪器后者可提供更高强度的声刺激,以用于极重度听力损失耳.     

短纯音及切迹噪声掩蔽的短纯音ABR用于儿童听力评估的研究

目的研究儿童短纯音（tone burst）及同侧切迹噪声（notched noise）掩蔽短纯音诱发的ABR反应阈,与短声诱发的听性脑干反应（click-evoked auditory brainstem response,c-ABR）以及40Hz听觉事件相关电位（40Hz Auditory Event Related Potentials,40Hz AERP）反应阈的关系,以评价这些测试方法在儿童听力评估中的应用价值。方法应用SmartEP听觉诱发电位仪在29例（53耳）儿童（男18例,女11例,年龄2月-8岁）中测试短声ABR、短纯音ABR、两种不同强度切迹噪声掩蔽短纯音诱发的ABR（分别定义为c-ABR、tb-ABR、amtb-ABR和bmtb-ABR）及40Hz AERP。结果（1）fb-ABR、amtb-ABR、bmtb-ABR在2kHz、4kHz两个频率的反应阈与c-ABR的反应阈接近,反应阈之间有较好的相关性;（2）tb-ABR、amtb-ABR、bmtb-ABR的反应阈与40Hz AERP的反应阈在0.5、1、2、4kHz各个频率均接近并有较好的相关性。结论使用短纯音及同侧切迹噪声掩蔽短纯音诱发的ABR的反应阈预测儿童的纯音行为听阈是可行的。     

Auditory steady state response in pediatric audiology

The main issue regarding pediatric audiology diagnosis is determining procedures to configure reliable results which can be used to predict frequency-specific hearing thresholds.AimTo investigate the correlation between auditory steady-state response (ASSR) with other tests in children with sensorineural hearing loss.MethodsProspective cross-sectional contemporary cohort study. Twenty-three children (ages 1 to 7; mean, 3 years old) were submitted to ASSR, behavioral audiometry, click audiometry brain stem response (ABR), tone burst ABR, and predicting hearing level from the acoustic reflex.Resultsthe correlation between behavioral thresholds and ASSR was (0.70- 0.93), for the ABR tone burst it was (0.73 -0.93), for the ABR click it was (0.83-0.89) only at 2k and 4 kHz. The match between the ASSR and the hearing threshold prediction rule was considered moderate.Conclusionthere was a significant correlation between the ASSR and audiometry, as well as between ABR click (2k and 4 kHz) and for the ABR tone burst. The acoustic reflex can be used to add information to diagnosis in children.     

Functional hearing loss in children

This report reviewed 39 school-age children diagnosed as having a functional hearing loss utilizing auditory brainstem response (ABR) audiometry during the past 5 years at the Department of Otolaryngology, Kyushu University Hospital in Japan. Twenty-seven cases were females and 12 were males. Seven cases had a hearing loss unilaterally and 32 bilaterally. Although pure-tone audiometry revealed a variety of audiogram shapes, two-thirds of the cases had a flat or saucer-shaped audiogram with a mild to moderately severe hearing loss. ABR audiometry for the frequencies of 1, 2 and 4 kHz indicated a normal hearing threshold in 65 ears of 35 patients, and mild threshold elevations of at least one frequency in the remaining 6 ears of 4 patients. Three illustrative cases were demonstrated, and a discussion was held regarding the features in audiometric tests, and environmental factors surrounding the children with this condition. We emphasized that the physiological hearing measurement such as ABR audiometry should be performed when any discrepancy was noted between the patient's history and results of pure-tone audiometry, because of not infrequent occurrence of functional hearing loss.     

Auditory steady-state responses for children with severe to profound hearing loss

OBJECTIVE: To investigate the clinical usefulness of the dichotic single-frequency auditory steady-state response (ASSR) for estimation of behavioral thresholds in children with severe to profound congenital sensorineural hearing loss. DESIGN: A comparative experimental research design was selected to compare behavioral and ASSR thresholds for the sample. Behavioral pure-tone audiometry served as the criterion standard. SETTING: Hearing Clinic, Department of Communication Pathology, University of Pretoria, Pretoria, South Africa. PATIENTS: A referred sample of 10 patients (20 ears), 5 girls and 5 boys aged 10 to 15 years (mean age, 13 years 4 months), with severe to profound sensorineural hearing impairment. MAIN OUTCOME MEASURES: The difference, and correlation, between 160 pure-tone behavioral and ASSR thresholds at 0.5, 1, 2, and 4 kHz. RESULTS: Mean differences between ASSR and behavioral thresholds were 6 dB for 0.5 kHz and 4 dB for 1, 2, and 4 kHz, with standard deviations varying between 8 and 12 dB. No significant differences (P<.05) were observed between ASSR and behavioral thresholds, except at 0.5 kHz, and Pearson correlation coefficients varied between 0.58 and 0.74 across the evaluated frequencies, with best correlation at 1 kHz and worst at 0.5 kHz. CONCLUSIONS: The ASSR thresholds provided reliable estimations of behavioral thresholds for children with severe to profound hearing loss and indicated an increased sensitivity for more profound hearing loss.     

The pure-tone hearing thresholds of otologically healthy 14-year-old children

The mean pure-tone air conduction (AC) and bone conduction (BC) hearing thresholds (HT) of 534 randomly selected, caucasian, white, urban children with normal otoscopy, otomicroscopy and impedance audiometry, i.e. normal middle ear function, are presented here. Children with pathological middle ear findings or abnormal impedance audiometry were excluded. The average age was 13.8 years, SD 0.5, at the date of examination. The mean air conduction thresholds varied between 0.6 dB at 1 kHz and 9.9 dB at 6 kHz, and the bone conduction thresholds varied between -1.1 dB at 0.5 kHz and 1.1 dB at 4 kHz. The pure-tone average (PTA) (the average of AC hearing thresholds of 0.5, 1 and 2 kHz) of all ears was 1.5 dB. Ninety to ninety-eight per cent of pure-tone AC hearing thresholds at frequencies of 0.5-4 kHz were between -5 dB and 10 dB. The distributions are presented and compared.     

Using a combination of click- and tone burst-evoked auditory brain stem response measurements to estimate pure-tone thresholds

DESIGN: A retrospective medical record review of evoked potential and audiometric data were used to determine the accuracy with which click-evoked and tone burst-evoked auditory brain stem response (ABR) thresholds predict pure-tone audiometric thresholds. METHODS: The medical records were reviewed of a consecutive group of patients who were referred for ABR testing for audiometric purposes over the past 4 yrs. ABR thresholds were measured for clicks and for several tone bursts, including a single-cycle, Blackman-windowed, 250-Hz tone burst, which has a broad spectrum with little energy above 600 Hz. Typically, the ABR data were collected because the patients were unable to provide reliable estimates of hearing sensitivity, based on behavioral test techniques, due to developmental level. Data were included only if subsequently obtained behavioral audiometric data were available to which the ABR data could be compared. Almost invariably, the behavioral data were collected after the ABR results were obtained. Because of this, data were included on only those ears for which middle ear tests (tympanometry, otoscopic examination, pure-tone air- and bone-conduction thresholds) indicated that middle ear status was similar at the times of both tests. With these inclusion criteria, data were available on 140 ears of 77 subjects. RESULTS: Correlation was 0.94 between click-evoked ABR thresholds and the average pure-tone threshold at 2 and 4 kHz. Correlations exceeded 0.92 between ABR thresholds for the 250-Hz tone burst and low-frequency behavioral thresholds (250 Hz, 500 Hz, and the average pure-tone thresholds at 250 and 500 Hz). Similar or higher correlations were observed when ABR thresholds at other frequencies were compared with the pure-tone thresholds at corresponding frequencies. Differences between ABR and behavioral threshold depended on behavioral threshold, with ABR thresholds overestimating behavioral threshold in cases of normal hearing and underestimating behavioral threshold in cases of hearing loss. CONCLUSIONS: These results suggest that ABR thresholds can be used to predict pure-tone behavioral thresholds for a wide range of frequencies. Although controversial, the data reviewed in this paper suggest that click-evoked ABR thresholds result in reasonable predictions of the average behavioral thresholds at 2 and 4 kHz. However, there were cases for which click-evoked ABR thresholds underestimated hearing loss at these frequencies. There are several other reasons why click-evoked ABR measurements were made, including that they (1) generally result in well-formed responses, (2) assist in determining whether auditory neuropathy exists, and (3) can be obtained in a relatively brief amount of time. Low-frequency thresholds were predicted well by ABR thresholds to a single-cycle, 250-Hz tone burst. In combination, click-evoked and low-frequency tone burst-evoked ABR threshold measurements might be used to quickly provide important clinical information for both ends of the audiogram. These measurements could be supplemented by ABR threshold measurements at other frequencies, if time permits. However, it may be possible to plan initial intervention strategies based on data for these two stimuli.     

Threshold prediction in children with sensorioneural hearing loss using the auditory steady-state responses and tone-evoked auditory brain stem response

Objective

The purpose of this study was to compare ASSRs to tone-evoked ABR and to behavioral thresholds obtained on follow-up audiometry at 500, 1000, 2000, and 4000 Hz in infants and young children.

Methods

The study included 17 infants and young children ages between 2 months and 3 years old, with sensorineural hearing loss. The ASSRs thresholds were compared with the tone-evoked ABR thresholds, and with the behavioral thresholds obtained on follow-up audiometry.

Results

The correlation of tone-evoked ABR and ASSRs thresholds at 500, 1000, 2000 and 4000 Hz was 0.91, 0.76, 0.81, 0.89, respectively. ASSRs and behavioral hearing thresholds obtained on follow-up were highly correlated, with Pearson r values exceeding 0.94 at each of the test frequencies.

Conclusions

Multiple ASSRs have strong correlations to tone-evoked ABR and to behavioral thresholds obtained during follow-up in hearing impaired infants and young children. These results might be useful in order to provide further evidence for the use of multiple ASSRs, as an alternative tool to tone-evoked ABR, although further data are still required.     

Refining the audiological assessment in children using narrow-band CE-Chirp-evoked auditory steady state responses

Objective: To demonstrate the feasibility and reliability of simultaneous binaural recording of auditory steady-state responses (ASSR) in young children using narrow-band CE-Chirps as stimuli. Design: Prospective cohort study comparing ASSR thresholds to four frequency stimuli (0.5, 1, 2, and 4 kHz), with click-evoked auditory brainstem responses (ABR) and behavioral response audiometry. Study sample: Thirty-two young children (mean age 7.4 ± 5.2 months) referred for auditory assessment were evaluated. Results: The mean duration for ABR recordings was 13.3 ± 7.2 min versus 22.9 ± 15.8 min for ASSR (p < 0.01). ASSR (means of 2 and 4 kHz thresholds) were highly correlated with ABR thresholds (R² = 0.935, p < 0.001), though significantly different (3 ± 10.7 dB, p = 0.02). ASSR (means of 0.5, 1, 2, and 4 kHz thresholds) were highly correlated with mean behavioral response audiometry thresholds (R² = 0.968, p < 0.001). ASSRs were highly and significantly correlated with behavioral response audiometry at 0.5, 1, 2, and 4 kHz (R² = 0.845, 0.907, 0.929, and 0.859 respectively, p < 0.001). 87.5% and 90.7% ASSR thresholds were within a ± 10 dB range around their corresponding ABR and mean behavioral response audiometry thresholds. Conclusions: Narrow-band CE-Chirps allow a fast and reliable assessment of auditory thresholds in children, especially in the low-frequency range, by comparison with other stimuli.     

儿童分泌性中耳炎的听力学分析

目的 分析儿童分泌性中耳炎的听力学特征,探讨不同听力学测试方法在儿童分泌性中耳炎诊断中的作用和准确性,为儿童分泌性中耳炎的诊断提供理论依据.方法 回顾性分析2010年1月～2011年6月诊断为分泌性中耳炎住院治疗的46例(81耳)患儿的资料.所有患儿均行中耳鼓膜切开,将声导抗、畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)、纯音测听(pure tone audiometry,PTA)结果与术中所见进行比较分析,了解不同听力学测试方法在评估儿童分泌性中耳炎中的作用和准确性.结果 ①46例(81耳)患儿的DPOAE检查结果均提示双耳未通过,声导抗检查均为B型导抗图.鼓膜切开证实70耳有分泌物(86.42%),11耳无明显分泌物(13.58%).②34例(59耳)行ABR测试的患儿,鼓膜切开证实49耳(83.05%)有积液,其中6耳ABR反应阈正常,43耳ABR反应阈升高;46耳ABRⅠ波潜伏期延长,3耳Ⅰ波潜伏期正常.鼓膜切开证实无积液的10耳(16.95%),5耳ABR反应阈正常,5耳ABR反应阈升高;4耳ABRⅠ波潜伏期延长,6耳Ⅰ波潜伏期正常.③12例(22耳)行PTA测试的患儿,所有耳的听阈值均异常,气骨导差均大于10 dB,鼓膜切开证实22耳均有积液.④统计学分析结果显示,ABR气导反应阈值(Kappa=0.364,P<0.01)、Ⅰ波潜伏期(Kappa=0.561,P<0.01)与中耳积液有相关性.结论 声导抗测试对评估儿童分泌性中耳炎有较高的敏感性,PTA气导听阈及气骨导差、ABR气导反应阈值、ABRⅠ波潜伏期及DPOAE亦可较好地反映儿童中耳功能.