三个月婴儿的听性行为反应

目的 探索利用行为法对三个月龄婴儿进行听力筛查的可行性。方法 对323名北京市区78－104天的婴儿进行了听力检测，测试声为1kHz,90dB SPL和2kHz,90dB SPL两种纯音。给声时观察并用摄像机记录婴儿的听觉行为反应。结果 听性行为反应在1kHz,90dB和2kHz,90dB的引出率分别为：眼部反应70.6%和71.5%，头部反应39.0%和42.4%，肢体反应82.4%和87.9%，其他反应17.0%和17.3%。结论 公凭上述一种听性行为反应不足以作为听力筛查的依据。若同时观察肢体反应和眼部反应，并以其中之一的引出作为听性行为反应引出的阳性指征，则引出率可达到95％左右，可以满足听力筛查的要求。     

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。     

60例高危新生儿听性脑干反应分析

听性脑干反应 (ＡＢＲ)可评价脑干和周围的听觉功能 ,现已广泛应用于儿科临床各领域。本文对 2 0 0 0年儿科收住的6 0例高危新生儿所做的ＡＢＲ进行了分析 ,旨在了解几种新生儿常见疾病对听力的影响。1　资料和方法1.1　临床资料　 6 0例患儿均为儿科病房收住的高危新生儿 ,其中男 32例 ,女 2 8例 ;胎龄最小 35周 ,最大 4 1周 ,平均38.5周 ;出生体重最小 190 0克 ,最大 4 75 0克 ,平均 32 90克 ;检查日日龄最小 2天 ,最大 30天仅 1例 ,平均 7.9天 ;经临床确诊其中新生儿窒息 18例 ,新生儿高胆红素血症 2 1例 ,新生儿感染 13例 ,早产儿 8例。…     

听性稳态反应在新生儿听力评估中的应用

目的 探讨听性稳态反应(auditory steady-state responses,ASSR)在新生儿听力评估中的准确性及应用价值.方法 对30例(60耳)畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)正常的新生儿和45例(78耳)DPOAE异常的新生儿进行ASSR与听性脑干反应(auditory brainstem response audiome-try,ABR)测试,比较ASSR与ABR阈值差异有无统计学意义,并进行两者反应阈的相关性分析.结果 ①DPOAE正常组:ASSR 250 Hz反应阈与ABR阈值差异有统计学意义(P＜0.05),ASSR平均阈值及4 000 Hz反应阈与ABR阈值差异无统计学意义(P＞0.05),ASSR的250、500、1 000 Hz反应阈与ABR阈值相关性不明显,但2 000、4 000 Hz反应阈与ABR阈值有明显的相关性;②DPOAE异常组:ASSR的250～4 000 Hz阈值及平均阈值与ABR阈值差异均无统计学意义(P＞0.05).ASSR各频率反应阈与ABR阈值均有显著的相关性.结论 ASSR可以比较准确地评估听力筛查正常新生儿的平均听阈和中、高频听阈以及听力筛查未通过新生儿的各频率听阈.     

高危新生儿的听性脑干反应结果分析

目的探讨高胆红素血症、早产低体重和缺氧三个因素对新生儿听性脑干反应(auditorybrainstemresponse,ABR)结果的差异性。方法选取在本院听力中心行ABR检查的高危新生儿607例(1214耳),分为高胆红素血症组394例(788耳)、早产低体重组122例(244耳)和缺氧组29例(58耳),合并多种高危因素组62例(124耳),对以上组的ABR结果进行分析比较。结果高胆红素血症组、早产低体重组、缺氧组、合并多种高危因素组的ABR异常率分别为27.79%、36.07%、34.48%、38.71%。高胆红素血症组的异常率和早产低体重组比较有统计学差异(P<0.05),和缺氧组比较无统计学差异(P>0.05),早产低体重组的异常率和缺氧组比较无统计学差异(P>0.05),合并多种高危因素组的异常率和高胆红素血症组比较有统计学差异(P<0.05),和早产低体重组及缺氧组相比均无统计学差异(P>0.05)。结论这三种高危因素中,早产低体重新生儿听力损失发病率较高,程度也较重。另外合并多种高危因素的新生儿听力损失的几率和程度仅较高胆红素血症组的新生儿高。     

新生儿多种听损伤高危因素共存时的听性脑干反应特征分析

目的探讨新生儿高胆红素血症与缺氧缺血性脑病(hypoxic—ischemic encephalopathy，HIE)、极低出生体重(very low—birth weight，VLBW)分别或同时存在时的听性脑干反应(auditory brainstem response，ABR)特点，为早期治疗干预提供参考。方法299例(598耳)高危新生儿分为单纯高胆红素血症组、单纯：HIE组、高胆红素血症 HIE组、高胆红素血症 VLBW组、HIE VLBW组、高胆红素血症 VLBW HIE6组，对每组患儿予ABR检测。结果当新生儿高胆红素血症与HIE、VLBW三种高危因素同时存在时，其异常发生率、重度异常发生率、平均反应阈均较单纯高胆红素血症和单纯HIE显著提高，异常耳中的ABR各波缺失率、反应阈增高的发生率同样亦存在显著增高的现象。结论当新生儿高胆红素血症与缺氧缺血性脑病、极低出生体重同时存在时，听损伤的几率相应增加，听损伤的程度也随之加重。此类患儿更应列为及早干预、重点随访的对象。     

新生儿听行为侧听与刺激声类型关系的研究

目的探讨新生儿听行为与刺激声类型的关系,为新生儿听行为筛选测听选择声刺激类型与听反应行为方式提供依据。方法１０２名新生儿,经瞬态诱发性耳声发射（Ｔｒａｎｓｉｅｎｔｅｖｏｋｅｄｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｉｏｎ,ＴＥＯＡＥ）证实其一耳或双耳有正常的ＴＥＯＡＥ波形为研究对象。声场给声,刺激声分别为０５、１、３ｋＨｚ纯音、高频窄带噪声（中心频率３ｋＨｚ,带宽２５４４～３６５２Ｈｚ）以及白噪声。分析恒定强度声刺激下眼睑反应、头部反应、面部反应、肢体反应的反应次数。结果（１）在诱发各种类型听性反应的反应率时,纯音低于噪声,高频窄带噪声低于白噪声;（２）在恒定强度声刺激下,眼睑反应的反应率最高,肢体反应次之;（３）白噪声、高频窄带噪声引出眼睑反应次数无差异。白噪声引出眼睑反应次数与肢体反应次数无差异。结论（１）高频窄带噪声与白噪声是理想的刺激声,眼睑反应与肢体反应是理想的听性反应;（２）高频窄带噪声与眼睑反应、白噪声与肢体反应是最佳组合。     

不同月龄婴幼儿听性稳态反应和听性脑干反应的相关性分析

目的 了解不同月龄婴幼儿听性稳态反应和听性脑干反应反应阈的相关性.方法 对象为299例(497耳)1～36月龄的婴幼儿,分为1～月龄组208耳,4～月龄组81耳,7～月龄组47耳,13～月龄组53耳,19～36月龄组108耳,将各组ABR反应阈均值分别与ASSR的2、4 kHz反应阈及2、4 kHz反应阈的平均值进行相关性分析.结果 1～月龄组ABR反应阈与ASSR的2、4 kHz反应阈及2、4 kHz反应阈平均值相关系数分别为0.499、0.541、0.531;4～月龄组分别为0.678、0.705、0.726;7～月龄组分别为0.792、0.717、0.777;13～月龄组分别为0.934、0.880、0.915;19～36月龄组分别为0.817、0.810、0.867.结论 1～18月龄婴幼儿听性稳态反应和听性脑干反应反应阈的相关性随月龄增加而增加,12月龄以上均为高度相关.     

Refractory severe facial nerve cross-stimulation and loss of auditory sensation after ten years of uneventful cochlear implant use. A rare and challenging case

Abstract

Facial nerve stimulation after cochlear implantation has been well described. When the implant is first activated it is usually possible to 'programme out' the unwanted cross-stimulation. We report an exceptional case of delayed facial nerve stimulation and auditory failure after ten years of uncomplicated implant use. This sudden change proved refractory to reprogramming strategies. The patient refused contralateral implantation as he felt there was residual aided hearing. The implant was removed and replaced. Integrity testing of the explanted device showed it to be functioning normally. Severe facial nerve cross-stimulation persisted and the patient failed to regain his previous auditory sensation. Subsequently, despite extensive investigation and a trial of fluoride therapy, after a third implant he has performed equally badly leading to non-use.     

Validating self-reporting of hearing-related symptoms against pure-tone audiometry,otoacoustic emission,and speech audiometry

Objective: To validate self-reported hearing-related symptoms among personnel exposed to moderately high occupational noise levels at an obstetrics clinic. Design: Sensitivity, specificity, and predictive values were calculated for questionnaire items assessing hearing loss, tinnitus, sound sensitivity, poor hearing, difficulty perceiving speech, and sound-induced auditory fatigue. Hearing disorder was diagnosed by pure-tone audiometry, distortion product otoacoustic emissions, and HINT (Hearing In Noise Test). Study sample: Fifty-five female obstetrics personnel aged 22–63 participated; including 26 subjects reporting hearing loss, poor hearing, tinnitus, or sound sensitivity, and 29 randomly selected subjects who did not report these symptoms. Results: The questionnaire item assessing sound-induced auditory fatigue had the best combination of sensitivity?≥85% (95% CIs 56 to 100%) and specificity?≥70% (95% CIs 55 to 84%) for hearing disorder diagnosed by audiometry or otoacoustic emission. Of those reporting sound-induced auditory fatigue 71% were predicted to have disorder diagnosed by otoacoustic emission. Participants reporting any hearing-related symptom had slightly worse measured hearing. Conclusions: We suggest including sound-induced auditory fatigue in questionnaires for identification of hearing disorder among healthcare personnel, though larger studies are warranted for precise estimates of diagnostic performance. Also, more specific and accurate hearing tests are needed to diagnose mild hearing disorder.     

Correlation of CT analysis and audiometry in Japanese otosclerosis

OBJECTIVE: To determine the extent of audiometric correlation with CT findings. METHODS: Forty-four patients (82 ears) with surgically confirmed otosclerosis underwent preoperative CT examination. Based on the computed tomography (CT) findings, the ears were classified into five groups as follows: Group A, the group with no pathological CT findings; Group B1, the group with demineralization localized in the region of the fissula antefenestram; Group B2, the group with demineralization extending towards the cochleariform process from the anterior region of the oval window; Group B3, the group with extensive demineralization surrounding the cochlea; and Group C, the group with thick anterior and posterior calcified plaques. RESULTS: There were 32 ears (39.0%) in Group A, 21 ears (25.6%) in Group B1, 16 ears (19.5%) in Group B2, 7 ears (8.5%) in Group B3, and 6 ears (7.3%) in Group C. The mean bone conduction levels were greater in the order of the extent of demineralization: Groups A, B1-B3 suggesting positive relationship between the cochlear function and the degree of labyrhinthine otosclerosis. CONCLUSION: A good correlation between the preoperative CT findings and audiometry findings suggests that CT with a slice intervals between 0.5 and 1mm could provide useful informations in assuming the extent of otosclerosis in the inner ear.     

Earphones in extended high-frequency audiometry and ISO 389-5

Abstract

Objective: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model. Design: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones. Study sample: A total of 223 otologically-normal subjects (aged 5–25 years old) participated in the hearing determination. Results: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones. Conclusions: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.     

The importance of high-tone audiometry in monitoring for ototoxicity

Summary Early detection of ototoxicity is of vital importance in cases in which ototoxic drugs are administered. Ototoxicity as a result of cis-platinum administration is well documented. Auditory damage may be reduced by changes in dose, drugs or methods of treatment. As ototoxicity appears to be most pronounced in the higher frequencies of sound, any changes can be assessed at an earlier stage by using high-frequency audiometry to test patients at frequencies from 8 to 20 kHz. Our present study demonstrates the utility of monitoring auditory function at frequencies higher than conventionally tested in patients receiving cis-platinum.     

The hearing system in newborns from the Upper Silesia. Assessment of TEOAE depending on selected parameters of delivery disorders

Transient evoked otoacoustic emission (TEOAE) is an accepted test for screening of the cochlea function in newborns. In this study 300 newborns was tested using TEOAE, as well as analysing such parameters as birth weight, Apgar scale, bilirubinaemia. The study indicated the tendency of TEOAE to decrease in newborns with low birth weight and low Apgar scores. Hyperbilirubinaemia seems to have an influence on cochlea function monitored by TEOAE, especially if there were simultaneously low Apgar scores. A similar tendency, although slightly stronger, was observed in the preterm newborn group. TEOAE seems to be a good method of recording the negative influence on the cochlea activity such factors as low birth weight and asphyxia. Hyperbilirubinaemia with asphyxia acts upon the cochlea similarly. All these tendencies were observed more strongly in the preterm newborn group. It is concluded that TEOAE analysis demonstrated its utility as a screening test assessing the hearing state in newborns, additionally the associations of cochlea activity was found with a few parameters of delivery disorders.     

高危新生儿听力筛查及听损伤高危因素分析

目的:通过对高危新生儿听力筛查,识别应当接受听力学评估的新生儿;发现和证实高危新生儿听损伤的高危因素.方法:用DPOAE初筛,对初筛未通过者用DPOAE加ABR进行复筛,复筛未通过者进行听力学诊断.应用Logistic逐步回归法分析听力障碍相关高危因素.结果:共筛查327例,初筛未通过率为37.0%;复筛未通过率为11.0%,确诊10例,听力障碍发病率为3.39%.高危因素为窒息、低体重(<1 500 g)和头颈部畸形.结论:①对高危儿进行听力筛查,DPOAE和ABR相结合是一种可靠、可行的筛查方法;②本资料中与听损伤相关的高危因素为窒息、低体重(<1 500 g)和头颈部畸形.