正常听力青年人言语诱发ABR与扩展高频测听的性别与年龄差异

目的 探讨正常听力青年人言语声诱发听性脑干反应(speech-evoked auditory brainstem response, s-ABR)以及扩展高频测听的性别、年龄差异，旨在提供不同性别、年龄正常听力人群的参考数据。方法 招募171例(171耳)18～42周岁纯音听阈正常、无噪声暴露史的正常听力青年人，其中，女82耳，男89耳；18～30岁(大于18岁小于等于30岁)组96耳(男46耳，女50耳),30～42岁(大于30小于等于42岁)组54耳(男、女各27耳),分别进行常频及扩展高频测听、s-ABR测试，比较s-ABR各波潜伏期和幅值以及各频率阈值的差异，分析s-ABR各波潜伏期、幅值以及V/A复合体与常频及扩展高频纯音测听的相关性。结果 性别比较：(1)女性s-ABR的波V、C和F潜伏期显著短于男性(P<0.05),V/A幅值显著高于男性(P<0.05);(2)除4 kHz外，其余各频率平均听阈无明显性别差异(P>0.05)。年龄比较：(1)18～30岁组波O幅值显著高于30～42岁组(P<0.05),V/A斜率显著大于30～42岁组；(2)除0....     

刺激声时程对有无噪声暴露史听力正常青年人言语声诱发听性脑干反应的影响北大核心CSCD

目的分析不同时程言语声诱发听性脑干反应(speech evoked auditory brainstem responses,s-ABR)在有无噪声暴露史听力正常青年人中应用的差异,探讨其用于隐性听力损失诊断的临床应用价值。方法选取18~40周岁听阈正常、有噪声暴露史的男性工人15例(接噪组,平均年龄31.53±6.56岁)以及听阈正常、无噪声暴露史的男青年25例(对照组,年龄23.20±4.60岁)进行40 ms/da/音和170 ms/da/音的s-ABR测试,比较两组两种时程刺激声s-ABR潜伏期、波间期和幅值。结果接噪组170 ms/da/音s-ABR的O波潜伏期明显较对照组延长(P<0.05),其余V、A、D、E、F波潜伏期及各波振幅、波间期两组间差异均无统计学意义(均为P>0.05);两组40 ms/da/音s-ABR各波潜伏期、波间期及振幅差异均无统计学意义(P>0.05);对照组170 ms/da/音s-ABR各波潜伏期明显较40 ms/da/音s-ABR延长,各波波间期明显较40 ms/da/音s-ABR增宽(均P<0.05);接噪组170 ms/da/音s-ABR V、A、F、O波潜伏期显著延长(P<0.05),而两种时程刺激声s-ABR各波间期差异无统计学意义(P>0.05)。结论不同时程言语声诱发s-ABR测试可以用于不同的听觉处理机制分析;40 ms时程/da/音的s-ABR各波潜伏期可能对于隐性听力损失的诊断更有价值。     

言语诱发听性脑干反应的主波特性

目的探讨正常成人言语诱发听性脑干反应(speech evoked auditory brainstem response,speech-ABR)主波的电生理特性。方法记录64例正常成人右耳的speech-ABR,分析主波的极性、潜伏期及幅值及其与性别、年龄的相关性。结果 speech-ABR的主波主要为正极性;除E波极性与性别显著相关外,其他主波极性的性别和年龄差异无统计学意义。V波和A波潜伏期女性较男性显著缩短,V波幅值女性较男性显著增大;而两者潜伏期和幅值的年龄差异无统计学意义。在C、D、E、F和O波中,两种极性的潜伏期差异(除E波和O波外)以及幅值差异无统计学意义;而其潜伏期和幅值的性别和年龄差异亦无统计学意义。结论 speech-ABR各主波的潜伏期和幅值受极性、性别和年龄差异的影响较小,具有较高的稳定性,是言语感知机制基础及临床研究的良好指标。     

健康青年言语诱发听性脑干反应与最大言语识别率的关系

目的：探讨言语诱发听性脑干反应（speech evoked auditory brainstem response,s-ABR）与最大言语识别率（phonetically balanced maximum,PBmax）之间的相互关系。方法测试健康青年41耳的PBmax及其对应强度的s-ABR,分析s-ABR主波潜伏期和基频（fundamental frequency,F0）幅值、第一共振峰（first formant,F1）幅值与PBmax的关系。结果以PBmax1=100%、100%＜PBmax2＜90%及PBmax3≤90%分为3个组,结果显示3组PBmax及其s-ABR F0、F1幅值和各主波潜伏期的差异有统计学意义（P＜0.05）。对s-ABR的主波潜伏期和F0、F1幅值与PBmax进行相关分析,结果显示s-ABR电生理特性与PBmax均表现出显著相关性（P＜0.05）,各主波潜伏期与PBmax负相关,而F0幅值和F1幅值分别与PBmax正相关。结论 s-ABR的电生理特性和言语识别功能关联紧密,这些电生理特性有望成为评价言语识别功能的客观指标,并可能联合或者单独应用于言语识别功能的相关研究。     

年龄对自然更年期后女性脑干言语编码能力的影响

目的 分析年龄对更年期后女性脑干言语编码能力的影响.方法 对纯音听阈、声导抗 、短声听性脑干反应(click-ABR)测试结果均正常的20例双侧卵巢切除女性(43~53岁)和20例自然更年期后女性(50~61岁)行言语诱发听性脑干反应(speech-ABR)测试,刺激声为/da/音,采用插入式耳机,右耳给声,比较两组speech-ABR测试结果.结果 双侧卵巢切除女性和自然更年期后女性speech-ABR波形特征类似,均由瞬态反应(V、A和O波)、过渡部分C波以及周期性反应(D、E、F波)构成;与更年期后女性相比,双侧卵巢切除女性除瞬态成分O波潜伏期(48.10±0.98 ms)显著短于更年期后女性(48.87±0.50 ms)(P<0.01),周期成分F波幅值(-0.13±0.07 μV)显著大于更年期后女性(-0.09±0.04 μV)(P<0.05),其余各波的幅值、潜伏期及V/A复合波斜度差异均无统计学意义(均为P>0.05).将两组数据合并后就年龄对speech-ABR各波幅值及潜伏期的关系进行相关性分析,结果显示仅O波潜伏期与年龄成轻度正相关关系(P<0.05),其余各波幅值及潜伏期与患者年龄均无相关性.结论 年龄对更年期后脑干言语编码能力的影响较小,仅表现为使脑干听觉神经元对刺激末信号放电的同步性和时间分辨力降低.     

健康青年人言语诱发听性脑干反应的成分及特性

目的 探讨正常青年人言语诱发听性脑干反应(speech evoked auditory brainstemresponse,speech-ABR)的电生理特性及其与诱发言语声学特性的关系,并比较和分析与短声诱发听性脑干反应(click evoked auditory brainstem response,click-ABR)的差异.方法 记录31名31耳正常听力青年短声及合成言语/da/诱发的听性脑干反应.计算/da/和speech-ABR的时域及频域参数,并分析两者的关系.结果 正常青年人speech-ABR由一系列主波组成,可分为起始部分(包括V,A波)、过渡部分(C波)、频率跟随部分(D-E-F波)和终止部分(O波).A波分别与V、C、D、E及F波潜伏期有相关性(P＜0.05),其中与V波潜伏期的相关性最强(r=0.847,P＜O.01);D、E及F波潜伏期相互间相关(P＜0.01);C波只与OR部分的V波和A波有相关性(P＜0.05);O波潜伏期呈相对独立性,与其他主波无相关(P＞0.05).与click-ABR相比,speech-ABR的V波和Ⅲ波潜伏期延迟(P＜0.01),Ⅲ波出现率降低(P＜0.01),而Ⅰ波潜伏期的延迟和出现率的降低无统计学意义(P＞0.05).结论 speech-ABR是研究人类听觉诱发电位的一种新手段,其成分主要来源于脑干.speech-ABR主要成分关联密切,类似于听性脑干诱发电位中短声诱发的Ⅰ～Ⅴ波、SNIO及低频声诱发的FFR的结合,较好地反应了刺激言语的声学信息,是研究听觉言语处理机制的良好工具.     

言语诱发听性脑干反应的影响因素分析

目的探讨言语诱发听性脑干反应(speech evoked auditory brainstem response,s-ABR)的影响因素,揭示s-ABR更多的电生理特性。方法将24名健康成人(24耳)的s-ABR采用两种刺激率(11.1次/s、20.0次/s)和两种刺激强度(80d B SPL、60d B SPL)进行2×2×6析因实验,分析s-ABR波形评分值、各主波潜伏期及幅值。结果 s-ABR波形评分值差异无统计意义(p>0.05);各主波潜伏期的刺激率差异无统计学意义;各幅值(除外Ⅴ波)的刺激率差异亦无统计学意义;大部分主波潜伏期(除外A波、F波及O波)的强度差异有统计学意义(p<0.05),大部分主波幅值(除外Ⅴ波和O波)的强度差异则无统计学意义;波形量化评分、各主波潜伏期和幅值均无刺激率和刺激强度的交互效应(p>0.05)。结论 s-ABR测试的刺激率和刺激强度在一定范围内没有相互影响,测试中可根据需要选择刺激率和刺激强度。     

学龄儿童与青年人言语诱发听性脑干反应的比较

目的 比较学龄儿童与青年人言语诱发听性脑干反应( speech-ABR)的基本特征,探讨学龄期儿童脑干言语处理能力的发育情况.方法 对纯音听阈、声导抗、耳声发射和短声听性脑干反应(click-ABR)测试结果均正常的20名青年人(21～ 26岁)和18名学龄儿童(6～11岁)行speech-ABR测试.刺激声为/da/音,采用插入式耳机,右耳给声.结果 学龄儿童与青年人speech-ABR波形均由瞬态反应(V、A、C、O波)及周期性反应(D、E、F波)等几部分构成.学龄儿童的O波潜伏期(47.80 ±0.38)ms短于青年人(48.10±0.40) ms,差异具有统计学意义(t=2.330,P=0.026);学龄儿童F波波幅(-0.21±0.15)μV大于青年人(-0.12±0.08)μV,差异具有统计学意义(t=2.146,P =0.043);二者其余各波的潜伏期及波幅差异均无统计学意义(P值均＞0.05).结论 学龄儿童与青年人speech-ABR的基本特征相近,其脑干言语处理能力不亚于青年人.     

不同强度言语声诱发听性脑干反应及听处理偏侧化分析

目的：探讨不同强度言语声诱发听性脑干反应（speech evoked auditory brainstem response ,s－ABR）的时域和频域变化以及脑干水平是否存在听处理偏侧化现象。方法分别以40、60和80 dB H L言语声对29例健康青年行双耳s－ABR检测,分析双耳时域参数中的主波潜伏期、幅值以及频域参数中的基频（F0）、共振峰（F1～F5）。结果三种刺激强度下,左右耳各主波潜伏期及幅值之间差异均无统计学意义（ P＞0．05）;随言语刺激声强增大,计算强度每降低20 dB时s－ABR各主波潜伏期延长平均值,瞬态性主波V、A、C、O波及周期性主波D、E、F波的潜伏期均显著缩短（P＜0．05）,幅值显著增加（P＜0．05）;周期性主波潜伏期延长更明显（P＜0．05）。s－ABR频域分析显示,从F0及F1～F5幅值依次降低,与强度变化一致;双耳记录的s －ABR具有很高的相似度,其时域参数和频域参数耳别间差异无统计学意义（ P＞0．05）。结论 s －ABR较好编码了言语的时域和频域信息,且时域和频域参数高度对应并具有相同的强度响应性;瞬态性和周期性成分的s－ABR各主波不同潜伏期特性可能提示更多编码信息;言语在听性脑干水平的处理并无明显偏侧化现象。     

学龄前儿童言语诱发听性脑干反应的性别差异

目的 探讨学龄前儿童的言语诱发听性脑干反应(speech-ABR)的性别差异及其与语言、音乐能力的关系。方法 研究对象为135例3～6岁学龄前儿童，均通过了新生儿听力筛查且无听觉系统疾病；其中，男65例，女70例，在清醒状态下进行speech-ABR测试，并由儿童的父母填写幼儿多元智力量表。结果 相较于男生，女生speech-ABR的波V、波A潜伏期均显著缩短(P<0.05),波A波幅显著增大(P<0.05)。排除年龄干扰进一步分析发现，女生的波V、波A波幅与语言智力得分显著正相关(分别为r=0.421,P<0.001;r=0.267,P<0.05),男生波V的潜伏期、女生波V波幅与音乐智力得分显著相关(分别为r=-0.296,P<0.05;r=0.295,P<0.05)。结论 学龄前儿童言语诱发听性脑干反应存在显著的性别差异；脑干听觉功能与学龄前儿童的语言和音乐能力的发展密切相关，且性别是其中不可忽略的重要因素。     

生殖激素对正常青年人言语听性脑干反应特性的影响

目的 分析正常青年人生殖激素浓度与言语诱发听性脑干反应(speech-ABR)幅值及潜伏期的相关性,探讨生殖激素对青年人言语听性脑干反应特性的影响.方法 选择纯音听阈、声导抗、短声诱发听性脑干反应(click-ABR)测试均正常的青年35例为研究对象,其中女性17例(27.29±1.83岁),男性18例(28.17±2.50岁),分别行speech-ABR测试,刺激声为/da/音,采用插入式耳机,右耳给声,记录并分析各波潜伏期及波幅,同时检测血清中雌二醇、总睾酮的浓度,分析雌二醇、总睾酮的浓度与speech-ABR各波幅值及潜伏期的相关性.结果 ①女性speech-ABR各波(V、A、D、E、F、O波)潜伏期均比男性短(P<0.05),V/A复合波斜度大于男性,除O波外,女青年speech-ABR其余各波幅值均显著大于男性(P<0.05).②女青年雌二醇水平(118.77±102.66 pg/ml)显著高于男青年(52.91±14.77 pg/ml)(P<0.05),而总睾酮浓度(457.65±140.82 pg/ml)显著低于男青年(3 677.37±1 155.80 pg/ml)(P<0.05).③speech-ABR各波潜伏期与雌二醇浓度呈负相关(P<0.05),相关系数在0.2~0.4之间,与总睾酮浓度呈正相关关系(P<0.05),相关系数在0.4~0.7之间.④speech-ABR各波幅值随雌二醇浓度增加而增大,正向波V波与雌二醇浓度呈正相关,而负向波A、D、E、F及O波呈负相关,相关系数在0.2~0.7之间;speech-ABR各波幅值随总睾酮浓度增加而降低,起始复合波V波、A波及V/A斜率与睾酮的相关系数在0.4~0.6之间,为中度相关(P<0.05);而周期性成分与睾酮浓度的相关性不强,其中D波幅值与总睾酮浓度的相关性无统计学意义(P>0.05),而E波和F波的相关性也只是弱相关(P<0.05);此外,结束波O波幅值与睾酮水平无关(r=0.133, P>0.05).结论 生殖激素水平与speech-ABR的幅值及潜伏期存在一定相关性,可能是导致正常青年人言语诱发听性脑干反应特性性别差异的原因之一.     

Effects of age and sex on auditory brain stem response. A new aspect

The age and sex dependence of the latencies and interpeak intervals (IPI) of the auditory brain stem response (ABR) was investigated in 86 males and 69 females. The latencies of the waves I, III and V as well as the IPI I-V and III-V are significantly shorter in females than in males. A correlative linear dependence on age could be shown for the latencies of waves I, III and V in males and for the wave V latency in females. The slopes of the regression lines calculated for the dependence of ABR latencies I, III and V on age tend to be steeper in males than in females. The slope increases from wave I to wave V. The male and female regression lines intersect the latency axis at about the same point (at the same latency value at age A = O). On the basis of these results, the hypothesis is established, that age and sex dependence is not caused by different mechanisms. The ABR latency differences between males and females are in the main the result of the ABR age dependence being less pronounced in females than in males.     

Speech evoked auditory brainstem response findings in children with epilepsy

Objectives

Children with epilepsy are at a considerable risk of cognitive impairment and school failure. Previous studies have typically documented abnormal responses in children with epilepsy at cortical level using speech stimuli. Recent studies reported that abnormal neural encoding of a speech syllable could be detected at the level of the brainstem using speech-evoked auditory brainstem response (ABR). The aim of this study is to investigate speech-evoked (ABR) results in children with epilepsy.

Methods

The study group consisted of 38 recently diagnosed epileptic children; none of them has received antiepileptic therapy. They were 22 males and 16 females with age 9.1 ± 3.1 years. The control group consisted of 38 healthy normal hearing children with matched age and gender distribution. All subjects underwent full history taking, basic audiologic evaluation including pure-tone, speech audiometry and immittance testing. Click ABR response was recorded monaurally from both ears at 90 dB nHL then speech ABR was recorded monaurally from each ear at 80 dB SPL.

Results

Though the study group disclosed normal click ABR compared to age matched normative values, speech-evoked ABR revealed a delayed waves V and A latencies in both ears. These findings reflect abnormal neural encoding of speech at the level of brainstem. The younger the age of epileptic child the more prolonged wave A latency and increased V/A inter-latency values.

Conclusions

Speech-evoked ABR results denote abnormal timing in the brainstem; such brainstem abnormality could be detected by speech evoked ABR rather than conventional click evoked ABR.     

伴脑白质病语前聋患儿人工耳蜗植入术后听觉言语康复效果分析

目的 探讨伴脑白质病的语前极重度感音神经性聋患儿人工耳蜗植入的可行性及术后听觉言语康复效果.方法 海南省人民医院耳鼻咽喉科2013年9~11月行人工耳蜗植入的14例伴脑白质病语前聋患儿为研究组(年龄1~6岁,平均3.79±1.93岁),同期无中枢神经系统病变的语前聋患儿16例为对照组(年龄1~6岁,平均4.38±1.93岁),术前均行临床听力学、影像学检查及语言能力、智力水平等评估,经乳突后鼓室面神经隐窝入路一期行人工耳蜗植入术,术后均到海南省聋儿康复中心进行言语康复训练;采用听觉行为分级标准(categories of auditory performance,CAP)和言语可懂度分级标准(speech intelligibility rate,SIR)对两组术后康复效果进行评估,比较两组患儿术后不同阶段的CAP和SIR分级.结果 所有患儿人工耳蜗植入术后均获得听觉反应和不同程度的言语交流能力,随着康复时间延长两组患儿CAP及SIR分级均呈上升趋势;研究组术后6、12和24个月CAP平均分级分别为2.571±0.416、3.714±0.496、5.000±0.492级,SIR平均分级分别为1.357±0.133、2.143±0.275、3.071±0.245级,与对照组CAP(分别为2.688±0.313、3.875±0.364、5.000±0.354级)及SIR(分别为1.500±0.129、2.313±0.176、2.875±0.221级)比较,差异均无统计学意义(P>0.05).结论 伴脑白质病的语前极重度感音性聋患儿经过术前充分评估后可以实施人工耳蜗植入,术后2年内听觉言语康复效果与不伴脑白质病的同龄患儿相当.     

Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing

Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy, metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group ( p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I–III, III–V and I–V was not significant ( p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies ( p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients.     

Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing

Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy. metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group (p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I-III, III-V and I-V was not significant (p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies (p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients.     

Differences in responses from the cochleae and central nervous systems of females with low versus high acceptable noise levels

Studies of acceptable noise level (ANL) consistently report large intersubject variability in acceptance of background noise while listening to speech. This variability is not related to age, gender, hearing sensitivity, type of background noise, speech perception in noise performance, or efferent activity of the medial olivocochlear pathway. An exploratory study was conducted to determine if differences in aggregate responses from the peripheral and central auditory system can account for intersubject variability in ANL. Click-evoked otoacoustic emissions (CEOAEs), binaural auditory brainstem responses (ABRs), and middle latency responses (MLRs) were measured in females with normal hearing with low (n = 6) versus high (n = 7) ANLs. Results of this preliminary study indicate no differences between the groups for CEOAEs or waves I or III of the ABR. Differences between the two groups emerge for the amplitudes of wave V of the ABR and for the Na-Pa component of the MLR, suggesting that physiological variations arising from more central regions of the auditory system may mediate background noise acceptance.