纯音骨导听阈测试的掩蔽问题

目的：通过对一组耳科正常青年人及不同性质的耳聋患者进行韦伯试验(WT)及骨导掩蔽测试，以探讨骨导测试现象的规律，为临床测试提供指导。方法：分别对20例耳科正常青年人及113例有不同性质听力损失的患者进行WT及骨导掩蔽测试。结果：当双耳均无传导障碍时，骨导听阈取决于双耳耳蜗听敏度，WT偏向取决于双耳听敏度之差。不同性质的传导性病变，使不同频段的骨导听阈降低。一耳正常，另耳为传导性聋时，WT3～5个频率偏患耳；另耳为耳蜗性聋且气导耳间差大于40dB时，患耳骨导越边。双耳传导性聋或双耳混合性聋或一耳传导性聋另耳混合性聋，骨导听阈取决于双耳病变的不同性质、不同程度，WT偏向无规律。当双耳骨导听阈正常而气导听阈大于耳间衰减时，则掩蔽无法实施。结论：为避免中枢掩蔽和过度掩蔽的影响，实验发现：①双耳均无传导障碍，且双耳气导听阈之差大于40dB，测优势耳骨导时不需掩蔽，劣势耳骨导听阈越边；②一耳正常、另耳为传导性聋，测试患耳骨导时不需掩蔽；③若双耳存在传导性病变，且骨导听阈正常而气导听阈大于耳间衰减，则掩蔽无法实施，放弃掩蔽测试。     

影响助听效果的相关因素分析

目的：研究影响中～重度感音神经性聋助听效果的相关因素。方法：选择中～重度感音神经性聋耳60例,分别测试其助听前后各项听力学指标,并考察可能影响助听效果的因素,对结果进行因子分析。结果：助听前听阈（HL）、言语察觉阈（SPT）、言语识别阈（SRT）、言语识别率（SRS）以及助听HL对助听效果有显著影响,而受试者的最适阈（MCL）、年龄、受教育时间、耳聋时间、助听器佩戴时间对助听效果也有一定作用。结论：助听器不只是一个听力补偿工具,而且具有一定的治疗作用。     

极重度感音神经性聋佩戴助听器与人工耳蜗植入患儿残余听力的比较分析

目的:通过回顾性比较分析极重度感音神经性聋患儿接受佩戴助听器和人工耳蜗植入手术2种不同干预方式人群的听力学评估参数,探讨极重度感音神经性聋患儿有效残余听力的临床判断方法.方法:选取听力学评估和言语康复训练资料完整的22例双耳极重度感音神经性聋患儿,其中10例佩戴助听器并接受超过3个月的言语康复训练,另外12例接受人工耳蜗植入手术,其中有10例年龄区间与佩戴助听器组一致.佩戴助听器组患儿,根据言语康复训练效果分为良好(7例)和较差(3例),分别统计其佩戴助听器前ASSR和听力言语康复训练期间裸耳纯音测听在500、1000、2000、4000 Hz 4个频点的听阈阈值情况.年龄与佩戴助听器组一致的10例接受人工耳蜗植入术患儿,根据术前有否佩戴助听器情况,分为曾佩戴助听器但听力言语康复效果差者(5例)和未接受佩戴助听器者(5例),分别统计其佩戴助听器前和(或)手术前的ASSR在500、1000、2000、4000 Hz 4个频点的听阈阈值情况.结果:①ASSR的阈值情况.佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,平均每耳有2.71个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.92±7.43 )dB HL;佩戴助听器言语康复训练效果较差的3例患儿,再加上曾佩戴助听器但听力言语康复效果差而接受人工耳蜗植入术的5例,共8例(16耳),平均每耳只有1.06个频点可引出ASSR反应,所引出的ASSR平均阈值为(110.88±8.52 )dB HL.②裸耳纯音测听情况.佩戴助听器且言语康复训练效果良好的7例(14耳)患儿,所测频点的平均听阈为(96.11±7.81) dB HL;其中,每耳平均有3个频率点的裸耳纯音测听阈值≤100 dB HL.而在效果差的3例(6耳)患儿中,所测频点的平均听阈为(112.19±5.15) dB HL,裸耳纯音测听阈值≤100 dB HL耳的数量为0.结论:500、1000、2000、4000 Hz 各频率引出ASSR的频点数量和裸耳纯音测听阈值≤100 dB HL的数量,是临床上判断极重度感音神经性聋患儿有否存在可利用助听残余听力的有效指标.     

传导性聋的诊断及手术治疗的临床分析

目的 分析传导性聋的诊断和手术治疗的方法和疗效.方法 2000年1月～2006年11月间,36例(40耳)鼓膜完整的传导性聋患者,术前听力检查语言频率(0.5、1、2 kHz)平均气导听阈为59.7±16.5 dB HL,气骨导差平均为42.1±15.8 dB.根据听骨链的病变情况采用相应的鼓室成形术,Ib型10耳,IIIa型6耳,IIIb型11耳,IV型13耳.结果 根据鼓室探查所见,先天性听骨链畸形25耳(62.5%),砧镫关节松弛7耳(17.5%),鼓室硬化症6耳(15%),早期隐匿性胆脂瘤型中耳炎2耳(5%).以术后语言频率气骨导差缩小大于15 dB或气导听阈小于40 dB HL为手术有效标准,36耳有效,有效率为90%(36/40),术后语言频率听力与术前相比差异有统计学意义.结论 根据病史、体检、听力学检查、颞骨CT检查并结合术中探查的听骨链病变的类型以明确诊断,并采取相应的鼓室成形术治疗传导性聋,可取得良好的效果.     

对称性聋患者单耳助听后双耳言语识别率差别探讨

目的通过检测对称性聋患者单耳助听后双耳言语识别率的差别来进一步研究听觉剥夺效应。方法选取右耳助听4～5年的双耳对称性感音神经性聋患者15名,在标准隔声室中,测试其双耳的纯音气导和骨导听闻,然后再采用汉语普通话单音节词表分别进行左右裸耳言语识别率测试,并将所得数据进行对比研究。结果15名受试者右耳配戴助听器前及配戴4～5年后两耳间平均听阈无显著性差异（P〉0．05）;受试者右耳助听前及助听4～5年后左、右耳平均听阀前后无显著性差异（P〉0．05）;右耳助听4～5年后,受试者左、右耳裸耳言语识别率存在显著性差异（t=2．76,P=0．02〈0．05）。结论对称性感音神经性聋患者单耳助听后裸耳平均听阈无显著改变,但非助听耳言语识别能力显著下降。     

骨导植入式助听装置研究进展

目前助听器的相关技术发展迅猛,已成为听力康复的重要手段之一,大多数不需手术治疗的耳聋患者可使用气导式助听器来重新获得声音。虽然目前气导助听器的适应症不断在扩大,但仍不能满足各种耳聋患者的需求。当外耳道至中耳的鼓膜－听骨链系统受到损伤或合并有内耳病变导致的传导性或混合性聋,外中耳畸形和病理原因导致的慢性分泌性中耳炎或外耳道病变导致的听力损失,腮腺炎或听神经瘤导致的单侧极重度感音神经性聋等,依靠气导式助听器均无法获得满意的听觉补偿［1］。而无法使用气导助听器或效果不佳的患者,可通过骨导增益来获得良好的听觉效果,此时骨导助听装置是此类患者获得听觉补偿的选择。     

晚期耳硬化症CO2激光辅助镫骨开窗术疗效的初步观察

目的　探讨CO2激光辅助镫骨开窗人工镫骨植入术治疗晚期耳硬化症的效果。方法　2010年1月~2014年1月间15例（16耳）临床确诊为晚期耳硬化症的患者在我科接受了CO2激光辅助镫骨开窗人工镫骨植入术,术前言语频率平均气导听阈70.21 dB HL,平均骨导听阈38.49 dB HL,平均气骨导差（air conduction-bone conduction gap,ABG）31.72 dB HL,所有病例术后随访超过半年。结果　术后半年言语频率平均气导听阈 43.7 dB HL,平均骨导听阈28.95 dB HL,平均气骨导差14.75 dB HL,ABG≤20 dB者9耳,占比56.3%,ABG闭合≤10 dB者6耳,占比37.5%。无一例术后出现顽固性眩晕、感音神经性聋及面瘫等严重并发症。结论  CO2激光辅助技术降低了镫骨开窗手术严重并发症的几率,多数患者术后听力明显提高,是一种安全、实用、相对经济的选择。     

新型植入式助听器及其耳后装置的应用经验

有些重度传导性聋患者不适宜佩戴传统的气导或骨导助听器，而应使用植入式骨传导装置。该文对一种新的植入式助听器进行了研究。这种助听器由XA－11型植入体及耳后体外处理器组成。选择10例患者接受植入手术，这10例患者均气导损失大于40dB而骨导在25dB以内。术后检测结果显示，10例中7例能成功地提高听力，弥补气骨导差距，而另外8例效果较差。分析这3例中有2例骨导分别为23和25dB，而另1例则高频损失较明显。结果提示这种植入体的应用中起决定作用的是听力损失中的感育成分。XA－11型植入体的厂商建议植入耳的骨导平均听力不应大于25d…     

外耳道胆脂瘤49例临床特点及诊治分析

目的 探讨外耳道胆脂瘤的临床特点及诊治方法 .方法 回顾性分析武汉大学人民医院耳鼻咽喉-头颈外科2000～2005年收治的49例外耳道胆脂瘤患者的临床资料.结果 术前所有患者外耳道均见灰白色或黄白色软组织充填,外耳道皮肤可见慢性炎症.所有病例病变以外耳道为中心,外耳道均有不同程度的侵蚀扩大;其中8例患者病变向远深部扩展侵犯乳突和/或鼓膜、上鼓室;2例面神经垂直段骨质破坏.根据病变范围.10例患者直接在手术显微镜下彻底清除病变;31例患者行耳内切口显微镜下彻底清除病变,术中见鼓膜紧张部穿孔5例,术后均行Ⅱ期鼓膜修补术;4例患者行乳突根治术,术中见鼓膜缺如,听骨链残缺;4例患者行改良乳突根治术,术中见听骨链完整,2例松弛部穿孔,术后行Ⅱ期鼓室成型术.术前45例(91.8%)患者为传导性聋,言语频率平均气导听阈为49.3±9.1 dB HL;4例(8.2%)为混合性聋,言语频率平均气导听阈为65.2±10.7 dB HL,平均骨导听阈为50.5±11.3 dB HL.除4例行乳突根治术的患者以外,其余患者术后气导听阈均有较大提高,言语频率平均气导听阈提高15～23 dB.随访18个月～6年未见复发.结论 外耳道胆脂瘤可以造成广泛破坏,术前颢骨薄层CT扫描对诊断有较大帮助.其治疗应根据病变范围、局部感染与否选择合适术式尽早彻底清除病灶.术后患者气导听力多有较大提高.     

皮下植入Xomed骨导助听器在英国的经验

Xomed 骨导助听器是一种电磁感应式助听装置。其内装置通过手术埋置于颞骨皮下,外装置则通过内装置中的磁铁吸引保持在位。声音处理器分耳级和体级两种。声音进入外装置后,由线圈产生电磁场,引起磁铁、颅骨、内耳的振动。其植入对象为双耳传导性耳聋,纯音骨导听阈(0.5、1、2 kHz)不超过25dB(HL)。在英国已有23例患者接受了 Xomed 骨导助听器。作者通过对其中18例患者的植入理曲、以前的助听方式、植入技术和手术问题,目前病人的使用状况和满意程度、纯音听阈、     

Outcome prediction for Bonebridge candidates based on audiological indication criteria

ObjectiveTo re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.MethodsWe assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65 dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects.ResultsWe found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found.ConclusionBone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38 dB HL to achieve an aided sound field threshold of at least 30 dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.     

外中耳畸形患者骨桥植入效果分析

目的分析6例外中耳畸形患者植入骨桥后的听觉及言语识别能力,探讨骨桥植入的适应症及效果。方法对6例外中耳畸形患者骨桥植入术前及术后开机时进行纯音测听和言语测听,比较植入前后听阈及安静时声强65 dB SPL下的单音节、双音节、语句的言语识别率。结果 6例患者术后助听听阈及言语识别阈较术前裸耳均明显改善,助听听阈平均改善43.2±11.1 dB;言语识别阈平均改善38.8±7.7 dB,中高频相对低频补偿的更多;言语识别率亦较术前明显提升,单音节言语识别率平均提高63.33%±22.51%,双音节言语识别率平均提高77.83%±28.92%,语句言语识别率平均提高78.33%±17.08%。结论骨桥植入可以改善传导性和混合性听力损失患者的听觉言语能力,为外中耳畸形及听骨链畸形伴传导性或混合性听力损失患者的有效听觉补偿方法。     

Fitting range of the BAHA Cordelle

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30?and 70 dB HL, and an additional air-bone gap of about at least 30?dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.     

Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge® (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60–80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.     

Transcutaneous bone conductive implants in patients with conductive/mixed hearing loss: audiological outcomes in noise condition

Background: Recently, the use of transcutaneous bone conduction implants (BCIs) has been increased. However, scarce data about BCI hearing recovery in noise conditions have been reported.

Objectives: To investigate the audiological benefits obtained with transcutaneous BCI-Sophono Alpha System in noise conditions. To evaluate post-implantation clinical outcomes and patient satisfaction levels.

Materials and methods: Fourteen patients suffering from conductive or mixed hearing loss implanted with the Sophono Alpha System were evaluated. Patients underwent physical examination, free-field pure-tone and speech audiometry both in unaided and aided conditions. The matrix sentence test was employed with fixed noise at 65?dB, and with a fluctuating primary signal, in three different conditions of noise presentations (S0/N0, S0/Ncontra, S0/Nipsi).

Results: Hearing gain, expressed as the difference between pre-implant AC and post-implant SAS free field, was on average 26.7?dB. The unaided speech recognition score in quiet conditions had a mean value of 64.6%, and improved after SAS implantation, achieving mean values of 98.2%. SRT₅₀ with the matrix sentence test improved in all three conditions of noise presentation.

Conclusions: Sophono Alpha System devices represent a valid treatment option for hearing rehabilitation of patients with conductive or mixed hearing loss. The audiological results regarding hearing gain in noise conditions were good.     

外伤所致传导性耳聋的诊断与手术治疗(附20例报告)

目的 分析外伤所致传导性耳聋的症状体征、听力学表现及影像学特点,总结诊断要点和手术治疗效果.方法 回顾性分析解放军总医院2008年1月～2011年3月收治的具有明确外伤史、鼓膜完整的传导性听力下降患者20例.每位患者均进行详细病史询问、临床检查、听力测试和影像检查.行鼓室探查术,根据患者听骨链损伤的不同类型,行听骨链重建术.术后1～3个月复查纯音听力,比较术前和术后的纯音听阈,总结分析手术治疗效果.结果 本组20例患者,手术探查听骨链发现砧骨移位14例,包括砧镫关节脱位、锤砧关节分离以及二者兼具的听骨链损伤,锤骨移位且粘连固定2例,镫骨足弓骨折2例,砧骨长脚骨折1例,镫骨底板自前庭窗脱出1例;其中3例砧骨移位患者术中可见面神经明显水肿.根据鼓室探查情况行相应的听骨链重建术,15例行自体听骨雕凿后的听骨链重建术,1例行砧镫关节复位术,4例行人工听骨植入术,3例合并面瘫患者行听骨链重建术的同时行面神经减压术.术后1～3个月随访,患者自觉听力提高,纯音测听示言语频率内气导平均听阈恢复至30±11 dB,平均气骨导差为18±10 dB.伴有面瘫患者的面神经功能恢复至HBⅠ级.结论 有外伤史的患者如有听力下降,应行全面细致的耳科检查、听力学检查和高分辨颞骨CT扫描,如纯音测听气导听阈下降且存在明显的气骨导差,或颞骨CT显示听骨链形态异常,应考虑系听骨链中断引起的传导性耳聋.应根据听骨链损伤的不同类型,重建听骨链,恢复患者听力,合并面瘫者,同时行面神经探查减压手术.     

Aided auditory steady-state responses in infants

Infants with hearing loss routinely receive hearing aids several months before reliable behavioral responses to amplified sound can be observed. This necessitates objective measures to validate hearing-aid fittings. A single report has demonstrated the use of ASSRs to determine aided thresholds in children but data in young infants is still lacking. The current study explored aided ASSR compared to unaided ASSR thresholds and subsequent behavioral thresholds in a group of six young infants with hearing loss who received hearing aids between three and six months of age. Aided ASSR thresholds were obtained in 83% of frequencies where aided behavioral thresholds were obtained, with a mean threshold difference of 13±13 dB. The aided ASSR-based threshold estimates were within 15 dB of behavioral thresholds in 63% of cases, indicating a moderate correlation (r = 0.55). Comparing aided and unaided ASSR measurements revealed an average functional gain of 36±15 dB. These results indicate that ASSRs can provide the first evidence of robust hearing aid benefit in young infants several months before behavioral responses are observed.     

Retrospective audiological analysis of bone conduction versus round window vibratory stimulation in patients with mixed hearing loss

Objective: To compare audiological outcomes in mild-to-moderate mixed hearing loss patients treated with a bone-anchored hearing aid or an active middle-ear implant. Analysis aimed to refine criteria used in preoperative selection of implant type. Design: Retrospective comparative analysis of audiological data. Follow-up time ranged between 0.55 and 8.8 years. Study sample: For detailed comparative analysis, 12 patients (six in each group) with comparable bone conduction thresholds and similar clinical characteristics were selected. A larger cohort of 48 patient files were used to evaluate overall audiological indication criteria (24 per group). Results: In free-field tone audiometry, Baha patients showed mean aided thresholds between 40–48 dB, whereas hearing thresholds for VSB patients were 25–43 dB. Baha and VSB users had mean WRS of 56% and 82%, respectively, at 65 dB. Better speech understanding in noise was seen with the VSB. Conclusion: Analysis of the main cohort (n = 48) showed that treatment with round window vibroplasty leads to better hearing performance than treatment with a bone-anchored hearing device, if the bone conduction pure-tone average (0.5 to 4 kHz) is poorer than 35 dB HL. Audiological analysis in the smaller comparative analysis showed similar findings.     

Assessment of basal sound identification skills and communication abilities in profoundly deaf children fitted with hearing aids or a cochlear implant

Basal auditory functions and early verbal communication skills were examined in young, profoundly deaf children with hearing aids or a cochlear implant. The hearing aid users (n = 23) were subdivided on the basis of their (unaided) hearing thresholds into: group A (pure tone average (PTA) at 0.5, 1 and 2 kHz: 90–100 dB HL); group B (PTA: 100–110 dB HL); and group C (PTA > 110 dB HL). All the children with a cochlear implant (n = 20) had a profound sensorineural hearing loss with a PTA that exceeded 120 dB HL. Functional hearing was evaluated by means of basal sound identification. The child’s communication abilities with hearing aids or a cochlear implant were assessed using structured observations on the Scales of Early Communication Skills for Hearing Impaired Children. The basal auditory functions on a sound identification level improved over time in the cochlear implant users and groups A and B. Hardly any improvement was seen in group C. The performance of all the groups (either hearing aid or cochlear implant) on the Scales of Early Communication Skills for Hearing Impaired Children at 6 months after fitting the device and at later evaluations, was close to the average level for their age.     

Fitting range of the BAHA Cordelle

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.