软带骨桥在双侧小耳畸形患者中的应用

目的 探讨佩戴软带骨桥在双侧小耳畸形患者中的临床应用效果。 方法 选取36例双侧小耳畸形患者,每例患者分别佩戴软带骨桥与软带骨锚式助听器(BAHA),佩戴前后分别测量声场纯音测听,并随访观察佩戴软带骨桥后患者的日常交流及对声音的反应情况。 结果 36例双侧小耳畸形患者佩戴软带骨桥后行声场纯音测听结果显示,平均气导听力提高38.8 dB,佩戴软带BAHA后行声场纯音测听结果显示,平均气导听力提高34.5 dB,二者比较差异无统计学意义(P>0.05),患者日常生活交流情况明显改善。 结论 对于先天性双侧小耳畸形患者,佩戴软带骨桥后,听力提高显著,效果良好。     

软带BAHA在先天性中外耳畸形患者的应用

目的观察软带BAHA(Bone-anchored hearing aids,骨锚式助听器))在双侧先天性中外耳畸形患者的听力改善效果,探索其适应症。方法比较6例佩戴软带BAHA前后的双侧先天性中外耳畸形患者听力情况,包括日常交流情况、纯音(声场)测听或条件反射测听。结果 6例患者或家属反映佩戴BAHA后,日常交流情况明显改善,纯音(声场)测听或条件反射测听气导阈改善30.2dB。结论软带BAHA对双侧先天性中外耳畸形患者是一种简单、有效的听力解决方案。     

植入式BAHA在小耳畸形患者中的应用

目的探讨植入式BAHA(Bone-anchored hearing aids,骨锚式助听器)在双侧先天性小耳畸形患者中的临床应用。方法对16例双侧先天性小耳畸形患者,植入式BAHA术前、术后的听力(包括纯音声场测听、日常交流、对声音的条件反射)进行比较。结果 16例患者听力均明显改善,佩戴BAHA后日常交流生活明显改善,纯音声场测听言语频率气导听力提高35.5d B。结论植入式BAHA,并发症少,效果满意,是目前双侧先天性小耳畸形患者解决听力问题的最佳方案。     

软带BAHA与植入式BAHA在先天性中外耳畸形患者的效果比较

目的比较软带BAHA与植入式BAHA(Bone-anchored hearing aids,骨锚式助听器)对双侧先天性中外耳畸形患者听力改善的效果。方法通过佩戴软带BAHA组6例(其中3例为自身对照)与植入式BAHA组3例的组间比较及自身对照,比较2种方式佩戴患者/家属佩戴前后主观感觉听力改善情况、日常交流、0.5-4k Hz纯音(声场)测听或条件反射测听。结果 2种佩戴方式均能使患者获得明显的听力改善,达到交流水平,0.5-4k H纯音(声场)测听或条件反射测听平均气导阈改善软带组为29.8d B(3例自身对照为31.3d B),植入式佩戴41.8d B,植入式BAHA较软带BAHA更进一步改善12d B(自身对照10.5 d B),且软带BAHA在0.5k Hz、1k Hz,植入式BAHA在0.5k Hz、1k Hz、2k Hz改善最好,均达正常听阈水平。结论软带BAHA与植入式BAHA对双侧先天性中外耳畸形患者都是有效的听力解决方案,植入式BAHA佩戴效果更好。     

植入式BAHA临床应用初步报告

目的观察植入式BAHA(Bone-anchored hearing aids,骨锚式助听器)在双侧先天性中外耳畸形患者的听力改善效果,探索BAHA规范植入技术。方法在一侧耳后区颞骨上植入BAHA钛质植入体,成人一期完成,小儿分二期完成。比较3例双侧先天性中外耳畸形患者,佩戴植入式BAHA前后的听力情况,包括日常交流、纯音(声场)测听或条件反射测听。结果 3例患者均手术顺利,术后恢复好。植入式BAHA佩戴后,患者及/或家属反映日常交流明显改善,纯音(声场)测听或条件反射测听0.25k～4k平均气导阈改善39.1dB。结论植入式BAHA对双侧先天性中外耳畸形患者是一种有效的听力解决方案,规范的植入技术是手术成功、减少并发症的保证。     

振动声桥与软带BAHA在双侧中外耳畸形患者的效果比较

目的比较振动声桥(VSB)与软带BAHA(骨锚式助听器)对双侧先天性中外耳畸形患者听力改善的效果。方法通过2例自身对照患者,比较VSB与软带BAHA使用前后,纯音测听(声场)与安静和噪声下65d BSPL言语识别率。结果 2种方式均使患者获得明显的听力改善,在纯音测定(声场)中,气导听阈在1k Hz-8k Hz,VSB助听后达到正常水平(<25d B),而软带BAHA助听在30-50d B之间,但在0.25k Hz与0.5k Hz,软带BAHA比VSB能进一步改善10-25d B。安静状态下,对单音节词和双音节词识别率,VSB比BAHA高7%-38%;但安静与噪声环境下句子识别率仅高2-10%。结论 VSB与BAHA都是双侧先天性中外耳畸形患者的有效听力解决方案。VSB在高频(1k Hz-8k Hz)助听效果较BAHA好,但低频(0.25k Hz与0.5k Hz)反之;安静状态下对单音节词和双音节词识别率VSB更好,而在安静和噪声下对句子识别率VSB比BAHA稍高。     

传导性或混合性耳聋患者佩戴骨锚式助听器软带的预期效果

目的 研究分析传导性或混合性耳聋患者进行佩戴骨锚式助听器(BAHA)软带后的听力改善情况。方法 参与研究者62例, 在声场进行BAHA软带佩戴前后纯音听力测试及问卷调查, 了解患者佩戴BAHA后的听力情况及主观感受。结果 62例佩戴BAHA后0.25～4 kHz气导听力均得到了不同程度提高, 对声音的方向感及噪声下言语交流能力提高。结论 BAHA能改善传导性聋或混合性聋患者的听力。     

双侧先天性外中耳畸形患者骨锚式助听器效果分析

目的 评估双侧先天性外中耳畸形患者应用骨锚式助听器(bone-anchored hearing aid,BAHA)后的听力效果及满意度.方法 双侧先天性耳廓畸形合并外耳道闭锁患者7例,单侧耳廓畸形伴双侧中耳畸形3例,佩戴软带BAHA后单侧植入BAHA钛植入体.分别测试患者在声场中裸耳与应用软带BAHA、植入式BAHA后的平均听阈、言语识别率及言语识别阈.以BAHA应用情况调查问卷和儿童格拉斯格受益列表(Glasgow children's benefit inventory,GCBI)分析患者应用BAHA后的生活质量提高程度和满意度.结果 患者裸耳平均听阈为(64.8 ±5.9)dBHL,佩戴软带BAHA后平均听阈降至(30.2±3.7) dBHL,佩戴植入式BAHA后平均听阈为(20.3±3.9) dBHL,三者两两比较,差异均具有统计学意义(P值均＜0.05).佩戴软带BAHA后患者听阈较裸耳平均下降(36.1±8.0)dB;植入式BAHA听阈较软带BAHA平均下降(12.2 ±3.4)dB.在45dBHL和65dBHL给声强度下,裸耳言语识别率分别为(3.00±1.07)％和(57.55 ±10.30)％,植入BAHA后言语识别率提高至(89.39±5.83)％和(91.19 ±4.16)％,二者差异具有统计学意义(P值均＜0.05).裸耳平均言语识别阈为(63.1±5.9) dBHL,佩戴植入式BAHA后为(24.7±3.5) dBHL,二者差异具有统计学意义(P＜0.05).BAHA应用情况调查问卷显示患者应用软带BAHA和植入式BAHA均获得满意效果,GCBI平均受益分数为(35.59 ±14.35)分.结论 对于双侧先天性外中耳畸形患者,应用BAHA可显著改善其听力及生活质量,患者满意度较高.     

四种助听装置对双侧先天性中外耳畸形患者效果的比较

目的比较BAHA(软带与植入式佩带)、振动声桥(VSB)、骨桥(BB)与骨导助听器(BCHA)对双侧先天性中外耳畸形患者听力改善的效果,为听力解决方案的选择提供参考。方法比较四种助听装置(5组),包括软带BAHA(6例)、植入式BAHA(3例)、VSB植入(5例)、BB植入(2例)及骨导助听器(12例),共28例患者助听前后交流情况、0.5k Hz-4k Hz纯音测听或条件反射测听(声场)平均气导阈值改善情况及安静和噪声环境下65d BSPL言语识别率。结果助听后均能完成日常交流。平均气导阈值改善分别为29.8d B(61.3d B/31.5d B)、41.8d B(63d B/21.2d B)、45.5d B(69.3d B/23.8d B),36.9d B(66.9d B/30d B),31.1d B(63.6d B/32.5d B)。句子识别率,助听前11-31%,助听后软带BAHA和植入骨桥89.5-93.5%,植入式BAHA和VSB 96-100%。结论四种助听装置(5组)均能使患者获得明显的听力改善。软带BAHA与骨导助听器类似,听力曲线呈弓形,在0.5k、1 k Hz最佳,30d B左右,植入BAHA在2k Hz进一步改善达正常水平,植入VSB在高频(2k Hz左右)效果好,但低频1k Hz以下不理想;而BB听力曲线呈上升型,阈值在20-40 d B水平。助听后句子识别率植入式BAHA和VSB较软带BAHA和植入骨桥好。同时还要结合患者的发育状况、听力水平、经济能力来选择助听方案。     

60岁以上听功能障碍者助听器远程验配86例

目的 分析186例60岁以上听功能障碍患者助听器验配情况,探讨老年听功能障碍者听力及助听器选配特点,为助听器验配寻找新思路。方法 统计186例250～8 000 Hz的纯音听阈,根据听力情况,进行常规助听器验配和调试100例, 利用网络远程助听器验配86例, 跟踪最终验配情况。结果 远程验配及常规验配两组患者佩戴助听器后听力提高和言语分辨率提高结果相同, 差异无统计学意义。结论 常规和远程验配均可以给听功能障碍患者选配正确的助听器, 能够有效改善老年患者耳聋症状,提高老年患者听力。远程验配可以减少患者验配成本, 更好地保障验配服务。     

The evaluation of a surgery and the short-term benefits of a new active bone conduction hearing implant - the Osia®

IntroductionModern medicine offers a wide spectrum of different hearing devices, and bone conduction implants can be found among them.ObjectiveThe presentation of the outcomes of the implantation of a new active bone conduction hearing implant – the Osia®, and its comparison with the well-known passive transcutaneous system – the Baha® Attract.MethodsEight adult patients with bilateral mixed hearing loss were randomly divided into two groups. Group 1 was implanted with the Osia®, and group 2 was implanted with the Baha® Attract. The details of the surgery were analyzed, along with the functional and audiological results.ResultsIn all the cases, the surgery was successful, and the healing uneventful. In both groups, it was observed that pure tone audiometry and speech audiometry in free field improved significantly after the implantation (mean gain in pure tone audiometry for the Osia group 42.8 dB SPL and for the Baha group 38.8 dB SPL). In the Osia group, the results after the surgery were much better than with the Baha® 5 Power processor on the Softband. The patients implanted with the Osia® evaluated the quality of their hearing as being superior to those implanted with the Baha® Attract. There was an evident improvement in the abbreviated profile of hearing aid benefit questionnaire and in the speech, spatial and qualities of hearing scale for both systems. In the abbreviated profile of hearing aid benefit, changes were more evident in the Osia group (in global score 49% vs. 37.2%).ConclusionImplantation of the Osia® is an effective treatment option for the patients with bilateral mixed hearing loss. The surgery is safe but more complex and time-consuming than the Baha® Attract implantation. The preliminary audiological results as well as the overall quality of life indicate that the Osia® is a better solution than the Baha® Attract. However, future studies should be carried out to make further observations in a larger group of patients, and with longer follow-up.     

助听器助听效果的客观评价

目的 评价助听器的助听效果。方法 所采用的客观测试包括,声场情况下助听与未助听的由短声引起民的听性脑干反应（ＡＢＲ）测试及由短纯音引起的颅顶慢反应（ＳＶＲ）测试。结果与结论 ＳＶＲ阈值与声场纯音测试阈值间有高度的相关性,两种测试方法所测得的听力补偿间无显著性差异。     

纯音声场测听可行性研究报告

本文的目的是探讨纯音用于声场测听的可行性。普遍认为声场测听适宜刺激为啭音和窄带噪声，而纯音仅作为耳机测听和消声室中测试信号。本文通过对纯音声压分布、声场变异以及频率漂移对参考点声压级影响的研究发现，扩散场中纯音声压分布的均匀性虽不如啭音，但在某些范围其能量仍可充分扩散，这些区域声场测试结果受受试者头位改变和／或频率漂移影响轻微。对２０名重度感音神经性耳聋患者的测试结果证实了上述结论。由此认为，如在声场校正基础上合理选择参考点位置，用纯音进行声场测听是可行的。     

82例耳鸣患者半倍频程频率纯音测听的特征及意义

目的 :观察常规倍频程纯音测听听阈无异常的耳鸣患者的半倍频程频率测试结果并探讨其特征及临床意义。方法 :应用纯音听力计对 82例 (14 0耳 )倍频程纯音测听听阈无异常的耳鸣组患者和 30例 (6 0耳 )正常对照组进行半倍频程频率测试。结果 :耳鸣组 14 0耳中 ,发现 37.14 %存在听力下降 ;主要为高频下降 ;大多为轻度下降 ;下降的频率与耳鸣频率有高度一致性 ;耳鸣的强度 (dBSL)与听力下降与否无关。结论 :半倍频程频率测试方法可为倍频程纯音测听听阈无异常的耳鸣患者早期听力损害的检出提供直接参考依据 ,对临床早期发现其潜在的耳蜗病变有积极意义     

The bone conduction implant: Clinical results of the first six patients

Objective: To investigate audiological and quality of life outcomes for a new active transcutaneous device, called the bone conduction implant (BCI), where the transducer is implanted under intact skin. Design: A clinical study with sound field audiometry and questionnaires at six-month follow-up was conducted with a bone-anchored hearing aid on a softband as reference device. Study sample: Six patients (age 18–67 years) with mild-to-moderate conductive or mixed hearing loss. Results: The surgical procedure was found uneventful with no adverse events. The first hypothesis that BCI had a statistically significant improvement over the unaided condition was proven by a pure-tone-average improvement of 31.0 dB, a speech recognition threshold improvement in quiet (27.0 dB), and a speech recognition score improvement in noise (51.2 %). At speech levels, the signal-to-noise ratio threshold for BCI was ? 5.5 dB. All BCI results were better than, or similar to the reference device results, and the APHAB and GBI questionnaires scores showed statistically significant improvements versus the unaided situation, supporting the second and third hypotheses. Conclusions: The BCI provides significant hearing rehabilitation for patients with mild-to-moderate conductive or mixed hearing impairments, and can be easily and safely implanted under intact skin.     

煤矿井下噪声暴露工人畸变产物耳声发射检测

目的探讨畸变产物耳声发射（DPOAE）在监测及早期发现噪声性聋方面的价值。方法对73例142耳耳科正常人（对照组）和78例154耳煤矿井下噪声暴露工人（实验组,其中纯音听力正常组45例90耳,纯音听力异常组33例64耳）,行DPOAE0.5～16kHz检测,两组结果进行比较。结果实验组DPOAE幅值在3.0、4.0、6.0、11.2kHz处下降明显,与对照组比较差异有显著意义（P〈0.05）;而在12.5、14.0、16.0kHz频率两组差异无显著意义（P〉0.05）。纯音听力正常与异常的实验组分别与对照组比较,DPOAE幅值变化趋势相同,纯音听力正常与异常的实验组在3.0、4.0、6.0、11.2kHz处均下降,分别与对照组比较差异有显著意义（P〈0.05）;在11.2kHz处纯音听力异常的实验组下降更显著（P〈0.01）;实验组DPOAE引出率均下降,与对照组比较差异有显著意义（P〈0.05）。结论 DPOAE检查可用于噪声性聋的早期诊断和监测。     

New hearing test for functional deafness--the procedure to estimate the genuine hearing threshold]

This report describes a new procedure for examining functional deafness with binaural sound stimulation. This new hearing test can estimate the genuine pure tone hearing threshold quantitatively at every frequency by using the ordinary audiometer. In the case of the nonorganic deafness, even if the hearing disorders are bilateral or hemilateral, we believe that measuring auditory threshold separately, causes the deterioration of the threshold. Therefore, this procedure is designed so that the subject may not be aware of testing the auditory acuity of each ear, and utilizes the response of the phantom sound image in the head by simultaneous binaural presentation of sound stimulation. Our strategy is based on the following facts. If the normal subject has the same pure tone threshold level in both ears, the phantom sound image is formed in the median plane of the head by the equal suprathreshold tone level presented simultaneously in each ear. In the case of a unilateral auditory disorder, the sound image is localized to the center of the head only when sound stimulation louder than the threshold level of affected ear is given to both ears at the same time. Simultaneous binaural sound stimulation at a lower level than the threshold of the affected ear forms a lateralized sound image to the unaffected ear in the head. For patients with bilaterally similar hearing loss, the sound image is not formed if the stimulation is less than the threshold level of the pure tone. The band noise in the phase of each frequency with 50 dB HL was given binaurally to 10 normal hearing subjects, and the localization of the sound image formation was examined. This experiment confirmed that around the occipital region of the median plane in all subjects. Furthermore, comparing the formation threshold of the median plane image with the pure tone auditory threshold, proved that there was no significant difference statistically in either value. As a next step, 15 patients with unilateral sensorineural deafness were examined with this technique and we knew that the median sound images would not be formed with stimulation less than the pure tone auditory threshold of the affected ear. For clinical application, patients were classified into two groups with unilateral (6) and bilateral (2) functional deafness, and examined. Midline sound images definitely were formed with the lower magnitude of sound than the pure tone threshold by hemilateral nonorganic deafness. The difference of the forming threshold of the median sound image and the average of pure tone hearing level of the affected ear were maximum 100 dB, minimum 35 dB, and mean 69.4 dB. Furthermore, the difference of the median image forming threshold and the average hearing level of the unaffected ear were maximum 35 dB, minimum 0 dB, and mean 15.4 dB. In bilateral disorders, the midline plane sound image was formed with the corresponding level of the pure tone value in one subject, though the other one was determined by the maneuver method because it did not form a midline sound image. In conclusion, this examination can be readily used to estimate the genuine hearing threshold of the functional deafness.     

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。