儿童OSAHS不同刺激重复率听性脑干反应的临床研究

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep Apnea-hypopnea syndrome,OSAHS)的脑干听觉诱发电位反应(Brain Auditory Evoked Potention,BAEP)的特征。方法 对经多导睡眠检测确诊的儿童OSAHS患者87例,经声阻抗检查呈A型曲线,4～7岁,分别以11.1、33.1?Hz的不同刺激重复率进行BAEP测试,比较不同病变程度对两种刺激重复率听觉阈值、潜伏期及波间期差的影响。结果 与对照组比较,OSAHS轻度组：两种刺激重复率的 BAEPⅠ、Ⅲ、Ⅴ波的潜伏期及波间期差均在正常范围,Ⅴ波听阈为25dBnHL;中度组：刺激重复率33.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及波间期差无异常,Ⅴ波听阈25dBnHL;刺激重复率11.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期延长,差异具有统计学意义（P＜0.05）,Ⅰ～Ⅲ、Ⅰ～Ⅴ波间期延长,Ⅲ～Ⅴ间期在正常范围,Ⅴ波听阈28dBnHL;重度组：刺激重复率33.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及各波间期差均延长,Ⅴ波听阈35dBnHL;刺激重复率11.1Hz,Ⅰ、Ⅲ、Ⅴ波的潜伏期及波间期差均延长,Ⅴ波听阈40dBnHL。重度OSAHS患者两种刺激重复率各波潜伏期、波间期差听阈改变均具有统计学意义。结论 低频短声刺激能较早反映OSAHS患儿脑干功能的改变;重度OSAHS患儿的BAEP测试结果异常,提示OSAHS对听阈及听觉脑干传导功能都存在影响。     

儿童重度阻塞性睡眠呼吸暂停低通气综合征听性脑干反应的临床研究

目的:探讨儿童重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的听性脑干反应(ABR)的特征。方法:对37例(74耳)重度OSAHS儿童(OSAHS组)进行ABR测试,并与20例(40耳)正常儿童(对照组)进行比较。结果:①OSAHS组患儿ABRⅠ、Ⅲ、Ⅴ波的潜伏期分别为(1.67±0.20)ms,(3.87±0.31)ms,(5.70±0.31)ms;对照组分别为(1.60±0.11)ms,(3.81±0.23)ms,(5.61±0.23)ms;2组比较,ABRⅠ波潜伏期的延长有统计学意义(P<0.05)。②OSAHS组Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期分别为(2.19±0.19)ms,(1.82±0.22)ms,(4.01±0.22)ms;对照组分别为(2.26±0.15)ms,(1.73±0.21)ms,(4.05±0.23)ms;2组比较,Ⅲ～Ⅴ波间期的延长及Ⅰ～Ⅲ波间期的缩短有统计学意义(P<0.05)。③与对照组相比,OSAHS组波Ⅴ反应阈的提高有统计学意义(P<0.05)。结论:重度OSAHS患儿的ABR测试结果异常,提示OSAHS对耳蜗及听觉脑干的功能都存在影响。     

重度OSAHS患者持续正压通气治疗前后ABR及静态姿势描记结果分析

目的观察持续正压通气(continuous positive airway pressure,CPAP)治疗对重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者听性脑干反应(ABR)及静态姿势描记(posturography,PSG)的影响。方法对32例重度OSAHS患者持续正压通气治疗前后及20例正常对照者进行ABR测试及静态姿势描记检查,比较其结果。结果重度OSAHS患者ABR波I、V潜伏期及III-V波间期比对照组延长,PSG各指标增加;CPAP治疗3月后OSAHS组ABR各波潜伏期及波间期与治疗前比较差异无统计学意义,而PSG各指标较治疗前降低,差异有统计学意义(P<0.05或<0.01)。结论重度OSAHS患者的脑干听觉传导功能受损,静态平衡能力降低,CPAP治疗有助于早期改善静态平衡功能。     

阻塞性睡眠呼吸暂停低通气综合征的听性脑干反应特征

目的:分析阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的听性脑干反应(ABR)特征,探讨OSAHS对听觉通路的影响及其机制。方法:应用PSG对72例具有打鼾症状的患者进行检测并分为单纯鼾症组与OSAHS组,另选无打鼾症状的正常人为对照组,对3组的ABR进行分析。结果:OSAHS组波Ⅰ、Ⅴ潜伏期延长及波Ⅴ反应阈增高,与单纯鼾症组和对照组比较,差异均有统计学意义(均P<0.01)。结论:OSAHS的ABR主要表现为波Ⅰ、Ⅴ潜伏期延长及波Ⅴ反应阈增高,说明OSAHS对听觉通路的影响主要在耳蜗,而对脑干部位的影响尚不明确。     

阻塞性睡眠呼吸暂停低通气综合征患者的高刺激率ABR的临床分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征患者高刺激率ABR和常规刺激率ABR的临床价值及其与间歇性低氧的关系。方法对58例(116耳)OSAHS患者及正常成年人分别进行11次/秒及51次∕秒刺激率的听性脑干反应(ABR)测试,比较组间结果。结果 11次∕秒刺激率ABR,OSAHS组双耳的波I潜伏期(1.51±0.13ms)较对照组(1.33±0.07ms)延长;波V潜伏期(5.65±0.23ms)较对照组(5.53±0.23ms)延长;在51次/s刺激率下,患者组双耳的Ⅰ波潜伏期、Ⅴ波潜伏期均比正常人延长,(1.64±0.12ms)较对照组(1.44±0.06ms)延长;波V潜伏期(5.92±0.26ms)较对照组(5.80±0.18ms)延长;有统计学意义(P<0.05)。而在两种刺激率下,两组人群双耳的Ⅰ~Ⅴ波间期、波间期差值之间的差异均无统计学意义(P>0.05)。结论高刺激率ABR可发现中度及重度OSAHS患者耳蜗功能的损伤。     

阻塞性睡眠呼吸暂停低通气综合征的听觉功能评价

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea—hypopnea syndrome，OSAHS)患者听觉功能有无损伤。方法对19例OSAHS患者及16例正常对照者分别进行纯音测听、声导抗及听性脑干反应(ABR)检测，将两组结果进行统计学分析。结果 纯音听阈及声导抗测试两组无显著性差异；OSAHS患者ABR的波Ⅲ及波V潜伏期延长，两组之间有显著性差异；OSAHS患者．ABR I-Ⅲ和I—V波间期延长，两组之间有非常显著性差异。结论 OSAHS患者长期的夜间反复缺氧会导致听觉功能的损伤，ABR可监测OSAHS患者听觉功能的早期损害。     

阻塞性睡眠呼吸暂停低通气综合征患者听性脑干反应及前庭脊髓反射的观察

目的观察不同程度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OS-AHS)患者听性脑干反应(auditory brainstemresponse,ABR)及前庭脊髓反射(vestibulospinal reflex,VSR)的结果。方法对轻、中、重三组OSAHS患者和对照组进行ABR测试及静态姿势描记检查(posturography,PSG),对其中28例重度OS-AHS患者悬雍垂腭咽成形术(UPPP)手术前后分别进行ABR、PSG测试并进行对比。结果重度OSAHS患者ABR的波I、V潜伏期及III-V波间期延长;中、重度OSAHS患者PSG各参数延长;28例重度OSAHS患者UPPP术后3个月ABR各波潜伏期及波间期与术前比较,差异无统计学意义,而PSG各参数均较术前降低。结论重度OSAHS患者的脑干听觉传导通路受损,中、重度OSAHS患者前庭脊髓反射功能降低,UPPP有助于早期改善前庭脊髓反射功能。     

儿童阻塞性睡眠呼吸暂停低通气综合征的听功能评价

目的探讨阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-Hypopnea Syndrome；OSAHS)儿童的听功能状态。方法选择OSAHS患儿65例（130耳），根据睡眠呼吸紊乱指数（AHI）分为2组：OSAHS轻度组（10次/h＞AHI≥5次/h）和OSAHS中重度组（AHI≥10次/h），作为实验组。并选择正常儿童20例（40耳）作为对照组。均行纯音测听、声导抗检查及纤维鼻咽喉镜检查，并对声导抗测试中鼓室导抗图为“A”型耳，进行听觉脑干诱发电位(ABR)和瞬态诱发耳声发射（TEOAE）检查。与对照组比较，进行统计学分析。结果 OSAHS患儿59例（118耳）正常儿童对照组20例（40耳）进入统计分析；①、125～8000 Hz各频率气导听阈，OSAHS轻度组与对照组比较无统计学意义（P＞0.05），中重度OSAHS组与对照组比较均有增高，差异有统计学意义(P<0.05)。②、OSAHS轻度组鼓室压图异常率51.52%（34/66），OSAHS中重度组鼓室压图异常率62.75%（31/52），组间比较无统计学差异(P>0.05)，与对照组比较均有统计学差异(P<0.05)；③、鼓室导抗图为“A”型的轻度及中重度OSAHS患儿的TEOAE通过率,与对照组比较差异均有统计学意义(均P<0.01)。④、鼓室导抗图为“A”型的轻度OSAHS患儿ABR听阈、各波潜伏期和波间期与对照组比较无统计学差异(P>0.05)；鼓室导抗图为“A”型的中重度OSAHS患儿波Ⅰ、Ⅴ潜伏期及波Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期比对照组延长,Ⅴ波反应阈亦较对照组提高，差异有统计学意义(P<0.05)。⑤、鼓室压曲线异常分别与语言频率平均听阈、腺样体肥大程度、AHI、最低血氧饱和度相关；⑥、对鼓室压图为“A”型的53耳及对照组40耳进行Logis-tic回归分析：腺样体肥大及AHI是OSAHS患儿耳蜗及听觉神经通路损害的危险因素。结论儿童OSAHS易出现中耳功能异常导致的传导性听力损失，同时中重度OSAHS患者还可能出现缺氧导致的耳蜗及听觉脑干的损害。     

听力正常孤独症谱系障碍儿童的听性脑干反应波形特征分析

目的 探究听力正常孤独症谱系障碍(autism spectrum disorder, ASD)儿童的听性脑干反应(ABR)特征及各波潜伏期和波间期与ASD严重程度分级的关系。方法 (1)将55例(110耳)听力正常ASD儿童和月龄、性别相匹配的55例(110耳)典型发育(typical development, TD)儿童,按月龄分为≤24月龄(22耳)、25～36月龄(40耳)、37～48月龄(28耳)及>48月龄(20耳)四个亚组。比较听力正常ASD儿童与TD儿童的ABR潜伏期和波间期是否存在差异。(2)根据第五版精神障碍诊断与统计手册(DSM-V)将ASD儿童按照严重程度分级,探究听力正常ASD儿童ABR各波潜伏期和波间期与其严重程度分级是否相关。结果 (1)≤24月龄时,ASD与TD儿童ABR各波潜伏期及波间期差异均无统计学意义(P>0.05);(2)25～36月龄时,与TD儿童相比,听力正常ASD儿童波Ⅲ潜伏期及Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期显著延长;37～48月龄时波Ⅲ、Ⅴ潜伏期及Ⅰ-Ⅲ、Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期显著延长;>48月龄时波Ⅴ潜伏期及Ⅲ-Ⅴ、Ⅰ-Ⅴ波间期显著...     

阻塞性睡眠呼吸暂停低通气综合征患者听性脑干诱发反应的研究

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是指患者睡眠时因上气道的阻塞性病变所引起的呼吸紊乱。呼吸中枢和听觉传导通路同处于脑干，一些学者探讨用听性脑干诱发反应(ABR)检测OSAHS患者的脑干神经系统功能。本实验用ABR检测OSAHS患者的脑干听觉传导功能，观察OSAHS患者夜间不断重复的减血氧对脑干听觉传导通路损伤的作用，为OSAHS的脑干听觉传导通路损伤找到一个客观的检查方法。     

Auditory brainstem responses to tonal stimuli in young and aging rats

The auditory brain stem response (ABR) was studied in young adult and aged rats using 3,8 and 40 kHz tone pips. The expected inverse relationship between frequency and latency was observed in the younger group for waves I, II and III, while the response to the highest frequency stimulus had the longest latency at wave V. Absolute latencies for waves I through V each showed age-related increments with more pronounced changes occurring to 3 and 40 kHz stimuli than to the frequency of maximum sensitivity (8 kHz). Threshold increases with age for the highest frequency approximately doubled those for the lower frequencies. Examination of interpeak intervals (IPI) I-III, III-V and I-V revealed aging effects. The largest IPI I-V increment occurred to 3 kHz stimulation which reflects changes at both I-III and III-V sub-intervals. These results demonstrate electrophysiological correlates of aging due to transformations in the peripheral auditory system coupled with alterations in brainstem auditory pathways.     

Auditory brainstem response in premature and full-term children

OBJECTIVES: To compare the absolute latencies of peaks I, III and V and interpeak intervals of premature and full-term children. METHODS: Prospective, comparative cohort study. Study subjects were premature and full-term children with auditory brainstem response (ABR) measured at ages 4, 12 and 20 months. The children had previously undergone otorhinolaryngolic and audiologic evaluations to exclude those with altered hearing. RESULTS: One hundred and twenty-four children were included in the study (73 premature). No differences were found between children of different sexes nor between the right and left ears of the individual children, so the statistical unit sed for the study was the ear. Using the t-test for independent samples, the absolute latencies of peaks I, III and IV and the interpeak intervals I-III, I-IV and III-V presented statistically significant differences between the groups at ages 4 and 12 months. At 20 months, only peak I failed to show a difference in absolute latency. Strong inverse correlation was found (Pearson's coefficient) between gestational age and absolute peak latency, as well as for interpeak intervals. CONCLUSIONS: Maturation of the auditory system, as measured by ABR, occurs differently between premature and full-term children, suggesting that gestational age be taken into consideration when using ABR in premature children younger than 20 months old.     

Influence of age and hearing loss on the latency shifts of the auditory brainstem response as a result of increased stimulus rate

Latency shifts of auditory brainstem response waves, I, III and V were studied as a function of increasing the stimulus repetition rate from 9 to 21, 42 and 63/s. There appears to be an accumulative retardation of the successive waves when faster click rates are administered that yield a prolongation of the interpeak intervals I-III and III-V. The effect on wave V and on the interpeak interval III-V seems to intensify with age (especially over 55 years). In ears with a flat sensorineural hearing loss, the adaptation of waves III and V is found to be somewhat smaller than in normal ears at the same intensity in dB SPL.     

BSER abnormalities in patients with spino-cerebellar degeneration

The short latency auditory electrical response (BSER) was evaluated in 15 patients suffering from spino-cerebellar atrophy (SCA). All patients had normal hearing and presented with various degrees of neurological involvement. BSER findings along with clinical symptoms furnished the following grouping of results: 1 Patients with recent and mild symptomatology showed excellent intratest stability, normal III-V and prolonged I-V and I-III interpeak values. 2 Patients with severe symptoms dating back 10-15 y showed low intratest stability, prolonged latency of waves I, III and V, along with remarkably lengthened I-III and III-V interpeak intervals. 3 Patients with moderate to severe symptoms, dating back 10-15 yr showed good stability, absence of wave II and IV, abnormally long I-III intervals and reduced III-V intervals.     

Auditory brainstem response in pediatric migraine: during the attack and asymptomatic period

OBJECTIVE: The aim of this study was to evaluate the hearing parameters of children with migraine during ictal and interictal period. METHOD: 16 pediatric patients with migraine and normal otolaryngologic examination were evaluated. Hearing parameters were assessed with auditory brainstem response (ABR) testing between and during the migraine attacks. Binaural absolute latencies of waves I, III and V, interpeak latencies I-III, III-V and I-V of ABR in response to 80 dB nHL clicks were calculated. Initial findings were compared with those of 20 healthy volunteers. RESULTS: Peak latencies of wave V and interpeak latencies of I-V were prolonged during the attack in migraineurs on the left. The side of latency elongation was not affected by the side of headache. When these parameters were separately compared for gender, they were prolonged in boys during the attack in migraineurs; however in girls, while there was statistically significant difference at interpeak latencies of I-V, no significant difference was noted at peak latencies of wave V. CONCLUSIONS: ABR waves did not exceed clinical norms in migraine patients in headache-free period. But, important effects on sensorineural hearing parameters were detected during the attack. Our results indicated a transient impairment of the auditory brainstem function during the headache in pediatric migraine patients.     

Auditory brain stem response throughout the menstrual cycle

A prospective study was performed to evaluate the changes in the auditory brain stem response (ABR) that occur in healthy premenopausal women throughout the menstrual cycle. Ninety-four women with ovulatory menstrual cycles underwent ABR testing by auditory evoked potentials for wave I, III, and V latencies and for interpeak I-III, I-V, and III-V intervals during the follicular, periovular, and luteal phases of the menstrual cycle. The wave latencies and the interpeak intervals showed shorter values during the periovular phase than during the luteal phase (p < .05) and shorter values during the follicular phase for wave I (p < .05) and interpeak interval I-V (p < .05). The ABR seems to be influenced by the variations of ovarian steroids that occur during the menstrual cycle.     

Diagnostic implications of stimulus polarity effects on the auditory brainstem response

The purpose of this study was to determine whether clicks presented in rarefaction or condensation modes produce more accurate diagnostic information. Subjects were 20 consecutive patients who were seen at the Mayo Clinic for unilateral acoustic neuromas. The nontumor ear served as a control to minimize intersubject variability in the latencies. A standard audiologic evaluation was followed by an auditory brainstem response (ABR) test for which the stimuli were rarefaction and condensation clicks. Responses were analyzed for the presence of waves I, III, and V; absolute latencies of waves I, III, and V; interpeak intervals I-III, III-V, and I-V; and interaural latency difference for wave V. The results indicated that measures from both polarities were similar in this set of patients and that neither click polarity provided diagnostic advantages over the other. Recommendations are to collect ABRs to both click polarities individually to obtain the full complement of waves on which to base the diagnostic impression.     

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 responses in Rett syndrome: effects of hyperventilation, seizures, and tympanometric variables

This study examined the effects of tympanometric variables, stage of disease, hyperventilation, and seizures on the auditory brainstem response (ABR) in Rett syndrome (RS). Thirty-four female children with RS ranging in age from 2 years, 3 months to 15 years, 7 months participated in the study. ABRs and tympanograms were recorded from all of the subjects. When the ABR peaks were identifiable, interpeak latency intervals (IPLIs) for I-III, III-V, and I-V were computed for each waveform. The peaks (I, III, and V) and IPLIs were characterized as abnormal if either the peaks were absent or the latencies were greater than 2 SD from the normative data (obtained on female children). Analyses revealed significant prolongation of wave I latencies in Rett children with abnormal tympanograms. ABR wave III latencies were significantly affected by the presence of seizures and hyperventilation. The Pearson chi-square statistic revealed significant differences in the rate of wave III and V abnormalities due to the presence and degree of hyperventilation and the presence of seizures. Wave I abnormalities were also observed in the presence of normal middle ear function, suggesting the presence of sensorineural hearing impairment in some RS children. Clinical implications of these findings are discussed.     

Auditory Brainstem Responses in Senile Presbycusis Patients over 90 years

Objective To analyze the characteristics of auditory brainstem response (ABR) in presbycusis patients el-der than 90 years. Methods Fourteen presbycusis patients elder than 90 years (presbycusis group, 91.1.4 ± 1.3 years, 26 ears) and 9 normal-hearing young adults (control group, 22.7 ± 1.2 years, 18 ears) participated in the study. Alternative click-evoked ABRs were recorded in both groups. The peak latency (PL) of peak I,Ⅲ, and V, and the inter-peak latency (IPI) of I-Ⅲ,Ⅲ-V, and I-V were compared between groups. Results In elder presbycusis patients, the occurrence rate of peak I andⅢwere both 76.9%, and that of peak V was 84.6%. In presbycusis group, the peak latencies of I, Ⅲ, V were significantly longer than that of control group (P<0.001). There was no significant difference between groups in the IPI of peak I-IⅢ (P=0.298, peakⅢ-V (P=0.254) and peak I-V (P=0.364). Conclusions Auditory brainstem responses in presbycusis pa-tients elder than 90 years showed worse wave differentiation.