学龄期听力正常儿童瞬态诱发耳声发射的特征及测试体会

目的 探讨学龄期听力正常儿童瞬态诱发耳声发射(TEOAE)的特征及测试方法.方法 对20例(男女各10例)听力正常的学龄期儿童行TEOAE检测,分析其特点.结果 ①学龄期儿童的TEOAE总强度为13.11±4.13 dB SPL,其中女性为14.16±4.24 dB SPL,男性为11.76±3.69 dB SPL,女性高于男性2.40 dB,但差异无统计学意义(P=0.091).TEOAE总重复率为86.43%±8.78%,A&B值为13.38±3.93 dB SPL,A-B值为3.55±2.80 dB;②学龄期儿童TEOAE频带信噪比(SNR)在1.5 kHz频带最高,之后随频率增加而降低,在4 kHz频带SNR最低.结论 学龄期儿童TEOAE的测试噪声及频带SNR的分布与成人接近,TEOAE反应强度高于成人,尤其在较高频带区.     

新生儿与成人瞬态诱发耳声发射性别差异的比较

目的探讨瞬态诱发耳声发射(TEOAE)的性别差异在新生儿与成人之间的变化。方法以短声刺激分别对120名(女62,男58)通过听力筛查的新生儿及53名(男26,女27)纯音听阈正常的青年成人行TEOAE检测,对两组TEOAE强度及频带信噪比(SNR)的性别差异进行分析。结果①成人组TEOAE强度性别差异(2.41dB)明显高于新生儿(0.99dB)。②新生儿SNR除1kHz男婴高于女婴外,其余频带均为女婴高于男婴,且SNR的性别差异随频率增加而增大,在3、4kHz差异有统计学意义(P<0.05)。成人不同频带SNR均为女性高于男性,除3kHz外也呈现随频率增加而增大的特征,在2、4kHz差异有统计学意义(P<0.05)。结论 TEOAE总强度的性别差异随年龄增加而增大,且新生儿及成人频带SNR的性别差异均随频率增加而增大,成人低频区SNR的性别差异较新生儿更明显。     

瞬态诱发耳声发射检测职业性听力损伤的可行性研究

目的 :探讨瞬态诱发耳声发射 (TEOAE)检测职业性听力损伤的可行性及临床应用价值。方法 :选择 90例 (180耳 )噪声暴露工人为实验总组 ,按噪声暴露时间长短又分为 1、2、3组 ;另选 11例 (2 2耳 )正常听力青年人作为对照组 ,行纯音听阈和TEOAE测试。结果 :各实验组纯音听阈值明显高于对照组 ,TEOAE总重复率、幅值和信噪比及各频段重复率、幅值和信噪比明显低于对照组 (P <0 .0 5或P <0 .0 1)。实验 1、2、3组间比较 ,随着噪声接触时间的增加 ,各频率点纯音听阈提高 ,TEOAE总重复率、幅值和信噪比及各频段重复率、幅值和信噪比变小 ,在 2 .5 0～ 3.5 0kHz和 3.5 0～ 4 .5 0kHz频段最明显。结论 :用TEOAE检测职业性听力损伤是可行的 ,有临床应用价值 ,最敏感频段为 2 .5 0～ 3.5 0kHz和 3.5 0～ 4 .5 0kHz频段。     

基层医院新生儿听力筛查方法与评定标准的建立

目的 :探讨新生儿听力筛查的最佳方法与相关标准。方法 :应用Cepella耳声发射仪对 12 77例(2 5 5 4耳 )新生儿作瞬态诱发耳声发射 (TEOAE)测试。以 4个频带中 3个频带信噪比≥ 3dB为通过标准。结果 :通过率为 89.4%,测试时间以产后 2d以上为佳。结论 :TEOAE是新生儿听力筛查的首选方法 ,频带信噪比≥ 3dB为最适当的筛查标准。     

SISI联合TEOAE在噪声性听力损失筛查中的应用

目的 探讨短增量敏感指数(SISI)测试及瞬态诱发耳声发射(TEOAE)在噪声性听力损失筛查中的意义。方法 50例纯音听阈正常并有噪声暴露史的受试者作为噪声组，另外50例未接受噪声暴露的纯音听阈正常者作为对照组，两组平均年龄分别为19.58±1.03、19.90±1.20岁。两组分别行气导纯音听阈、SISI、TEOAE检测，分析两组间的结果差异。结果 噪声组和对照组0.25～8 kHz气导纯音听阈均小于20 dB HL,差异无统计学意义(P>0.05)。噪声组各频率SISI均高于对照组，差异有显著统计学意义(P<0.01)。噪声组TEOAE波形总体相关率为92.32%±1.99%,对照组为97.92%±0.49%(P<0.05);噪声组反应幅值为16.00±1.04 dB SPL,对照组为20.27±0.70 dB SPL(P<0.05);噪声组信噪比为12.66±1.55 dB,对照组为20.95±0.89 dB(P<0.01)。SISI 6 kHz与TEOAE 3.5～4.5 kHz频段信噪比负相关(P<0.05)。结论 高频率SISI联合提高筛...     

宽频带白噪声适度暴露对小鼠听力损害的实验研究

目的通过100dB SPL宽频带白噪声对成年C57小鼠进行单次2小时的暴露,观察该种噪声对小鼠听功能损害的特点。方法选取5⁶周龄ABR听阈正常的C57小鼠(每组5-7只),随机分为5个实验组分别为:噪声暴露后即刻(P0)、1天(P1)、3天(P3)、7天(P7)、14天(P14)。实验组小鼠于100dB SPL宽频带白噪声环境下暴露2h,本实验采用噪声暴露前的小鼠作为对照组。每只实验小鼠分别于噪声暴露前及暴露后各时间点进行ABR阈值检测以评估听力受损情况,实验采用统计噪声暴露前、后各时间点小鼠ABR差值(阈移)的方法分析实验结果。结果噪声暴露后即刻,小鼠各频率的ABR阈移均为最大值(P<0.01):Click(11.92±7.51dB)、4kHz(11.92±5.60dB)、8kHz(12.31±5.99dB)、16kHz(21.54±8.75dB)、32kHz(20.00±8.90dB),且在各个频率的阈移中,以16kHz及32kHz处的高频听力损失最严重,明显高于Click、4kHz及8kHz处的阈移(P<0.05)。脱离噪声环境24小时后各频率的ABR阈移开始下降,2周以后,小鼠各频率ABR阈值均完全恢复至暴露前水平(P>0.05):Click(1.11±6.01dB)、4kHz(1.11±3.33dB)、8kHz(1.11±4.17dB)、16kHz(1.67±4.33)、32kHz(2.78±4.41)。结论 100dB SPL宽频带白噪声单次有限暴露可以造成小鼠出现一定程度的听力损害。在频率分布上,高频区域的听力损害更为明显。同时,本研究表明,这种噪声下小鼠听力损害可以表现自我主动恢复的特征。     

ABR、40Hz-AERP和ASSR与主观纯音听阈测定的相关性研究

目的分析听性脑干反应(ABR)、40 Hz听觉相关电位(40 Hz-AERP)、多频稳态听觉诱发电位(ASSR)电反应阈与纯音测听各频率主观听阈的相关性。方法运用纯音测听、ABR、40 Hz-AERP、ASSR为一组测试组合,对55例(84耳)患者进行检测,分析ABR、40 Hz-AERP(500 Hz、1 kHz)、ASSR(500 Hz、1 kHz、2 kHz、4 kHz)客观电反应阈与纯音测听500 Hz、1 kHz、2k Hz、4 kHz的主观听阈的差值及相关性。结果 ABR与纯音测听2 kHz+4 kHz均值的相关系数最高,为0.829。40 Hz-AERP的500 Hz、1 kHz电反应阈与纯音测听500 Hz、1 kHz听阈的相关系数分别为0.507和0.667。ASSR 500 Hz、1 kHz、2 kHz、4 kHz的电反应阈与纯音相应频率听阈的相关系数分别为0.507、0.715、0.793和0.816。以上相关性均有统计学意义(P0.01)。84耳纯音测听听阈均值为39.8±22.9 dB HL, ABR、ASSR电反应阈均值分别为41.1±18.0 dB nHL和42.4±22.9 dB nHL,40 Hz-AERP/500Hz和1 kHz均值分别为39.5±18.0dB nHL和40.2±19.4 dB nHL。结论 ABR、40 Hz-AERP、ASSR电反应阈与纯音测听各频率主观听阈显著相关,测试结果准确可靠。测试组合可以推断听力曲线的形态,对不能主动配合完成主观测听的婴幼儿及伪聋患者的听力学的辅助诊断非常有价值。     

对侧抑制对噪声暴露后的瞬态诱发耳声发射的影响

目的 :了解对侧抑制对噪声暴露前后瞬态耳声发射 (TEOAE)的影响。方法 :观察对侧抑制 (6 0dBSPL宽带噪声 )对噪声暴露前后TEOAE反应幅值、波重复率、频带信噪比、频带重复率等指标的变化。结果 :短时噪声暴露后 ,TEOAE各指标的数值都有所下降 ,敏感地反映出噪声暴露对耳蜗功能的影响。对侧抑制在噪声暴露前可引起较小的下降 ,部分指标有显著性改变。暴露后 ,对侧抑制使TEOAE指标下降更明显。结论 :噪声暴露可对耳蜗功能状态产生明显影响 ,降低耳声发射的测值。对侧抑制对耳蜗进行负反馈调节 ,可明显提高TEOAE测试检出噪声暴露所引起改变的敏感度。     

纯音听阈正常的耳闷患者诱发性耳声发射分析

目的:对纯音听阈正常的耳闷患者进行诱发性耳声发射分析,以早期发现这些患者的耳蜗损害.方法:采用丹麦Madsen公司Capella耳声发射仪对纯音听阈正常的耳闷患者43例(72耳,耳闷组)及正常人30例(60耳,对照组)分别进行TEOAE及DPOAE检测,记录和分析各频率DPOAE的检出率、幅值,TEOAE的通过率、反应波信噪比、波形重复性及各频带反应波信噪比和重复性.结果:①DPOAE检出率仅在0.50、0.75 kHz两频点上耳闷组明显低于对照组(P＜0.05),其余各频率点差异均无统计学意义(P＞0.05);②TEOAE通过率对照组为100%,耳闷组为90.28%,2组比较差异有统计学意义(X2=6.16,P＜0.05);③与对照组相比,纯音听阈正常的耳闷患者各频率DPOAE的幅值、TEOAE的反应波信噪比、波形重复性及各频带反应波信噪比和重复性均降低,差异有统计学意义(P＜0.05或P＜0.01).结论:部分纯音听阈正常的耳闷患者已存在耳蜗外毛细胞的损害,利用诱发性耳声发射的方法可在其听力损失出现之前早期发现此类病变.     

短音骨导听性稳态反应中伪迹的研究

目的 研究短音骨导听性稳态反应中的伪迹问题.方法 对21例(21耳)双耳极重度感音神经性聋患儿行骨导ASSR检测,刺激信号为0.5～4 kHz倍频程的短音(tone pip),0.5 kHz刺激信号上升、下降时间均为4ms;1、2、4 kHz为2 ms,0.5、1、2、4 kHz刺激信号的刺激速率分别为77、85、93、101 Hz.通过B-71骨振器给声,记录ASSR波形并观察是否出现伪迹,分析其原因.结果1、4 kHz出现伪迹的强度分别为115和100.5 dB,0.5和2 kHz分别在120.5和112 dB(re:1μN)(以上强度约相当于听力级的60 dB HL)未出现伪迹.结论 骨导AS-SR的最大输出较气导小,且易出现伪迹,故骨导听力损失超过中度以上者,不宜行短音骨导听性稳态反应测试.     

背景噪声对新生儿瞬态诱发耳声发射的影响

目的 分析背景噪声对新生儿瞬态诱发耳声发射(TEOAE)的影响.方法 对122例通过听力筛查的新生儿(244耳,女62例,男60例)分别以短声刺激行TEOAE检测,用quick TEOAE模式,叠加次数大于100次.并以背景噪声分组,比较安静组与噪声组之间TEOAE差异.结果 ①新生儿TEOAE的背景噪声为(33.94...     

新生儿自发性耳声发射与瞬态诱发性耳声发射的相关性

目的分析自发性耳声发射（spontaneous otoacoustic emission,SOAE）与瞬态诱发性耳声发射（transient evoked otoacoustic emission,TEOAE）之间的相关性。方法新生儿112例（224耳）,其中女59例,男53例,出生后2～4天内行SOAE及TEOAE检测。结果每耳SOAE信号峰数量与其TEOAE强度相关（r=0.43,P〈0.001）。每耳最大SOAE波幅与其TEOAE强度相关（r=0.49,P〈0.001）。不同耳依据其SOAE信号峰数量将其分为4组：I组无SOAE信号峰;II组为单SOAE信号峰;III组为2～3个SOAE信号峰;IV组为3个以上信号峰。I组TEOAE强度为（10.96±3.77）dBSPL,II组（12.87±3.27）dBSPL,III组（15.61±3.23）dBSPL,IV组（17.100±4.51）dBSPL,各组间的TEOAE强度差异均具有统计学意义。II组SOAE最大强度（-13.54±9.21）dBSPL,III组（-4.56±7.22）dBSPL,IV组（1.00±7.35）dBSPL,各组间最大SOAE波幅差异具有统计学意义。结论SOAE信号峰数量、最大SOAE波幅与TEOAE强度之间存在正相关关系,SOAE信号峰越多,最大SOAE波幅也越强,同时TEOAE强度也越强。     

Identification of neonatal hearing impairment: transient evoked otoacoustic emissions during the perinatal period

OBJECTIVES: 1) To describe transient evoked otoacoustic emission (TEOAE) levels, noise levels and signal to noise ratios (SNRs) for a range of frequency bands in three groups of neonates who were tested as a part of the Identification of Neonatal Hearing Impairment multi-center consortium project. 2) To describe the relations between these TEOAE measurements and age, test environment, baby state, and test time. DESIGN: TEOAEs were measured in 4478 graduates of neonatal intensive care units (NICUs), 353 well babies with at least one risk indicator, and 2348 well babies without risk factors. TEOAE and noise levels were measured for frequency bands centered at 1.0, 1.5, 2.0, 3.0, and 4.0 kHz for a click stimulus level of 80 dB SPL. For those ears not meeting "passing" stopping criteria at 80 dB pSPL, a level of 86 dB pSPL was included. Measurement-based stopping rules were used such that a test did not terminate unless the response revealed a criterion SNR in four out of five frequency bands or no response occurred after a preset number of averages. Baby state, test environment, and other test factors were captured at the time of test. RESULTS: TEOAE levels, noise levels and SNRs were similar for NICU graduates, well babies with risk factors and well babies without risk factors. There were no consistent differences in response quality as a function of test environment, i.e., private room, unit, open crib, nonworking isolette, or working isolette. Noise level varied little across risk group, test environment, or infant state other than crying, suggesting that the primary source of noise in TEOAE measurements is infant noise. The most significant effect on response quality was center frequency. Responses were difficult to measure in the half-octave band centered at 1.0 kHz, compared with higher frequencies. Reliable responses were measured routinely at frequencies of 1.5 kHz and higher. CONCLUSIONS: TEOAEs are easily measured in both NICU graduates and well babies with and without risk factors for hearing loss in a wide variety of test environments. Given the difficulties encountered in making reliable measurements for a frequency band centered at 1.0 kHz, its inclusion in a screening program may not be justified.     

Assessment of the medial olivocochlear efferent system in children. pure tone 1.0 kHz and 2.0 kHz suppressive effects on transient evoked otoacoustic emission

The role of medial efferent system in regulating outer hair cell function has been studied by many investigators. Usually narrow band noise or white noise as contralateral stimulation (CS) suppressors have been used and changes in OAE amplitudes estimated. Thirty children aged 6-15 years (mean 12.5 +/- 4.7), without any changes in tonal and impedance audiometry and with negative history regarding otiatric diseases were examined. Transient evoked otoacoustic emissions (TEOAE) were recorded using ILO 92 Otodynamics Analyser. CS was performed using 1.0 kHz and 2.0 kHz continuous pure tones of 30 dB SL or 50 dB SL. Effects of CS on TEOAE evoked by click of 80, 70 and 60 dB SPL were investigated. TEOAE analysis included assessment of TEOAE amplitude of half octave frequency bandwidth (HOFBW-1.0; HOFBW-1.5; HOFBW-2.0; HOFBW-3.0 and HOFBW-4.0 kHz) and 0.8 kHz frequency bandwidth (0.8-FBW) amplitudes centred at 1.0; 2.0; 3.0; 4.0 and 5.0 kHz. TEOAE amplitude recorded for stimuli 80, 70 and 60 dB SPL without CS decreased: mean values respectively 6.1 +/- 4.2; 5.4 +/- 4.5 and 3.3 dB SPL +/- 4.3. CS effect on TEOAE was observed for all CS options, however, larger suppressive effect was recorded on TEOAE elicited by 70 dB SPL stimulus using 1 kHz/50 dB SL tone as a suppressor and on TEOAE elicited by 60 dB SPL stimulus using 2 kHz/50 dB SL tone as a suppressor. HOFBW and 0.8-FBW analyses showed the association between the frequency/intensity of the suppressors and decreasing of amplitudes of adequate frequency bands. It is concluded that the described method of investigating of the medial olivocochlear efferent system seems to be sensitive and confirms frequency-dependent suppressive effect on OAE.     

瞬态诱发耳声发射测试结果分析

目的：为取得听功能正常耳瞬态耳声发射测试结果的正常值敏感参数,为临床应用提供诊断依据。方法：采用ＩＬＯ－８８耳动态分析仪对听功能正常的６０耳进行测试。短声声刺激强度为８０ｄＢ ＳＰＬ,刺激方式为非线性模式。结果：对稳定性、Ａ－Ｂ差值、反应幅值、波重复性、频带重复性及信噪比、主频等分别进行分析,得出了正常值。结论：频谱分析、反应幅值及重复性三者综合分析为判断听力正常与否的主要敏感参数。     

TEOAE amplitude growth,detectability, and response threshold in linear and nonlinear mode and in different time windows

Transitory evoked otoacoustic emissions (TEOAE) have been recorded in 60 ears of 31 adult volunteers with nearly normal hearing at stimulus levels ranging from 83 dB SPL peak equivalent down to the individual response threshold using linear and nonlinear recording mode. The stimulus level dependence of response incidence and amplitude has been analysed for the integral response and in time windows selecting response components of limited latency ranges. At stimulus levels above 70 dB SPL peak equivalent the TEOAE records received in linear mode are contaminated with stimulus artifacts. At moderate stimulus levels the TEOAE amplitude differs only to a small extent between the two recording modes. At low levels the linear mode turns out to be better suited for signal detection due to its inherent lower noise level. The response threshold, defined as the highest stimulus level yielding a reproducibility of at least 60%, is significantly correlated to hearing threshold. The consideration of time windowed responses yields best results with respect to incidence and threshold of responses in the latency range between 5 and 10 ms, but it does not enhance frequency specificity.     

TEOAE amplitude growth, detectability, and response threshold in linear and nonlinear mode and in different time windows

Transitory evoked otoacoustic emissions (TEOAE) have been recorded in 60 ears of 31 adult volunteers with nearly normal hearing at stimulus levels ranging from 83 dB SPL peak equivalent down to the individual response threshold using linear and nonlinear recording mode. The stimulus level dependence of response incidence and amplitude has been analysed for the integral response and in time windows selecting response components of limited latency ranges. At stimulus levels above 70 dB SPL peak equivalent the TEOAE records received in linear mode are contaminated with stimulus artifacts. At moderate stimulus levels the TEOAE amplitude differs only to a small extent between the two recording modes. At low levels the linear mode turns out to be better suited for signal detection due to its inherent lower noise level. The response threshold, defined as the highest stimulus level yielding a reproducibility of at least 60%, is significantly correlated to hearing threshold. The consideration of time windowed responses yields best results with respect to incidence and threshold of responses in the latency range between 5 and 10 ms, but it does not enhance frequency specificity.