遗传性无综合征耳聋一家系畸变产物耳声发射测试

目的　探索遗传性进行性无综合征耳聋患者的听功能改变特点。方法　一个常染色体显性遗传进行性无综合征耳聋家系 5 2名成员及听力正常组 15名 ,进行了纯音测试及畸变产物耳声发射 (distortionproductotoacousticemissions,DPOAE)测试。结果　无综合征耳聋家系中 34名成员纯音测试为感音神经性聋 ,其中纯音听阈均值 (puretoneaverage ,PTA)≥ 40dB的 15例 (2 9耳 )DPOAE反应缺失 ,PTA≤ 35dB伴高频下降的 12例 (2 3耳 )DPOAE高频或高、中频振幅下降或缺失 ;2 1名 (42耳 )纯音听阈正常成员中 ,有 12例 (15耳 )DPOAE高频或高、中频振幅下降或缺失。结论　DPOAE能鉴别出耳蜗亚临床的病理改变 ,对该病的早期诊断 ,遗传咨询有指导意义。     

母系遗传性聋家系的纯音测听及畸变产物耳声发射测试的相关分析

目的：探讨母系遗传非综合征性聋的听力学特征及畸变产物耳声发射测试对其听改变早期诊断的优越性。方法：对六个母系遗传家系成员共102人进行纯音测听、DPOAE评估其听力，比较纯音测听与DPOAE检测耳蜗早期病变的灵敏性。结果：纯音测听为感音神经性聋的38例中，PTA≥45d B HL的18例，DPOAE反应缺失；PTA＜45dB HL的20例，DPOAE高频或高、中频振幅下降或缺失；纯音测听正常者中4例DPOAE显示高频或高中频振幅下降。结论：母系遗传非综合征性聋的听力损害为双侧、对称性、进行性感音神经性聋，早期表现高频损害，DPOAE可在纯音听阈改变之前，发现早期耳蜗轻微的病理变化，对早期诊断及遗传咨询有较大指导意义。     

对感音神经性聋的几种耳声发射观察

采用耳动态分析仪ILO－92对369例感音神经性聋患者进行了畸变产物耳声发射（DPOAE）、瞬态诱恨性耳声发射（TEOAE）和自发性耳声发射（SOAE）测试。结果表明：DPOAE可以准确地反映患耳相应的频率损失范围，其出率和幅值与主观听阈水平有关。对所有患耳均进行了SOAE测试，检出率为9.4%，低于听力正常人49％的检出率；其中蜗后性听力损失耳的SOAE检出率为100％。由于任何早期的耳蜗病理变化均可对OAE作出反应，故它可对感音神经性听力下降患者的耳蜗功能作出早期预测和评估。     

畸变产物耳声发射在突发性聋恢复过程中的变化

目的:探讨畸变产物耳声发射(DPOAE)测试对于耳蜗功能损害的检测价值.方法:利用GSI-60型耳声发射检测仪,对30例(60耳)突发性聋(突聋)患者进行DPOAE测试,观察其发病和恢复过程中的耳声发射(OAEs)变化,及其与纯音听阈变化的关系.并对患者进行治疗与随访.结果:患耳的DPOAE检出率、幅值低于健耳,检出阈升高;在恢复过程中,DPOAE的幅值、检出阈也随听阈一起改善;听阈的恢复率高于幅值和检出阈的恢复率.结论:突聋患者DPOAE呈中重度感音神经性听力下降的变化;在恢复过程中,DPOAE幅值、检出阈的恢复迟于听阈的恢复.表明DPOAE是一种能敏感、直接地反映耳蜗功能的指标.     

听神经病的临床与听功能特征

目的:探讨听神经病的临床与听功能特征。方法:总结分析54例听神经病患者的临床资料、听力学测试及电生理检查情况。结果:纯音听力图呈上升型70耳,覆盆型25耳,平坦型5耳,下降型4耳;低频、中频及高频平均阈值为(67.63±15.30,43.61±16.28,32.25±14.80)dB HL。声导抗鼓室图全部正常,77耳镫骨肌声反射消失,31耳声反射阈部分增高。听性脑干反应(ABR)全部未引出。畸变产物耳声发射(DPOAE)正常引出,26例行对侧声抑制未受影响。16例言语识别率差,与纯音听阈不成比例。23例颞骨CT或MRI未见异常。10例伴有周围神经病。结论:ABR自波Ⅰ起缺失而DPOAE正常引出,言语分辨力差与纯音听阈不成比例,镫骨肌声反射及OAE交叉抑制异常,纯音听力图多呈上升型以低频损失为主,是听神经病听功能的重要特征。提示病损主要位于耳蜗内听神经纤维。应与一般的感音神经性聋和中枢性聋相鉴别。     

耳声发射正常的听觉障碍类型

目的：分析总结临床中耳声发射正常的听觉障碍类型。方法：对83例听觉障碍患者行纯音听阈、阻抗、听性脑干反应（ABR）、40Hz AERP、自发性耳声发射（SOAE）、瞬态耳声发射（TEOAE）、畸变产物耳声发射（DPOAE）测试及CT和（或）MRI扫描。结果：耳声发射（OAE）正常的听觉障碍包括：①听神经病68例;②听神经瘤2例;③皮层聋或中枢性聋3例;④听觉过敏2例;⑤功能性聋2例;⑥伪聋6例。结论：耳声发射检测在蜗后性聋、中枢性聋、非器质性聋和其他一些特殊类型听觉障碍的诊断和鉴别诊断中具有重要临床意义。     

突发性聋耳声发射与预后的关系

目的本文旨在了解突发性聋患者耳声发射的变化与预后的关系. 方法利用GSI-60型及CELESTA-503 型耳声发射检测仪对29例突发性聋的患者进行了畸变产物耳声发射(DPOAE)的测试,并对其进行了治疗和随访. 结果患耳的DPOAE检出率、幅值低于健耳与正常组,检测阈升高.OAE 检出率与预后的相关性检验无显著相关性. 结论突聋患者OAE 呈中重度感音神经性听力下降的改变.OAE检出与否与预后好坏无统计学意义上的相关性.     

听神经病

目的介绍一种特殊的感音神经性听力疾患-听神经病,探讨其临床特征及听力学特点.方法报道5例听神经病患者,2例为成人;3例为儿童.记录患者的临床资料,并对患者进行纯音测听、脑干电反应测听、耳声发射、耳蜗电图及语言辨别率等听力学检查.结果5例均主诉听力下降,听力学检查纯音听阈为轻、中度感音神经性聋,与纯音测听不相符的语言辨别率明显下降,不能引出脑干诱发电位(ABR),耳蜗电图基本正常,畸变产物耳声发射(DPOAE)基本正常.提示外毛细胞功能正常,病变可能在听神经.结论听神经病是一种主诉听力下降,纯音听阈为轻、中度感音神经性聋,不能引出脑干诱发电位(ABR),畸变产物耳声发射正常的听力疾患,临床上应与其他感音神经性聋区别.     

畸变产物耳声发射对耳蜗性聋和耳蜗后性聋的鉴别诊断意义

目的 探讨畸变产物耳声发射（DPOAE）鉴别诊断耳蜗性聋和耳蜗后性聋的意义。方法 采用ILO96耳动态分析仪对49例耳蜗性聋和4例耳蜗后性聋进行DPOAE测试。结果 耳蜗性聋组的DPOAE图显示出DPOAE幅值随纯音听阈的升高有不同程度的下降,并显示出很好的频率特异性,当纯音听阈＞50dBHL时,DPOAE消失。耳蜗后性聋组的DPOAE图显示出的DPOAE幅值变化不明显,仍在正常范围,与纯音听阈长吭程度缺乏相对应关系。结论 DPOAE是一种有效的辅助性鉴别诊断耳蜗性聋和耳蜗后性聋的方法。     

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.     

遗传性无综合征耳聋一家系畸变产物耳声发射测试

目的 探索遗传性进行性无综合征耳聋患者的听功能改变特点。方法 一个常染色体显性遗传进行性无综合征耳聋家系５２名成员及听力正常组１５名,进行了纯音测试及畸变产行耳中发射（ｄｉｓｔｏｒｔｉｏｎ ｐｒｏｄｕｃｔ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｉｓｓｉｏｎｓ,ＤＰＯＡＥ）测试。结果 无综合征耳有系中３４名成员纯音测试为感音神经性夺聋,其中纯音听阀均值（ｐｕｒｅ ｔｏｎｅ ａｖｅｒａｇｅ,ＰＴ）≥４０ｄＢ的５     

畸变产物耳声发射临床应用价值的探讨

研究了７３例（１３９耳）纯音听阈正常耳及各种感音神经性聋耳的ＤＰＯＡＥ，发现ＤＰＯＡＥ对耳蜗功能异常的改变早于纯音测听，并可精确地反映耳蜗毛细胞在相关频率上的功能状态；ＤＰＯＡＥ幅值及引出率随纯音听阈的提高而下降，当纯音听阈＞５０ｄＢ（ＨＬ）时，ＤＰＯＡＥ幅值明显降低或缺失；蜗后病变耳ＤＰＯＡＥ正常，当蜗后病变累及耳蜗时，ＤＰＯＡＥ幅值可异常，其异常程度与纯音听阈不平行。认为ＤＰＯＡＥ有广泛临床应用价值。     

畸变产物耳声发射在舰艇艇员听力调查中的应用

目的了解舰艇艇员的听力状况并探讨纯音听力图与DPOAE听力图的关系。方法对100名(200耳)舰艇艇员进行纯音、声导抗、DPOAE测试,测试仪器均为GSI系列产品。根据纯音测听结果将其分成正常、低频听力下降、高频听力下降及全频听力下降四个组,并结合纯音听力图与DPOAE听力图进行比较。结果纯音听阈正常组的DPOAE检出率及DPOAE振幅明显高于低频听力下降组、高频听力下降组及全频听力下降组(P＜0.01或0.05);DPOAE听力图与纯音听力图个各在频率均有很好的对应关系。结论DPOAE作为一种评价耳蜗毛细胞功能状态,在征兵、部队听力普查中较传统的纯音听阈测试更有意义。     

畸变产物耳声发射在军事噪声致爆震性聋早期监测中的作用

目的探讨畸变产物耳声发射(DPOAE)在军事噪声致爆震性聋早期监测中的作用。方法将听力正常的炮兵某部男性官兵88例(176耳)随机分成两组,每组44例(88耳),实验组参加火炮实弹射击训练,对照组未参加火炮实弹射击训练。对照组及实验组训练前后进行纯音测听及DPOAE测试,对两组结果进行比较分析。结果实验组训练后80耳中耳传导功能无障碍,其中13耳纯音听阈示感音神经性听力损失,DPOAE检查亦异常;67耳纯音听阈正常,其中15耳DPOAE幅值在4kHz处降低。与训练前、对照组比较,实验组训练后2、4及8kHz纯音听阈升高(P<0.05或P<0.01),以4kHz处升高最为明显;实验组训练后2、3、4、6及8kHzDPOAE幅值降低(P<0.05或P<0.01),其中以4kHz处降低最为明显。结论畸变产物耳声发射在军事噪声致爆震性聋早期监测中有一定应用价值,可对其防护、诊断和治疗提供指导和帮助。     

Outcomes of transient evoked otoacoustic emission testing in 6-year-old school children: a comparison with pure tone screening and tympanometry

OBJECTIVES: (1) To establish test performance measures for Transient Evoked Otoacoustic Emission testing of 6-year-old children in a school setting; (2) To investigate whether Transient Evoked Otoacoustic Emission testing provides a more accurate and effective alternative to a pure tone screening plus tympanometry protocol. METHODS: Pure tone screening, tympanometry and transient evoked otoacoustic emission data were collected from 940 subjects (1880 ears), with a mean age of 6.2 years. Subjects were tested in non-sound-treated rooms within 22 schools. Receiver operating characteristics curves along with specificity, sensitivity, accuracy and efficiency values were determined for a variety of transient evoked otoacoustic emission/pure tone screening/tympanometry comparisons. RESULTS: The Transient Evoked Otoacoustic Emission failure rate for the group was 20.3%. The failure rate for pure tone screening was found to be 8.9%, whilst 18.6% of subjects failed a protocol consisting of combined pure tone screening and tympanometry results. In essence, findings from the comparison of overall Transient Evoked Otoacoustic Emission pass/fail with overall pure tone screening pass/fail suggested that use of a modified Rhode Island Hearing Assessment Project criterion would result in a very high probability that a child with a pass result has normal hearing (true negative). However, the hit rate was only moderate. Selection of a signal-to-noise ratio (SNR) criterion set at > or =1 dB appeared to provide the best test performance measures for the range of SNR values investigated. Test performance measures generally declined when tympanometry results were included, with the exception of lower false alarm rates and higher positive predictive values. The exclusion of low frequency data from the Transient Evoked Otoacoustic Emission SNR versus pure tone screening analysis resulted in improved performance measures. CONCLUSIONS: The present study poses several implications for the clinical implementation of Transient Evoked Otoacoustic Emission screening for entry level school children. Transient Evoked Otoacoustic Emission pass/fail criteria will require revision. The findings of the current investigation offer support to the possible replacement of pure tone screening with Transient Evoked Otoacoustic Emission testing for 6-year-old children. However, they do not suggest the replacement of the pure tone screening plus tympanometry battery.     

糖尿病患者瞬态诱发耳声发射对侧抑制现象的临床研究

目的:研究听力正常的糖尿病患者瞬态诱发耳声发射(TEOAE)对侧抑制现象.方法:分别对30例听力正常的糖尿病患者(糖尿病组)及30例健康对照者(对照组)行纯音听阈、声导抗、TEOAE检测,并通过在其对侧耳中加入60 dB SPL的宽带噪声后TEOAE对侧抑制效应测试以评估其传出神经功能.结果:糖尿病组受试者的纯音听阈及TEOAE的幅值稍低于对照组,但两者间差异无统计学意义;其TEOAE的对侧抑制效应低于对照组,其中在2000 Hz及4 000 Hz处差异有统计学意义(P<0.05).结论:糖尿病患者在其外周听力尚处于正常状态时,其听觉传出神经的功能即已发生了改变.     

听神经病的听功能状态分析

目的 :探讨听神经病的听功能状态及病损部位。方法 :分析 6 5例听神经病患者的临床资料、纯音测听、声导抗测试、听性脑干反应 (ABR)、4 0Hz听觉相关电位及OAE检查结果。结果 :听神经病的低频听力损失源于蜗后的传入、传出神经及听性脑干受损 ,表现为声反射、传出抑制、ABR异常及诱发性OAE与纯音听阈不呈平行关系 ,与之相对应 ,低频区的外毛细胞处于失抑制的超常活动状态 ,表现为低频区SOAE增强、TEOAE反应幅值及DPOAE幅值升高 ;听神经病的高频听力损失源于耳蜗的外毛细胞损害 ,表现为高频区DPOAE幅值与纯音听阈呈一致性下降 ;听神经病的中频听力损失最轻或接近正常 ,表现为 2kHz附近的纯音听阈和DPOAE幅值均接近于正常。结论 :听神经病的传入、传出系统及耳蜗水平均有不同程度的功能障碍 ,其病损部位主要在耳蜗传入、传出神经 ,向上可侵及脑干 ,向下可侵及耳蜗     

On a possible prognostic value of otoacoustic emissions: a study on patients with sudden hearing loss

Otoacoustic emissions (OAE) and pure tone audiogram (PTA) were examined in 26 ears of 25 patients suffering from sudden hearing loss from the 1st day to up to 505 days following the drop of hearing to test the hypothesis whether the OAEs are capable of delivering predictive information about the recovery process. The patients were selected from 50 candidates according to the following criteria: one or both ears exhibited a systematic and significant recovery of pure tone threshold in at least one frequency, OAEs were detectable and PTA available, a conductive hearing loss was excluded, and the auditory brainstem responses (ABR) yielded no signs of retrocochlear disorders. Transitory evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE) were measured under constant stimulus and recording conditions in three to nine sessions. The relation between OAE level and actual pure tone threshold was subject to a regression analysis. The correlation between both parameters is small but significant. Even smaller correlations are observed if the OAE level is related to former hearing loss, whereas the correlation improves if the OAE level is compared to the pure tone threshold measured in a later session. The slopes of individual trajectories that connect the successive results of one ear in a plane defined by hearing loss and OAE level show a remarkable accumulation around zero, i.e., in many cases the OAEs remain unchanged even if the hearing loss decreases. The comparison of the OAE levels measured at an early stage with later audiograms shows that there are only a small number of cases with small initial emissions and good final threshold or large initial emissions and bad final threshold. This means that small initial OAEs end up with a remaining final hearing deficit, whereas a high OAE level immediately after drop of threshold correlates with good outcome. The reliability of an individual prediction based on the OAE level combined with the threshold after sudden hearing loss and the consequences for the physiologic mechanisms underlying the sudden hearing loss remain to be proved in further investigations.     

原发性高血压患者听觉功能早期损害的临床研究

目的：探讨高血压对听觉功能早期损害的听力学特征,为临床研究和防治耳聋提供参考。方法：将68例（136耳）原发性高血压患者分为无眼底动脉硬化的高血压A组35例（70耳）,及伴有眼底动脉硬化的高血压B组33例（66耳）;另选30例（60耳）年龄、性别匹配且无高血压,听力正常者为对照组,分别进行纯音听阈、畸变产物耳声发射（DPOAE）等听力学测试。结果 高血压B组2000～8000Hz纯音听阈提高（P〈0．05）,高血压A组的纯音听阈与对照组比较差异均无统计学意义（P〉0．05）;高血压A、B组的DPOAE反应幅值下降（P〈0．01）,仅高血压B组4000Hz的DPOAE检出率下降（P〈0．05）。结论：高血压会影响患者的听觉系统,即使患者主观上无明显的听力下降,但听觉功能可能已出现早期改变。