言语诱发听性脑干反应的主波特性

目的探讨正常成人言语诱发听性脑干反应(speech evoked auditory brainstem response,speech-ABR)主波的电生理特性。方法记录64例正常成人右耳的speech-ABR,分析主波的极性、潜伏期及幅值及其与性别、年龄的相关性。结果 speech-ABR的主波主要为正极性;除E波极性与性别显著相关外,其他主波极性的性别和年龄差异无统计学意义。V波和A波潜伏期女性较男性显著缩短,V波幅值女性较男性显著增大;而两者潜伏期和幅值的年龄差异无统计学意义。在C、D、E、F和O波中,两种极性的潜伏期差异(除E波和O波外)以及幅值差异无统计学意义;而其潜伏期和幅值的性别和年龄差异亦无统计学意义。结论 speech-ABR各主波的潜伏期和幅值受极性、性别和年龄差异的影响较小,具有较高的稳定性,是言语感知机制基础及临床研究的良好指标。     

学龄儿童与青年人言语诱发听性脑干反应的比较

目的 比较学龄儿童与青年人言语诱发听性脑干反应( speech-ABR)的基本特征,探讨学龄期儿童脑干言语处理能力的发育情况.方法 对纯音听阈、声导抗、耳声发射和短声听性脑干反应(click-ABR)测试结果均正常的20名青年人(21～ 26岁)和18名学龄儿童(6～11岁)行speech-ABR测试.刺激声为/da/音,采用插入式耳机,右耳给声.结果 学龄儿童与青年人speech-ABR波形均由瞬态反应(V、A、C、O波)及周期性反应(D、E、F波)等几部分构成.学龄儿童的O波潜伏期(47.80 ±0.38)ms短于青年人(48.10±0.40) ms,差异具有统计学意义(t=2.330,P=0.026);学龄儿童F波波幅(-0.21±0.15)μV大于青年人(-0.12±0.08)μV,差异具有统计学意义(t=2.146,P =0.043);二者其余各波的潜伏期及波幅差异均无统计学意义(P值均＞0.05).结论 学龄儿童与青年人speech-ABR的基本特征相近,其脑干言语处理能力不亚于青年人.     

年龄对自然更年期后女性脑干言语编码能力的影响

目的 分析年龄对更年期后女性脑干言语编码能力的影响.方法 对纯音听阈、声导抗 、短声听性脑干反应(click-ABR)测试结果均正常的20例双侧卵巢切除女性(43~53岁)和20例自然更年期后女性(50~61岁)行言语诱发听性脑干反应(speech-ABR)测试,刺激声为/da/音,采用插入式耳机,右耳给声,比较两组speech-ABR测试结果.结果 双侧卵巢切除女性和自然更年期后女性speech-ABR波形特征类似,均由瞬态反应(V、A和O波)、过渡部分C波以及周期性反应(D、E、F波)构成;与更年期后女性相比,双侧卵巢切除女性除瞬态成分O波潜伏期(48.10±0.98 ms)显著短于更年期后女性(48.87±0.50 ms)(P<0.01),周期成分F波幅值(-0.13±0.07 μV)显著大于更年期后女性(-0.09±0.04 μV)(P<0.05),其余各波的幅值、潜伏期及V/A复合波斜度差异均无统计学意义(均为P>0.05).将两组数据合并后就年龄对speech-ABR各波幅值及潜伏期的关系进行相关性分析,结果显示仅O波潜伏期与年龄成轻度正相关关系(P<0.05),其余各波幅值及潜伏期与患者年龄均无相关性.结论 年龄对更年期后脑干言语编码能力的影响较小,仅表现为使脑干听觉神经元对刺激末信号放电的同步性和时间分辨力降低.     

采用纯音和汉语言语声刺激测试听觉事件相关电位的对比研究

目的 比较纯音和汉语言语声刺激诱发的听觉事件相关电位(auditory event-related potentials,AERP)波形,探讨用汉语言语声刺激测试中国人AERP的可行性.方法 采用汉语言语和纯音作为声刺激对正常青年人(44名,83耳)进行AERP测试,对波形进行评分.比较言语和纯音声刺激诱发的AERP的潜伏期、幅值及波形评分.结果 言语声刺激比纯音更容易记录到典型AERP波形,差异有统计学意义(X2=4.0,P=0.039).分析言语及纯音刺激均记录到的72组AERP波形,言语和纯音刺激诱发的P3的潜伏期、幅值差异均无统计学意义(P>0.05),但言语诱发的AERP波形评分较纯音高(t=6.57,P=0.000).左耳言语刺激诱发的AERP的N2、P3潜伏期短于纯音,差异均有显著统计学意义(前者P=0.002,后者P=0.003),而右耳差异无统计学意义(P>0.05).结论 汉语普通话单词较符合AERP测试的要求和我国日常言语的习惯,汉语言语刺激较纯音可能更适合中国人的AERP测试.     

生殖激素对正常青年人言语听性脑干反应特性的影响

目的 分析正常青年人生殖激素浓度与言语诱发听性脑干反应(speech-ABR)幅值及潜伏期的相关性,探讨生殖激素对青年人言语听性脑干反应特性的影响.方法 选择纯音听阈、声导抗、短声诱发听性脑干反应(click-ABR)测试均正常的青年35例为研究对象,其中女性17例(27.29±1.83岁),男性18例(28.17±2.50岁),分别行speech-ABR测试,刺激声为/da/音,采用插入式耳机,右耳给声,记录并分析各波潜伏期及波幅,同时检测血清中雌二醇、总睾酮的浓度,分析雌二醇、总睾酮的浓度与speech-ABR各波幅值及潜伏期的相关性.结果 ①女性speech-ABR各波(V、A、D、E、F、O波)潜伏期均比男性短(P<0.05),V/A复合波斜度大于男性,除O波外,女青年speech-ABR其余各波幅值均显著大于男性(P<0.05).②女青年雌二醇水平(118.77±102.66 pg/ml)显著高于男青年(52.91±14.77 pg/ml)(P<0.05),而总睾酮浓度(457.65±140.82 pg/ml)显著低于男青年(3 677.37±1 155.80 pg/ml)(P<0.05).③speech-ABR各波潜伏期与雌二醇浓度呈负相关(P<0.05),相关系数在0.2~0.4之间,与总睾酮浓度呈正相关关系(P<0.05),相关系数在0.4~0.7之间.④speech-ABR各波幅值随雌二醇浓度增加而增大,正向波V波与雌二醇浓度呈正相关,而负向波A、D、E、F及O波呈负相关,相关系数在0.2~0.7之间;speech-ABR各波幅值随总睾酮浓度增加而降低,起始复合波V波、A波及V/A斜率与睾酮的相关系数在0.4~0.6之间,为中度相关(P<0.05);而周期性成分与睾酮浓度的相关性不强,其中D波幅值与总睾酮浓度的相关性无统计学意义(P>0.05),而E波和F波的相关性也只是弱相关(P<0.05);此外,结束波O波幅值与睾酮水平无关(r=0.133, P>0.05).结论 生殖激素水平与speech-ABR的幅值及潜伏期存在一定相关性,可能是导致正常青年人言语诱发听性脑干反应特性性别差异的原因之一.     

不同强度言语声诱发听性脑干反应及听处理偏侧化分析

目的：探讨不同强度言语声诱发听性脑干反应（speech evoked auditory brainstem response ,s－ABR）的时域和频域变化以及脑干水平是否存在听处理偏侧化现象。方法分别以40、60和80 dB H L言语声对29例健康青年行双耳s－ABR检测,分析双耳时域参数中的主波潜伏期、幅值以及频域参数中的基频（F0）、共振峰（F1～F5）。结果三种刺激强度下,左右耳各主波潜伏期及幅值之间差异均无统计学意义（ P＞0．05）;随言语刺激声强增大,计算强度每降低20 dB时s－ABR各主波潜伏期延长平均值,瞬态性主波V、A、C、O波及周期性主波D、E、F波的潜伏期均显著缩短（P＜0．05）,幅值显著增加（P＜0．05）;周期性主波潜伏期延长更明显（P＜0．05）。s－ABR频域分析显示,从F0及F1～F5幅值依次降低,与强度变化一致;双耳记录的s －ABR具有很高的相似度,其时域参数和频域参数耳别间差异无统计学意义（ P＞0．05）。结论 s －ABR较好编码了言语的时域和频域信息,且时域和频域参数高度对应并具有相同的强度响应性;瞬态性和周期性成分的s－ABR各主波不同潜伏期特性可能提示更多编码信息;言语在听性脑干水平的处理并无明显偏侧化现象。     

言语诱发听性脑干反应的潜伏期特性分析

目的探讨不同刺激强度下健康成人言语诱发听性脑干反应（speech evoked auditory brainstem response,speech-ABR）的潜伏期特性及其在脑干神经元编码言语信息中的意义。方法记录32例健康成人32耳在4种刺激强度（20、40、60、80dBSPL）、11.1次/s速率下的speech-ABR,分析不同强度条件下speech-ABR的潜伏期和相关性。结果 speech-ABR由一系列主波组成,分为起始部分（包括V和A波）、过渡部分（C波）、频率跟随部分（D-E-F波）和终止部分（O波）。随着强度的降低,各主波潜伏期逐渐延长,差异有统计学意义（P〈0.05）。强度降低20dBSPL级差时,潜伏期的平均延长值表现为V、A、C、O波接近,D、E、F波接近。不同强度下,V-A-C波潜伏期之间、D-E波潜伏期、E-F波潜伏期的相关性均有统计学意义,且相关系数大于0.40,其中V-A波潜伏期的相关系数大于0.80;强度降低时,潜伏期间的相关性有统计学意义的主波逐渐增多。结论健康成人speech-ABR各主波的潜伏期随着刺激强度降低而显著延长;起始反应和频率跟随反应的潜伏期及其显著相关性具有不同的变化特点。言语强度降低时,speech-ABR主波潜伏期的显著延长以及主波潜伏期间相关性的改变可能与言语的不易被识别有关。     

学龄前期自闭症谱系障碍儿童与健听儿童言语诱发听性脑干反应的比较研究

目的　比较学龄前期自闭症谱系障碍（autism spectrum disorders,ASD）患儿与健听儿童言语诱发听性脑干反应（speech evoked auditory brainstem responses,speech-ABR）的基本特征,探讨ASD患儿脑干言语处理能力。方法　对声导抗、耳声发射、短声听性脑干反应测试结果正常的10例ASD患儿（3～6岁）和9名健听儿童（3～6岁）行speech-ABR测试,采用强度为80 dB SPL的/da/作为刺激声。结果　两组speech-ABR曲线均由瞬态成分（V、A、C、O）和周期性成分（D、E、F）组成,两组潜伏期及波幅差异均 无统计学意义（P＞0.05）。结论　学龄前ASD患儿与健听儿童speech-ABR具有相似的基本特征,两者脑干言语处理能力相近。     

正常听力儿童的失匹配负波检查

目的 探讨正常听力儿童的失匹配负波(MMN)的特点,同时分析不同性别、不同耳儿童MMN的差异。方法 对44例纯音测听、听性脑干反应检测正常的儿童分别进行双耳的MMN检查,其中男25例,女19例。采用经典的oddball模式,标准刺激和偏差刺激分别为1 000 Hz和2 000 Hz 的短纯音测试受试者MMN,观察不同性别、不同耳儿童MMN潜伏期及波幅的特点并比较差异。结果 44例受试者的双耳均可正常引出MMN 波形,男性儿童左耳MMN平均潜伏期为(170.24±32.83)ms,平均波幅为(3.40±2.04)μV;男性儿童右耳MMN平均潜伏期为(172.51±24.19)ms,平均波幅为(4.20±2.29)μV;女性儿童左耳MMN平均潜伏期为(162.13±31.40)ms,平均波幅为(4.01±2.82)μV;女性儿童右耳MMN平均潜伏期为(170.30±33.11)ms,平均波幅为(3.76±2.80)μV。所有受试者左右耳间MMN潜伏期及波幅差异无统计学意义(P>0.05);男性左右耳间MMN潜伏期差异无统计学意义(P>0.05);男性左右耳间MMN波幅差异具有统计学意义(P<0.05);女性左右耳间MMN潜伏期及波幅差异均无统计学意义(P均>0.05)。男女间MMN潜伏期及波幅差异无统计学意义(P均>0.05)。结论 正常听力的儿童双耳在频率差异的短纯音刺激下均能稳定的引出MMN波形,在儿童中性别、不同耳对MMN的潜伏期和波幅无明显影响,但不能排除性别是MMN检查中影响其规范数据的一个因素,需要扩大样本量进一步研究。     

言语诱发听性脑干反应的影响因素分析

目的探讨言语诱发听性脑干反应(speech evoked auditory brainstem response,s-ABR)的影响因素,揭示s-ABR更多的电生理特性。方法将24名健康成人(24耳)的s-ABR采用两种刺激率(11.1次/s、20.0次/s)和两种刺激强度(80d B SPL、60d B SPL)进行2×2×6析因实验,分析s-ABR波形评分值、各主波潜伏期及幅值。结果 s-ABR波形评分值差异无统计意义(p>0.05);各主波潜伏期的刺激率差异无统计学意义;各幅值(除外Ⅴ波)的刺激率差异亦无统计学意义;大部分主波潜伏期(除外A波、F波及O波)的强度差异有统计学意义(p<0.05),大部分主波幅值(除外Ⅴ波和O波)的强度差异则无统计学意义;波形量化评分、各主波潜伏期和幅值均无刺激率和刺激强度的交互效应(p>0.05)。结论 s-ABR测试的刺激率和刺激强度在一定范围内没有相互影响,测试中可根据需要选择刺激率和刺激强度。     

儿童孤独症患者脑干听觉诱发

目的通过观察儿童孤独症患者脑干听觉诱发电位的改变,探讨听觉诱发电位检测在听觉障碍儿童孤独症诊断中的临床意义.方法按DSM-IV诊断标准确诊的15例孤独症患儿和14例正常对照组,同期接受听觉诱发反应检测,比较两组间波I～V各波峰潜伏期、波峰潜伏期差和波幅的差异.结果孤独症患儿左侧波V、右侧波II峰间潜伏期和右侧I～III、I～V峰间潜伏期差较对照组显著延长(P<0.05～0.005),孤独症组右侧波III振幅较对照组增高(P<0.05),其他各指标两组间无显著性差异.结论孤独症患儿脑干听觉诱发电位的突出改变是潜伏期有延长的趋势;对就诊于耳鼻咽喉科的听阈正常而有听觉障碍,言语交往能力差,脑干听觉诱发电位检查潜伏期延长的儿童,应警惕孤独症或其他神经精神发育障碍.     

Detailed Analysis of Auditory Brainstem Responses in Patients with Noise-induced Tinnitus

The role of the auditory brainstem in tinnitus is questionable. This study aimed comprehensively to assess auditory brainstem responses (ABRs) in patients suffering from noise-induced tinnitus (NIT). ABRs were recorded from 13 chronic NIT patients (21 ears) and 11 (21 ears) age and hearing matched control subjects without tinnitus. ABRs were recorded with scalp electrodes placed ipsilateral and contralateral to the stimulated ear, and in three orthonormal differential configurations. The ABRs were analyzed as a function of time, frequency and voltage space. A significantly enhanced ipsilaterally recorded, time domain wave III amplitude was observed for the tinnitus patients. This finding was not confirmed by any of the other ABR measures, which were indistinguishable between subject groups. Although this may be a spurious result, it nonetheless may point to an alteration in the functioning of the putative wave III auditory brainstem generator, which deserves further study.     

Analysis of auditory brain stem response and otoacoustic emission in unilateral tinnitus patients with normal hearing

ObjectiveIn patients with unilateral tinnitus with normal hearing, several studies have compared the ipsilateral and contralateral ears; however, few studies have investigated its relationship with the duration of tinnitus. We compared the auditory brainstem response and otoacoustic emission parameters between ipsilateral and contralateral ears in adults with unilateral tinnitus and normal hearing.MethodsThis retrospective review included 84 patients with unilateral tinnitus and normal hearing who underwent auditory brainstem response and otoacoustic emission; they were categorized according to the duration of tinnitus. The latencies and amplitudes of waves I, III, and V, and V/I ratio of both ears in auditory brainstem response, and the results of distortion-product otoacoustic emission and transient evoked otoacoustic emission were examined. The auditory brainstem response parameters, distortion-product otoacoustic emission parameters, and transient evoked otoacoustic emission parameters between the ipsilateral and contralateral ears along the duration of tinnitus were analyzed. Moreover, the failure rates of both distortion-product otoacoustic emission and transient evoked otoacoustic emission between the ears along with the duration and the effects of the variables on the amplitude and latency of each wave were examined.ResultsIn this study, laterality seemed to have an effect on wave I latency in the multiple linear regression analysis. The distortion-product otoacoustic emission failure rate of the ipsilateral ear was higher than that of the contralateral ear in all patients. However, there was no remarkable difference between the ears in the distortion-product otoacoustic emission and transient evoked otoacoustic emission parameters throughout the duration.ConclusionWe found that outer hair cells and the distal portion of the cochlear nerve are possible pathologic lesions in tinnitus with normal hearing and cochlear synaptopathy could be suspected. Further studies, including those on inner hair cells and higher central cortex, are needed.     

Interaural stacked auditory brainstem response measures for detecting small unilateral acoustic tumors

The Stacked auditory brainstem response (SABR) was developed and investigated as a screening tool for small (≤1 cm) unilateral acoustic tumors (vestibular schwannomas) that were missed by standard clinical auditory brainstem response (ABR) measures [Don et al.: Am J Otol 1997;18:608-621; Audiol Neurotol 2005;10:274-290]. While the SABR measure provided much greater sensitivity than the standard ABR measures for small tumor detection, we believed that the large intersubject variability of the SABR measure compromised both the sensitivity and specificity of the measure. However, as we demonstrate in this paper, the variability between ears of a given individual is small. Thus, we introduced an interaural SABR (ISABR) amplitude difference measure to improve the sensitivity and specificity of the SABR amplitude measure to detect small unilateral acoustic tumors. Its main advantages are two-fold. First, it is somewhat immune to variables that affect the absolute SABR amplitudes because it is a relative measure. Second, it is better at assessing tumor patients with very large and non-tumor patients with very small absolute SABR amplitudes. We believe that the ISABR is a useful addition to ABR measures aimed at detecting the presence of unilateral acoustic tumors.     

Role of auditory stimulation in maturation of the auditory pathway

OBJECTIVE: To compare the maturation of the auditory pathway, as shown by electrical brainstem auditory potentials (EABRs), in ears with and without prior auditory stimulation. MATERIAL AND METHODS: Electrophysiological data were collected prospectively from ears which had received cochlear implants. Implant-evoked (Imp)EABRs were recorded. Thirty children, implanted after January 2000, were selected according to a strict inclusion/exclusion protocol. All the children had received a 22-channel Nucleus cochlear implant (CI24 series). Intraoperatively, ImpEABRs were recorded using the Medelec Synergy Evoked Response system in conjunction with Nucleus Neural Response Telemetry software. The ImpEABR latencies of waves eII, eIII and eV and the morphology of wave eV were assessed. RESULTS: ImpEABRs alter during the first 12 months of life. The latency becomes shorter during this period and the morphology of wave eV alters from a broad shape to a more distinct waveform. This appears to occur independently, even in the absence of auditory stimulation. CONCLUSION: The development of electrical brainstem auditory potentials is not dependent on auditory stimulation.     

听神经病听力学分析

目的 探讨听神经病的听觉电生理特点。方法 总结了10例听神经病患者的病史、纯音测听、镫骨肌反射、听性脑干反应（auditory brainstem response,ABR)、耳蜗电图、畸变产物耳声发射（distortion product otoacoustic emission,DPOAE)及对侧白噪声抑制试验、中潜伏期反应和慢皮层反应。5例患者作了颅脑CT或磁共振成像（magnetic resonance imaging,MRI)。结果 患者男女兼有，平均年龄为20．3岁，10余岁的青少年占多数。9例主诉双耳听力下降，1例双耳鸣。纯音测听示19耳为轻度至中度的低频下降型感音神经性听力损失，听力损失最严重的频率为0．5kHz或（和）0．25kHz；1耳听力正常。19耳镫骨肌反射消失，1耳纯音测听为上升型曲线者反射阈提高。ABR不能引出或仅出现波V和（和）波1。全部病例均可记录到DPOAE，但不能被对侧噪声抑制。耳蜗电图示大部分病例动作电位（action potential,AP)消失或振幅很小，负总和电位（negative summating potential,-SP)振幅绝对平均值为0．595μV，慢皮层反应皆正常，6例测中潜伏期反应5例正常。CT或MRI无异常发现。结论 听神经病早期纯音测听可正常，但其镫骨肌反射和ABR消失或阈值升高，其确切病变部位尚不明了，可能位于脑干平面以下的听觉系统。     

听神经病患者的耳蜗电图特征

目的:了解听神经病患者的耳蜗电图特征。方法:用外耳道银球电极记录听神经病组和正常对照组的耳蜗电图,比较两者的-SP波幅差异,统计患耳AP出现的情况。结果:听神经病患者-SP波的引出率为100％,并且其波幅与正常对照组的差异有显著性意义(P<0.01)。AP波幅较小,但引出率高达84％。结论:听神经病患者的-SP可引出且波幅增大。     

Auditory brainstem responses to CE-Chirp® stimuli for normal ears and those with sensorineural hearing loss

Objective: Evaluation of the characteristic differences between click-and CE-Chirp-evoked auditory brainstem responses (ABRs) in normal hearing and sensorineural hearing loss. Design: A prospective study. Ears with normal hearing and with sensorineural hearing loss were evaluated. Pure-tone audiometry and click-and CE-Chirp evoked ABRs exams were conducted for all ears. Visual detection levels, wave-V amplitudes, and latencies of the ABRs were assessed. Study sample: Twenty-two ears with normal hearing and 22 ears with sloping type sensorineural hearing loss were examined. Results: In normal-hearing ears, mean amplitudes were larger for CE-chirps than for clicks at all intensities until 80 dB nHL, at which the amplitudes dropped off, presumably due to upward spread of excitation. In ears with sensorineural hearing loss, however the drop-off was less significant at 80 dB nHL. Comparisons with pure-tone audiometry findings revealed ABRs to CE-Chirps to correlate at 0.5, 1, 2, and 3 kHz, and to clicks at 1, 2, 3, and 4 kHz. Conclusions: The CE-Chirp has advantages over clicks for examining normal ears. However, under high-level stimulation, these advantages are no longer present. In ears with sensorineural hearing loss, the upward spread of excitation is less prominent. The CE-Chirps results correlate significantly to low frequency audiometric findings at 0.5 kHz, while clicks do not.     

Audiologic and vestibular findings in a sample of human immunodeficiency virus type-1-infected Mexican children under highly active antiretroviral therapy

OBJECTIVE: There is little information about audiologic and vestibular disorders in pediatric patients infected with the Human Immunodeficiency Virus type-1 (HIV-1). The aim of this study was to evaluate audiologic and vestibular disorders in a sample of HIV-1-infected children receiving Highly Active Antiretroviral Therapy. METHODS: Patients underwent pure tone audiometry, speech discrimination testing, auditory brainstem responses, electronystagmography, and rotatory testing. HIV-1 viral load and absolute CD4+ cell counts were registered. RESULTS: Twenty-three patients were included, aged 4.5 years (median, range 5 months to 16 years). Pure tone audiometry was carried out in 12 children over 4 years of age: 4 (33%) showed hearing loss, 2 were conductive. Auditory brainstem responses were measured in all 23 patients, suggesting conductive hearing loss in 6 and sensorineural hearing loss in 2. Most patients with conductive hearing loss had the antecedent of acute or chronic suppurative otitis media but with dry ears at the time of evaluation (p=0.003). Abnormal prolongations of interwave intervals in auditory brainstem responses were observed in 3 children (13%, 4 ears), an abnormal morphology in different components of auditory brainstem responses in 4 (17.4%, 7 ears), and abnormal amplitude patterns in 11 patients (48%, 17 ears). Vestibular tests were abnormal in all six patients tested, with asymmetries in caloric and rotatory tests. Although differences were not significant, in general, audiologic abnormalities were more frequent in patients with more prolonged HIV-1 infections, higher viral loads, or lower absolute CD4+ cell counts. CONCLUSIONS: Conductive hearing loss associated with previous otitis media events, abnormalities in auditory brainstem responses suggesting disorders at different levels of the auditory pathways, and unilateral vestibular hyporeflexia were frequent findings in our sample of HIV-1-infected children under Highly Active Antiretroviral Therapy. These findings suggest that HIV-1-infected children should be submitted to audiologic and vestibular evaluation as early as possible in order to reduce their impact on the psychosocial development of these patients.