听性稳态反应的可靠性评价

目的对正常听力组和聋儿组在不同时间进行两次听性稳态反应测试,并比较两次测试结果的差异程度,从而对ASSR的应用价值及可靠性做出评价。方法分别对7例正常听力年轻人和12例年龄在2～5岁的聋儿在不同时间进行两次ASSR测试,将4个测试频率前后两次的反应阈值进行比较,分析其差异。结果正常组每个测试频率两次结果比较差异无统计学意义,且标准差很小;听力异常组4个测试频率前后两次的反应阈值均有部分病例有一定的差异,程度多为5dB。阈值的这种小幅波动可能是ASSR本身特点所致。结论ASSR测试结果有较高的可靠性。     

刺激电极在鼓阶内位置对听神经兴奋性的影响

目的　通过记录电诱发听性脑干反应 (electricallyevokedauditoryresponse ,EABR)阈值变化 ,探讨植入刺激电极在豚鼠耳蜗鼓阶内的位置对听神经兴奋性的影响。方法　在手术显微镜下 ,将标准刺激电极放在靠近蜗轴位置 ,用压碎的肌肉轻轻封住圆窗口 ,记录二次EABR阈值 ,取均值。然后取出刺激电极 ,再次植入电极靠近耳蜗鼓阶的外侧壁 ,再记录二次EABR阈值 ,取均值 ,然后比较前后二次记录到的EABR阈值变化。结果　植入电极在耳蜗鼓阶外侧壁的EABR阈值为 1.14± 0 .4 5mA ,较耳蜗内侧壁EABR阈值 (0 .2 8± 0 .0 9mA)明显升高 ,二者有显著性差异 (P <0 .0 1)。结论　电刺激听神经如果采用间距不宽的双极电极 ,其有效性同电极在耳蜗鼓阶内的位置密切相关 :植入电极越靠近被刺激的听神经成份 ,被检测到的EABR的阈值就越低。此为实验室设计蜗旁多导电极提供了依据     

颈上神经节切除对豚鼠耳蜗血流及听性脑干反应阈的影响

目的研究豚鼠颈交感神经节对耳蜗血流及听觉生理功能的调节作用。方法在正常豚鼠单侧耳蜗螺旋蜗轴动脉局部滴加逆行追踪剂辣根过氧化物酶(horseradishperoxidase,HRP),观察双侧交感颈上神经节、星状神经节内的阳性神经元分布;建立单侧颈上神经节切除模型,观察术后不同时间点双侧耳蜗血流、听性脑干反应的情况;建立单侧颈上神经节切除后噪声性听损伤模型,观察颈上神经节切除对噪声损伤导致的听觉阈移是否有保护作用。结果耳蜗螺旋蜗轴动脉局部给予逆行追踪剂后同侧颈上神经节内可见阳性神经元;单侧颈上神经节切除1周后,术侧耳蜗底回血管纹处血流较对侧升高,听性脑干反应阈值无明显变化;颈上神经节切除对噪声导致的听损伤有一定的保护作用。结论交感颈上神经节切除对豚鼠耳蜗血流及听觉生理功能有一定的影响。     

肾虚的临床听力学特性初步研究

目的 探讨肾虚的临床听力学特征性表现，为临床肾虚辨证及中医肾主耳理论提供听力学指标。方法 对肾虚组46人（83耳），非肾虚对照组49人（89耳），正常对照组41人（82耳）均进行纯音听阈测试、SISI试验、音衰试验及听性脑干反应（ABR）测试，观察三组对象各频率段听阈、SISI试验及TD试验得分、ABR波I、Ⅲ、Ⅴ潜伏期及波Ⅴ潜伏期耳间差值（ILD），然后进行组间比较及统计分析。结果 肾虚组与对照组比较，具有以下听力学特征：高频听力下降（P＜0．05），SISI试验得分增高（P＜0．05，P＜0．01），ABR测试ILD增大，波I、波V潜伏期延长（P＜0．05）。结论 肾虚证对听力的影响具有一定的特性，上述表现能否作为临床肾虚辨证的客观指标，值得进一步研究。     

视听功能整合效应同步诱发电位的初步研究

目的应用视听同步诱发电位技术探索成年人视听神经功能整合的电生理特性。方法分别于视听同步诱发电位的同步程序下,同步测试闪光视觉诱发电位(flash visual evoked potential,FVEP)和听性脑干反应(au-ditory brainstemresponse,ABR),以及同步程序下单独记录ABR,对10名正常成人(20眼和20耳)进行检测并比较:①同步程序下同步测试ABR与同步程序下单独记录ABR的变化;②不同声音刺激强度时同步程序下的FVEP变化特点。结果①同步程序下同步测试ABR与同步程序下单独记录ABR比较,70dB nHL短声刺激时,前者波Ⅴ潜伏期、Ⅰ-Ⅴ、Ⅲ-Ⅴ波间期较后者延长(P<0.05);但短声刺激强度为30、50dB nHL时,ABR各波潜伏期差异无统计学意义(P>0.05);②不同声音刺激强度时同步程序下FVEP N1、P1、N2波潜伏期,N1-P1、P1-N2振幅差异无统计学意义。结论在视听信号整合输入过程中,视听信号进入大脑是有序性:存在视觉信号对听觉信号的时间指导性(影响潜伏期),以期达到信息内环境的稳定性。     

感音神经性聋患者窄带CE-Chirp ASSR测试结果初步分析

目的探讨感音神经性听力损失患者CE-Chirp声诱发听性稳态反应(auditory steady state response,CE-Chirp ASSR)与纯音听阈各频率反应阈值的相关性。方法选取中、重度听力损失患者18例(30耳)为受试者,听性稳态反应调制频率为90 Hz,分别测试窄带CE-chirp ASSR和纯音听阈500、1000、2000和4000 Hz的反应阈值,并进行相关性分析。结果 0.5-4.0 kHz频率CE-Chirp ASSR反应阈与纯音听阈的的相关系数r分别为0.671、0.704、0.563、0.687(P<0.01)。结论 CE-Chirp ASSR反应阈与纯音听阈有显著相关性,在客观听力评估中有较好的准确性。     

听障儿童听觉能力发展特点的研究

目的 探讨听障儿童的听觉能力发展特点.方法 对483名1～10岁听障儿童的家长实施<小龄儿童听觉发展问卷>,利用SPSS 17.0分析问卷得分.结果 ①不同生理年龄组儿童的问卷得分存在极显著性差异(F=16.063,P＜0.01),听障儿童生理年龄越大,问卷得分越高;②不同听觉年龄组儿童的问卷得分存在极显著性差异(F=17.168,P＜0.01),听障儿童听觉年龄越大,问卷得分越高;③人工耳蜗组儿童的问卷得分高于助听器组,差异达到极显著性水平(t=2.912,P＜0.01).结论 生理年龄、听觉年龄以及助听设备类型等可能均是影响听障儿童听觉能力发展的因素;干预越早,听障儿童的听觉能力发展越接近于健听儿童.     

高频率探测音鼓室压测试结合同侧声反射诊断中耳积液初探

通过临床流行病学的方法对７６例耳镜检查疑有ＭＥＥ的１０２耳的鼓室区测试结果的准确性进行评价。鼓室压图分别用２２６Ｈｚ和６７８Ｈｚ的探测音测试其声导和声纳，并同时测试同侧声反射阈，将测试结果与鼓膜穿刺结果进行比较：发现用６７８Ｈｚ探测音的声纳测试为诊断ＭＥＥ较好的测试方法：Ｂ６７８的Ｉ型图，无论声反射存在与否，均可视为无ＭＥＥ的批征，Ｂ６７８Ⅲ型图结合声反射〉１１５ｄＢ，则可作为有ＭＥＥ标志，而Ⅱ，     

On-Line Computer Scoring of the Auditory Brainstem Response for Estimation of Hearing Threshold

Auditory brainstem responses (ABRs) to click stimuli have become established as a useful indicator of hearing thresholds in infants and young children. Although the investigation is objective in so far as the patient is concerned, a subjective element remains in the decision by the operator as to whether or not an ABR is present in an averaged waveform. A simple on-line computer detection technique is described which removes some of the reliance placed upon the operator. The technique employs a scanning window for correlation and amplitude analysis of pairs of averaged ABR waveforms.

The reliability and accuracy of computer and operator scoring of 25 thresholds in normally hearing adults and 50 thresholds in infants and young children with suspected hearing impairment have been investigated. In the adult group, 96% of computer estimates of the threshold were within ± 10 dB of the subjective hearing threshold, compared with 92% for operator scoring. There were 92% of computer and operator scores within ± 10 dB of each other. In the patient group there was equally good agreement between computer and operator scoring with 90% of the thresholds within ± 10 dB of each other; the incidence of possible false-positive thresholds was also lower with computer scoring.

This on-line scoring technique, therefore, offers useful assistance to the operator; requires only limited computing power, and is suitable for use in a routine clinical environment.     

中文版《小龄儿童听觉发展问卷》的有效性研究

目的 考察中文版<小龄儿童听觉发展问卷>的有效性.方法 对168名2岁以内健听儿童的家长进行中文版问卷调查,利用调查所得数据检验中文版问卷的信度、效度等各项有效性指标.结果 中文版<小龄儿童听觉发展问卷>的各项有效性指标均达到要求;回归分析曲线表明,中文版问卷得到的数据曲线和德语原版问卷一致性非常高.结论 中文版<小龄儿童听觉发展问卷>的有效性符合要求.可以推广使用.     

听觉认知速度老年化的初步研究

用人－机对话方式，以听觉信息处理速度（IPS）为指标，进行与年龄相关的听觉认知速度变慢的初步研究。被试者为150名20－72岁身体健康的医务人员。结果显示：40岁以后，IPS随增龄而变小，听觉正确辨别时（RT）则随增龄而延长；IPS及RT与年龄间呈线性函数关系，前者呈负相关，后者呈正相关。因此，在临床上IPS及RT有可能被作为老年听力减退及中枢认知功能的评价方法之一。     

Residual Inhibition Functions Overlap Tinnitus Spectra and the Region of Auditory Threshold Shift

Animals exposed to noise trauma show augmented synchronous neural activity in tonotopically reorganized primary auditory cortex consequent on hearing loss. Diminished intracortical inhibition in the reorganized region appears to enable synchronous network activity that develops when deafferented neurons begin to respond to input via their lateral connections. In humans with tinnitus accompanied by hearing loss, this process may generate a phantom sound that is perceived in accordance with the location of the affected neurons in the cortical place map. The neural synchrony hypothesis predicts that tinnitus spectra, and heretofore unmeasured “residual inhibition functions” that relate residual tinnitus suppression to the center frequency of masking sounds, should cover the region of hearing loss in the audiogram. We confirmed these predictions in two independent cohorts totaling 90 tinnitus subjects, using computer-based tools designed to assess the psychoacoustic properties of tinnitus. Tinnitus spectra and residual inhibition functions for depth and duration increased with the amount of threshold shift over the region of hearing impairment. Residual inhibition depth was shallower when the masking sounds that were used to induce residual inhibition showed decreased correspondence with the frequency spectrum and bandwidth of the tinnitus. These findings suggest that tinnitus and its suppression in residual inhibition depend on processes that span the region of hearing impairment and not on mechanisms that enhance cortical representations for sound frequencies at the audiometric edge. Hearing thresholds measured in age-matched control subjects without tinnitus implicated hearing loss as a factor in tinnitus, although elevated thresholds alone were not sufficient to cause tinnitus.

冲击波对豚鼠螺旋神经节细胞谷氨酸免疫反应及听阈的影响

豚鼠经平均压力峰值１８４ｄＢ（ＳＰＬ）的冲击波一次暴露后，分别测８、２４、７２小时、７天的螺旋神经节（ＳＧ）细胞谷氨酸免疫反应（Ｇｌｕ－ＩＲ）阳性产物的光密度值，均较对照组明显增高（Ｐ＜０．０１）。以８小时者光密度最大，７天者最小。免疫透射电镜发现，爆震后８小时豚鼠ＳＧⅠ型、Ⅱ型细胞浆内ＬＵ－ＩＲ阳性产物明显增多。不同时间组ＡＢＲ阈移与Ｇｌｕ－ＩＲ阳性产物光密度的变化率成正相关（ｒ＝０．９１９，Ｐ＜０．０５）。提示冲击波所致听力损伤与ＳＧ细胞内Ｇｌｕ变化有关。     

The Dependence of Auditory Nerve Rate Adaptation on Electric Stimulus Parameters, Electrode Position, and Fiber Diameter: A Computer Model Study

This paper describes results from a stochastic computational neuron model that simulates the effects of rate adaptation on the responses to electrical stimulation in the form of pulse trains. We recently reported results from a single-node computational model that included a novel element that tracks external potassium ion concentration so as to modify membrane voltage and cause adaptation-like responses. Here, we report on an improved version of the model that incorporates the anatomical components of a complete feline auditory nerve fiber (ANF) so that conduction velocity and effects of manipulating the site of excitation can be evaluated. Model results demonstrate rate adaptation and changes in spike amplitude similar to those reported for feline ANFs. Changing the site of excitation from a central to a peripheral axonal site resulted in plausible changes in latency and relative spread (i.e., dynamic range). Also, increasing the distance between a modeled ANF and a stimulus electrode tended to decrease the degree of rate adaptation observed in pulse-train responses. This effect was clearly observed for high-rate (5,000 pulse/s) trains but not low-rate (250 pulse/s) trains. Finally, for relatively short electrode-to-ANF distances, increases in modeled ANF diameter increased the degree of rate adaptation. These results are compared against available feline ANF data, and possible effects of individual parameters are discussed.     

A Study of Auditory Evoked Responses during Sleep

The evoked responses to tones in different stages of sleep were studied on a group of normally hearing students. The stage of sleep was monitored by experienced workers in EEG and the responses recorded together with the stage of sleep in which they were elicited. Attention was paid to the shape, amplitude, latency, and clarity (i.e. the ease with which a decision between ‘response’ and ‘no response’ for a given stimulus could be reached) of responses. Statistical attention was paid to the relationship between stage of sleep and the above qualities of the responses

It was found most useful to stimulate with a 1 000-Hz tone of 75 dB ISO intensity since this gave a clear response without disturbing the depth of sleep. Responses when awake were taken as a control. The most favorable periods, from this study, appeared to be stages two and three (after Osward); the least favorable were stages four and that of rapid eye movement (REM)

It is hoped that this study will form a useful background against which drug-affected evoked responses can be studied (as in the topic of sedation for ERA)     

内听动脉痉挛对听力的影响及局部应用血管扩张剂的保护作用

目的探讨内听动脉痉挛造成的耳蜗缺血对听功能的影响及局部使用血管扩张剂对听力的保护作用。方法将15只(30耳)大白兔暴露面听神经血管复合体后,分为局部应用去氧肾上腺素组(实验组1,10耳)、局部注射罂粟碱后再放置去氧肾上腺素组(实验组2,10耳)和局部放置生理盐水组(对照组,10耳),分别用听性脑干反应(ABR)和畸变产物耳声发射(DPOAE)观察三组兔听功能的变化。结果在面听神经血管复合体局部使用去氧肾上腺素组可造成内听动脉明显痉挛,听觉功能明显下降(P<0.05);局部使用罂粟碱预防组与对照组相比听觉功能无明显下降(P<0.05)。结论内听动脉痉挛可使听觉功能明显下降,局部使用罂粟碱可预防血管痉挛,对动物听力具有保护作用。     

A Microanalytical Study on Human Auditory Ossiclcs in Normal and Pathological Conditions

A microanalytical study of human auditory ossicles was performed in 11 normal adults, 13 infants, 13 foetuses, 7 middle ear cholesteatoma. 7 chronic otitis and 1 facial nerve schwannoma. Malleus and incus ossification is initiated in the foetal period, the Ca/P ratio reaching a value of 1.8–1.9 in the 29-gestation-week foetus and continues in Ihe infant period until adult, except for the marginal area of the malleus head which appears mineralized in the infant. The normal Ca/P ratio for malleus is 2.10, and 2.19 for incus. In the stapes, mature Ca/P ratio values (2.11) appear in the footplate of the 23-gestation-weeks foetus. Stapes ossification continues in its head and crura, but never reaches malleus and incus values. We have confirmed that there is a relationship between Ca/P ratio and sulphur values in the ossification process; so when the first increases the second decreases. Finally, in our pathological material we have not found any significant alteration of Ca/P ratio, sulphur or other elements studied.