听力正常耳鸣与诱发性耳声发射的关系

目的:分析听力正常的耳鸣患者的耳蜗功能,探讨耳鸣的客观检查手段。方法:对听力正常的单侧 耳鸣患者50例(50耳,耳鸣1组)、听力正常的双侧耳鸣患者23例(46耳,耳鸣2组)和正常人34例(68耳,对照 组)进行瞬态诱发耳声发射(TEOAE)和畸变产物耳声发射(DPOAE)。耳鸣1、2组同时进行耳鸣频率匹配检查, 并分析在TEOAE及DPOAE测试结果中有无相应表现。结果:①TEOAE通过率,耳鸣1组为64.0%,耳鸣2组 为91.3%,对照组为100%(1组P<0.01,2组P>0.05);②DPOAE通过率,3组均为100%;但耳鸣1组在 3.125kHz及8.837kHz的波幅均值较对照组低,两组差异具有统计学意义(P<0.05);③耳鸣音调分布为0.25 ～8.00kHz。在TEOAE频谱中及DPOAE听力图中,部分耳表现出与匹配频率相对应的低反应峰或频率成分 缺失以及低幅值。结论:部分听力正常的耳鸣患者已有耳蜗毛细胞的损害;TEOAE及DPOAE可以作为外周性 耳鸣诊断的一种客观检测方法;前者对耳蜗性耳鸣的早期诊断敏感而直观,而后者适用于耳鸣的频率分析。     

耳鸣与耳声发射的关系

本从耳鸣与耳声发射的耳蜗机制，基本特性，不同类型的ＯＡＥ和诊断意义等方面就二的关系进行了综述，耳鸣与ＳＯＡＥ耳蜗机制上可能存在着同源性，即耳鸣可以由ＳＯＡＥ引起，但在人群中出现率很小，且二应在频率，强度，掩蔽和抑制上存在相关性，ＴＥＯＡＥ和ＤＰＯＡＥ与耳鸣的产生机制可能关系不大，但对于分析耳鸣在耳蜗机制是有帮助的，各种ＯＡＥ对于耳鸣的诊断，分析耳鸣的部位和性质有一定的意义。     

耳鸣与耳声发射

为探讨耳鸣的产生原因和客观检测手段以及耳鸣与耳声发射（ＯＡＥ）的关系，报道耳鸣患者的２７３例（３０６耳）畸变产物耳声发射（ＤＰＯＡＥ），自发性耳声发射（ＳＯＡＥ）和瞬态诱发性耳声发射（ＴＥＯＡＥ）的特点，结果提示：（１）耳鸣频率与ＳＯＡＥ频率不一致，（２）９４．８％感音神经性聋性耳鸣患者ＤＰＯＡＥ图在相应频率有振幅下降或缺失，５９％听力正常耳鸣耳出现某些频率ＤＰＯＡＥ振幅下降和反应缺失，且不能记录     

诱发性耳声发射应用于新生儿听力筛选

新生儿听力筛选可以及时发现婴幼儿听力损害 ,以便早期进行干预。因此 ,一种快速而行之有效的新生儿听力筛选方法———耳声发射技术 (ＯＡＥ) ,近几年来正成为国内外耳科常用技术之一。本文就近几年来ＯＡＥ在新生儿听力筛选中的研究进展作一介绍。1　新生儿听力筛选的必要性在我国听力言语残疾居五类残疾之首。我国现有听力言语残疾人 2 0 0 0万 ,0～ 7岁的聋哑儿童约 74万 ,且以每年约 2～ 4万新发生的聋儿递增[1] 。目前 ,由于没有一个有效的方法作普遍性的新生儿听力筛选 ,一般到 2～ 3岁才发现其听力障碍 ,结果导致言语发育障碍 ,智力…     

耳鸣患者瞬态诱发耳声发射的对侧抑制效应观察

目的　探讨耳鸣患者在瞬态诱发耳声发射（TEOAE）的对侧抑制中的表现。方法　对136例耳鸣患者收集其基本资料及耳鸣残障量表（tinnitus handicap inventory,THI）评估,并进行TEOAE的对侧抑制检测。同时,选取40名正常受试者进行对侧抑制TEOAE检查作为对照组进行对比。分析耳鸣组和对照组总体抑制（overall suppression,OS）值间的差异,及耳鸣患者的性别、年龄、侧别、患病时间和THI分级对其对影响。结果　耳鸣组与对照组间OS值存在显著性差异（Z =2.88,P =0.004）,性别、年龄、患病时间和THI分级对OS值无明显影响（P >0.05）。结论　耳鸣患者的TEOAE对侧抑制值有所降低,存在内侧橄榄耳蜗束（medial olivocochlear,MOC）功能障碍。耳鸣患者的性别、年龄、侧别、患病时间和THI分级对TEOAE平均抑制影响不大。     

诱发性耳声发射临床应用初探

对86例(172耳)听力正常和异常者进行了诱发性耳声发射(EOAE)检查。EOAE阈值与主观听阈呈正相关,纯音听阈均值≥50dBHL者EOAE消失。提示EOAE是一种客观、敏感、准确而且快速的听力评价新方法,且对于临床耳聋的鉴别诊断具有一定的价值。     

畸变产物耳声发射与瞬态诱发耳声发射的相关性观察

目的：探讨畸变产物耳声发射（DPOAE)和瞬态诱发耳声发射(TEOAE)的特点和相关性。方法：以20例（40耳）耳科正常青年人观察噪声暴露前后在无对侧抑制（NCS)状态下和有对侧抑制（CS)状态下TEOAE的频带信噪比、频带反应幅值，与DPOAE的2f1-f2幅值、信噪比相互间的相关性。结果：DPOAE与TEOAE虽由不同的刺激声所引出，有各自的图形特征，但在绝大多数相近频率点上，其测量值有较好的相关性，形成一定的数量关系。结论：TEOAE测试较为快捷并有中频优势，而DPOAE则有很好的频率特异性和高频优势。二者幅值及信噪比间有良好的相关性，可得出有统计意义的线性回归方程参数，听觉损害，噪声性。     

诱发性耳声发射在诊断耳蜗性聋的应用

对35例(57耳)耳蜗性聋进行EOAEs检查,结果表明,耳蜗性聋之EOAEs多表现为阈值升高或波缺失;行为听阈>40dB HL者多记录不到EOAEs,EOAEs能否出现与ABRV波反应阈值呈正相关。提示EOAEs检查对本病早期诊断是一种有效手段。     

耳鸣与耳声发射

为探讨耳鸣的产生原因和客观检测手段以及耳鸣与耳声发射（ＯＡＥ）的关系，报道耳鸣患者２７３例（３０６耳）畸变产物耳声发射（ＤＰＯＡＥ）、自发性耳声发射（ＳＯＡＥ）和瞬态诱发性耳声发射（ＴＥＯＡＥ）的特点。结果提示：①耳鸣频率与ＳＯＡＥ频率不一致；②９４．８％感音神经性聋伴耳鸣患者ＤＰＯＡＥ图在相应频率有振幅下降或缺失，５９％听力正常耳鸣耳出现某些频率ＤＰＯＡＥ振幅下降和反应缺失，且不能记录到ＳＯＡＥ，而在ＳＯＡＥ频率附近ＤＰＯＡＥ有良好反应高峰。耳声发射可望用于发现早期耳蜗病变。     

言语障碍儿的诱发性耳声发射的检测分析(附31例报告)

目的　研究言语障碍儿 (speechdisorderchildren ,SDC)的诱发性耳声发射 (evokedotoacousticemis sion ,EOAE)的特征 ,评价其对SDC的听力诊断作用。方法　应用Capella耳声发射分析仪对 31例SDC进行畸变产物耳声发射 (distortionproductotoacousticemission ,DPOAE)和瞬态诱发耳声发射 (transientevokedotoacaustice mission ,TEOAE)检测 ,同时每例均进行听性脑干反应 (auditorybrainstemresponse ,ABR)、声导抗测试 ,以ABR检查结果为标准 ,评价EOAE的诊断价值。结果　SDC的EOAE的幅值、信噪比 (S/N ratio)、相关系数 (correlationcoffi cient,Corr)明显低于正常儿 (P <0 .0 1) ,扫描时间、叠加次数明显高于正常儿 (P <0 .0 1) ,其检出率明显低于正常儿 (P <0 .0 1)。以ABR为标准 ,DPOAE和TEOAE的灵敏度同为 95 .5 % ,特异度分别为 80 %和 6 0 % ,准确度分别为 95 .2 %和 93.5 %。结论　SDC的EOAE明显异常于正常儿 ,EOAE对SDC的听力诊断具有较高的应用价值 ,DPOAE的频率特异性对SDC的听力评估、助听器选配可能更有意义。     

Quantitative analysis of cochlear active mechanisms in tinnitus subjects with normal hearing sensitivity: multiparametric recording of evoked otoacoustic emissions and contralateral suppression

Objective

Aim of this study was to investigate the possible role played by outer hair cells and cochlear efferent system functionality when tinnitus develops in normal hearing ears. A multiparametric approach was used, entailing recording and analysis of a set of otoacoustic emissions (OAEs): distortion product (DPOAEs), transient evoked (TEOAEs) and efferent-mediated TEOAE suppression in the presence of contralateral acoustic stimulation (CAS).

Methods

Fifty-four subjects with normal hearing sensitivity participated in the study. Twenty-three suffered from chronic subjective tinnitus whereas thirty-one did not have tinnitus and acted as control subjects. DPOAEs were measured with eliciting tones of frequency ratio 1.22 and intensity 65 and 55 dB SPL in the frequency range 0.5–8 kHz. TEOAEs were recorded with the ‘linear’ protocol using clicks at 60 dB peak SPL both in the absence and in the presence of CAS at two different intensities. DPOAE amplitude, TEOAE amplitude, and TEOAE suppression were analysed as relevant parameters.

Results

Significantly reduced DPOAE amplitude in the frequency range 1.5–8 kHz, lower TEOAE amplitude, and slightly decreased TEOAE suppression were measured in tinnitus subjects compared to non-tinnitus controls. In particular, 74% of tinnitus subjects exhibited abnormal DPOAEs, 13% had abnormal TEOAEs, whereas abnormal TEOAE suppression was found in 9% of patients.

Conclusion

Overall, the present work revealed the presence of abnormal OAEs, in particular at higher frequencies, in tinnitus subjects with normal hearing sensitivity. A minor (i.e., sub-clinical) outer hair cell dysfunction, particularly in high-frequency cochlear regions, might thus be assumed in normal hearing tinnitus subjects. In order to better put in light the possible role played by outer hair cells in low-frequency cochlear regions, or by the cochlear efferent system, additional analyses would be needed.     

Application of distortion product otoacoustic emissions to inflation of the eustachian tube in low frequency tinnitus with normal hearing

Objective

This study was designed to investigate the applications of distortion product otoacoustic emissions to assess the efficacy of eustachian tube inflation on low frequency tinnitus with normal hearing.

Methods

Ninety-four patients (155 ears) suffering from subjective tinnitus with normal hearing sensitivity participated in this study. Control group consists of fifty volunteers (100 ears) without tinnitus. They were subjected to full history taking, otoscopy, basic audiologic evaluation and distortion product otoacoustic emissions (DPOAE). As for the patients with decreased DPOAE amplitude over a limited frequency range from 0.5 to 1 kHz, we offered nose dropping and tubal inflation for a week and DPOAE was preformed again. The patients were followed up for a month.

Results

34.8% DPOAE-gram showed decreased amplitude at the frequencies from 0.5 to 1 kHz in tinnitus group and “the ring” is mostly lower in pitch. Among the patients accepted the treatment of eustachian tube inflation, 16.7% the tinnitus disappeared, no recurrence within one month; 66.67% the tinnitus reduced within one month. 95.5% the amplitude of DPOAE showed improved over the limited frequency. 16.7% the tinnitus still existed.

Conclusion

The changes of the mechanical properties of ossicular chain or the tympanic membrane influenced by tympanum pressure may cause tinnitus, which is sub-clinical prior to the changes of audiometry and tympanometry. The low frequency tinnitus may gain transitory relief from ringing with the tubal inflation. DPOAE was proved to be a useful tool in the evaluation of the efficacy of tubal inflation on low frequency tinnitus with normal hearing.     

听力正常人畸变产物耳声发射的基本特性

利用动态分析仪ＩＬＰＯ－９２，对４８例听力正常人在４组不同原始刺激强度下进行畸变产物耳声发射检查，结果发现平均ＤＰＯＡＥｓ图呈双叶型轮廓：在１．５ｋＨｚ和５ｋＨｚ附近。     

Quantitative analysis of cochlear active mechanisms in tinnitus subjects with normal hearing sensitivity: Time-frequency analysis of transient evoked otoacoustic emissions and contralateral suppression

Objective

The aim of this study was to analyze the fine structure of transient evoked otoacoustic emissions (TEOAEs) and contralateral suppression effects in tinnitus subjects with normal hearing in order to assess whether a minor cochlear or efferent dysfunction, possibly limited in narrow cochlear regions, might play a role in tinnitus.

Methods

TEOAEs were recorded, both in the absence and in the presence of contralateral acoustic stimulation, in 23 tinnitus patients with normal hearing sensitivity and in 31 non-tinnitus control subjects. The broad-band TEOAE recordings were analyzed by using an innovative algorithm and separated into a set of 33 narrow-band frequency components, that represent the different cochlear contributions to the whole TEOAE response. In each frequency component, three different parameters were analyzed and compared between tinnitus and non-tinnitus subjects, i.e., reproducibility, latency, and the suppression effects induced by contralateral acoustic stimulation.

Results

Significantly lower reproducibility was observed in the frequency components of the tinnitus subjects compared to the controls, whereas no significant differences in latency and in suppression effects were observed between tinnitus and non-tinnitus ears.

Conclusions

The analysis of the fine structure of TEOAEs revealed that the tinnitus subjects involved in this study might, possibly, have a minor dysfunction of the cochlear active mechanisms that resulted in frequency components with lower reproducibility. Conversely, the analysis of suppression effects in the narrow-band frequency components of TEOAE indicated that the subjects involved showed no relevant damage to the efferent regulatory mechanisms that control the cochlear activity, neither through the cochlea as a whole, nor in limited cochlear regions.     

新生儿与成人瞬态诱发耳声发射差异的频谱特性分析

目的 比较新生儿与成人瞬态诱发耳声发射(TEOAE)的差异,并分析其频谱特性.方法 以短声刺激分别对120名通过听力筛查的新生儿(男58,女62)和32名平均纯音听阈(听力级)在20 dB以内的成年人(男15,女17)行TEOAE检测,对于测试结果 行频谱分析和半倍频程分析.结果 ①新生儿组TEOAE总强度(声压级,下同)为(15.18±4.39)dB,高于成人组的(9.51±4.12)dB,差异具有统计学意义(t=9.303,P<0.05).②新生儿的频带重复率、频带重复率非0比例、频带信噪比检出率及频带信噪比在第1频带(0.8 kHz)最低,在3.2 kHz最大;而成人在第5频带(4.0 kHz)处最低,在1.5 kHz最大.③新生儿与成人最大频带信噪比强度差为7.09 dB,二者出现的频率位置相差约1.7 kHz.④半倍频程分析显示新生儿TEOAE最大能量为(10.50±5.09)dB,在2828 Hz处,而成人为(2.84±5.33)dB,在1414 Hz处;二者最大反应在强度上相差7.66 dB,出现的频率位置相差1414 Hz.⑤成人1.5 kHz区的TEOAE信号最强,之后其信噪比随频带增高而降低,而新生儿信噪比却呈现随频带增高而增强的特征;从第1频带到第5频带,新生儿与成人TEOAE强度的差值随频带增高也逐渐增大.结论 成人TEOAE总强度低于新生儿.新生儿频带信噪比及半倍频程能量反应峰的分布频率及反应强度均高于成人.     

The relationship between auditory threshold and evoked otoacoustic emissions

The aim of this study was to compare transiently evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE) in normal hearing ears (n = 44) and ears with cochlear hearing loss (HL) to obtain defined data on qualitative and quantitative correlations. In addition, we wanted to determine the reliability with which a clinical examiner could predict a typical, idealized audiometric configuration from TEOAE measurements. In the hearing-impaired subjects (n = 149), a 50% reduction of OAE incidence was caused by a mean HL of 10.5 dB for TEOAE compared to 27 dB SPL for DPOAE. A 90% incidence reduction was found at a mean threshold elevation of 33 dB for TEOAE and 51 dB for DPOAE. Correlation between TEOAE amplitudes and HL was in general rather low (r = –0.1 to –0.5), while DPOAE amplitudes showed a slightly better correlation with HL (r = –0.3 to –0.6). In general, efforts to derive an audiogram from evoked OAE have been more promising for DPOAE than for TEOAE. However, our studies showed that approximately 40% of the ears with HL could be categorized correctly into one of five typical audiometric patterns from TEOAE measurements. Additionally, a cochlear HL in or near the medium frequency range was much more likely to cause a reduction in TEOAE than an isolated low- or high-frequency lesion. Accordingly, TEOAE were often preserved in ears with isolated HL in the high or low frequencies. Received: 7 May 1998 / Accepted: 25 September 1998     

Transient evoked otoacoustic emissions in rock musicians

Objective: Our focus in this study was the assessment of transient evoked otoacoustic emissions (TEOAEs) in a large group of rock musicians. A further objective was to analyse tinnitus among rock musicians as related to TEOAEs. Design: The study was a cross-sectional survey of rock musicians selected at random. A control group was included at random for comparison. Study sample: We recruited 111 musicians and a control group of 40 non-musicians. Testing was conducted by using clinical examination, pure tone audiometry, TEOAEs and a questionnaire. Results: TEOAE SNR in the half-octave frequency band centred on 4?kHz was significantly lower bilaterally in musicians than controls. This effect was strongly predicted by age and pure-tone hearing threshold levels in the 3–6?kHz range. Bilateral hearing thresholds were significantly higher at 6?kHz in musicians. Twenty percent of the musicians had permanent tinnitus. There was no association between the TEOAE parameters and permanent tinnitus. Conclusions: Our results suggest an incipient hearing loss at 6?kHz in rock musicians. Loss of TEOAE SNR in the 4?kHz half-octave frequency band was observed, but it was related to higher mean 3–6?kHz hearing thresholds and age. A large proportion of rock musicians have permanent tinnitus.     

Comparison of transient evoked otoacoustic emissions and distortion product otoacoustic emissions when screening hearing in preschool children in a community setting

OBJECTIVE: The first purpose of this study was to compare transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) to determine if they resulted in equivalent signal-to-noise ratios (SNRs) when used for hearing screening in a preschool population in a community setting. The second purpose was to determine if the OAE methods would result in equivalent pass/refer rates. The third purpose was to determine the agreement between the pass/refer rates from a tympanometric screening and the pass/refer rates from each OAE method. METHODS: Thirty-three preschool children ages 4 months to 4 years, 4 months were tested using DPOAE and TEOAE. The frequencies 800-4000Hz were compared. The tympanometric gradient was obtained from a tympanogram done on each ear. A multivariate statistic was used to compare the emission SNR from both methods. A chi(2) statistic was used to compare the pass/refer rates from both methods. The agreement between the pass/refer rates from the OAE screens and from the tympanometric gradient were compared. RESULTS: TEOAE and DPOAE SNRs were significantly different in the low frequency however, there were no significant differences found in the high frequencies. There were no significant pass/refer differences found between the methods at any frequency. When comparing the agreement between the OAE methods with the tympanometry, both methods produced nearly equivalent agreement with tympanometric gradient. However, the overall correspondence between OAE findings and tympanometry was not perfect. CONCLUSIONS: Both methods are effective and especially equivalent in the high frequencies and can be recommended for use in a preschool population in the field. Tympanometric gradient disagreed with both OAE screening results about 25% of the time. Finally, our study also found that higher refer rates can be expected when young (<3 years) preschool children are included in the screen.     

Effect of smoking on transient evoked otoacoustic emissions and contralateral suppression

Objective

The present study compared the amplitudes of transient evoked otoacoustic emissions (TEOAEs) and efferent suppression in smokers and non-smokers taking age into consideration.

Methods

Fifty smokers and fifty non-smokers who had normal hearing sensitivity with age range of 20–69 years were considered for the present study. TEOAEs were measured in both the groups of subjects across different age groups. The functioning of the efferent auditory system was evaluated in both the groups by recording the TEOAEs in the presence of a contralateral white noise (CWN) of 70 dB SPL.

Results

Age did not have a significant effect on the TEOAEs amplitude in both the groups of subjects. However, the TEOAEs amplitude was significantly reduced in smokers compared to non-smokers. The results found a significant effect of age on the amplitude of efferent suppression in smokers, however, no significant effect was found in the non-smokers group.

Conclusions

It was found that the difference in the amplitude of efferent suppression in smokers was significantly greater for each age group between 20 and 49 years compared to each age group from 50 to 69 years. Results have important implication on the damage to the cochlear structures from smoking.