自觉听力正常的后循环缺血患者纯音听阈与耳声发射结果分析

目的：探讨自觉听力正常的后循环缺血（posterior circulation ischemia ,PCI）患者的纯音测听和耳声发射的结果及临床意义。方法选择经临床确诊为PCI且自觉听力正常的患者40例（80耳）作为实验组,健康成年人30例（60耳）作为对照组,两组均行纯音测听、瞬态诱发耳声发射（TEOAE）和畸变产物耳声发射（DPOAE）检查,对结果进行统计学分析。结果 PCI组125～8000 Hz各频率气导听阈与对照组比较差异无统计学意义（ P＞0．05）;PCI组的TEOAE检出率（47．5％,38／80）低于对照组（95．0％,57／60）,差异有统计学意义（P＜0．01）;PCI组DPOAE各频率检出率、幅值均低于健康对照组（P＜0．05）,尤以高频区明显（P＜0．01）。结论后循环缺血可以影响耳蜗的血液供应,导致常规纯音测听难以发现的耳蜗功能损害,尤以高频区明显。     

畸变产物耳声发射对噪声性聋早期发现的应用

目的 从听力学角度评价畸变产物耳声发射检测对噪声性听损伤早期发现的临床价值。方法 利用声级计测定某食品包装材料有限公司生产车间,同时利用纯音测听、声导抗、耳声发射、对生产车间接触噪声的43名工人进行听力检测并同时进行外耳检查和噪声接触史调查。结果 生产车间九个机器点的噪声水平平均93.7dB(A),超过国家规定标准,受检的43名工人声导抗检测全部正常,23人听力检测异常,其中7人纯音测听呈噪声性聋早期、中期听力损伤改变,16人纯音测听正常而耳声发射不合格。结论 畸变产物耳声发射检测对接触噪声的人群是一种有一定价值的监测和早期发现噪声性聋的检查方法。     

听神经病患者纯音听力和耳声发射表现特征分析

目的 探讨听神经病的病损部位及发病机制。方法 常规检测听神经病患者（10例，20耳）和正常听力者（10例，20耳）的纯音听力及DPOAE，并对结果进行比较和统计学分析。结果 听神经病组20耳中18耳纯音测听呈低频下降型听力损失，另2耳呈鞍型听力曲线，低频（250．500、1000Hz）听力损失一般大于40dB。畸变产物耳声发射均可引出，各频率耳声发射幅值与正常对照组差异无统计学意义，纯音听力与相应频率耳声发射出现矛盾。结论 听神经病的病损部位可能位于耳蜗传人通路，神经冲动非同步化或同步化受损是听神经病的发病机制之一。     

听外周偏侧性的病理发现

目的：观察生理和蜗后病理条件下听觉外周系统的偏侧性，以加深对双侧对称性疾病的认识。方法：检测65例听神经病患者和65例正常健康青年纯音测听、自发性耳声发射（SOAE）、瞬态诱发性耳声发射（TEOAE）及其对侧抑制效应，从耳蜗和传出神经两个水平分析左右听活动。结果：①听神经病患者右耳各频率平均纯音听阈约高于左耳5dB；②正常组TEOAE幅值右耳大于左耳（P＜0．01），听神经病患者组TEOAE幅值右耳大于左耳（P＜0．05）；③正常组传出抑制功能右耳大于左耳（P＜0．01），听神经病患者组传出抑制功能左、右耳均有障碍，右耳略重于左耳，但无统计学差异（Ｐ＞0．05）；④无论是正常组还是听神经病患者组均在右耳较易记录到SOAE；⑤正常组SOAE强弱左右耳间无统计学差异（P＞0．05）；听神经病患者组SOAE右耳强于左耳（P＜0．01）。结论：听觉外周系统具有偏侧性（右侧优于左侧）；在同一蜗后病理条件下，听活动较强的一侧病理损害则较重，听活动较弱的一侧病理损害则较轻；听神经病患者右耳听力损失稍重于左耳，可能来源于听外周系统本身的固有属性。     

自觉听力正常耳鸣患者纯音听力及畸变产物耳声发射临床分析

目的分析自觉听力正常耳鸣患者的纯音听力特征,并探讨自觉听力正常耳鸣患者畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)测定值与纯音听阈值之间的相关性及其意义。方法 2010—2011年在我科就诊的以耳鸣为第一主诉但无明显自觉听力障碍患者114例(190耳),对所有入组患者进行纯音测听及DPOAE检测。分析DPOAE测定值与纯音听阈值之间的相关性,并结合其发病的可能危险因素进行相关分析。结果自觉听力正常的耳鸣患者中,听力异常可达76.84%(146/190)。纯音测听表现为:高频下降型46.31%(88/190);低频下降型14.73%(28/190);正常23.15%(44/190);其它类型15.78%(30/190)。其危险因素主要为:噪声接触,疲劳和/或精神压力、其他基础疾病等。所有频率(f0)的DPOAE幅值与各频率纯音听阈间存在负相关,且有明显的频率对应关系。结论自觉听力正常的耳鸣患者存在一定程度的听力损失,尤其以高频听力下降为多见。DPOAE测定值与其纯音听阈之间呈明显的负相关关系,且DPOAE测试频率与纯音听阈频率间存在明显的对应关系,DPOAE检测作为一种客观指标,可以在一定程度上反映自觉听力正常耳鸣患者的听力损失程度,有一定的临床应用价值。     

自身对照瞬态诱发耳声发射在伪聋筛查中的意义

目的探讨自身对照瞬态诱发耳声发射(transient-evoked otoacoustic emissions，TEOAE)在伪聋筛查中的意义。方法以自身对侧耳和正常人耳(15例，30耳)作对照，应用TEOAE技术对43例外伤后述单侧听力损失者进行筛查，并以听性脑干反应(ABR)作为受检者听阀的客观指标。结果①TEOAE作为听力筛查手段，其敏感度达97．72％，准确度为95．92％；②TEOAE各频率引出率在伪聋组与自身对照组及正常对照组比较无显著差异。结论TEOAE具有快速、灵敏、客观的特点，可作为一项常规听力检查应用于临床伪聋筛查中。     

应用畸变产物耳声发射和扩展高频测听对顺铂耳毒性的临床研究

目的：应用0．5—16kHz畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)和扩展高频测听对顺铂耳毒性进行临床研究。方法:对24例应用顺铂进行初次化疗的妇科肿瘤病人于化疗前后分别进行0．5—16kHz DPOAE、常频纯音测听及扩展高频测听检查，比较DPOAE和常频纯音测听、扩展高频测听的结果。结果：顺铂化疗后扩展高频区纯音听阈升高，DPOAE在3kHz、4kHz处及扩展高频区下降明显。结论：常频DPOAE较常频纯音测听更敏感，和扩展高频测听检查一样均可用于顺铂耳毒性的监测。扩展高频DPOAE可能比常频DPOAE更敏感。DPOAE与纯音听闻可能并非一一对应关系。病人对顺铂的易感性可能随着年龄的增加逐渐减低。     

耳声发射对氨基甙类药物耳毒性监测的探讨

为了评估氨基式类药物治疗对耳声发射的影响，记录了由于严重全身感染而用高浓度丁腔卡那霉素治疗的患者的瞬态诱发耳声发射（TEOAE）进行测试。患者男4例，女5例，年龄18～65岁。急性淋巴细胞白血病1例，急性粒细胞白血病5例，慢性粒细胞白血病1例，何杰金氏病1例，Waldenstr6m’s病1例。丁胶卡那霉素用量6．2～32．sg，疗程9～33天。未用其它耳毒性药物，耳镜检查正常，无前庭疾患及听力损失。用标准阈值法作纳音测听，频率范围0．25～BkHZ。TEOAE测试用短声和4kHZ短纯音刺激，强度分别为85dBSPL和75dBSPI。，叠加256次。测试间…     

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.     

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。     

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.     

Lesion site in sudden deafness: study with electrocochleography and transiently evoked otoacoustic emission

We examined electrocochleogram (ECochG) and transiently evoked otoacoustic emission (TEOAE) on five cases of sudden sensorineural hearing loss which had no abnormalities detected on diagnostic imagings and showed complete recovery of hearing. At the initial examination, three cases showed a broadened wave 1 with prolonged latency in the auditory brainstem response (ABR) at 90 dB HL. The ECochG AP showed a broad waveform, low amplitude, and high threshold. CM threshold, although increased, was relatively well preserved compared with hearing threshold measured with conventional pure-tone audiometry. The thresholds in TEOAE examination were similar to those for CM and preserved better when compared with pure-tone audiometric thresholds. These findings suggest that the location of the disorder in these three cases involved not only the cochlea but also the retrocochlear auditory pathway. The other two cases showed normal ABR waveforms at 90 dB HL at the initial examinations. ECochG examination showed that a normal AP in one case and a smaller amplitude AP, an elevated threshold, and normal waveform of AP in the other ear. CM thresholds coincided with the conventional audiometry thresholds. These findings suggest that hearing loss in these two cases involved primarily the sensory hair cells.     

Transient evoked otoacustic emission in children with juvenile idiopatic arthritis

Juvenile idiopathic arthritis (JCA) is an inflammatory systemic disease of connective tissue which etiology is still unknown. Progressive arthritis is the basic symptom, with pain, oedema, stiffness and movement impediment are typical for. Chronic process of arthritis might be accompanied by rheumatoid nodes, pericarditis, myocarditis, changes in the lungs and kidney, which appear with various frequency and indicates on systemic form of disease. The incudo-malleolar and incudo-stapedial joints are synovial in type. It should be expected that these joints might be affected by rheumatoid changes similar to those observed in joints in other parts of the body. Copeman was the first who described transient conductive hearing loss in patients with exacerbated rheumatoid process--and he called it oto-arthritis. He stressed that it was the consequence of the rheumatoid lesions in joints of ear ossicules. In adult patients with JCA in 60% of cases the perceptive hearing-loss is observed possibly because of the chronic course of the disease and its farmacological treatment. The aim of the study was the assessment of the functional state of the peripheral part of hearing organ on the basis of TEOAE. This study was preceded by examination of hearing with pure tone audiometry, speech audiometry, high frequency audiometry and impedance audiometry. The analysis of results was done in correllation to form of JCA and its activity. The research was carried out on the group of 45 children suffering from JCA; 14 boys and 31 girls between 5-18 years of age. In all children from experimental group the examination was performed in the active phase of disease process. Mean duration of the disease was 33.5 month. In all children TEOAE was obtained no matter on the form of JCA. Children with systematicus form of JCA--more aggressive type than others--have the recordings of TEOAE with small amplitude and narrow range of frequency. Those results show that rheumatoid lesions in conductive mechanism of the middle ear are insufficient for the development of the conductive hearing loss. As a results of chronic pathological process destructions of hearing organ may lead to the cochlear lesions and this way to perceptive hearing loss.     

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。     

The effects of high-frequency hearing loss on low-frequency components of the click-evoked otoacoustic emission

Click-evoked otoacoustic emission (CEOAE) input/output (I/O) functions were measured in ears with normal hearing and in ears with sensorineural hearing loss above 2000 Hz. The low- to midfrequency CEOAEs obtained from the ears with high-frequency hearing loss were significantly reduced in level compared to the CEOAEs obtained from the ears with normal hearing even though there were no significant group differences in the 250-2000 Hz pure-tone thresholds. The findings are discussed within the context of two hypotheses that explain the low- to midfrequency reduction in transient-evoked otoacoustic emission (TEOAE) magnitude: (1) subclinical damage to the more apical regions of the cochlea not detected by behavioral audiometry, or (2) trauma to the basal region of the cochlea that affects the generation of low-frequency emissions. It is proposed that localized damage at basal cochlear sites affects the generation of low- to midfrequency CEOAE energy.     

听觉神经病

目的　探讨听觉神经病的临床特点、听力学及电生理特征。方法　总结了 17例听觉神经病患者的病史、纯音及语言听力、镫骨肌反射、听性脑干反应 (auditorybrainstemresponse ,ABR)、耳蜗电图、鼓岬电刺激试验、耳声发射及对侧声抑制试验的特点。结果　该病多在青春期后起病 ,女性较多发 ,表现为渐进性双耳对称性听力下降 ,纯音听力以低频损失为主 ,语言接受阈升高 ,分辨率下降 ,镫骨肌反射及ABR引不出或阈值明显升高与纯音听力不成比例 ,耳蜗微音器电位正常 ,听神经动作电位引不出 ,耳声发射波幅高、时程长且不为对侧声刺激所抑制。结论　听觉神经病的诊断应在除外各种已知原因的感音神经性聋后 ,根据其纯音听力与客观测听的不一致及电生理学上的耳蜗活动与中枢系统反应分离的特征作出 ,对该病的认识尚需进一步深入。     

听觉神经病

目的 探讨听觉神经病的临床特点、听力学及电生理特征。方法 总结了１７例听觉神经病患者的病史、纯音及语言听力、镫骨肌反射、听性脑干反应（ａｕｄｉｔｏｒｙ ｂｒａｉｎｓｔｅｍ ｒｅｓｐｏｎｓｅ，ＡＢＲ）、耳蜗电图、鼓岬电刺激试验、耳声发射及对侧声抑制试验的特点。结果 该病多在青春期后起病，女性较多发，表现为是性双耳对称性听力下降，纯音听力以低频损失为主，语言接受阈升高，分辨率下降，镫骨肌反射及ＡＢＲ引     

Correlations between audiogram and objective hearing tests in sensorineural hearing loss

Owing to its subjective nature, behavioral pure-tone audiometry often is an unreliable testing method in uncooperative subjects, and assessing the true hearing threshold becomes difficult. In such cases, objective tests are used for hearing-threshold determination (i.e., auditory brainstem evoked potentials [ABEP] and frequency-specific auditory evoked potentials: slow negative response at 10 msec [SN-10]). The purpose of this study was to evaluate the correlation between pure-tone audiogram shape and the predictive accuracy of SN-10 and ABEP in normal controls and in patients suffering from sensorineural hearing loss (SNHL). One-hundred-and-fifty subjects aged 15 to 70, some with normal hearing and the remainder with SNHL, were tested prospectively in a double-blind design. The battery of tests included pure-tone audiometry (air and bone conduction), speech reception threshold, ABEP, and SN-10. Patients with SNHL were divided into four categories according to audiogram shape (i.e., flat, ascending, descending, and all other shapes). The results showed that ABEP predicts behavioral thresholds at 3 kHz and 4 kHz in cases of high-frequency hearing loss. Also demonstrated was that ABEP threshold estimation at 3 kHz was not affected significantly by audiogram contour. A good correlation was observed between SN-10 and psychoacoustic thresholds at 1 kHz, the only exception being the group of subjects with ascending audiogram, in which SN-10 overestimated the hearing threshold.     

Beidohriger Zahlentest im St?rger?usch nach Sauer

Objective

For the determination of speech intelligibility in the expertise of hearing loss, the Freiburg speech test (number test and monosyllable test) is recommended in the Federal Republic of Germany. In the former German Democratic Republic, Sauer’s binaural number test with 70?dB background noise (“beidohriger Zahlentest”, BZT) was a standard element in expert opinions and was used in the calculation of bodily injury (“K?rperschaden”). In the current practice, a hearing test in noise is still lacking. The present study analyzes whether and to what degree the impairment (“Grad der Sch?digungsfolgen”, GdS) changes when also considering Sauer’s test.

Material and methods

In a collective of 78 patients with hearing loss (66 patients with high-frequency hearing loss and 12 patients with pancochlear hearing loss) and 22 normal hearing controls, the following audiometric measurements were conducted: pure tone audiometry, speech audiometry (Freiburg speech test), free field audiometry with and without noise, and Sauer’s test. Subsequently, the hearing loss for both sides was calculated taking into consideration the values obtained with and without Sauer’s test, and the respective GdS was determined.

Results

Patients with high-frequency hearing loss and pancochlear hearing loss had a trend for higher GdS (approximately 2 and 5%, respectively), compared to the established algorithm without the use of hearing tests in noise. However, neither the Mann–Whitney U-test nor the Bland–Altman analysis yielded relevant differences between the two methods to calculate the GdS.

Conclusion

The routine implementation of Sauer’s test in the expertise of hearing loss cannot be recommended, since no relevant change in the GdS can be expected. This is especially true for high-frequency hearing loss. In pancochlear hearing loss, use of Sauer’s test can be considered if problems concerning hearing in situations with background noise are present—at least until more advanced hearing tests optimized for use in noise have been integrated into the tables for GdS calculation.     

刺激强度对正常人瞬态耳声发射的影响

为确定听力正常人的瞬态耳声发射基本特征,了解不同刺激强度对瞬态耳声发射的平均振幅和频谱的影响,以作为与听力异常的人群进行对照的标准.利用地—88耳动态分析仪对听力正常的25耳进行测试,分别记录用70、76、82 dB SPL三种刺激声刺激时的瞬态耳声发射的平均振幅和频谱,三种刺激声强度下,瞬态耳声发射的平均振幅分别为5.97、9.22、12.76 dB SPL,增长率分别为54.4%、39.4O,频谱的频率分布于0.4～6kHz范围内,以4kHz以下为主,其峰值位于1025、1513Hz处,以 P_95为指标,在刺激声强度低于82 dB SPL时,瞬态耳声发射的频谱中各频率点的强度有不同程度的升高,由于听力正常人的频谱具有相对不连续性的高频下降趋势,与正常人纯音听阈并不完全对应,故不能单纯根据瞬态耳声发射的频谱对纯音听阈进行评估,而要综合考虑.