小于胎龄儿听性脑干反应的研究

对２６例小于胎龄儿听性脑干反应的阈值，各波潜伏期及波间期等项参数进行测试。并以１０５例正常新生儿和４４例窒息新生儿作对照。结果显示：小于胎龄儿ＡＢＲ的阈值提高者较正常新生儿组高，且波，ⅠⅢ潜伏期延长明显，波Ⅴ潜伏期亦延长。     

正常新生豚鼠听性脑干反应的时域和频域特性

本文对正常新生豚鼠听性脑干反应（ＡＢＲ）时域和频域特性进行了研究。结果表明：正常新生豚鼠ＡＢＲ的反应阈为２２±４ｄＢｎＨＬ（０ｄＢｎＨＬ＝１７ｄＢＳＰＬ），约比正常成年豚鼠ＡＢＲ的反应阈高１０ｄＢｎＨＬ；正常新生豚鼠波Ⅲ潜伏期、Ⅰ─Ⅲ波间期均明显长于正常成年豚鼠（Ｐ＜０．０１），而波Ⅰ潜伏期无显著性差异（Ｐ＞０．０５）；潜伏期─强度函数曲线的斜率大于正常成年豚鼠；功率谱表明，与正常成年豚鼠相比较，０～２００Ｈｚ、５１０～９００Ｈｚ频段谱能量有显著性差异（Ｐ＜０．０５、Ｐ＜０．０１）。     

高刺激率ABR测试对椎基底动脉短暂缺血发作性眩晕的研究

本研究采用本室所建立的高刺激率（５１次／秒）ＡＢＲ测试论断椎基底动脉短暂缺血发作性眩晕（ＶＢＴＩＶ）的方法，分别测试３１例ＶＢＴＩＶ病人及３１例年龄及性别匹配的正常中老年人，以探讨年龄及性别对测试结果是否有影响。结果显示：ＶＢＴＩＶ组高刺激率ＡＢＲ测试各波潜伏期及波间期比其性别及年龄匹配的正常中老年组明显延长（Ｐ＜０．０１），异常率明显增高（Ｐ＜０．０１）；正常中老年组的高刺激率ＡＢＲ异常率与本室     

椎基底动脉短暂缺血性眩晕发病时间与高刺激率听性脑干反应潜伏期的相关性研究

本研究采用高刺激率（５１次／ｓ）ＡＢＲ测试６７例不同发病时间（１～７２天）的椎基底动脉短暂缺血性眩晕（ＶＢＴＩＶ）病人，以ＡＢＲ５１－１１次／ｓ各波潜伏期与波间期差作为分析参数来探讨ＶＢＴＩＶ发病后不同时间（天）与高刺激率ＡＢＲ波潜伏期（ｍｓ）的相关性。结果显示：ＶＢＴＩＶ发病后不同时间与高刺激率ＡＢＲ５１－１１次／ｓⅤ波、Ⅰ—Ⅴ间期、Ⅲ—Ⅴ间期呈显著性负相关（相关系数分别为—０．５７、—０．５１、—０．４５，相关系数的ｔ检验，Ｐ＜０．０１），其测试时间越早，脑缺血程度越重，波潜伏期延长越明显，证实高刺激率ＡＢＲ测试可用于ＶＢＴＩＶ的动态监测和提示预后。     

甲状腺功能低下对ABR和DPOAE的影响

为了探讨甲状腺功能低下（甲低）时听觉功能损害的部位及可能的致病机理，用含甲硫咪唑（０．１５ｇ／Ｌ）的饮用水喂养大鼠制造甲低模型，对甲低前后的大鼠进行听性脑干反应（ＡＢＲ）和畸变产物耳声发射（ＤＰＯＡＥ）的检测。结果发现：甲低后ＡＢＲ阈值明显升高；而ＡＢＲ各波潜伏期及波间期无明显变化。ＤＰＯＡＥ“听力图”显示甲低后ＤＰＯＡＥ振幅明显下降；ＤＰＯＡＥ阈值明显上升。提示耳蜗是甲低时听觉功能损害的主要部位，文中对可能的发病机理进行了讨论。     

高刺激率听性脑干反应诊断椎基底动脉短暂缺血性眩晕──最佳测试时间研究

本研究对６７例椎基底动脉短暂缺血性眩晕（ＶＢＴＩＶ）患者按不同发病时间分组（１～７、８～１５、＞１５天）行高刺激率（５１次／秒）听性脑干反应（ＡＢＲ）测试。结果显示：ＶＢＴＩＶ发病后１～７天组的高刺激率ＡＢＲ波潜伏期及波间期比８～１５天组及＞１５天组明显延长，差异有高度显著性（Ｐ＜０．０１）；且异常率亦明显增高，１～７、８～１５、＞１５天组异常率分别为８８．４６％、７６．１９％及２５．００％，差异有高度显著性（Ｐ＜０．０１）．本研究表明：ＶＢＴＩＶ末次发作后１～７天为高刺激率ＡＢＲ测试的最佳时间，在此期间测试有效高的异常率，可为ＶＢＴＩＶ的早期诊断提供更多的客观依据。     

脑干听觉诱发电位对高危新生儿听力检查的意义：附116耳…

对５８例（１１６耳）高胆红素血症及缺血缺氧脑病新生儿进行脑干听觉诱发电位（ＢＡＥＰ）检查。结果显示，两组高危新生儿的听觉系统均有损害。反应阈较正常儿增高，以周围性损害为主，合并脑室扩张之高危患儿损害最重，与一般高危儿相比，差异非常显著（Ｐ〈０．０５）；患儿血中胆红素高，听力损失就较重，Ｐ〈０．０１，１年后对ＢＡＥＰ异常的２０耳进行追踪复查，反应阈全部恢复正常。提示对缺血缺氧脑病和高胆红素血症的新生     

内耳血流对ABR波I与畸变产物耳声发射的影响

为研究在耳蜗血流（ＣＢＦ）障碍时ＡＢＲ波Ｉ振幅,潜伏期及畸变产物耳声发射（ＤＰＯＡＥ）的振幅和时相的变化,进行了试验研究。用５只２～４ｋｇ重的雄性幼兔,经后颅窝手术．在内听动脉（ＩＡＡ）放入探极,测量术前术中和术后ＡＢＲ波Ｉ振幅潜伏期及ＤＰＯＡＥ的振...     

缺氧缺血性脑病新生儿瞬态诱发耳声发射测试

目的了解应用瞬态诱发性耳声发射（ｔｒａｎｓｉｅｎｔｅｖｏｋｅｄｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｉｏｎｓ,ＴＥＯＡＥ）对正常新生儿高危新生儿行听力筛查的可行性。方法采用ＳＦ－Ⅰ型耳声发射接受器与ＣｏｍｐａｃｔＡｕｄｉｔｏｒｙＴＩＰ－３００电反应测听仪联合记录,对２０名正常新生儿及３６名缺氧缺血性脑病（ｈｙｐｏｘｉａ－ｉｓｃｈｅｍｉｃｅｎｃｅｐｈａｌｏｐａｔｈｙ,ＨＩＥ）新生儿进行ＴＥＯＡＥ和ＡＢＲ测试。结果ＨＩＥ患儿ＴＥＯＡＥ多表现为阈值升高或波缺失,ＴＥＡＯＥ能否出现与ＡＢＲ之Ｖ波阈值密切相关,重度ＨＩＥ的ＴＥＯＡＥ出波率较轻度者明显减低。结论ＴＥＯＡＥ可早期发现缺氧等高危因素所致听力损伤,因此有可能成为早期监测新生儿及高危儿听力的一种方法。     

脑干肿瘤切除术中的听性脑干反应分析

目的　探索脑干肿瘤手术中听性脑干反应（ａｕｄｉｔｏｒｙ ｂｒａｉｎｓｔｅｍ ｒｅｓｐｏｎｓｅ,ＡＢＲ） 变化规律及其监护作用。方法　对５ 例脑干肿瘤手术患者,从术前、术中至术后进行了ＡＢＲ的动态观察,对术中监护记录的４００ 余份ＡＢＲ的潜伏期、振幅和波形分化的资料进行分析和统计学处理。结果　术中牵拉、分离、挤压均可引起ＡＢＲⅠ、Ⅲ和Ⅴ波潜伏期延长,振幅降低,波形分化差等改变,其中３ 例动态变化指标好,呈可逆性变化,均康复出院。另２ 例术后潜伏期持续延长、波形分化差,动态变化指标差,呈不可逆性变化,术后１ 例死亡,１ 例未苏醒。析因分析显示：手术操作对听性脑干诱发电位的影响有显著性意义（ 方差分析,Ｐ＜ ０．０１） 。结论　在脑干肿瘤手术中,ＡＢＲ能敏感地反映脑干功能,潜伏期、振幅、波形及其动态变化均是术中可靠的观察指标。     

353例NICU患儿自动听性脑干反应结果分析

目的探讨新生儿重症监护病房(neonatal intensive care unit,NICU)听力筛查模式及容易导致听力损失的高危因素。方法运用自动听性脑干反应(automatic auditory brainstemresponse,AABR)对353例(706耳)重症监护病房的新生儿进行初步听力筛查,随机抽样109例(218耳)正常新生儿为对照组,对比分析不同高危因素对筛查结果的影响。结果筛查NICU患儿353例(706耳),初筛未通过184例(281耳),初筛阳性率39.8%(281/706);筛查正常新生儿组109例(218耳),初筛未通过23例(27耳),初筛阳性率为12.4%(27/218),两组初筛阳性率差异有显著统计学意义(P=0.000),NICU的新生儿听力筛查初筛阳性率远高于正常新生儿。NICU新生儿不同疾病的初筛阳性率分别为:新生儿窒息46.4%,新生儿肺炎45.9%,高胆红素血症38.8%,早产儿38.1%,足月小样儿35.0%,其他34.0%。结论应用AABR技术进行听力筛查是可行的。在NICU中普及听力筛查,并对这些患儿随访、复筛,及时发现其听力损失,是提高新生儿听力损失早期诊断率的重要手段。     

早产儿畸变产物耳声发射的特性分析

目的 :研究早产儿畸变产物耳声发射 (DPOAE)的幅值、信噪比、本底噪声等基本特性。方法 :应用DP2 0 0 0型耳声发射仪对 31例早产儿 (5 9耳 )和 19例足月新生儿 (35耳 )在出生后 3d～ 1周内行DPOAE检测。结果 :早产儿DPOAE反应幅值曲线有一峰点 (f2 =15 87Hz)和一谷点 (f2 =4 0 0 0Hz) ,早产儿各频率反应幅值均低于足月新生儿相应频率 (P <0 .0 5 ) ;早产儿DPOAE信噪比SNR于f2 =4 0 0 0Hz处最高 ,f2 =10 0 0Hz处最低 ,4 0 0 0Hz、3175Hz及 15 87Hz、12 6 0Hz、10 0 0Hz处SNR均低于足月儿相应水平 (P <0 .0 5 ) ;早产儿DPOAE本底噪声在低频段 (f2 =12 6 0Hz、10 0 0Hz)显著高于其他频率 ,4 0 0 0Hz处噪声水平最低 (P <0 .0 1) ,3175Hz、2 5 2 0Hz及 2 0 0 0Hz处早产儿组噪声水平均低于足月儿组 (P <0 .0 5 )。结论 :早产儿DPOAE反应幅值、信噪比及本底噪声与足月儿相比差异均有统计学意义。该差异与耳蜗外毛细胞发育过程相关 ,还可能与中耳及外耳的发育有关     

Hearing screening in newborn infants. Comparative studies and cost analysis with different instruments

BACKGROUND: The necessity of screening examinations in newborns today cannot be denied. Up to now, it has only been achieved in a few countries to introduce a general hearing screening for newborns. METHODS: We examined 100 newborns (200 ears) at their third day of life. All ears were evaluated with the TEOAE-screening-device ECHOSCREEN. In addition, we carried out BERA screening examinations with the ALGO PORTABLE or with the EVOFLASH on 100 of these 200 ears. As a reference method, we utilized TEOAE-examinations with the ILO-88 for all ears. RESULTS: 4.5% of the 200 ears examined with the ECHOSCREEN were conspicuous due to accumulation of earwax problems. With the ALGO-system, none of the ears was conspicuous. Among the 100 ears examined with the EVOFLASH we found negative results with seven ears (4 children). These findings will be discussed in detail. Furthermore, we analyzed the costs for one-step- and two-step-screenings. Costs for a one-step-screening of both ears would be DM 14.27 with Echoscreen, DM 44.69 with ALGO, DM 32.19 with Evoflash for one patient including material and personnel costs. Costs for a two-step-screening would be DM 16.28 with Echoscreen and ALGO, DM 15.72 with Echoscreen and Evoflash, calculated per child on the basis of 812,173 newborn children in the year 1997 in Germany. CONCLUSION: On the basis of all these results, we recommend a two-step-screening with TEOAE and BERA-devices.     

Growth of Evoked Otoacoustic Emissions during the First Days Postpartum: A Preliminary Report

Evoked otoacoustic emissions (EOAEs) were recorded twice in 20 ears of 15 newborns. The recordings were performed in a room of the well baby ward, using the ILO88 in its default setting, i.e. with click stimulation. On the first test occasion, the infants were between 3 and 51 h of age, and EOAEs were identified in 10 ears. On the second test occasion, while the infants were at least 1 day older (range 42–107 h), EOAEs were present in all ears. The second EOAE was stronger, so the EOAE appeared to grow in the first days postpartum. This might be due to middle ear clearance of amniotic fluid, shortly after birth. The results of the EOAEs of the second examination were compared with 10 EOAEs in adult ears. The response levels of the newborns were significantly higher than in the adults. The (cross-)correlation peak value of the two tests' waveforms is over 0.75, however sometimes only after filtering around the most pronounced emission frequencies. The study proves that newborns failing the EOAE screen in the first 24 h after birth can pass if retested 1 day later, simply because of growth of EOAE strength.     

Growth of evoked otoacoustic emissions during the first days postpartum. A preliminary report.

Evoked otoacoustic emissions (EOAEs) were recorded twice in 20 ears of 15 newborns. The recordings were performed in a room of the well baby ward, using the ILO88 in its default setting, i.e. with click stimulation. On the first test occasion, the infants were between 3 and 51 h of age, and EOAEs were identified in 10 ears. On the second test occasion, while the infants were at least 1 day older (range 42-107 h), EOAEs were present in all ears. The second EOAE was stronger, so the EOAE appeared to grow in the first days postpartum. This might be due to middle ear clearance of amniotic fluid, shortly after birth. The results of the EOAEs of the second examination were compared with 10 EOAEs in adult ears. The response levels of the newborns were significantly higher than in the adults. The (cross)-correlation peak value of the two tests' waveforms is over 0.75, however sometimes only after filtering around the most pronounced emission frequencies. The study proves that newborns failing the EOAE screen in the first 24 h after birth can pass if retested 1 day later, simply because of growth of EOAE strength.     

唇腭裂新生儿听力检测

目的 分析唇腭裂新生儿瞬态声诱发耳声发射、鼓室图以及听性脑干反应(ABR)的特点,以探讨相关听力学检查对这类新生儿的临床应用价值.方法 采用瞬态声诱发耳声发射(transiently evoked otoacoustic emission,TEOAE)及鼓室图测试,对23例（46耳）唇腭裂新生儿进行新生儿听力筛查,初筛...     

NICU患儿听力筛查结果分析

目的分析新生儿重症监护病房（NICU）患儿听力筛查结果。方法对2008年1月～2009年1月间3130例NICU患儿用TEOAE初筛、复筛,对复筛未通过患儿行ABR诊断性检查。结果未通过TEOAE初、复筛的513例（709耳）患儿中,以早产儿和肺部疾患阳性率最高,其中102例（156耳）患儿经诊断性ABR检查,确诊为听力损失130耳（83．33％,130／156）,其中轻度听力损失38耳,中度55耳,中重度15耳,重度16耳,极重度6耳,肺部疾患、高胆红素血症和早产儿阳性率最高。结论NICU患儿听力损失发生率高,肺部疾病、高胆红素血症和早产儿是引起听力损失最主要的高危因素。     

不同分娩方式新生儿自动听性脑干反应听力初筛的最佳时间探讨

目的 探讨应用自动听性脑干反应(automatic auditory brainstem response,AABR)对不同分娩方式新生儿进行听力初筛的最佳时间.方法 应用Chirp声诱发的AABR(Chirp-AABR)对2016年8月1日至2016年10月31日出生的550例新生儿(顺产组300例,剖宫产组250例)进行听力初筛,顺产组各有100例分别在出生后<24 h、24~48 h、48~72 h三个时间段进行听力初筛,剖宫产组分别有50、100和100例在上述三个时间段进行听力初筛;未通过者42天采用畸变产物耳声发射和AABR进行复筛,复筛未通过者3个月内进行听力学诊断.结果 顺产组新生儿出生后24~48 h内初筛通过率(93.00%)显著高于<24 h者(83.00%)(x2=4.735,P=0.03<0.05),而与48~72 h初筛者通过率(95.00%)比较差异无统计学意义(x2=0.355,P=0.55>0.05);剖宫产组新生儿出生后24~48 h初筛通过率(83.00%)显著高于<24 h者(68.00%)(x2=4.371,P=0.04<0.05),而显著低于48~72 h的通过率(94.00%)(x2=5.944,P=0.02<0.05).结论 顺产新生儿应用AABR听力初筛可在出生后24~48 h进行,而剖宫产新生儿AABR听力初筛时间应选择出生后48 h.     

Titan听力测试平台在新生儿听力筛查及听力诊断中的应用

目的应用Titan对初筛未通过的听力高危新生儿进行复筛,评价Titan在新生儿听力筛查及听力诊断中的作用。方法对223例（446耳）初筛未通过的听力高危新生儿在出生后第40天左右（前后不超过3 d）应用Titan分别行自动听性脑干反应（automated auditory brainstem response, AABR）、耳声发射（otoacoustic emission,OAE）、声导抗检测;AABR、OAE系统自动判断是否通过,声导抗检测采用1 KHz探测音,鼓室压低于-50 dapa、声顺＜0.3 ml认定为异常;统计数据,并分析其结果。结果AABR复筛通过436耳,复筛通过率为97.76%（436/446）,OAE复筛通过348耳,通过率为78.03%（348/446）,二者差异有显著性（χ2=81.59,P<0.05）;声导抗检测异常者共81耳,异常率为18.16%（81/446）,其中在AABR复筛未通过10耳中存在声导抗检测异常者共1耳,异常率为10%（1/10）,OAE复筛未通过98耳中存在声导抗检测异常者共57耳,异常率为58.16%（57/98）,二者差异有显著性（χ2=6.64,P<0.05）。结论Titan是一款集AABR、OAE、声导抗检测于一体的新型听力检测仪器,应用于新生儿听力筛查可有效降低假阳性率,并能及早评价患儿的中耳功能,鼓室负压、咽鼓管功能不良是新生儿听力筛查假阳性率高的一个重要因素。     

Ossicular Reconstruction with Sheehy PORP

Objective To report tympanoplasty cases completed with Sheehy Partial Ossicular Replacement Prostheses (PORP). Methods Seventy eight (83 ears) of 89 cases who received Sheehy PORP for ossicular chain reconstructionwere reviewed. These cases were followed for more than 6 months (mean: 21.3 months). The pre-and post-operative average air conduction thresholds and Air-Bone Gap (ABG) at 0.5, 1 and 2 kHz were compared. Results All 83 ears showed uneventful healing at 1 month postoperatively. PORPs in 2 ears without cartilage reinforcement were found dislocated at 3 months. Preoperative hearing thresholds were from 35.75 to 68.5 dB HL (mean: 59.13±15.23 dB HL). Postoperative mean hearing threshold improved to 32.23±13.21 dB HL (P < 0.01). Mean air-bone gap (ABG) improved from 36.95±12.19 dB preoperatively to 21.71±12.05 dB after surgery (P < 0.01). In 68 ears (81.9%), postoperative ABGs were either ≤ 20 dB or improved by 15 dB or more compared to before surgery (defined as satisfactory). Conclusion PORP as a ossicular reconstruction material appears to provide satisfactory results. Attention should be paid to avoid of postoperative dislocation. Long-term outcomes remain to be assessed.