256例腭裂患者临床听力学研究

目的通过对腭裂患者行畸变产物耳声发射(Distortion Product Oto-acoustic Emission,DPOAE)、声导抗测试(Acoustic Immittance Measurement,AIM)、听性脑干反应(Auditory Brainstem Response,ABR)研究,探讨这类患者临床听力学特点,以及性别、年龄、手术等因素对患者听力的影响。方法回顾分析256例腭裂患者(术前243例、术后13例)临床听力学数据。将术前2岁内患者174例按性别分为男、女组,所有术前者243例按年龄分为≤2岁组(A组)、>2岁≤6岁组(B组)、>6岁组(C组),术后≥5年者13例编为D组。DPOAE检查选择1818、2730、3616、5434Hz 4个频点有≥3个频点通过即为该耳通过。AIM以A型图为正常,其它类型均为异常。ABR阈值检查以能重复引出V波的最小刺激强度为ABR阈值,ABR阈值>35 dB nHL即为该耳异常。结果腭裂患者不同性别间DPOAE、AIM、ABR阈值无明显差异(P>0.05),A组DPOAE、AIM、ABR阈值较C组差异显著(P<0.05),A、B组DPOAE、ABR检查差异显著(P<0.05),AIM无明显差异(P>0.05),B、C组DPOAE差异显著(P<0.05),AIM、ABR阈值无明显差异(P>0.05)。C、D组年龄相仿,AIM、ABR检查示差异显著(P<0.05),A、B、C组DPOAE检查较ABR异常率高(P<0.05),差异具有统计学意义。结论腭裂患者不同性别间听力无明显差异,随着年龄的增长,腭裂患者听力呈自愈趋势,腭裂修复术能在一定程度上促进腭裂患者听力的恢复。DPOAE可以作为唇腭裂婴幼者听力检查的手段,但仍需进一步结合AIM及ABR检查,以明确听力损害水平及类型。     

唇腭裂术后患儿的听力学特征分析

目的：探讨唇腭裂术后患儿的听力学特征。方法：对62例唇腭裂术后患儿进行DPOAE、ABR和声导抗检查,分析其听力学检查结果。结果：以ABR阈值为诊断标准,诊断为听力异常者共51耳,以轻度和中度异常为主;63耳鼓室导抗图异常,表现为不同程度的中耳功能障碍;26耳DPOAE检查未通过。结论：唇腭裂术后患儿听力异常的比例高。3种客观听力学检查方法在唇腭裂术后的患儿检查中具有高度一致性。     

唇腭裂患儿的听觉脑干反应检测

目的：研究唇腭裂患儿听力损失的特点。方法：对68例（136耳）腭裂、70例（140耳）唇腭裂患儿进行ABR测试,均按年龄分为3组（〈6个月,6～12个月,13～24个月）,并与80例（160耳）同样分为3组的正常对照组儿童进行比较。结果：91．9％腭裂及89．3％唇腭裂患儿存在听力障碍,且大部分为中重度听力障碍,其各波潜伏期及反应阈值均较正常儿童明显延长和增加,12个月以下腭裂、唇腭裂患儿其Ⅰ～Ⅴ波波间期与正常儿童比较差异无统计学意义,13～24个月腭裂、唇腭裂患儿其Ⅰ～Ⅴ波波间期与正常儿童比较差异有统计学意义。腭裂与唇腭裂患儿比较差异无统计学意义,两组患儿听觉阈值均随年龄的增长而降低。腭裂患儿Ⅴ波引出率及唇腭裂患儿Ⅰ、Ⅲ、Ⅴ波引出率均随年龄增大而提高。结论：大部分唇腭裂患儿存在听力障碍,因此要早期发现,及时治疗和干预,但由于婴幼儿的中枢神经系统还处于一个不断发育成熟的阶段,所以需要动态的听力客观评估。     

听性脑干反应联合听觉多频稳态诱发反应在儿童听力筛查和诊断中的应用

目的利用听觉稳态诱发反应（auditory steady state evoked response,ASSER）联合听性脑干反应（auditory brainstem response,ABR）测试对婴幼儿进行听力检测,评价两种方法对婴幼儿听力损伤早期发现及损失程度评估的作用。方法对7 6例（1 5 2耳）畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）复筛未通过的婴幼儿及门诊就诊疑有听力损失的婴幼儿进行ASSER和ABR测试,对结果进行比较。结果7 6例（1 5 2耳）婴幼儿ABR反应阈与ASSER高频反应阈比较,差异无统计学意义（P＆lt;0.0 5）。ABR在最大输出无反应而ASSER测试中各频率能引出反应。结论ASSER联合ABR检查可以更全面的评估婴幼儿的真实听力情况,对ABR无反应的患儿还应进行ASSER测试,有助于全面评估其听力损失程度。     

不同病因致婴幼儿听力障碍的听力学分析

目的 探讨不同病因致婴幼儿听力障碍的特点及其鉴别诊断。方法 30例（60耳）正常听力婴幼儿为对照组，年龄6～24个月，行ABR、ASSR、视觉强化测听（vision reinforcement audiometry，VRA）和声导抗检查。20例（36耳）异常听力患儿（年龄6～24个月）根据其所患疾病分为3个组：Ⅰ组7例为围产期缺氧缺血，Ⅱ组7例为出生时核黄胆，Ⅲ组6例为出生时高胆红素血症，对各组患儿分别行畸变产物耳声发射（distortion-product otoacouslic emission，DPOAE）、耳蜗微音电位（CM）、ABR、ASSR、声导抗和VRA检查，并采用F检验进行数据统计学处理。结果①Ⅰ组所有病例DPOAE和CM存在、鼓室导抗图为A型，ABR异常，其中一部份患儿的Ⅲ-Ⅴ波间期延长，另外1例（2耳）ABR的波Ⅳ与波Ⅴ消失，各频率（0．25、0．5、1、2．4kHz）ASSR平均反应阈明显高于VRA平均阈值，其平均相关系数为r=0．41～0．65。②Ⅱ、Ⅲ组一部份患儿（7耳）CM存在，而DPOAE消失（Ⅱ组6耳、Ⅲ组1耳），ABR的波Ⅴ潜伏期和Ⅰ-Ⅲ波间期延长，其中Ⅱ组的ASSR反应阈较接近VRA阈值，其平均相关系数为r=0．92～0．97，而Ⅲ组两者平均阈值的相关系数为r=0．69～0．86。③3组各频率平均ASSR／VRA阈值差值的差异均有统计学意义。结论 不同病因致婴幼儿听力障碍的听力学检测结果不同，应综合分析，这对于采用何种干预方法以及预测干预效果都有非常重要的意义。     

学龄前腭裂患儿听力学特征分析

目的　对正常儿和腭裂患儿的听力学检查结果进行分析比对,以探讨腭裂患儿的听力学特点以及年龄因素的影响。方法　对60例（120耳）腭裂患儿和76例（152耳）正常儿进行听性脑干反应（auditory brainstem response,ABR）和声导抗检查。结果　≤1岁的腭裂患儿比1～2岁和2～6岁患儿的ABR阈值增加（前者S=5.927,后者S =6.020,P <0.05）。同一年龄段的患儿与正常儿相比,ABR阈值增加（t =8.588、5.436、7.003,P <0.001）,I、III、V波潜伏期明显延长（<1岁组t =9.388、4.727、2.398,1～2岁组t =5.386、6.218、5.255,2～7岁组t =7.038、7.282、7.308,P 均<0.05）。腭裂患儿的高频听力损失程度为轻、中度,无重度和极重度听力障碍。3个年龄段腭裂患儿阈值异常率、鼓室图异常率、镫骨肌声反射异常率和分泌性中耳炎患病率差异均无统计学意义（P >0.05）,而听力损失程度构成比差异有统计学意义（χ 2=14.20,P＜0.01）。结论　在学龄前婴幼儿腭裂群体中,当鼓室导抗图表现为B型或C型曲线,镫骨肌声反射未引出,同时ABR听阈增加,I、III、V波潜伏期延长,而各波间期无明显延长时,要高度警惕发生分泌性中耳炎,故应在早期行腭裂整复术同时进行鼓室置管术。     

新生儿黄疸患儿听力筛查分析

目的探讨新生儿黄疸患儿耳蜗功能及听觉传导通路受损情况及其影响因素。方法应用畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)检查对195例(390耳)正常新生儿及452例(904耳)新生儿黄疸患儿进行听力筛查。结果正常组与新生儿黄疸组比较,听力筛查的通过率、DPOAE信号水平(Level)、信噪比(SNR)均有显著性差异;病理性黄疸和核黄疸组ABR阈值高于正常组(P<0.05);ABR阈值增高的48耳中,有32耳DPOAE正常。结论新生儿黄疸患儿耳蜗损害程度与血中胆红素浓度增高呈正相关性;血中胆红素浓度增高除损害耳蜗外,还可能损伤听觉传导通路;对有高危因素的新生儿,单一的听力检查不能全面反应听功能状况,最好结合两种以上检查方法,防止漏诊。     

应用畸变产物耳声发射进行新生儿听力筛查388例报告

目的 早期发现新生儿听力损失,以便进行诊断和干预.方法应用GS170自动耳声发射听力筛查仪,应用畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）对2006年6月1日～2007年3月31日在广州市天河区中医院出生的388例活产婴儿进行听力初筛,未通过者42天内进行复筛,复筛未通过者行听性脑干反应（ABR）检测进一步确诊.结果 388例新生儿中有387例例接受听力初筛,初筛率99.74%,357例通过初筛,初筛通过率92.25%;复筛19例,复筛率63.33%,复筛通过率100%.结论 DPOAE听力筛查未通过的新生儿应于出生后42天内行ABR检查,进一步确诊.     

听力筛查未通过婴幼儿的听力学特点及原因

目的探讨听力筛查未通过婴幼儿的听力学特点及原因。方法应用听性脑干反应（auditory brainstem response,ABR）、40Hz听觉相关电位（40 Hz auditory event related potential,40 Hz AERP）、畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）、鼓室声导抗及声反射方法,对126例听力筛查未通过的婴幼儿进行听力学诊断性检查,确认听力损失的程度及性质,并对听力损失婴幼儿的原因进行分析。结果126例（252耳）婴幼儿中,感音神经性聋61例（48.41%）,传导性聋48例（38.09%）,ABR反应阈值正常范围17例（13.50%）。此组患儿既往病史有母孕期感染病史21例、先兆流产9例、高龄6例、延期妊娠7例、伴全身系统疾病10例;新生儿期黄疸13例、缺氧窒息18例、早产儿及低体重8例、伴其他新生儿疾病8例、有听力损失家族史5例,颅面畸形3例,中枢神经系统疾病6例,第2胎9例。结论听力筛查未通过的婴幼儿听力评估后有不同的表现,本组感音神经性聋较传导性聋所占比例高,多数听力损失患儿伴有高危因素。     

听力筛查未通过婴幼儿客观听力评估与特征分析

目的分析听力筛查未通过婴幼儿的干扰因素及临床听力学特征。方法选取2004年8月—2006年1月广州市及周边地区妇幼保健院系统出生并行耳声发射（otoacoustic emissions，OAE）新生儿听力筛查，因二次听力筛查未通过转诊本院的患儿，月龄2～6个月，共166例（315耳）。详细询问并登记病史，按其首次听力评估时的月龄分为2～3个月组和4～6个月组，行听性脑干反应（auditory brainstem response，ABR）、畸变产物耳声发射（distortion product otoacoustic emissions，DPOAE）、鼓室声导抗和镫骨肌反射等客观听力测试。首次听力评估异常者，建议1～3个月后（以不超过6个月龄为限）进行第二次听力评估，比较前后两次ABR、DPOAE、鼓室声导抗曲线和静态声顺值的转归情况，并确定诊断。结果①166例听力筛查未通过婴幼儿中，有新生儿高胆红素血症史者比例最高（34例，20．5％）；其次为有新生儿窒息史（10例，6．0％）。②4～6个月组鼓室声导抗B型曲线的比例（13例，17耳，17．9％）高于2～3个月组（11例，14耳，8．0％），X。=26．22，P〈0．01。③4～6个月组ABR正常的比例（24例，29耳，37．2％）明显高于2～3个月组（34例，45耳，23．4％），x。=5．27，P〈0．05；在有两次评估记录的受试者中（24例，45耳），第二次ABR测试结果较第一次测试结果好转的比例为56．0％（11例，14耳）。（砚～6个月组DPOAE正常的比例（19例，31耳，39．7％）略低于2～3个月组（50例，81耳，42．2％），X。=0．14，P〉0．05；在有两次评估记录的受试者中（24例，45耳），第二次DPOAE测试结果较第一次好转的比例为32．0％（6例，8耳）。⑤166例听力筛查未通过受检者中，有4例（4耳）诊断为听神经病，均为单耳发病。结论在新生儿听力筛查未通过婴幼儿中，存在中耳因素对听力筛查结果和评估的影响，同时低月龄婴幼儿听觉神经系统存在发育完善的过程。对筛查和评估结果应作充分、恰当的解释，避免加重患儿家长的心理负担。     

obstructive sleep apnea-hypopnea syndrome and hearing in children

Objective To explore the relationship between hypoxemia and hearing in children with obstructive sleep apnea-hypopnea syndrome. Methods Auditory brainstem responses (ABRs) were recorded in 68 ears and distortion product otoacoustic emissions (DPOAEs) in 60 ears in children with OSAHS and type "A" tympanograms, and in 30 ears in normal children. Results ABR latencies of waves Ⅰ, Ⅲ and Ⅴ, and Ⅰ-Ⅲ, Ⅲ-Ⅴ and Ⅰ-Ⅴ intervals were not statistically different between OSAHS and normal children. Wave Ⅰlatency was delayed in children with OSAHS compared to normal children3 (P<0.05). DPOAE amplitudes in children with mild OSAHS were lower than normal children at 8 kHz (P<0.05). DPOAEs were lower at 6 kHz and 8 kHz in children with moderate/severe OSAHS than normal children (P<0.05). Conclusion Cochlear function was affected when AHI was at or greater than lO/hour. ABR and DPOAE can be used to detect early changes in auditory function in children with OSAHS.     

Factors contributing to hearing impairment in patients with cleft lip/palate in Malaysia: A prospective study of 346 ears

ObjectiveTo determine the factors contributing towards hearing impairment in patients with cleft lip/palate.MethodA prospective analysis was conducted on 173 patients (346 ears) with cleft lip and palate (CL/P) who presented to the combined cleft clinic at University Malaya Medical Centre (UMMC) over 12 months. The patients' hearing status was determined using otoacoustic emission (OAE), pure tone audiometry (PTA) and auditory brainstem response (ABR). These results were analysed against several parameters, which included age, gender, race, types of cleft pathology, impact and timing of repair surgery.ResultsThe patients' age ranged from 1–26 years old. They comprised 30% with unilateral cleft lip and palate (UCLP), 28% with bilateral cleft lip and palate (BCLP), 28% with isolated cleft palate (ICP) and 14% with isolated cleft lip (ICL). Majority of the patients (68.2%) had normal otoscopic findings. Out of the 346 ears, 241 ears (70%) ears had passed the hearing tests. There was no significant relationship between patients' gender and ethnicity with their hearing status. The types of cleft pathology significantly influenced the outcome of PTA and ABR screening results (p < 0.001). There was no significant difference between the repaired and unrepaired cleft groups and the outcome of hearing tests. However, hearing improvement occurred when palatal repair was performed at the age of <1year old (OR = 2.37, CI 1.2 = 4.6, p = 0.01).ConclusionMajority of the cleft patients had normal hearing (70%). Hearing threshold varied significantly between the different types of cleft pathology. Surgery conferred no significant impact on the hearing outcome unless surgery was performed at the age of <1 year old.     

Outcome of newborn hearing screening by ABR compared with four different DPOAE pass criteria

The purpose of this study is to compare the effectiveness and utility of distortion product otoacoustic emission (DPOAE) and auditory brain stem response (ABR) testing as screening methodologies suitable for universal application at a large birthing hospital. Five hundred sixty-nine neonates (1184 ears) without risk indicators for hearing loss underwent DPOAE and ABR screening before hospital discharge at birth. All ears (100%) passed the ABR screening. DPOAE results were categorized on the basis of the number of frequencies at which emissions were obtained as well as presence versus absence of a replicated response at each test frequency. Pass and refer rates varied widely, on the basis of whether the presence of DPOAE response at 2000 Hz or replication were required. With the most stringent criteria, only 64.44% of ears passed, whereas with the least stringent criteria 88.94% passed. Given that 100% of ears passed according to the gold standard of the ABR screening, these results indicate false-positive rates ranging from 11% to 35% by DPOAE screening. This discrepancy in pass and refer rates when various criteria are applied indicates the need for standardization and further comparison of appropriate pass criteria for newborn hearing screening programs.     

不同月龄婴儿声反射与畸变产物耳声发射测试结果分析

目的探讨不同月龄婴儿226 Hz和1000 Hz探测音的中耳声反射测试与畸变产物耳声发射（DPOAE）联合筛查的意义。方法测试对象为来泸州医学院附属医院进行听力筛查或复查的188例（350耳）3天～12月龄的婴儿,分为3天～1月龄组（125耳）,2～3月龄组（89耳）,4～6月龄组（76耳）,7～12月龄组（60耳）,分别进行226、1000Hz探测音声导抗,畸变产物耳声发射测试,对226、1000Hz探测音中耳声反射引出率和DPOAE的通过率进行比较分析。结果3天～1月龄组226、1000Hz探测音声反射引出率和DPOAE的通过率分别为81％、69％、73％;2～3月龄组分别为91％、72％、74％;4～6月龄组分别为90％、83％、79％;7～12月龄组分别为43％、66％、60％。226Hz声反射引出率与DPOAE通过率差异有统计学意义（P〈0．01）,1000Hz声反射引出率与DPOAE通过率差异无统计学意义（P〉0．05）,并且DPOAE筛查结果与1000Hz探测音的声反射结果较一致。结论1000Hz探测音声导抗测试对婴儿中耳功能的诊断价值比226Hz探测音的敏感性更高,与DPOAE协同用于婴儿听力筛查具有良好的临床价值。     

比较单一的DPOAE和DPOAE/AABR联合技术进行的目标新生儿听力筛查方法研究

目的通过单一的畸变产物耳声发射（DPOAE）和DPOAE／自动听性脑干反应（AABR）联合技术进行目标新生儿的听力筛查，以研究目标新生儿听力筛查的敏感性。方法记录出生3～24天的200名新生儿（400耳）的单一畸变产物耳声发射（DPOAE）和DPOAE／AABR联合技术测试的结果。筛查对象来自复旦大学附属儿科医院和上海儿童医学中心新生儿重症监护室（NICU）的有高危听力损害的新生儿。结果在开始的听力筛查中，共有29名新生儿（14．5％）在单一的DPOAE中未通过，而9名（4．5％）在联合运用DPOAE和AABR检查中未通过。在随访的诊断评估中，包括耳科检查、声阻抗、诊断性的听性脑干反应（DABR），6名新生儿11耳（3％）在出生后2个月时最终被诊断为真正的感音神经性听力损失。运用DPOAE和AABR联合测试，使高危儿童听力筛查的敏感性高达98．5％，并能够大大减少假阳性率。在频率分析中发现在通过AABR（短声刺激）测试的23耳中，高频的DPOAE通过率（％）比较高（2562Hz为93％，3187HZ为88％）。没有通过AABR测试的15耳，低频（500、1000和1593Hz）的DPOAE通过率（％）比高频（2562．3187和4031Hz）略高。结论DPOAE和AABR联合测试技术可以广泛运用于新生儿听力筛查，敏感性较高，可以减少假阳性并提供频率特异性。     

Similarities and differences in distortion-product otoacoustic emissions among four FDA-approved devices

Similarities and differences in distortion-product otoacoustic emissions (DPOAEs) among four Food and Drug Administration (FDA) approved devices were assessed quantitatively. DPOAEs were recorded from 42 adult subjects (84 ears) ranging in age from 19 to 40 years. All subjects had hearing thresholds of 20 dB HL or better for the test frequencies from 0.25 to 8.0 kHz and normal acoustic immittance findings. DPOAEs were collected in a quiet non-sound-treated room. DPOAE measurement parameters included an f2/f1 ratio of approximately 1.2, with f1 at 65 dB SPL (L1) and f2 at 55 dB SPL (L2). There were no significant differences in the mean emissions levels among the four devices. This investigation showed that validity criteria, pass criteria, and strategies for DPOAE measurements interact to produce varying pass and refer results. However, when DPOAEs are obtained with consistent validity criteria, pass criteria, and strategies for measurement, the results are remarkably consistent.     

CD1 hearing-impaired mice. I: Distortion product otoacoustic emission levels, cochlear function and morphology

The levels of distortion product otoacoustic emissions (DPOAEs) were measured in a strain of hearing-impaired mutant mice (CD1) at various stages of outer hair cell impairment and compared to those of a control inbred strain (CBA/J). Parallel measurements of cochlear potentials and auditory brainstem evoked responses (ABRs) were performed and surface preparations of organs of Corti were observed using phalloidin staining of filamentous actin. Comparison of DPOAEs (elicited by stimulus levels of 60 and 70 dB SPL) with standard functional tests allowed the categorization of CD1 ears into two groups on the basis of the presence or absence of DPOAE, which corresponded to mean ABR thresholds greater or less than 40 dB nHL respectively. When adopting ABR threshold as the gold standard, this procedure yielded rates of false-positives and -negatives ranging from 5 to 16%. However, individual predictions of electrophysiological function from DPOAE levels were not accurate, owing to their large variance, and attempts to optimize stimulus levels did not reduce this variance. In contrast, the profiles of DPOAE level vs. f₂ exhibited large correlations with ABR threshold profiles as a function of f₂. It was also noteworthy that the mean levels of DPOAEs in CD1 mice recorded in frequency intervals with normal ABR thresholds were significantly smaller than those of CBA/J mice. Although hearing loss was revealed early both by DPOAEs and by other functional tests, surface preparations often remained normal until about 3–4 months of age.