紫杉醇对豚鼠听阈的影响

目的：探讨紫杉醇对豚鼠听阈的影响。方法：将30只雌性豚鼠随机分为6组（1个对照组和5个实验组,每组5只）,实验组分别予以不同剂量紫杉醇腹腔内注射,检测用药前、后各组动物ABR阈值。结果：实验组听力水平用药后均显著减低,相关分析显示,总药量与听力损失程度之间无显著相关性。结论：紫杉醇可导致轻到中度听力损失。     

Self-reported participation restrictions in normal hearing individuals in thyroid ontogeny: Evidence of subclinical changes

Purpose

To verify evidence of subclinical alterations through self-reported participation restrictions in normal hearing individuals and congenital hypothyroidism patients.

分泌性中耳炎骨导听阈改变的临床观察

目的证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳炎,尤其是顽固的分泌性中耳炎提供依据.方法115例(164耳)分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0.5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数.分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组.结果在164耳中,出现骨导听阈提高的共94耳(57.3%).双侧组与单侧组骨导听力损失程度差异均无显著性(P>0.05);单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;不同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大.结论半数以上分泌性中耳炎可以导致感音神经性聋.在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势.     

Cochlear microphonics in sensorineural hearing loss: lesson from newborn hearing screening

The diagnostic dilemma surrounding the presence of cochlear microphonics (CM) coupled with significantly elevated auditory brainstem response (ABR) thresholds in babies failing the newborn hearing screening is highlighted. A case report is presented where initial electo-diagnostic assessment could not help in differentiating between Auditory Neuropathy/Auditory Dys-synchrony (AN/AD) and sensorineural hearing loss (SNHL). In line with the protocol and guidelines provided by the national Newborn Hearing Screening Programme in the UK (NHSP) AN/AD was suspected in a baby due to the presence of CM at 85 dBnHL along with click evoked ABR thresholds of 95 dBnHL in one ear and 100 dBnHL in the other ear. Significantly elevated thresholds for 0.5 and 1kHz tone pip ABR fulfilled the audiological diagnostic criteria for AN/AD. However, the possibility of a SNHL could not be ruled out as the 85 dBnHL stimuli presented through inserts for the CM would have been significantly enhanced in the ear canals of the young baby to exceed the threshold level of the ABR that was carried out using headphones. SNHL was eventually diagnosed through clinical and family history, physical examination and imaging that showed enlarged vestibular aqueducts. Presence of CM in the presence of very high click ABR thresholds only suggests a pattern of test results and in such cases measuring thresholds for 0.5 and 1 kHz tone pip ABR may not be adequate to differentiate between SNHL and other conditions associated with AN/AD. There is a need for reviewing the existing AN/AD protocol from NHSP in the UK and new research to establish parameters for CM to assist in the differential diagnosis. A holistic audiological and medical approach is essential to manage babies who fail the newborn hearing screening.     

新生儿耳聋多因素logistic回归分析

目的探讨新生儿耳聋的发病情况和听力筛查结果多因素分析。方法回顾性分析2002年6月～2004年12月我院出生的有条件进行TEOAE筛查的4666例新生儿并使用筛查登记表收集病例资料中的相关信息,对收集到的资料进行单因素与多因素logistic回归分析。结果新生儿TEOAE第一次筛查通过率80.5%,第二次筛查通过率91.5%,第三次筛查通过率53.3%。对3次筛查不通过的46人行ABR测试,其中14人双耳通过,16人双耳不通过,16人单耳不通过,新生儿耳聋患病率6.9‰(32/4666)。单因素分析发现多胎、外耳畸形、窒息病史、低体重、高胆红素血症、早产、阿氏评分<7分等因素与新生儿TEOAE筛查通过率相关。多因素logistic回归分析确定外耳畸形、窒息病史、低体重、高胆红素血症等为危险因素。结论外耳畸形、窒息病史、低体重、高胆红素血症等因素的是新生儿耳聋高危因素,应对新生儿围产期高危影响因素积极预防和治疗,减少耳聋发病率。     

Evaluation of the impact of hearing loss in adults: Validation of a quality of life questionnaire

ObjectivesThe impact of hearing loss and of auditory rehabilitation (hearing aid, cochlear implant) on quality of life is a crucial issue. Commonly used questionnaires to assess quality of life in these patients (Nijmegen, APHAB, GBI) are time-consuming, difficult for patients to fill out, and show poor sensitivity to small improvements or deterioration. The objective of the present study was to validate a dedicated quality of life scale for hearing-impaired adults with or without auditory rehabilitation.Material and methodsERSA (Évaluation du Retentissement de la Surdité chez l’Adulte: Evaluation of the Impact of Hearing Loss in Adults) is a self-administered questionnaire. It is divided into 4 domains, each comprising 5 questions graded from 1 to 10. The questions are simple, and formulated so patients will answer according to how they feel at the actual time of the session. Test-retest reliability was measured in 38 patients. Internal coherence and validity against the APHAB questionnaire as gold standard and in relation to hearing performance were measured in 122 patients at auditory assessment. Sensitivity to change in hearing was measured in 36 cochlear implant patients, before and 6 or 12 months after implantation.ResultsTest-retest reliability was very satisfactory (ρ = 0.88). Internal coherence was good for all questions. External validity, comparing ERSA to APHAB scores in the same non-implanted hearing-impaired patients, was good (ρ = 0.52). Additionally, ERSA scores correlated with hearing performance in adverse conditions (monosyllabic words: ρ = 0.22; sentences in noise: ρ = 0.19). In patients tested before and after cochlear implantation, improvement in hearing performance in silence and in noise correlated with an improvement in ERSA score (ρ = 0.37 to 0.59, depending on the test), but not to GBI score.ConclusionThe ERSA questionnaire is easy and quick to use, reliable, and sensitive to change in hearing performance after cochlear implantation.     

Simulation of a hearing loss at long versus short test tones

At long test tones, a hearing loss (abrupt drop at 3 kHz) is simulated in good approximation by presenting a continuous masking noise of appropriate spectral distribution to a normal ear. When shortening the test tones, the increase in threshold is systematically smaller for the impaired ear than for the ear with simulated hearing loss, showing normal temporal integration. Comparing threshold curves at long versus short test tones, for the hearing loss simulation only an upward shift is found. For the impaired ear, however, the magnitude of the hearing loss apparently increases with increasing test tone duration; moreover, the spectral characteristic of the hearing loss is quite different at long versus short test tones.     

听力损失与突发性聋预后的关系

目的：探索听力损失对突发性聋预后的影响。方法:对146例（167耳）突聋患者的临床资料进行回顾性分析，应用SAS 统计软件对纯音听阈情况与预后的关系进行统计学处理。结果:单因素分析显示，初诊时听力损失曲线为全聋型，纯音高频听阈（4?000?Hz及8?000?Hz）损失较重，高频听阈（4?000?Hz+8?000?Hz）大于低频(250?Hz+500?Hz)听阈的患者预后不佳；多因素分析显示，8?000?Hz的听阈水平与预后关系最为密切，其次为4?000?Hz听阈及听力损失类型。结论：从单、多因素分析的结果可以看出，对突聋应采用多因素逐步分析的方法进行研究，以使预后和疗效评估更具准确性和客观性；高频听力损失程度是突发性聋预后的一个可靠评估因素。     

The latency of auditory nerve-brainstem responses in sensorineural hearing loss

Summary The use of auditory nerve-brainstem responses in differential diagnosis of hearing loss is based on several properties of these responses including response latency. The auditory nerve response latency has been shown to be prolonged in conductive hearing loss. The latency of the brainstem responses is also often prolonged in retrocochlear hearing loss. However, the effect of sensorineural hearing losses on auditory nerve response latency is not clear. Several authors report that response latency is prolonged in sensorineural loss, whereas others claim that it is unchanged.To study this, auditory nerve-brainstem responses to 75 dB HL clicks were recorded in normal-hearing subjects and in those with various degrees of high-frequency sensorineural hearing loss. In the more extreme hearing losses, the auditory nerve response could not be seen in the response trace, so the latency of the earlobe positive wave from the region of the inferior colliculus was considered as mirroring auditory nerve response latency, since the time interval between these two waves has been shown to be constant.The average latency of the more severe hearing loss group (more than 40 dB hearing loss at 4 kHz) was found to be only 0.35 ms longer than that of the normal-hearing group. This value is smaller than that seen in most conductive and retrocochlear hearing losses.This result warrants continued use of prolonged auditory nerve response latency (greater than 0.35 ms) as an indicator of conductive hearing loss. Possible explanations for smaller latency prolongation than expected of the auditory nerve response in sensorineural hearing loss are discussed based on the properties of single auditory nerve fibers.Part of a PhD thesis to be submitted by R. Kinarti to the Senate of the Tel-Aviv Universtity     

The Yoruba version of LittlEARS Auditory Questionnaire: Evaluation of auditory development in children with normal hearing

The goal of this study was to translate the LittlEARS Auditory Questionnaire into Yoruba language for use with Yoruba-speaking parents and to evaluate the psychometric properties of the Yoruba version of questionnaire. Translation of the LittlEARS Auditory Questionnaire into Yoruba language was done using a back-translation method. The study participants included 423 parents of normal hearing children aged 6–24 months. Psychometric analyses (scale analysis and item analysis) of the translated questionnaire was done. The scale characteristics in the dataset are: Internal consistency: Cronbach's alpha?=?0.907; reliability; Split-half?=?0.701; predictive accuracy; Guttman's lambda?=?0.583; correlation between total score and children's age?=?0.783. The regression analysis showed that 75.3% of the variance in the total scores can be explained by age. The Yoruba version of the LittlEARS Auditory Questionnaire is a dependable and valid tool as evidenced by the results of psychometric analyses. The tool is useful for assessing auditory development in children between 6 and 24 months of age.     

Influence of myelography on the developmental curve of auditory brainstem responses and hearing loss

Auditory threshold and auditory brainstem response studies were conducted in 50 patients before and after myelography. Analysis of amplitudes and latencies of auditory brainstem measurements demonstrated significant disorders of function of the cochlea and auditory pathway. The Jewett I wave showed a prolongation of latency from 1.92 to 1.98 ms using an average of all repetition rates. The Jewett III wave showed prolongation from 4.01 to 4.14 ms and the Jewett V wave prolongation from 6.01 to 6.16 ms. At the same time average amplitudes for Jewett III and V decreased. In most of the patients these disorders of function were found to be subclinical. However, 12 patients had changes ranging from a subjectively slight hearing loss to an audiometrically defined acute hearing loss. The reasons for these disorders could not be clarified. An open cochlear aqueduct through which perilymph can enter the subarachnoid space, leading to secondary endolymphatic hydrops, was suggested as the cause for the losses found. Changes in brainstem audiometry were also explained by changes in osmolality of inner ear fluids, leading to the development of an endolymphatic hydrops.     

Auditory neuropathy/dyssynchrony as a cause of failed neonatal hearing screening

The prevalence of auditory neuropathy/dyssynchrony (AN/AD) is not exactly known. We retrospectively analysed the prevalence of this condition among 135 infants who failed a neonatal screening. Hearing screening was performed by automated auditory brainstem responses (AABR). Unilateral presence of click-evoked oto-acoustic emissions with absent auditory brainstem responses was found in 4 infants. Magnetic resonance imaging of the posterior fossa showed an aplasia/hypoplasia of the ipsilateral cochlear nerve in these 4 cases. The prevalence of AN/AD was 19% in infants with confirmed hearing loss. Our findings underscore the role of AABR in neonatal hearing screening.     

全植入式助听器治疗中重度耳聋

目的 探讨全植入式助听器(Carina)治疗中重度和重度耳聋的安全性和效果.方法 分析随访12个月以上的三例接受全植入式助听器手术的中重度至重度耳聋患者术后康复的效果.比较术前术后纯音测听和言语测听的差异,观察植入体日常使用情况及与传统助听器效果的比较.结果 手术顺利,无并发症.术后手术侧无助听听阈(听力级,下同)平均升高8.3 dB,四个频率(0.5、1、2、4 kHz)纯音听阈功能性增益平均为35.4 dB,言语听阈平均降低22.5 dB,患者主观满意度评分明显高于传统助听器.结论 全植入式助听器是治疗中重度和重度耳聋患者的有效方法 ,其远期疗效需要进一步观察.     

Self-reported hearing difficulty and hearing Okamoto/Nakanishi/Tatara impairment in Japanese people living in a community

Nine hundred and eighteen people aged 40 years and over were examined to assess the relationship between self-reported hearing difficulty and hearing impairment at 1 kHz and 4 kHz during annual health check-ups. After adjustment for potential confounding factors of selfreported hearing difficulty such as age, sex, noise exposure, ear disease and tinnitus, the odds ratios for self-reported hearing difficulty at 1 kHz compared with a hearing threshold of 30 dB were 1.74, 3.37 and 4.97 for hearing thresholds of 40 dB, 50 dB, and over 50 dB, respectively ( p-value for trend = 0.003). At 4 kHz, the respective odds ratios for self-reported hearing difficulty were 1.53, 2.59 and 1.83 ( p-value for trend = 0.012). These results suggest that self-reported hearing difficulty is closely associated with the severity of hearing impairment at 1 kHz and 4 kHz in a community-residing population and that people with hearing impairment at 1 kHz would be more sensitive to their hearing difficulty than those with hearing impairment at 4 kHz.

Sumario Novecientas dieciocho personas con edades de 40 an?os o ma´s fueron evaluadas para establecer la relacio´n entre la dificultad auditiva auto-reportada y un trastorno auditivo real en 1 kHz y 4 kHz, durante sus evaluaciones anuales de salud. Luego de hacer ajustes para posibles factores de confusio´n en el auto-reporte de la dificultad para escuchar, como la edad, el sexo, la exposicio´n al ruido, la enfermedad otolo´gica o el acu´feno, se establecio´ que la razo´n de posibilidades (odds ratio) para la dificultad auditiva en 1 kHz comparada con un umbral auditivo de 30 dB, fue de 1.74, 3.37 y 4.97 para umbrales auditivos de 40 dB, 50 dB y por encima de 50 dB, respectivamente (valor p de la tendencia igual a 0.003). A 4 kHz, las razones de posibilidad respectivas para la dificultad auditiva auto-reportada fueron 1.53, 2.59 y 1.83 (valor p de la tendencia igual a 0.012). Estos resultados sugieren que la dificultad auditiva auto-reportada esta´ estrechamente asociada con la severidad del trastorno auditivo en 1 kHz y en 4 kHz, en una poblacio´n de residentes de una comunidad, y que las personas con trastornos auditivos en 1 kHz seri´an ma´s sensibles a su dificultad auditiva que aquellos con alteraciones en 4 kHz.     

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。     

The frequency of auditory neuropathy detected by universal newborn hearing screening program

OBJECTIVE: Auditory neuropathy/auditory dyssynchrony (AN/AD) has become a well-accepted clinical entity. The combined use of oto-acoustic emissions (OAEs) and auditory brainstem response (ABR) testing in the universal newborn hearing screening (UNHS) has led to the easy recognition of this disorder. Although, we are now able to diagnose AN/AD reliably, little is known about its epidemiology, etiology, and especially the frequency of its occurrence. The primary goal of this study was to determine the frequency of AN/AD in the Western Anatolian region of Turkey. The secondary goal was to compare the detection rate of AN/AD before and after the implementation of the UNHS in the audiology department of Dokuz Eylul University Hospital. METHOD: Between 2005 and 2007, among the 23,786 newborns who were screened by automated click evoked oto-acoustic emissions (a-CEOAE) and automated auditory brainstem responses (a-ABRs), 2236 were referred to our department. All necessary audiological tests were performed for all the referred newborns. Among them, babies with deficient or abnormal ABR in combination with normal OAEs were considered as having AN/AD. These babies were evaluated with additional diagnostic audiological tests. Furthermore, comparison of the incidence of children diagnosed with AN/AD before and after the implementation of UNHS in our audiology department was also performed. RESULTS: Among the referred newborns, 65 had abnormal or deficient ABR test results. Ten of these 65 newborn babies (mean diagnostic age: 5.7 months) with hearing impairment showed electrophysiological test results that were consistent with AN/AD. The frequency of AN/AD in these 65 children with hearing loss was 15.38%. Moreover, the frequency of AN/AD within UNHS was found to be 0.044%. Seven of the 10 babies with AN/AD had hyperbilirubinemia as a risk factor, which is a high rate to be emphasized. On the other hand, the retrospective investigation of children diagnosed with AN/AD in the same audiology department between 1999 and 2005 (i.e. before the implementation of UNHS) revealed only 7 children, with an average diagnostic age of 34 months. CONCLUSION: After implementing the UNHS, the incidence of AN/AD in the audiology department increased from 1.16 to 4.13. Furthermore, the age of diagnosis of AN/AD decreased from 34 months to 5.7 months. This study shows that AN/AD, when screened, is a comparatively common disorder in the population of hearing-impaired infants. While newborn hearing screening provides early detection of babies with hearing loss, it also helps to differentiate AN/AD cases when the screening is performed with both a-ABR and automated oto-acoustic emission (a-OAE) tests. Thus, the routine combined use of a-ABR and a-OAE tests in UNHS programs, especially for the high-risk infants, can provide better detection of newborns with AN/AD. Furthermore, hyperbilirubinemia is merely an association and maybe etiologically linked.     

X连锁隐性非综合征型低频神经性听力减退的大家系报道

目的　探讨和分析低频神经性听力减退的遗传学因素。方法　从先证者出发 ,调查一个家系发病情况 ;应用Cyrillic 2 1软件绘制系谱图 ;通过系谱图分析遗传学特征 ,通过临床检查分析疾病的表型特征。结果　调查现存家系成员 10 1人 ,获得 4 3人的临床听力学资料。 4 3人中有 6人被诊断为低频神经性听力减退 ,均为男性 ,年龄 18～ 2 6岁 ;患者仅以听力减退为单一症状 ;临床表型特征为轻、中、重度及极重度听力损失 ,听性脑干反应均未引出 ,畸变产物耳声发射部分引出 ;患者发病年龄在 10～ 16岁之间。结论　本研究发现了一个 5代相传的遗传性聋大家系 ,遗传特征是以男性发病为主的X连锁隐性遗传。该家系的发现提示低频神经性听力减退可以是由遗传因素造成的。     

听力筛查未通过婴幼儿的客观听力评估

目的 分析听力筛查未通过婴幼儿的客观听力学特征,为早期干预提供科学依据。方法 对听力筛查未通过患儿286例进行听力诊断性检查。采用听性脑干反应(ABR)、40Hz听觉相关电位(40Hz-AERP)、畸变产物耳声发射(DPOAE)、声导抗进行评估。结果 286例婴幼儿中双耳听力正常95例(33.22%);听力损失者191例(66.78％),其中单耳听力损失70例(24.47％),双耳听力损失121(42.31％);传导性听力损失59例(20.63%),感音神经性听力损失132例(46.15%);轻度听力损失91例(31.82%),中度43例(15.03%),重度20例(6.99％),极重度37例(12.94％)。191例听力异常者只有16例复查,占8.38％,复查结果：听力正常2例,双耳听力损失10例,单耳听力损失4例。结论 部分听力筛查未通过婴幼儿的听力可随着听觉神经系统发育的完善恢复正常;同时中耳病变也是部分婴幼儿听力筛查未通过的影响因素;客观听力学组合测试可有效评估听力筛查未通过患儿的听力特征,为听力损失的早期诊断、早期干预提供科学依据;听力异常患儿的复查率低和失访率高仍是目前亟需解决的问题。     

Backward and forward masking in listeners with severe sensorineural hearing loss

Using synthetic stimuli, backward and forward masking by a first-formant stimulus were measured for two tasks: (1) discrimination of a second-formant transition and (2) pure-tone detection. 16 listeners with moderate to severe sensorineural hearing impairment were studied. Many of the listeners showed backward and forward discrimination masking, sometimes extending as far as 200 ms before or after the first-formant interval. There were large individual differences in degree and temporal extent of masking. The masking contribution of sensitivity shifts, as indicated by pure-tone detection levels, appeared to be limited to a range of only 50 ms before or after the first-formant masker.     

新生儿听力损失高危因素与听力筛查研究进展

目的随着听力筛查工作不断的推广以及听力筛查技术不断的革新，新生儿听力损失的高危因素也逐渐明确，本文就以下听力损失高危因素进行相关阐述：①低胎龄出生儿；②新生儿感染性疾病；③新生儿缺氧性疾病；④高胆红素血症；⑤耳毒性药物的影响；⑥遗传因素；⑦环境因素，并对相关高危因素损害听力机制进行阐明；探讨了目前各种听力筛查方法在听力筛查工作中的优势、不足之处以及改进方法。进而得出结论：针对有高危因素的新生儿，应严格按照听力筛查工作流程对其进行严格的筛查，同时联合耳聋基因筛查，长期对其听力进行检测和随访。