畸变产物耳声发射在伪聋和夸大性聋检测中的应用

目的：探讨畸变产物耳声发射（DPOAE）对伪聋和夸大性聋的鉴别诊断作用。方法：采用ILO 96耳动态分析仪对外伤后诉听力下降,而又不配合纯音听阈（PTT）检测的患者进行DPOAE检测与分析。结果：经PTT检测的129例（150耳）外伤性听力下降患者中,有102例（121耳）,作DPOAE检测结果显示伪聋占66．12％（80／121）,夸大性聋占33．88％（41／121）。经ABR检测反应阈值,证实DPOAE检测结果客观、可靠。结论：DPOAE作为外伤后听力损失鉴别诊断的常规检测方法,可对伪聋和夸大性聋作出客观、可靠的诊断和鉴别诊断。     

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。     

外伤后听觉损害的评估

用综合听力测试方法对外伤后听阈测试困难的４００例５３１耳进行了听力损害的鉴别。真实纯音听阈（ＰＴＡ）检出率达９５．２９％。发现有听力损害者占８２．１１％，其中与外伤有关者占６８．８１％。具有非器质性聋因素者占７７．５９％，其中夸大性聋占（受检耳）５７．２５％，伪聋占１６．２０％，功能性聋占４．１４％。对真实ＰＴＡ检出的必要性、可能性、方法及对非器质性聋的处理原则进行了讨论。     

外伤后听觉损害的评估

用综合听力测度方法对外伤后听阈测试困难的４００例５３１耳进行了听力损害的鉴别。真实纯音听阈（ＰＴＡ）检出率达９５．２９％。发现有听力损害者占８２．１１％。其中与外伤有关者占６８．８１％。具有非器质性聋因素者占７７．５９％，其中夸大性聋占（受检耳）５７．２５％，伪聋占１６．２０％，功能性聋占４．１４％。对真实ＰＴＡ检出的必要性、可能性、方法及对非器质性聋的处理原则进行了讨论。     

畸变产物耳声发射测试对噪声性聋诊断的敏感度和特异度

目的 探讨畸变产物耳声发射测试对噪声性聋的诊断价值。方法 对115名军人（204耳）进行DPOAE幅值测试,采用两个等强度L1＝L2＝70dB SPL的纯音信号f1、f2＝1．2。测试1、2、4kHz和6kHz DPOAE幅值,根据DPOAE幅值是否大于或小于标准值,判断听力正常与否。并同纯音听阈进行对照。结果 1、2、4和6kHz各频率的敏感度分别是70％、67％、85％和73％;特异度分别是71％、66％、84％和75％。结论 DPOAE幅值测试用于诊断噪声性聋,缺乏足够的敏感性和特异性,单一的DPOAE幅值测试,不能诊断噪声性聋。     

伪聋52例的临床分析

目的通过准确的听力评估,鉴别听力损害与伪聋。方法运用纯音听阈测试、声导抗、畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)和40Hz相关电位(40Hz—AERP)为一组测试组合,以客观测试的结果来印证主观测试的准确性,对患者进行心理暗示,以取得真实的纯音听阈。结果 303例外伤后导致听力下降者中有伪聋者52例(72耳),占同期外伤性聋的58%,其中男性40例,女性12例。结论通过测试组合的方式,并经心理暗示方法可明确伪聋的诊断。     

无相关畸形的遗传性感觉神经性聋

遗传性聋种类繁多,目前估计已达140种。由于遗传性聋大部分是隐性遗传,某些类型常表现为外显不全或延迟显性,且听力学损害无特异性,故在临床上涉及到的问题比较复杂,诊断也较难,特别是无相关畸形者,虽然是最简单的类型,但常不为耳科医生所认识。要从原因众多的感觉神经性聋中确诊出遗传性聋实非易事。本文就无相关畸形的遗传性感觉神经性聋的有关问题,特别是诊断和咨询方面的问题     

耳外伤患者的听力学表现（附32例37耳分析）

耳外伤后主诉听力下降的患者中，有不少夸张性聋或伪聋。为了解患耳的真实听力，作者采用主客观测听及观察临床表现的综合方法，对32例37耳作出了较正确的诊断，并对纯音测听、响度优势试验、MCIL测定及ABR检查等进行了讨论。     

响度优势测试在伪聋鉴别中的临床价值

目的评价响度优势测试(Stenger测试)在伪聋鉴别中的可靠性及应用价值。方法对74例外伤后自述有听觉损害的患者进行组合测试，包括纯音测听、Stenger测试、言语测听、声导抗、耳声发射、ABR等，根据综合分析结果来判断Stenger测试结果与其它主客观检查结果是否一致。结果74例患者中，Stenger测试阴性者37例，阳性者35例，2例不确定，无法判断是否伪聋。在37例阴性结果的病例中，36例结果与组合测试结果一致；在35例Stenger测试为阳性结果的病例中，31例与组合测试结果一致。结论Stenger测试是一种鉴别伪聋的简便易行而且比较可靠的方法。但是因为各种检查方法各有其优缺点，最好能根据具体情况进行组合测试。     

免疫介导的内耳病临床评价与治疗

免疫介导的内耳病（immunemediatedInnereardisease，IED）首先由McCabe（197）描述，为少数可逆性感音神经性聋的病因之一。其特点为发展迅速的进行性感音神经性聋，发病可超过几周或数月。表现为两侧不对称性聋，伴有耳鸣、眩晕、平衡障碍、共济失调及约30％病人有全身性免疫佳疾病。大剂量激素或其它免疫抑制剂治疗听力有明显改善为临床支持性诊断。实验室检查包括非特异性的抗核抗体（ANA）、血沉、类风湿因子、补体溶血、C3、C4及荧光密螺旋体抗原（FTA）；特异性的淋巴细胞移动抑制试验，淋巴细胞增殖或转化试验；采用间接免疫…     

Pseudohypacusis in a military population.

Pseudohypacusis, or non-organic hearing loss, was investigated as a possible marker for poor adaptation within the military environment. Eighteen active duty military patients who demonstrated pseudohypacusis were identified retrospectively from among all patients who underwent audiological evaluation at Naval Hospital, San Diego, during 1988. A control group of 33 patients with normal hearing was also randomly selected from the same population. Age, rank and military status one to two years later were compared, showing a significant difference between the groups in the rates of premature separation from the military. The results suggest that pseudohypacusis in a new recruit is a strong indicator that the subject may be separated prematurely from active duty in the military; this implies that it may be cost-effective for these patients to be separated from duty as soon as the diagnosis is made. Other trends in the data are discussed, and the literature is reviewed. The problem of pseudohypacusis as a method of increasing Veterans Association benefits is discussed. The signs of pseudohypacusis are important for all clinicians involved in audiological testing in order to make a correct diagnosis, avoid costly medical workup and refer affected patients for psychiatric evaluation when indicated.     

Pseudohypacusis: the most frequent etiology of sudden hearing loss in children

Sudden hearing loss is a rare pathology in children. Several factors may be responsible for it although the exact etiology remains frequently undiagnosed. Among them, pseudohypacusis has been reported. However, the extent to which this pathology contributes to sudden hearing loss in children is unknown. This study evaluates the incidence of pseudohypacusis in children presented with sudden hearing loss. The medical records of 48 children presented to our department because of sudden hearing loss from 2002 to 2007 were reviewed. Diagnostic process included both subjective and objective audiological tests while organic hearing losses were further subjected to proper evaluation and treatment. 26 cases (54%) of pseudohypacusis and 22 cases (46%) of organic sudden hearing loss were diagnosed. In the pseudohypacustic group, girls outnumbered boys (16:10) and their mean age was 10.5 years. Pseudohypacusis represents the most frequent etiology of sudden hearing loss in children. Its detection is relatively simple using conventional audiological tests though in some cases even experienced clinicians may come to incorrect diagnosis.     

Detection of pseudohypacusis: a prospective, randomized study of the use of otoacoustic emissions

OBJECTIVES: This study was designed to evaluate the effectiveness of transient otoacoustic emissions in an audiological protocol used in the evaluation of patients suspicious of pseudohypacusis. DESIGN: This was a prospective study of 72 adult patients suspicious of pseudohypacusis on the grounds of case history and inconsistent audiometric results. The subjects were randomly assigned to a treatment group or control group. The treatment group consisted of 42 patients who underwent a four-stage protocol that included (1) standard speech and pure-tone audiometry, (2) transiently evoked otoacoustic emissions (TEOAEs) and tympanometry, (3) repeat modified pure-tone audiometry, and (4) auditory brain stem response (ABR) audiometry. The control group consisted of 30 patients, who underwent an identical protocol except that Stage 2 (TEOAEs and tympanometry) was omitted. The main outcome measure was the mean exaggeration level defined as the difference in mean pure tone average (PTA) between the initial and the repeat session (mean PTAinitial minus mean PTArepeat). RESULTS: The mean PTA (average threshold at 1, 2, 3, and 4 kHz) on repeat audiometry was significantly better than the mean PTA obtained on the initial evaluation for each group. However, the mean exaggeration level was significantly greater for the treatment group (35.2 dB HL) than for the control group (11.0 dB HL). In addition, there was no significant difference between the mean PTArepeat (32.7 dB HL) and the mean click-evoked ABR threshold (31.6 dB nHL) for the treatment group whereas the mean PTArepeat (52.9 dB HL) was significantly poorer than the click evoked ABR threshold (29.2 dB nHL) for the control group. CONCLUSIONS: The inclusion of TEOAEs and tympanometry in an audiological protocol used in the evaluation of patients suspicious of pseudohypacusis resulted in a significantly greater threshold improvement on repeat modified pure-tone audiometry when compared to the improvement observed for a control group in which these tests were not performed.     

The management of pseudohypacusis in school-age children

Pseudohypacusis is a condition in which there is an apparent hearing loss in the absence of clinical or audiological evidence; indeed, audiological assessment for inconsistencies is the mainstay of diagnosis. It is easier to diagnose in children than in adults, due to a child's inability to produce consistently similar results on repeat tests. We have reviewed 15 children with pseudohypacusis, who had an average loss in the right ear of 57 dB, and of 59 dB in the left ear when tested by pure tone audiometry. Eight children were diagnosed by clinical impression and inconsistent pure tone audiograms but in order to confirm the diagnosis in the other seven children further testing with a speech audiogram was necessary and proved sufficient to establish the diagnosis in all cases. The hearing of all 15 children resolved spontaneously at between 2 and 70 months, when treated by careful monitoring and supportive therapy, and none of the children needed psychiatric referral.     

Diagnostic tools in pseudohypacusis in children

Pseudohypacusis is the term used for a non-organic or functional hearing loss. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to reproduce consistently erroneous results on repeated testing. Nevertheless, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. In a previous study from our department, we highlighted the usefulness of speech audiometry in establishing the diagnosis. However, with the advent of otoacoustic emissions testing, we have changed the emphasis of our testing protocol. Using otoacoustic emissions, the diagnosis of pseudohypacusis can be established quickly and easily.     

Audiological findings in 125 cases of acoustic neuromas.

The audiological findings in 125 patients with surgically confirmed acoustic neuromas are presented. Following the classification by Pulec et al. (1971) we found 20 medium-size and 105 large tumours; small tumours were not represented. A clear connection between the degree of hearing loss and tumour size was noted, while there was no correlation between duration of history and tumour size. An attempted evaluation of the different audiological tests (ABLB and Metz recruitment test, speech discrimination scores, tone decay, reflex decay, and Békésy tracings) that were applied to the patients, has been made. Attention is called to some audiological findings which, to our knowledge, have not been described previously. No patient in the entire material had normal hearing; 73 had anacusis, and 52 hearing losses of varying degree. In the presence of a normal contralateral ear, the evaluation of audiological tests at PTA thresholds poorer than 80 dB is rather questionable. Attention was therefore concentrated on 32 patients with a hearing loss of 80 dB or less. The pathophysiological basis for the typical hearing loss in patients with retrocochlear disease is a reduction in the number of active fibers in the acoustic nerve and it was to be expected that abnormal findings would be present especially in those tests that exert the greatest demand on the total transmission capacity of the nerve, in other words with the application of intense and/or prolonged sounds. The Metz test is just such a procedure and it is not surprising that it shows the highest degree of validity between all the tests. No single test suffices to distinguish cochlear from retrocochlear disease and it is necessary to use a battery of tests. Any unexpected variability in the outcome of ordinary routine test results has gradually become one main indication to pursue the diagnosis with more elaborate procedures, ant it has been a great help always to apply the Metz test as a part of our routine clinical examination.     

Importance of vestibulography in the acoustic neurinoma test battery

Vestibular, audiological and X-ray findings on 25 surgically confirmed neurinoma cases were reviewed to determine the diagnostic sensitivity of each in the neurinoma test battery. A comprehensive, retrocochlear audiological and vestibular work-up was run. X-ray procedures included posterior fossa myelograms in all but one instance, with all of the patients complaining of some auditory difficulties; progressive hearing loss and tinnitus were the most common complaints with tinnitus as the earliest symptom. Thirty-six percent of the cases had a retrocochlear audiological pattern, while 60 percent manifested a mixed cochlear and retrocochlear pattern, the remaining 4 percent presented cochlear findings. A correlation between audiological findings and standard X-ray views revealed that 32 percent of the cases presented equivocal audiometric and negative X-ray findings, while myelogram were performed on 24 percent of the patients, and all but two. cases were positive. One of these cases revealed negative findings, and the other was equivocal. Our clinical findings indicated that a routine vestibular work-up provided the indication for a more progressive neurinoma evaluation.     

Influence of noise type on speech reception thresholds across four languages measured with matrix sentence tests

Objective: To compare speech reception thresholds (SRTs) in noise using matrix sentence tests in four languages: German, Spanish, Russian, Polish. Design: The four tests were composed of equivalent five-word sentences and were all designed and optimized using the same principles. Six stationary speech-shaped noises and three non-stationary noises were used as maskers. Study sample: Forty native listeners with normal hearing: 10 for each language. Results: SRTs were about 3 dB higher for the German and Spanish tests than for the Russian and Polish tests when stationary noise was used that matched the long-term frequency spectrum of the respective speech test materials. This general SRT difference was also observed for the other stationary noises. The within-test variability across noise conditions differed between languages. About 56% of the observed variance was predicted by the speech intelligibility index. The observed SRT benefit in fluctuating noise was similar for all tests, with a slightly smaller benefit for the Spanish test. Conclusions: Of the stationary noises employed, noise with the same spectrum as the speech yielded the best masking. SRT differences across languages and noises could be attributed in part to spectral differences. These findings provide the feasibility and limits of comparing audiological results across languages.     

Social Hearing Handicap Index

As a supplement to the acoustic examination at the hearing centre, a questionnaire has devised to reflect patients’ hearing handicaps in daily life. It consists of 21 questions, with which a patient's bias to answer in scored. The principles on which the test was prepared are discussed in general and can therefore be applied to other languages. 25 normally-hearing individuals were examined, together with 198 patients with all kinds of hearing disorders; a rather high correlation (90%) was found between the social hearing handicap index (SHI), and the degree of hearing handicap (SRT). It has, however, been proved that other factor, such as lip-reading capacity, influence the social handicap. The SHI, before and after audiological treatment at the hearing centre, serves as a useful standard to control the effectiveness of our measures, since they are experienced by the patient himself.