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。     

京剧器乐的听力损伤（附55例调查报告）

本文对从事京剧打击乐的55人（110耳）进行了听力调查及动态观察。利用图表进行对比分析，发现110耳中高频听力损伤89耳，占81％；语频听力损伤32耳，占29.1%；其中伴有高频耳鸣78耳，占70．9％。动态观察30人（60耳），均为永久性听阈阈移。高频听力损伤最早出现的频率是4kHz，并见典型“V”谷，符合噪声性聋的诊断。     

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。     

突聋患者耳蜗电图与预后的关系

目的：探讨突发性聋（简称突聋）患者耳蜗电图与预后的关系。方法对139例（148耳）突聋患者进行耳蜗电图测试,测得－SP、AP振幅及－SP／AP值,分析引出耳蜗电图耳的不同听阈曲线类型分布,并比较各型听阈曲线耳中－SP／AP≥0．4与－SP／AP＜0．4者的疗效。结果148耳中47耳（10耳全聋,37耳平均听阈为88．93±16．72 dB HL ）未引出耳蜗电图,101耳引出耳蜗电图（平均听阈为57．90±17．91 dB HL ）,其中听阈曲线为低频听力损失型27耳（低频组）,高频听力损失型38耳（高频组）,平坦型听力损失型36耳（平坦组）;低频组中－S P／A P≥0．4者与－SP／AP＜0．4者疗效比较,差异无统计学意义（P＞0．05）,平坦组及高频组中－SP／AP≥0．4者疗效优于－SP／AP＜0．4者（P＜0．05）。结论突聋患者中全聋及极重度聋者耳蜗电图不能引出,低频听力损失型－SP／AP≥0．4者疗效与－SP／AP＜0．4者无统计学差异,平坦型及高频听力损失型－SA／AP≥0．4者疗效优于－SP／AP＜0．4者。     

晚期耳硬化症的治疗效果

目的探讨镫骨手术对晚期耳硬化症的治疗效果。方法随机抽取300例1970年至1999年间的耳硬化症手术病例，对符合晚期耳硬化症标准[500—2000Hz骨导听阈（听力级，下同）均值≥40dB，气导听阈均值≥70dB的混合性聋]的68例（77耳）进行回顾性分析。结果68例（77耳）术后，500—2000Hz纯音平均听阈：气导（听力级，下同）由术前的77．32dB减至53．70dB，提高23．62dB；71耳（92．21％）气导提高≥10dB，其中46耳（59．74％）气骨导差闭合。500～4000Hz纯音平均听阈：气导由79.01dB减至58．23dB，提高20。78dB；68耳（88．31％）气导提高≥10dB，其中32耳（41．56％）气骨导差≤10dB（闭合）。随访5～25年，听力稳定的有67耳，听力下降4耳（均为镫骨提高术患者，再次手术后听力均有提高），听力较术后进一步提高的有28耳。结论镫骨手术是治疗耳硬化症的有效手段，也是治疗晚期耳硬化症或极晚期耳硬化症的有效方法之一。镫骨手术对改善晚期耳硬化症或极晚期耳硬化症患者的听力有较大帮助。     

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。     

24耳胆脂瘤型中耳炎的听力损害

２４耳胆脂瘤型中耳炎的听力损害杨德生，康峰，吉云薇，弓玉鸾本文通过对２４耳胆脂瘤型中耳炎与２０耳单纯慢性化脓性中耳炎的纯音听阈比较发现：慢性化脓性中耳炎引起感音神经性聋以胆脂瘤型为多见，占本组８３．３％，而单纯性中耳炎者仅３０％。１临床资料经手术证实...     

听力障碍新生儿随访中听力恢复正常的原因分析

目的：分析新生儿普遍听力筛查中3个月内诊断为听力障碍婴儿其听力恢复正常的原因。方法：2001年11月～2005年6月在上海市出生并接受新生儿普遍听力筛查未通过者,转至上海市儿童听力障碍诊治中心接受听力学评估,均在出生3个月内诊断为听力障碍,并进行听力学跟踪随访至少6个月,对听力恢复正常者进行分析。结果：出生3个月内诊断为听力障碍者681例,随访6～24个月听力恢复正常者94例（115耳）,占13．8％。听力恢复正常者中发现有鼓室积液56例（64耳）,占59．6％;未发现有明确器质性原因者38例（51耳）,占40．4％。听力恢复正常115耳中听力障碍轻度105耳,占91．3％;中度8耳,占7．0％;中重度2耳,占1．7％;重度和极重度无恢复正常者。结论：出生3个月内诊断有听力障碍的患儿,随年龄增长其听力恢复正常的可能性以轻、中度聋为大。恢复原因主要是分泌性中耳炎自愈和听中枢生理性发育逐渐成熟。     

聋（哑）人致聋原因的调查分析

聋（哑）人致聋原因的调查分析洪凤美，于丽娟近期对慈溪市农村地区１０１例聋（哑）人致聋原因及聋（哑）防治进行了调查分析，其结果为：遗传因素引起的先天性聋（哑）占８．９２％；耳毒性药物致聋占６９．７％，其中庆大霉素致聋占耳毒性药物致聋的７２．８％，听力损...     

听神经瘤引起突发性听力减退

为了避免听神经瘤的误诊误治，对１９８６￣１９９５年收治听神经瘤１０４例中２３例（２４耳）首发症状表现为突发性听力减退者（占２３％）的病例进行分析。听力学检测：纯音听阈〉７１ｄＢ ＨＬ者１３耳，占５４．２％，听性脑干反应（ＡＢＲ）检测均有异常；耳蜗电图－ＳＰ／ＡＰ检测９耳中７耳〉０．４，占７７．８％，声反射检测１１耳均消失。眼震电图检测１８例，１７例异常（占９４．４％），影像学检查ＣＴ阳性率８８．８     

病程超过3周的突发性聋患者的临床疗效分析

目的 了解对病程超过3周的突发性聋患者以糖皮质激素等药物进行治疗的意义.方法 对北京大学人民医院耳鼻咽喉科2002年11月至2010年7月住院治疗的48例(58耳)病程超过3周的突发性聋患者的临床资料进行同顾性分析.根据本次入院治疗前的听力曲线分为3组,分别采用不同的治疗方案,观察其疗效.以SPSS 17.0统计软件对数据进行分析,患者治疗前后纯音测听阈值采用t检验.结果 低频下降型(6耳)、高频下降型(22耳)、全频下降型(30耳)治疗后有效率分别为83.3%、31.8%、36.7%.病程≥1年的共12耳,其治疗有效率58.3%(7耳).全频下降型中本次治疗前气导听阈均值≥90 dB(听力级)的9耳,7耳(77.8%)治疗有效,其中3耳(33.3%)达到显效标准;本次治疗前气导听阈均值＜90 dB的患者21耳,其中3耳(14.3%)治疗有效.结论 病程超过3周的突发性聋患者仍有积极治疗的意义.其中低频下降型治疗有效率最高,高频下降型有效率最低,全频下降型有效率居中.病程≥1年的突发性聋患者经积极治疗仍有改善听力可能.全频下降型、听功能损失程度较重的患者,通过积极治疗获益较大.

Abstract：

Objective To investigate and analyze the significance of a course of glucocortieosteroids and other drugs for the treatment of patients with sudden deafness present for at least three weeks.Methods A retrospective review was done on 48 patients (58 ears) with sudden deafness present for at least three weeks or more,who were admitted to the Department of Otorhinolaryngology,Peking University People's Hospital from November 2002 to July 2010.The patients were devided into three groups by the type of hearing threshold.The different treatments were used in the three groups.The SPSS 17.0 software was used to analyze the data.Results In patients with a low tone hearing loss (6 ears) ,83.3% improved.For patients with a high tone loss (22 ears) 31.8% improved.For a flat tone hearing loss (30 ears) 36.7% improved.For patients with a hearing loss more than one year (12 ears) there was improvement in 58.3% (7 ears)of the patients.In 9 ears which had a flat tone hearing loss of 90 dB or greater before treatment,77.8% (7 ears) improved with 33.3% (3 ears) having a significant improvement.In 21 ears which had a hearing threshold was under 90 dB,14.3% (3 ears) improved.Conclusions In the treatment of patients with sudden deafness which was longer than 21 days the treatment was significant,especially for those who had a 90 dB or greater flat-tone type hearing threshold before treatment.Even though the hearing loss was more than a year in some patients there was still a benefit from treatment.     

Evoked otoacoustic emissions in sensorineural hearing impairment: its clinical implications

This study was performed for the purpose of determining whether or not evoked otoacoustic emissions are useful as a clinical test. Two hundred and twenty-six sequences of the emission in response to stimulus tone bursts were averaged. The detection threshold of the emission was elevated in ears of inner ear impairment with profound sensorineural hearing loss, such as inner ear anomaly, mumps deafness, or sudden deafness, but it was not observed in ears of functional deafness. The mean interaural differences of emission threshold were near 35 dB in unilateral inner ear impairments with profound hearing loss. There was a positive correlation between the interaural difference of audiometric threshold and that of emission threshold in sudden deafness ears with various degrees of hearing loss. The incidence of continuous emission, whose duration was longer than 6 msec, was 30% in normal hearing ears and it was close to 90% in ears with bilateral or unilateral dip type hearing loss. The result was verified in a survey of a junior high school brass band. The conclusion is that there is clinical usefulness for the evoked otoacoustic emissions in evaluating cochlear function and in predicting noise susceptibility.     

Functional hearing loss in children who were not aware of their hearing loss

We investigated one hundred and fourteen ears of 60 children (8 males, 52 females, aged from 6 to 13 years) with diagnoses of functional hearing loss (FHL), and were not aware of their own hearing loss. Forty nine (81.7%) of 60 cases examined were detected by school screening tests, 6 (10.0%) were referred to our hospital because their families noticed poor hearing responses, and 5 (8.3%) were enrolled because they complained of otalgia or discomfort in the ear. Forty (66.7%) showed only pure tone threshold loss without complications, and the remaining 20 associated nonorganic disorders. In addition, our investigation found 11 cases (18.3%) with nonorganic otalgia, 5 (8.3%) with functional visual disturbance, 1 (1.7%) with enuresis nocturna who refused to attend school, 1 with tinnitus, 1 with vertigo, and 1 with tic. Moreover, 11 (18.3%) of the 60 cases were suspected of being in conflict with school and/or home. The Type V Békésy pattern, which is frequently observed in FHL and it has clinical utility to distinguish FHL from other types of organic hearing loss, was detected in 44 ears (38.6%). Fifty two (45.6%) of 114 ears showed normal pure-tone thresholds during the clinical course. Sixteen (14.0%) ears needed more than 1 year for thresholds to normalize. These findings suggest that some FHL cases without awareness of their hearing loss resemble psychogenic hearing loss. In such cases, otolaryngologists should carefully check the patient's individual circumstances, and when appropriate, refer patients for psychiatric consultation.     

Clinical features of bilateral progressive hearing loss associated with myeloperoxidase-antineutrophil cytoplasmic antibody

In this study, we analyzed the clinical features, diagnostic criteria, treatment, and outcome of atypical bilateral progressive hearing loss associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). The evaluation was made by audiogram and laboratory data in 6 cases treated at Hokkaido University Hospital. We measured MPO-ANCA by enzyme-linked immunosorbent assay; the result was positive in all cases. The hearing loss developed bilaterally and progressed to total deafness within several weeks. The onset of hearing loss was not simultaneous in the 2 ears. Methylprednisolone pulse therapy was effective in 9 ears. Three ears showed no improvement; 2 of the 3 ears had already exhibited total deafness at the first visit. After the treatment, the titer of MPO-ANCA decreased in all patients. The level of MPO-ANCA should be tested in patients with bilateral progressive hearing loss of unknown origin and can be used as a marker of the disease's activity.     

Labyrinthine window rupture as a cause of acute sensorineural hearing loss

Labyrinthine window rupture (LWR) is one cause of acute sensorineural hearing loss and need for early exploration is clear for good improved hearing. Acute sensorineural hearing loss of 60 dB or more treated from May 2006 to May 2010 were retrospectively analyzed. There were 21 ears of severe deafness, 18 ears of profound deafness, and 10 ears of total deafness. All patients were examined with temporal bone CT. Space-occupying lesions around the labyrinthine windows were suggestive images of LWR. Thirty-five ears were operated for LWR while 14 ears of SHL received conservative treatments. Fifty-seven percent of LWR improved 30 dB or more after sealing of both labyrinthine windows. Of the 15 markedly recovered ears, 14 ears were operated within 2 weeks from the onset. Of the five cured ears, four ears were operated within a week from the onset. As for the hearing prognosis of SHL, 88% of severe and profound deafness improved 30 dB or more but total deafness did not improve more than 30 dB. Exclusion of LWR from SHL and early surgical intervention in LWR will bring about good hearing prognosis to both LWR and SHL.     

尿毒症合并突发性聋患者的临床特征及预后

目的 分析尿毒症合并突发性聋(突聋)患者的临床特征及预后.方法 收集2015年1月-2019年12月在会理县人民医院治疗的尿毒症合并突聋患者29例(30耳),平均初诊听阈值为(62.33±13.68)dB HL;17耳(56.67％)伴耳鸣,8耳(26.67％)伴眩晕;9耳(30.00％)为平坦型,13耳(43.33％...     

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。     

儿童突发性聋的临床特征及预后相关因素分析

目的 分析儿童突发性聋的临床特征、疗效及影响预后的相关因素,为临床治疗及预后评估提供依据。 方法 收集2010年1月至2017年10月就诊的67例突发性聋患儿临床资料,对其临床特征及治疗效果进行回顾性分析,同时根据疗效将患者分为总体有效组(36例)及无效组(31例),采用单因素及多因素分析的方法分析患者的性别、年龄、病程、初诊听阈、是否伴发耳鸣、眩晕、病毒感染史、发病季节和听力曲线类型对预后的影响。 结果 儿童突聋患者中64.18%在春冬季发病,其就诊时听阈为(76.62±25.97)dB HL,耳鸣及眩晕伴发率分别为70.15%和61.19%,病毒感染率为19.40%,听力曲线中10.44%为低频下降型、2.99%为高频下降型、34.33%为平坦型及52.24%为全聋型。经治疗后,患者听阈为(60.41±31.52)dB HL,总体有效率为53.73%,其中痊愈率、显效率及有效率分别为20.90%、16.42%和16.42%。多因素分析结果显示,初诊听阈越高及听力曲线为全聋型,预后越差(P均<0.05);伴有病毒感染的非全聋型患者预后较好(P<0.05)。 结论 儿童突发性聋患者病毒感染率较高且大部分在春冬季发病,就诊时听力损失较重并常伴有耳鸣及眩晕,其听力曲线以平坦型及全聋型为主。就诊时听力损伤程度轻、伴有病毒感染的非全聋型患者预后较好。     

New hearing test for functional deafness--the procedure to estimate the genuine hearing threshold]

This report describes a new procedure for examining functional deafness with binaural sound stimulation. This new hearing test can estimate the genuine pure tone hearing threshold quantitatively at every frequency by using the ordinary audiometer. In the case of the nonorganic deafness, even if the hearing disorders are bilateral or hemilateral, we believe that measuring auditory threshold separately, causes the deterioration of the threshold. Therefore, this procedure is designed so that the subject may not be aware of testing the auditory acuity of each ear, and utilizes the response of the phantom sound image in the head by simultaneous binaural presentation of sound stimulation. Our strategy is based on the following facts. If the normal subject has the same pure tone threshold level in both ears, the phantom sound image is formed in the median plane of the head by the equal suprathreshold tone level presented simultaneously in each ear. In the case of a unilateral auditory disorder, the sound image is localized to the center of the head only when sound stimulation louder than the threshold level of affected ear is given to both ears at the same time. Simultaneous binaural sound stimulation at a lower level than the threshold of the affected ear forms a lateralized sound image to the unaffected ear in the head. For patients with bilaterally similar hearing loss, the sound image is not formed if the stimulation is less than the threshold level of the pure tone. The band noise in the phase of each frequency with 50 dB HL was given binaurally to 10 normal hearing subjects, and the localization of the sound image formation was examined. This experiment confirmed that around the occipital region of the median plane in all subjects. Furthermore, comparing the formation threshold of the median plane image with the pure tone auditory threshold, proved that there was no significant difference statistically in either value. As a next step, 15 patients with unilateral sensorineural deafness were examined with this technique and we knew that the median sound images would not be formed with stimulation less than the pure tone auditory threshold of the affected ear. For clinical application, patients were classified into two groups with unilateral (6) and bilateral (2) functional deafness, and examined. Midline sound images definitely were formed with the lower magnitude of sound than the pure tone threshold by hemilateral nonorganic deafness. The difference of the forming threshold of the median sound image and the average of pure tone hearing level of the affected ear were maximum 100 dB, minimum 35 dB, and mean 69.4 dB. Furthermore, the difference of the median image forming threshold and the average hearing level of the unaffected ear were maximum 35 dB, minimum 0 dB, and mean 15.4 dB. In bilateral disorders, the midline plane sound image was formed with the corresponding level of the pure tone value in one subject, though the other one was determined by the maneuver method because it did not form a midline sound image. In conclusion, this examination can be readily used to estimate the genuine hearing threshold of the functional deafness.     

突发性聋临床流行病学分析

目的进行突发性聋（以下简称突聋）的临床流行病学分析。方法回顾性分析我科2000年-2006年收治突聋患者332例的临床资料：对1980年至2006年我院耳鼻喉科突聋住院人数和耳鼻喉科总住院人数进行了统计。结果332例突聋中,男164例,占49.3％;女168例,占50.6％。发病年龄以41-50岁最多（89例）。右耳患病144例,左耳患病157例,双耳间隔50天至5年相继发生突聋者31例。听力下降前后出现耳鸣者295例,占88.9％,以低调、持续性耳鸣为主。有耳闷者111例,占33.4％。按职业分类：白领127例,蓝领101例,退休或无业居家者80例,学生22例,儿童2例。发病诱因：无明显诱因者78.3％,有感冒病史者10.5％,有劳累、压力大、情绪波动因素者9.3％,有其他因素者1.8％。根据突聋是否伴有头晕或眩晕将其分为三类：单纯表现为听力减退者179例（占53.9％）,伴发头晕者59例（占17.8％）,伴有眩晕者94例（占28.3％）。332例中伴发高血压病、冠心病和／或糖尿病者62人（占18.7％）;其中160例检查了血脂,查出血脂异常者92人（占57.5％）,以甘油三酯升高为主。分析我院1980年至2006年突聋患者住院人数占耳鼻喉科总住院人数的构成比发现：80年代构成比为1.69％,90年代为3.31％,2000年后为4.6％,三者有极显著性差异（P〈0.01）。结论332例突聋中男女发病构成和左右耳患病构成基本相同。以中、青年为高发人群。男性患病与职业有明显相关性,即白领比蓝领和居家者更易患突聋;女性患病与职业无明显相关性。精神压力大、过于劳累的人员易患突聋。突聋中单纯表现为听力减退的病人数多于伴有眩晕者,伴有眩晕者又多于伴有头昏者。其最常见的伴发病症为血脂代谢紊乱,以甘油三酯升高为主。近26年来我院突聋住院人数逐渐增多,提示突聋发病有增多趋势。