噪声暴露工人畸变产物耳声发射和扩展高频测听的研究

目的 :分析畸变产物耳声发射 (DPOAE)和常频纯音测听、扩展高频测听的关系 ,借以探讨DPOAE的产生机制以及在噪声性听力损伤的监测和早期诊断中的应用价值。方法 :对 4 2例耳科正常人 (对照组 )和 2 0例噪声暴露工人 (实验组 )进行 0 .5～ 16 .0kHzDPOAE、常频纯音测听及扩展高频测听的检测 ,比较对照组和实验组DPOAE和常频纯音测听、扩展高频测听的结果。结果 :实验组纯音听阈在 6 .0kHz处和扩展高频区下降明显 ,与对照组比较 ,差异有显著性意义 (P <0 .0 5 ) ;DPOAE幅值在 4 .0、6 .0和 11.2kHz处下降明显 ,与对照组比较 ,差异均有显著性意义 (P <0 .0 5 ) ;而在 12 .5、14 .0、16 .0kHz 3个频率处两组差异无显著性意义 (P >0 .0 5 )。结论 :常频DPOAE检查可用于噪声性聋的早期诊断和监测。DPOAE可能来源于对应频率区及较高频率区耳蜗外毛细胞 ,其产生部位和机制尚待深入研究     

机械纺织工人畸变产物耳声发射的临床研究

目的研究畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)在监测和早期发现噪声性聋(noise induced hearingloss,NIHL)方面的应用价值。方法检测160名(285耳)机械纺织工人(其中噪声性聋组125例224耳,有噪声接触史但纯音听阈正常者为对照组,共35例61耳)和75名听力正常人(正常对照组)的鼓室导抗图、镫骨肌反射、纯音听阈及DPOAE,比较三组的DPOAE幅值和引出率。结果①噪声性聋组DPOAE幅值及引出率均较正常对照组明显下降(P<0.05);②对照组与正常对照组比较,对照组的DPOAE幅值在4kHz处、引出率在3~6kHz处明显下降(P<0.05);③随着接触噪声工龄的延长,DPOAE引出率逐渐下降(P<0.05)。结论DPOAE可以客观地监测和早期发现噪声性聋,较纯音测听更有意义。     

短时纯音暴露对畸变产物耳声发射的影响

畸变产物耳声发射（ＤＰＯＡＥ）测试所采用的参数可以对测试结果有明显影响，为研究改变ＤＰＯＡＥ测试参数对反映耳蜗功能变化是否有影响，使１０只大白兔（１６耳）接触短时（３分钟）、中等强度（８２ｄＢ ＳＰＬ）的纯音暴露后发现，以等强原始音（Ｌ１＝Ｌ２）诱发的ＤＰＯＡＥ的幅度变化小于以差强原始音（Ｌ２＝Ｌ１－１２ｄＢ）诱发的ＤＰＯＡＥ（相差１０．１１ｄＢ），而其恢复过程也短于后者（相差１００．７１秒）。这     

短时纯音暴露对畸变产物耳声发射的影响

畸变产物耳声发射（ＤＰＯＡＥ）测试中所采用的参数可以对测试结果有明显影响，为研究改变ＤＰＯＡＥ测试参数对反映耳蜗功能变化是否有影响，使１０只大白兔（１６耳）接触短时（３分钟）、中等强度（８２ｄＢＳＰＬ）的纯音暴露后发现，以等强原始音（Ｌ１＝Ｌ２）诱发的ＤＰＯＡＥ的幅度变化小于以差强原始音（Ｌ２＝Ｌ１－１２ｄＢ）诱发的ＤＰＯＡＥ（相差１０．１１ｄＢ），而其恢复过程也短于后者（相差１００．７１秒）。这种差别可能提示在ＤＰＯＡＥ的产生过程中有多个生理机制发挥作用，而变化测试参数则可以选择性地突出表现其中某一个机制     

改装体检飞行员畸变产物耳声发射结果分析

目的探讨用纯音测听和畸变产物耳声发射对改装体检（对改飞高性能战斗机飞行员进行的全身体检,简称改装体检）飞行员听力评估的意义。方法将2008年3月～2009年2月进行改装体检的75名（150耳）飞行员按飞行时间分为A组（飞行650小时以上组40人80耳）和B组（飞行650小时以下组35人70耳）,分别进行纯音测听及畸变产物耳声发射检测．比较两组间的差异。结果根据《中国人民解放军审车毡行人员体格检查标准》．75人耳鼻咽喉专科飞行结论均为飞行合格。150耳中PTA正常128耳（85．33％,128／150）,异常22耳（14．67％,22／150）;DPOAE正常94耳（62．67％,94／150）,异常56耳（37．33％,56／150）。PTA正常的128耳中,94耳DPOAE幅值在正常范围,其余34耳（26．56％,34／128）有一个或几个频率幅值下降,其中1、3、dkHz下降耳数较多。PTA异常的22耳中。有20耳PTA曲线为3kHz和／或4kHz下降,表现为V型或U型曲线,其DPOAE听力图也表现为相应频率的幅值降低或未引出;其余2耳PTA及DPOAE曲线均表现为全频下降。两组DPOAE引出率差异无统计学意义,但在4kHz,两组的引出率均低于其他频率（P〈0．05）;在6、8kHz,A组DPOAE幅值低于B组（P〈0．05）,其余各频率两组的幅值差异无统计学意义。结论DPOAE可早期发现飞行员的噪声性听力损失,此部分人群是改飞后听力重点随访对象。     

钻井工人畸变产物耳声发射的检测

目的：了解畸变产物耳声发射（ＤＰＯＡＥ）在监测噪声性聋方面的应用价值。方法：检测１０２例（１９５耳）钻井工人ＤＰＯＡＥ的幅值和引出率。结果：钻井工人ＤＰＯＡＥ的幅值和引出率均较对照组明显下降;随着接触噪声工龄的延长,ＤＰＯＡＥ的引出率逐渐下降;纯音测听正常的接触噪声者与正常人相比,ＤＰＯＡＥ的幅值及引出率亦明显降低;ＤＰＯＡＥ高频段引出率与相应频段的纯音听阈存在着负相关。结论：ＤＰＯＡＥ能较好地反     

畸变产物耳声发射与瞬态诱发耳声发射的相关性观察

目的：探讨畸变产物耳声发射（DPOAE)和瞬态诱发耳声发射(TEOAE)的特点和相关性。方法：以20例（40耳）耳科正常青年人观察噪声暴露前后在无对侧抑制（NCS)状态下和有对侧抑制（CS)状态下TEOAE的频带信噪比、频带反应幅值，与DPOAE的2f1-f2幅值、信噪比相互间的相关性。结果：DPOAE与TEOAE虽由不同的刺激声所引出，有各自的图形特征，但在绝大多数相近频率点上，其测量值有较好的相关性，形成一定的数量关系。结论：TEOAE测试较为快捷并有中频优势，而DPOAE则有很好的频率特异性和高频优势。二者幅值及信噪比间有良好的相关性，可得出有统计意义的线性回归方程参数，听觉损害，噪声性。     

畸变产物耳声发射在舰艇艇员听力调查中的应用

目的了解舰艇艇员的听力状况并探讨纯音听力图与DPOAE听力图的关系。方法对100名(200耳)舰艇艇员进行纯音、声导抗、DPOAE测试,测试仪器均为GSI系列产品。根据纯音测听结果将其分成正常、低频听力下降、高频听力下降及全频听力下降四个组,并结合纯音听力图与DPOAE听力图进行比较。结果纯音听阈正常组的DPOAE检出率及DPOAE振幅明显高于低频听力下降组、高频听力下降组及全频听力下降组(P＜0.01或0.05);DPOAE听力图与纯音听力图个各在频率均有很好的对应关系。结论DPOAE作为一种评价耳蜗毛细胞功能状态,在征兵、部队听力普查中较传统的纯音听阈测试更有意义。     

高血脂豚鼠畸变产物耳声发射及耳蜗形态学观察

目的观察高血脂对豚鼠耳蜗形态和畸变产物耳声发射的影响。方法建立豚鼠高血脂模型，检测其畸变产物耳声发射，观察光镜及电镜下耳蜗形态学改变。结果高血脂组豚鼠畸变产物耳声发射各频率反应幅值均较正常组低；光镜下Corti器变形，基底膜结构破坏；电镜下外毛细胞排列紊乱，线粒体、内质网结构破坏。结论高血脂可造成豚鼠耳蜗外毛细胞线粒体和内质网损伤，导致畸变产物耳声发射幅值下降。     

阻塞性睡眠呼吸暂停低通气综合征患者的早期听觉损害评估手段探讨

目的探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的早期听觉损害评估方法。方法对31例(62耳)OSAHS患者和20例(40耳)对照组,分别检测常频(0.125～8 kHz)纯音气骨导和扩展高频(8～16 kHz)气导听阈、瞬态诱发性耳声发射(TEOAE)及畸变产物耳声发射(DPOAE)。结果①常频纯音听阈两组间无显著差异,而扩展高频听阈OSAHS组明显高于对照组(t=3.045～3.779,P=0.000～0.003);②TEOAE检出率OSAHS组为37.1%,而对照组为92.5%,组间差异显著,χ2=30.82,P=0.000;③在各个频率点DPOAE检出率和振幅,OSAHS组明显低于对照组(检出率χ2=22.94～34.31,P=0.000～0.000;振幅t=-2.740～-9.980,P=0.000～0.008)。结论对于OSAHS患者建议用耳声发射、扩展高频测听进行早期听觉损害评估。     

Acoustic stapedius muscle reflex in mercury-exposed Andean children and adults

In this study, a non-syndromic progressive bilateral high frequency hearing loss is described in a family with 141 identified members. Recent genetic analyses indicated a digenic inheritance with linkage to the gene loci DFNA2 and DFNA12. The affected family members who shared haplotypes at both loci (type I) showed an early postlingual onset and a more rapid rate of progress compared with those with one either of the two disease associated haplotypes (type II). The audiometric pattern was cochlear without a vestibular involvement. Auditory brainstem response audiometry and magnetic resonance imaging indicated normal retrocochlear features. The otoacoustic emissions were affected for both type I and type II, whereas the acoustic stapedius reflex thresholds were normal in most cases. It is concluded that both types had an outer hair cell/micro-mechanical abnormality, but that the DFNA 2 type might have an additional dysfunction at the level of the inner hair cells. It is furthermore pointed out that the application of refined audiometric techniques as well as a further development of new techniques is needed in order to characterize the phenotypes of the rapidly expanding number of genetically defined inner ear abnormalities.     

Otoacoustic Emissions in Smoking and Nonsmoking Young Adults

Objectives

The present study investigates the usefulness of transiently evoked otoacoustic emissions (TEOAEs) and distortion product OAEs (DPOAEs) in detecting small changes in the hearing of young smoking adults.

Methods

Otoacoustic emissions were acquired from the ears of 48 young adults (age, 20 to 27 years). The dataset was divided into two groups, smoking (24 persons/48 ears) and nonsmoking (24 persons/48 ears). The level of smoking was relatively small in comparison to previous studies, an average of 3.8 years and 8.7 cigarettes per day. In each ear three OAE measurements were made: TEOAEs, DPOAEs, and spontaneous OAEs (SOAEs). Pure tone audiometry and tympanometry were also conducted. Audiometric thresholds did not differ significantly between the datasets. Half-octave-band values of OAE signal to noise ratios and response levels were used to assess statistical differences.

Results

Averaged data initially revealed that differences between the two study groups occurred only for TEOAEs at 1 kHz. However when the datasets were divided into ears with and without SOAEs more differences became apparent, both for TEOAEs and DPOAEs. In ears that exhibited SOAEs, both smokers and nonsmokers, there were no statistically significant differences between evoked OAEs; however in all ears without SOAEs, evoked OAEs were higher in the ears of nonsmokers, by as much as 5 dB. These differences were most prominent in the 1-2 kHz range.

Conclusion

A general decrease in OAE levels was found in the group of smokers. However, in ears which exhibited SOAEs, there was no difference between the evoked OAEs of smokers and nonsmokers. We conclude that smoking had not yet measurably affected the ears of those with acute hearing (i.e., those who exhibit SOAEs). However, in ears without SOAEs, smokers exhibited smaller evoked OAE amplitudes than nonsmokers, even though their audiometric thresholds were within the norm.     

畸变产物耳声发射与响度重振现象关系的探讨

目的探讨响度重振与耳蜗主动机制异常之间的关系，为耳声发射用于诊断耳蜗性病变提供更多指标。方法通过对２０例（４０耳）健康人、５０例（６３耳）常规重振检测频率阳性者和１１例（１５耳）蜗后性聋耳进行畸变产物耳声发射（ｄｉｓｔｏｒｔｉｏｎｐｒｏｄｕｃｔｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｉｏｎ，ＤＰＯＡＥ）的输入－输出（Ｉ／Ｏ）曲线的测试和分析。结果重振检测阳性的患耳不同频率ＤＰＯＡＥ的Ｉ／Ｏ曲线斜率的均值与健康人对应频率Ｉ／Ｏ曲线斜率的均值相比明显增大（Ｐ＜０．０１），其ＤＰＯＡＥ的检测阈也明显提高。结论响度重振与耳蜗主动机制异常有特定联系，ＤＰＯＡＥ的Ｉ／Ｏ曲线对耳蜗主动机制的评价更直观、准确，可能成为一种有价值的诊断耳蜗性病变的指标。     

遗传性无综合征耳聋一家系畸变产物耳声发射测试

目的　探索遗传性进行性无综合征耳聋患者的听功能改变特点。方法　一个常染色体显性遗传进行性无综合征耳聋家系 5 2名成员及听力正常组 15名 ,进行了纯音测试及畸变产物耳声发射 (distortionproductotoacousticemissions,DPOAE)测试。结果　无综合征耳聋家系中 34名成员纯音测试为感音神经性聋 ,其中纯音听阈均值 (puretoneaverage ,PTA)≥ 40dB的 15例 (2 9耳 )DPOAE反应缺失 ,PTA≤ 35dB伴高频下降的 12例 (2 3耳 )DPOAE高频或高、中频振幅下降或缺失 ;2 1名 (42耳 )纯音听阈正常成员中 ,有 12例 (15耳 )DPOAE高频或高、中频振幅下降或缺失。结论　DPOAE能鉴别出耳蜗亚临床的病理改变 ,对该病的早期诊断 ,遗传咨询有指导意义。     

畸变产物耳声发射对突发性聋预后的评估价值

目的本文旨在探讨畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）在评估突发性聋患者预后中的作用。方法利用CELESTA2503型耳声发射检测仪对131例突发性聋患者治疗前进行DPOAE测试,并与其治疗效果进行统计学分析。结果 131例突发性聋患者中DPOAE检出率为30%,其中47.06%患者完全治愈,38.24%患者症状好转,14.71%患者未愈。而DPOAE未检出组,17.53%患者治愈,56.70%患者好转,25.77%患者未愈。DPOAE可检出的患者,治疗效果明显优于DPOAE未检出的患者（Z=-2.947,P〈0.05）。结论 DPOA E对突发性聋患者早期恢复有一定的监测作用。     

The effect of impulse noise exposure on distortion product otoacoustic emissions in the awake guinea pig

Distortion product otoacoustic emissions (DPOAE) are a sensitive detector of outer hair cell (OHC) function and were monitored in awake guinea pigs before and after impulse noise damaging the cochlea (peak intensity 153 dB SPL, rise time < 0.1 ms). Animals had stable DPOAE levels before noise exposure. In the first hours after noise exposure DPOAE levels were reduced significantly. Three different patterns of recovery of DPOAE were seen in the post-exposure period: restitution exceeding controls, partial recovery and no recovery. In general, DPOAE levels declined and types of recovery closely corresponded to changes in amplitudes of cochlear microphonics after noise exposure. These data suggest that the monitoring of DPOAE is a suitable method for diagnosing impaired OHC function. Received: 25 February 1999 / Accepted: 1 July 1999     

单侧突发性聋患者对侧耳耳声发射分析

目的研究突发性聋患者单耳发病时对侧耳的耳蜗功能状态。方法利用Capella耳声发射仪对单侧突发性聋患者的对侧耳50例(50耳,病例组)及正常人30例(60耳,对照组)分别进行瞬态声诱发耳声发射(TEOAE)及畸变产物耳声发射(DPOAE)检测,记录和分析TEOAE的通过率及各频率DPOAE的检出率、幅值。结果①TEOAE通过率对照组为100%,病例组为75%,两组比较差异有统计学意义(χ2=20.84,P<0.01);②DPOAE检出率在0.5、0.75、1.0、3.0、4.0 kHz频点上,病例组低于对照组(P<0.05或P<0.01);③与对照组相比,病例组各频率DPOAE的幅值均降低,差异有统计学意义(P<0.05或P<0.01)。结论部分突发性聋患者的对侧耳已出现早期耳蜗功能受累,利用耳声发射分析方法可在听力损失出现之前早期发现此类病变。     

Clinical investigation on spontaneous otoacoustic emission (SOAE) in 447 ears

OBJECTIVES: It is known that spontaneous otoacoustic emission (SOAE) is often observed in normal hearing ears, but concrete clinical application of SOAE test has been rarely reported, compared with transiently evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) tests. In addition, there have been a variety of opinions concerning laterality of SOAE, and influence of gender and hearing on SOAE. The reason for this may be that each report has the small number of subjects and lacks in statistical power. Therefore, in the present study, SOAE, TEOAE and DPOAE were measured in 447 ears of subjects at various ages with different hearing level, and statistical analysis was performed to investigate the clinical significance of SOAE. MATERIALS AND METHODS: The subjects were 447 ears in 268 patients (268 ears in females, and 179 ears in males). The age of subjects ranged from 0 to 75 years (mean: 30.8 years), and there were 222 left and 225 right ears. The subjects of schoolchildren or older (414 ears) received pure-tone audiometry, and infants (33 ears) received auditory brain-stem response (ABR). SOAE and TEOAE were measured using ILO88 (Otodynamics, Version 4.20). DPOAE was measured using ILO92 (Otodynamics, Version 1.32). RESULTS: Incidence of SOAE and the number of SOAE per ear were high in the subjects at age of 50 years or younger, in those with hearing level of not more than 30 dB, in the right ear, and in females. Incidence of SOAE in the whole of normal hearing ears was approximately 38%, but the ears with SOAE had almost normal hearing of not more than 30 dB. CONCLUSIONS: SOAE is useful for objective hearing assessment. Moreover, SOAE sometimes appeared in the ears in which TEOAE or DPOAE could not be confirmed, and it might be useful for definite diagnosis of disease state to measure SOAE in addition to TEOAE or DPOAE.     

豚鼠畸变产物耳声发射潜伏期的对侧抑制效应现象

目的通过观察对侧抑制效应中畸变产物耳声发射(distortion product otoacoustic