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。     

150耳胆脂瘤型中耳炎的听力分析

采用Madsen TBN-85型纯音测听仪，在隔音室内对148例（150耳）胆脂瘤型中耳炎患者的听力进行了测定。男85例，女63例，年龄5－66岁，其中50岁以上仅有4例。感音神经性聋、混合性聋53耳，占35％，其中有8耳全聋；传导性聋97耳。前者平均病程为14.2年，后者为13.1年，两者之间没有明显差异，提示感音神经性聋的发生率与病程关系不大。感音神经性和混合性聋对侧有中耳感染性病变者占28％，传导性聋对侧耳有病变者占19％，说明双侧中耳炎较单侧中耳炎易发生感音神经性聋。对比感音神经性聋和混合性聋与传导性聋鼓膜穿孔类型，发现边缘性穿孔的病例，前者明显多于后者，其余的穿孔类型则均无明显差异。     

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。     

耳声发射在新生儿听力筛查中的应用

目的探讨耳声发射在新生儿听力筛查中的作用。方法862名新生儿(包括48例听损伤高危儿)在出院前接受耳声发射测试，未通过者42天回访时复查，仍未通过者，行听性脑干反应检查。结果862名新生儿中，68例未通过耳声发射初筛，9例在42天回访时未通过复筛，经过听性脑干反应测试，1例未通过测试，经全面的听力学诊断，确诊为重度感音神经性聋，48例高危儿耳声发射及听性脑干反应均正常。结论耳声发射在新生儿听力筛查中应为首选方法，高危儿及未通过耳声发射筛查者，应做听性脑干反应检查，并注意跟踪、随访。     

成骨不全伴耳硬化症病人的耳蜗移植

耳蜗移植常用于先天性聋及各种原因引起的双侧重度聋。耳硬化症可引起语后进行性聋，可通过耳蜗移植治疗。成骨不全和耳硬化症可引起进行性听力减退，作者报道１例耳硬化症伴成骨不全病人的耳蜗移植，对术中及术后结果进行了讨论。患者女，４０岁，因双耳听力减退１年就诊...     

母系遗传性聋家系的纯音测听及畸变产物耳声发射测试的相关分析

目的：探讨母系遗传非综合征性聋的听力学特征及畸变产物耳声发射测试对其听改变早期诊断的优越性。方法：对六个母系遗传家系成员共102人进行纯音测听、DPOAE评估其听力，比较纯音测听与DPOAE检测耳蜗早期病变的灵敏性。结果：纯音测听为感音神经性聋的38例中，PTA≥45d B HL的18例，DPOAE反应缺失；PTA＜45dB HL的20例，DPOAE高频或高、中频振幅下降或缺失；纯音测听正常者中4例DPOAE显示高频或高中频振幅下降。结论：母系遗传非综合征性聋的听力损害为双侧、对称性、进行性感音神经性聋，早期表现高频损害，DPOAE可在纯音听阈改变之前，发现早期耳蜗轻微的病理变化，对早期诊断及遗传咨询有较大指导意义。     

耳硬化症的诊断问题(附251耳分析)

耳硬化症的发病率在我国较低,由于存在漏诊,实际发病率应高于一般印象。患者提供的其他致聋病史及鼓膜异常发现常引起误诊,因此,对病史和鼓膜异常发现应作具体分析。耳硬化症可表现为传音性聋,更常见的为混合性聋;少数患者或疾病晚期可表现为感音神经性聋。本文讨论了耳硬化症的诊断要点,并阐述诊治晚期耳硬化症的重要性。     

186耳突发性聋的听力学表现

１８６耳突发性聋的听力学表现尹蔚明１杨克林本文回顾分析了我科１９８８～１９９５年住院突聋患者及一部分变态反应室门诊患者的完整资料，对其突发性耳聋程度的分级、听力图类型及疗效判断标准进行了分析，报告如下。１临床资料共１６９例（１８６耳），其中男９５例，...     

对侧刺激声影响畸变产物耳声发射的临床意义

研究不同种类对侧刺激声对不同患者畸变产物耳声发射 (ｄｉｓｔｏｒｔｉｏｎｐｒｏｄｕｃｔｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｓｉｏｎ ,ＤＰＯＡＥ)的抑制作用 ,探讨其临床应用价值。一、材料和方法1.研究对象 :2 0例 ( 40耳 )健康人 ,2 5例 ( 2 7耳 )梅尼埃病患者 ,符合上海会议诊断标准[1] ,2 0例 ( 2 8耳 )低频感音神经性聋患者以及 5例 ( 5耳 )蜗后性聋患者 (其中听神经瘤 3耳、脑干病变 2耳 ) ,以上受试者均排除外耳及中耳疾患 ,均能引出明确的ＤＰＯＡＥ。均行纯音测听、声导抗测试以及听性脑干反应 (ａｕｄｉｔｏｒｙｂｒａｉｎｓｔｅ…     

畸变产物耳声发射对噪声性聋早期发现的应用

目的 从听力学角度评价畸变产物耳声发射检测对噪声性听损伤早期发现的临床价值。方法 利用声级计测定某食品包装材料有限公司生产车间,同时利用纯音测听、声导抗、耳声发射、对生产车间接触噪声的43名工人进行听力检测并同时进行外耳检查和噪声接触史调查。结果 生产车间九个机器点的噪声水平平均93.7dB(A),超过国家规定标准,受检的43名工人声导抗检测全部正常,23人听力检测异常,其中7人纯音测听呈噪声性聋早期、中期听力损伤改变,16人纯音测听正常而耳声发射不合格。结论 畸变产物耳声发射检测对接触噪声的人群是一种有一定价值的监测和早期发现噪声性聋的检查方法。     

Analyses of factors contributing to hearing aids use and both subjective and objective estimates of hearing

The use of hearing aids, regardless actual implementation, may be interpreted as a cry for help in hearing difficulty. We assessed factors contributing to hearing aid possession and predicted needs of hearing assistance from the distribution of hearing level in self-estimated (subjective) hearing loss and hearing loss pointed out by others (objective) in a population-based aging cohort. Of 1192 men and 1163 women aged 40 to 84 years, the prevalence of hearing loss using the criteria of a mean hearing threshold>25dB at frequencies of 0.5, 1, 2, and 4 kHz in the better ear was 23.6%. Hearing aids were possessed by 11.0% in the hearing loss group. Statistical analysis by gender was done to identify factors associated with hearing aid possession using stepwise multiple regression in which independent variables were age, hearing in the better and worse ear, and items from response to a questionnaire on self-estimated hearing loss, hearing loss pointed out by others, job, household income, financial satisfaction, education, housemate, how often others were talked to and how often those surveyed went out. Age, better-ear hearing, worse-ear hearing, and education statistically influenced hearing aid possession in men, and age, better-ear hearing, and hearing loss pointed out by others statistically influenced women. Age had a negative effect on hearing aid possession in both men and women, indicating that possession decreased with aging. Scattergrams were plotted with worse-ear hearing on the y axis and better-ear hearing on the x axis for 4 groups of respondents divided into groups with self-estimated hearing loss or hearing loss pointed out by others: (1) no subjective and objective hearing loss, (2) subjective but no objective hearing loss, (3) objective but no subjective hearing loss, and (4) both subjective and objective hearing loss. Many respondents had either subjective or objective or both subjective and objective hearing loss, even within 20 dB of hearing level of both ears in their 40s. These facts implied that early-stage candidates for hearing aids may not require threshold reduction, although aided thresholds were commonly used indicators in fitting.     

The New York State universal newborn hearing screening demonstration project: ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention

OBJECTIVE: To determine the ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention through a multi-center, state-wide universal newborn hearing screening project. DESIGN: Universal newborn hearing screening was conducted at eight hospitals across New York State. All infants who did not bilaterally pass hearing screening before discharge were recalled for outpatient retesting. Inpatient screening and outpatient rescreening were done with transient evoked otoacoustic emissions and/or auditory brain stem response testing. Diagnostic testing was performed with age appropriate tests, auditory brain stem response and/or visual reinforcement audiometry. Infants diagnosed with permanent hearing loss were considered for hearing aids and early intervention. Ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention were investigated regarding nursery type, risk status, unilateral versus bilateral hearing loss, loss type, loss severity, and state regions. RESULTS: The prevalence of infants diagnosed with permanent hearing loss was 2.0/1000 (85 of 43,311). Of the 85 infants with hearing loss, 61% were from neonatal intensive care units (NICUs) and 67% were at risk for hearing loss. Of the 36 infants fitted with hearing aids, 58% were from NICUs and 78% were at risk for hearing loss. The median age at identification and enrollment in early intervention was 3 mo. Median age at hearing aid fitting was 7.5 mo. Median ages at identification were less for infants from the well-baby nurseries (WBNs) than for the NICU infants and for infants with severe/profound than for infants with mild/moderate hearing loss, but were similar for not-at-risk and at-risk infants. Median ages at hearing aid fitting were less for well babies than for NICU infants, for not-at-risk infants than for at-risk infants, and for infants with severe/ profound hearing loss than for infants with mild/ moderate hearing loss. However, median ages at early intervention enrollment were similar for nursery types, risk status, and severity of hearing loss. CONCLUSIONS: Early ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention can be achieved for infants from NICUs and WBNs and for infants at risk and not at risk for hearing loss in a large multi-center universal newborn hearing screening program.     

陡降型听力曲线者助听器选配效果观察

目的 为陡降型听力曲线的听障者选配助听器，使其能听清楚高频的声音。方法 听障者配戴助听器前和配戴普通线性放大助听器、多通道全数字电脑编程助听器后进行助听听阈、声源觉察率测试，并分别进行比较。结果 听障者配戴普通线性放大助听器与没有配戴助听器时助听效果没有明显差异；配戴多通道全数字电脑编程助听器和配戴普通线性放大助听器助听听阈在高频区有显著性差异，在对低频的正常耐受下大幅度补偿高频，从而助听听阈接近正常。结论 陡降型听力曲线听障者配戴多通道全数字电脑编程助听器，经过多次调整，对高频部分的听敏度有大幅度的提高。     

北京某社区老年人群听力水平分布情况及自我认知能力的调查研究*

目的全面了解老年人群中不同听力水平分布情况和老年人对听力的自我认知能力.方法通过问卷调查获得老年人群听力水平自我评估结果,再通过纯音测听检测受试人群听力,评估老年人群对听力水平的自我认知能力.结果接受调查的516例老年人中,听力正常者181人(35.08%),轻度听力损失171人(33.14%),中度听力损失155人(30.04%),重度听力损失9人(1.74%);其中266人(51.55%)对自我的听力水平认知正确,171人(33.14%)自我认知听力水平高于实际水平,79人(15.31%)自我认知听力水平低于实际水平.结论在全身情况基本正常的老年人群中,50%以上的老年人能够正确认知自己的听力状况.     

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Abstract

Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.     

宁夏地区助听器康复救助项目受助者适配效果分析

目的调查分析宁夏地区136例听障患者发放助听器后的配戴效果,了解使用助听器情况及影响因素,为听障患者助听器验配及项目执行提供参考依据。方法通过询问病史,进行耳内镜检查、纯音听力测试,了解患者听力损失程度及听阈曲线类型,为患者进行助听器验配,采用助听器效果国际性调查问卷(the international outcome inwentory for hearing aids,IOI-HA)通过面对面问答或电话随访的方式进行助听器效果评价,比较不同配戴时间、听力损失程度、听阈曲线类型助听器IOI-HA的得分。结果118例(86.76%)助听器使用者认为配戴助听器后对生活有中等程度以上的帮助;130例(95.6%)助听器使用者认为使用助听器后生活满意度有中等及以上提高;每天使用时间及参与社会活动时仍存在的困难不同年龄段之间的平均得分不同,且差异具有统计学意义(P<0.05),随着年龄的增加,以上两个项目的平均得分逐渐减少;不同文化程度、听力损失程度、听阈曲线图类型的听力障碍患者配戴助听器使用效果组间差异无统计学意义。结论助听器使用者对配发的助听器总体较为满意,使用情况良好;助听器使用时,还要大力提倡坚持配戴、及早干预;加强对助听器配戴者回访的管理,对于助听器使用中的不足与问题应及时调试。     

干细胞移植治疗噪声性和药物性聋的比较实验研究

目的：比较耳蜗干细胞移植治疗噪声性聋豚鼠和药物性聋豚鼠模型的效果。方法选用清洁级健康成年纯白红目豚鼠120只,建立噪声性聋模型耳蜗干细胞移植组、噪声性聋模型空白对照组、药物性聋模型耳蜗干细胞移植组、药物性聋模型空白对照组,每组30只;向噪声性聋模型耳蜗干细胞移植组和药物性聋模型耳蜗干细胞移植组耳蜗分别注入耳蜗干细胞悬液10μl,向噪声性聋模型空白对照组和药物性聋模型空白对照组耳蜗分别注入10μl 生理盐水。于术后7、28、56 d 进行 ABR 检测并进行免疫荧光观测 Nestin 阳性细胞数和 MyosinⅦA阳性细胞数。结果在噪声性聋和药物性聋耳蜗干细胞移植组的耳蜗鼓阶处观测到 Nestin 阳性细胞和 MyosinⅦA 阳性细胞,但噪声性聋干细胞移植组的 Nestin 阳性细胞和 MyosinⅦA 阳性细胞数量多于药物性聋干细胞移植组;耳蜗干细胞移植后噪声性聋和药物性聋组 ABR 反应阈均下降,但术后28天和56天噪声性聋干细胞移植组ABR 阈值分别为52．61±5．14和40．39±4．59 dB SPL,低于药物性聋干细胞移植组（分别为66．39±4．77和60．41±4．17 dB SPL）。结论耳蜗干细胞移植对于噪声性聋豚鼠模型的治疗效果优于药物性聋豚鼠模型。     

Changing characteristics of first-time hearing aid applicants in The Netherlands in the past decade

This study assessed changes in the characteristics of first-time hearing aid applicants in the past decade. Age, gender, date, type and ear of first hearing aid and audiometry were determined for a sample of 705 first-time hearing aid applicants. Thirteen cohorts resulted, according to the year of first visit to the dispenser. Differences in age, hearing loss, gender and type and ear of first hearing aid between cohorts were analysed. The mean age of first-time hearing aid users increased from 59.52 years in 1987 to 71.84 years in 1999. The mean pure-tone average hearing loss in the better ear (1, 2 and 4kHz) decreased from 69.06 dB in 1987 to 51.86dB in 1999. Relatively more males than females were fitted with hearing aids. Our conclusions are that people are being fitted with hearing aids at older ages and with smaller degrees of hearing loss.     

中度和重度聋儿助听后早期听觉能力及言语可懂度发育

目的：评价耳聋儿童助听后1年内听觉及言语能力发展变化趋势,探讨耳聋程度对聋儿的听觉及言语发育水平的影响,为聋儿的有效康复提供临床参考资料。方法：患儿29例,男19例,女10例。助听器选配年龄3～8岁,平均5．6岁。根据听力损失程度将患儿分为中度听力损失组（14例）和重度听力损失组（15例）。分别使用听觉行为分级（CAP）和言语可懂度分级（SIR）问卷在助听前及助听后1、3、6、9、12个月时对患儿的听觉能力及言语可懂度发育情况进行评估。结果：经单因素方差分析,中度和重度聋患儿CAP平均得分在助听前差异有统计学意义（P〉0．05）。在助听后1、3、6、9、12个月均差异无统计学意义（P〉0．05）。同样中度和重度聋患儿SIR平均得分在助听前差异有统计学意义（P〈0．05）。在助听后1、3、6、9、12个月均差异无统计学意义（P〉0．05）。中度聋患儿cAP平均得分助听前与助听后6、9、12个月差异有统计学意义（P〈0．05）。中度聋患儿SIR平均得分助听前与助听后6、9、12个月差异有统计学意义（P〈0．05）;助听后1个月与12个月差异有统计学意义（P〈0．05）。重度聋患儿CAP平均得分助听前与助听后3、6、9、12个月差异有统计学意义（P〈0．05）,助听后1个月与9、12个月差异有统计学意义（P〈0．05）。重度聋患儿SIR平均得分助听前与助听后3、6、9、12个月差异有统计学意义（P〈0．05）,助听后1个月与6、9、12个月差异有统计学意义（P〈0．05）。结论：中度和重度聋组患儿助听后1年内早期听觉及言语能力有显著提高,但各自有不同的发育特点和规律。     

Changes in hearing aid use over the past 20 years

The aim of this study was to find out how the use of hearing aids has been affected by the changes in hearing rehabilitation, hearing aids and society over the past 20 years. Seventy-six first-time hearing aid users were interviewed at their homes, and the results were compared with those of an earlier study made with the same method in 1983 in Finland involving both new and experienced hearing aid users. Hearing aid use and handling skills as well as satisfaction with the hearing aid were explored with interviews using the same questions in both studies. The number of first-time hearing aid users who did not use their hearing aids had decreased from 33.3% in 1983 to 5.3% at the present. Conversely, the number of regular users rose from 40.9 to 56.6%. The use of hearing aids was increased. The users were better able use their hearing aids and were more satisfied with them and the number of those who considered the counseling provided sufficient had also increased.