三组新生儿的诱发性耳声发射的检测分析

目的　研究新生儿的畸变产物耳声发射 (DPOAE)和瞬态诱发耳声发射 (TEOAE)的特点 ,评价其在新生儿听力筛选中的作用。方法　应用Capella耳声发射分析仪对正常新生儿组、剖腹产儿组、新生儿监护病房组三组新生儿进行DPOAE、TEOAE检测。结果　得出正常新生儿的诱发性耳声发射 (EOAE)的正常参考值和正常新生儿的DPOAE图 ;三组新生儿EOAE筛查的通过率分别为 96.1% (12 3 / 12 8)、90 .8% (10 9/ 12 0 )、81.6% (93 /114 ) ,其中新生儿监护病房组的通过率与前两组比较有统计学意义 (P <0 .0 1) ;各组间DPOAE与TEOAE的筛查通过率差异均有统计学意义 (P <0 .0 1) ;正常新生儿与剖腹产儿的DPOAE的幅值和信噪比差异无统计学意义(P >0 .0 5)。结论　在病房内 (非隔音 )进行听力筛选时 ,可明显降低假阳性率 ;剖腹产因素对新生儿耳声发射未见影响 ;对高危新生儿进行听力筛选更有意义     

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。     

听力正常型耳鸣者DPOAE的特征

目的　探讨听力正常型耳鸣病人畸变产物耳声发射 (DPOAE)的临床特征。方法　对听力正常型耳鸣患者及无耳鸣听力正常者进行DPOAE测试 ,并进行对比。结果　DPOAE引出率二组均为 10 0 % ,幅值耳鸣组下降 ,高频段 (3～ 8kHz)二组差异有统计学意义 (P <0 .0 5)。结论　听力正常型耳鸣的发生可能与耳蜗外毛细胞的早期损伤导致超高频听力损失有关 ,DPOAE检测可能成为耳蜗早期改变或耳鸣发生发展的监测方法     

听力正常耳鸣患者的畸变产物耳声发射测试

目的探讨畸变产物耳声发射(DPOAE)对听力正常耳鸣患者的检测意义. 方法采用ILO96耳动态分析仪对26例(46耳)听力正常耳鸣患者进行DPOAE检测. 结果在听力正常耳鸣患者中,DPOAE正常率为63.04%(29/46耳),DPOAE异常率为36.96%(17/46耳).在DPOAE异常的17耳中,耳鸣频率与DPOAE反应幅值下降频率范围基本对应的有9耳(52.94%),有8耳(47.06%)不完全对应,但较接近. 结论对听力正常耳鸣患者进行DPOAE检测可以早期发现耳蜗存在的轻微损伤,对指导临床治疗,防止耳蜗病变进一步发展具有临床意义.     

正常出生新生儿瞬态诱发耳声发射与畸变产物耳声发射听力筛查结果比较

目的 探讨瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)和畸变产物耳声发射(distortion products otoacoustic emissions,DPOAE)用于新生儿听力筛查特点,为正常出生新生儿听力筛查方法的选择提供参考.方法 于出生后48~72小时,对1 062例正常出生的新生儿分别使用TEOAE和DPOAE进行听力初筛,其中135例未通过初筛者,在42天龄左右,同时进行TEOAE和DPOAE复筛;复筛未通过者3月龄左右进行诊断型听性脑干反应测试. 结果 1 062例新生儿中TEOAE初筛未通过率为11.02%(117/1 062),DPOAE未通过率为13.65%(145/1 062);135例进行了复筛,TEOAE和DPOAE未通过率分别为17.78%(24/135)和20.74%(28/135),DPOAE初、复筛未通过率均高于TEOAE,差异均有统计学意义(P<0.001);TEOAE和DPOAE在初筛和复筛中的一致率分别为96.04%和95.56%,kappa值分别为0.817和0.857.在初筛中TEOAE每耳的平均测试时间为24±25 s,DPOAE为40±34 s;在复筛中TEOAE为52±41 s,DPOAE为73±62 s,配对样本t检验显示两种方法的测试时间差异有统计学意义(P=0.000).复筛的135例中,共有7例(10耳)最终被诊断为不同程度的传导性听力损失(9耳)及感音神经性听力损失(1耳),这10耳TEOAE和DPOAE初、复筛均未通过. 结论 作为正常出生新生儿的听力筛查方法,TEOAE较DPOAE未通过率低,耗时少;作为新生儿听力筛查工具,TEOAE可能比DPOAE有优势.     

听力正常耳鸣患者的畸变产物耳声发射测试

目的:探讨畸变产物耳声发射(DPOAE)对听力正常耳鸣患者的检测意义。方法:采用ILO96耳动态分析仪对26例(46耳)听力正常耳鸣患者进行DPOAE检测。结果:在听力正常耳鸣患者中,DPOAE正常率为63.04%(29/46耳),DPOAE异常率为36.96%(17/46耳)。在DPOAE异常的17耳中,耳鸣频率与DPOAE反应     

不同月龄婴儿声反射与畸变产物耳声发射测试结果分析

目的探讨不同月龄婴儿226 Hz和1000 Hz探测音的中耳声反射测试与畸变产物耳声发射（DPOAE）联合筛查的意义。方法测试对象为来泸州医学院附属医院进行听力筛查或复查的188例（350耳）3天～12月龄的婴儿,分为3天～1月龄组（125耳）,2～3月龄组（89耳）,4～6月龄组（76耳）,7～12月龄组（60耳）,分别进行226、1000Hz探测音声导抗,畸变产物耳声发射测试,对226、1000Hz探测音中耳声反射引出率和DPOAE的通过率进行比较分析。结果3天～1月龄组226、1000Hz探测音声反射引出率和DPOAE的通过率分别为81％、69％、73％;2～3月龄组分别为91％、72％、74％;4～6月龄组分别为90％、83％、79％;7～12月龄组分别为43％、66％、60％。226Hz声反射引出率与DPOAE通过率差异有统计学意义（P〈0．01）,1000Hz声反射引出率与DPOAE通过率差异无统计学意义（P〉0．05）,并且DPOAE筛查结果与1000Hz探测音的声反射结果较一致。结论1000Hz探测音声导抗测试对婴儿中耳功能的诊断价值比226Hz探测音的敏感性更高,与DPOAE协同用于婴儿听力筛查具有良好的临床价值。     

畸变产物耳声发射在豚鼠庆大霉素中毒性耳聋早期监测中的作用

目的 研究畸变产物耳声发射（DPOAE）在豚鼠庆大霉素（gentamycin,GM）中毒性耳聋早期监测中的作用.方法经畸变产物耳声发射检测及耳廓反射正常的豚鼠16只（31耳）随机分成两组.GM组8只（16耳）每天肌肉注射GM100 mg/kg,连续10天;对照组8只（15耳）肌肉注射等量0.9%生理盐水10天.每组在肌肉注射前、注射第3、7天测试DPOAE,对1、2,4、6 kHz的DPOAE幅值进行比较分析.结果①对照组豚鼠在肌肉注射0.9%生理盐水的第3、7、10天与注射前比较,DPOAE引出率为100%,1、2,4、6 kHz的幅值差异无统计学意义（P＞0.05）.②GM组在肌肉注射庆大霉素第3天DPOAE的幅值与注射前及对照组比较,4、6 kHz处幅值差异有统计学意义（P＜0.05）;肌肉注射庆大霉素第7天,2,4、6 kHz处幅值差异有统计学意义（P＜0.05）.结论肌肉注射庆大霉素第3天即可发现豚鼠DPOAE 4 kHz以上的高频听力损害,第7天发现4 kHz以下的低频听力损害.     

儿童DPOAE测试不同搜索时间的比较及意义

目的探讨不同搜索时间对儿童DPOAE测试的影响。方法将50例(100耳)受试儿分为A组(30例60耳,听力正常)和B组(20例40耳,听力异常),Madsen Capella耳声发射仪搜索时间设定为10秒、100秒分别对两组进行DPOAE检测,比较两组不同搜索时间的检出率和实际检测所用时间。结果搜索时间为10秒、100秒时,A组DPOAE检出率均为100%,实际所用时间分别为48秒和53秒,差异无统计学意义(P>0.05);B组DPOAE检出率分别为2%和1%,差异无统计学意义(P>0.05),设定搜索时间为10秒时每耳平均所需时间67秒,显著短于搜索时间为100秒时平均所需时间590秒(P<0.01)。结论设定搜索时间为10秒时进行DPOAE测试对引出率无影响,但能显著缩短听力障碍儿童检测所用时间。     

畸变产物耳声发射在重度阻塞性睡眠呼吸暂停综合征中的特点及其临床意义

目的 观察并评估畸变产物耳声发射(DPOAE)检查在重度阻塞性睡眠呼吸暂停综合征(OSAS)患者中的特点并分析其临床意义.方法 选择60例经睡眠呼吸监测确诊为重度OSAS的患者为实验组,年龄、性别与实验组相匹配的正常人群15例作为对照组.应用耳声发射检测仪对两组进行DPOAE检查、纯音测听检查,对睡眠监测及DPOAE检测结果进行分析、比较.结果 重度OSAS患者主观听力无下降,但DPOAE在0.75～8kHz各频率反应幅值较正常对照组明显降低,与正常组比较,其结果有显著性差异;DPOAE反应幅值与血氧饱和度降低及呼吸紊乱指数具有显著的相关性.结论 大部分重度OSAS病人存在不同程度的耳蜗损害,主要表现为畸变产物耳声发射反应幅值的降低,该指标敏感性高,可以作为评估重度OSAS患者早期耳蜗损害的一项指标.     

Predicting severity of cochlear hair cell damage in adult chickens using DPOAE input-output functions

Distortion product otoacoustic emissions (DPOAE) were recorded from the ear canal of aged broiler chickens which have been shown to present with age-related cochlear degeneration [Hear. Res. 166 (2002) 82]. We describe the relationship between the shape of the DPOAE input-output (I/O) function and the type of hair cell damage present at and between the cochlear frequency places of the DPOAE primary tones (f1 and f2). The mid stimulus level compressive growth of the mean DPOAE I/O functions is reduced in a graded fashion relative to the severity of hair cell damage. However, individual DPOAE I/O functions within most hair cell damage groups show large variability from this characteristic. Various least squares regression models were used to predict hair cell density from indices derived from the DPOAE I/O function (area, threshold and slope). The results showed that no simple linear relationship exists between hair cell density and the DPOAE I/O function indices. Multivariate binary logistic regression used DPOAE I/O function indices to predict membership in hair cell damage groups. The logistic model revealed that DPOAE threshold can be used to predict the occurrence of severe/total hair cell damage with good specificity though poor sensitivity.     

Diagnostics of the cochlear amplifier by means of distortion product otoacoustic emissions

Distortion product otoacoustic emission (DPOAE) growth functions reflect the active nonlinear cochlear sound processing when using a primary-tone setting which accounts for the different compressions of the two primaries at the DPOAE generation site and hence provide a measure for objectively assessing cochlear sensitivity and compression. DPOAE thresholds can be derived from extrapolated DPOAE input/output (I/O) functions independently of the noise floor and consequently can serve as a unique measure for reading DPOAE measurements. The thus-estimated DPOAE thresholds exhibit a close correspondence to behavior audiometric thresholds and thus can be used for reconstructing an audiogram, i.e., a DPOAE audiogram. The DPOAE I/O functions' slope increases with cochlear hearing loss and thus provides a measure for assessing recruitment. Hence, DPOAE I/O functions can give more information for diagnostic purposes than those of DP grams, transiently evoked OAEs (TEOAEs), or auditory brain stem responses (ABRs). DPOAE audiograms can be applied in pediatric audiology to assess cochlear dysfunction in a couple of minutes. In newborn hearing screening, they are able to detect transitory sound-conductive hearing loss and thus can help to reduce the rate of false-positive TEOAE responses in the early postnatal period. Since DPOAE I/O functions are correlated with loudness functions, DPOAEs offer the possibility of basic hearing aid adjustments, especially in infants and children. Extrapolated DPOAE I/O functions provide a tool for a fast automated frequency-specific and quantitative evaluation of hearing loss.     

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。     

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（ｄｉｓｔｏｒｔｏｎ ｐｒｏｄｕｃｔ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｉｓｓｉｏｎ，ＤＰＯＡＥ）的输入－输出（Ｉ／Ｏ）曲线的测试和分析。结果 重振检测阳性患耳不同频率ＤＰＯＡＥ的Ｉ／Ｏ曲线斜率     

Correlation between DPOAE I/O functions and pure-tone thresholds

Different studies have been carried out in order to correlate audiometric thresholds and distortion product otoacoustic emissions measurements (DPOAE). However, high variability and external interferences make hearing thresholds estimates by means of the DPOAE very little sensitive. The aim of this study was to check the correspondence between the pure tone thresholds and the cochlear response thresholds by DPOAE Input/output functions, considering the influence of the following variables: gender, past of acute otitis media, and ear side.MethodProspective study comprehending 69 normal hearing individuals. Multiple mix regression models were applied to evaluate the correspondence between the two measurements studied.ResultsStatistically significant positive correlation was observed among all the frequencies compared (2000, 3000, 4000 e 6000 Hz).ConclusionsThe 1dB HL resolution pure tone thresholds and the above-mentioned variables had a direct impact on the high correlation between the measures studied, and it also reduced response variability. Nevertheless, response variability was still high, limiting the use of DPOAE I/O functions for hearing threshold estimates. We suggest that these variables should be considered for future studies with pure tone thresholds estimations by DPOAE I/O functions.     

Analysis of the distortion product otoacoustic emission (DPOAE) and input/output function (I/O) in tinnitus patient with normal hearing

Distortion Product Otoacoustic Emission (DPOAE) has been used as a tool to determine the presence of cochlear pathology. It is well known that the damage of Outer Hair Cells (OHCs) results in reduced auditory sensitivity and generation of tinnitus. At the same time tinnitus arises in normal hearing persons as well. The aim of this study was the assessment of the DPOEA amplitude and the behavior of DP I/O function in tinnitus patients with normal hearing threshold. The group of 48 tinnitus patients (92 ears) with normal hearing threshold and the control group of 30 normal hearing patients (40 ears) were investigated for this study. All subjects have undergone the measurement of DPOAE and DP I/O functions for frequencies: 1000, 2000 and 4000 Hz. In the tinnitus group there were observed the decrease in DPOAE amplitude for some frequencies and the steeper slope of I/O function. This means that the places with localized damage or dysfunction of OHCs on the basilar membrane can be responsible for the origin of tinnitus.     

Influence of ultrahigh-frequency hearing thresholds on distortion-product otoacoustic emission levels at conventional frequencies

This study examined the association between ultrahigh-frequency (UHF) hearing sensitivity and distortion-product otoacoustic emission (DPOAE) levels at conventional frequencies. Behavioral thresholds were measured from 2 through 16 kHz, and DPOAE levels were measured at discrete f2 frequencies between 2 through 8 kHz in 553 young normal-hearing adult male participants. A DPOAE frequency sweep was measured with primary stimulus levels of L1/L2 = 65/55 dB SPL and an f2/f1 of 1.2. Significant negative correlations, although weak, were found between UHF behavioral thresholds and DPOAE levels. As UHF behavioral thresholds worsened, DPOAE levels decreased at all frequencies. When the data were categorized into two groups, "better" and "worse" UHF behavioral thresholds, significant differences were apparent between the two groups for DPOAEs. Additionally, those with better UHF thresholds had better conventional thresholds compared to those in the worse UHF threshold group. The results of this age-restricted, large-sample-size study confirm and augment findings from earlier studies demonstrating that UHF hearing sensitivity has some influence on DPOAE measures at frequencies from 2 through 8 kHz with moderate stimulus levels. However, because those with better UHF thresholds also had better conventional thresholds and the significant correlations found were weak, this work supports the importance of UHF hearing testing in conjunction with otoacoustic emission measures to identify basal cochlear insults not evident from behavioral testing at conventional frequencies.     

水杨酸钠急性注射对清醒豚鼠畸变产物耳声发射的影响

目的研究急性注射水杨酸钠对清醒豚鼠畸变产物耳声发射（DPOAE）的影响及其特征，探讨其对外毛细胞（OHC）的毒性作用。方法采用CELESTA 503型耳声发射分析仪在清醒豚鼠上记录DPOAE（包括DP听力图及DP输入／输出函数曲线）来监测水杨酸钠对耳蜗及毛细胞功能的影响；急性水杨酸钠实验组及生理盐水对照组分别在注药前及注药后2、4、8h进行DPOAE测试；测试结果采用SPSS10．0统计软件进行分析。结果急性水杨酸钠注射主要引起DPOAE幅值和I／O斜率分别可逆性下降和升高，注射后2h变化最大，8h基本恢复；某些频率或强度的DPOAE幅值、I／O斜率在注药后与注药前结果有统计学差异（P〈0．01或P〈0．05），特别是8kHz。结论DPOAE幅值和I／O斜率分别叮逆性下降和升高表明OHC能动性下降，即耳蜗OHC功能改变为其耳毒性作用之一。     

Reference data for DPOAE in healthy newborns

Distortion Product Otoacoustic Emissions (DPOAE) can be used as an alternative to Transient Evoked Otoacoustic Emissions (TEOAE). This study aims to establish normal values for DPOAE in healthy newborns. DPOAE were determined with the Madsen Celesta 503 at 0.5, 1, 2, 4 and 8 kHz with an unequal stimulus level of the primaries (L1 = 65 dB SPL, L2 = 50 dB SPL). DPOAE were present in 92.4% of the ears of the 185 babies tested at 4 days after birth. The 5% quantile and the median of the DPOAE of the right and left ears were calculated for the five frequencies tested. At 4 kHz there was a significant sex effect (mean amplitude of DPOAE was higher in female than in male babies) and at 2 kHz a significant interaction effect was found between sex and side. The calculated reference limits are open to comparison with data obtained using other commercial equipment.     

Evaluation of glycerol test in Meniere's disease with pure tone audiometry and distortion product otoacoustic emission

The purpose of the work was to follow up changes in the pure tone audiometry and distortion products otoacoustic emissions (DPOAE) after glycerol administration in Meniere's patients. Twenty patients with Meniere's disease and 16 with cochlear hearing loss without vestibular symptoms were subjected to the glycerol test following the complete audiological evaluation. Glycerol was administered orally 1.5 ml/kg of body weight dissolved in the equal amount of the physiological saline. The results of the glycerol test were analyzed with reference to changes in the pure tone threshold and DPOAE testing. Both investigations were performed in four series: as an initial testing before the glycerol intake and next--one, two and three hours after the glycerol administration. DPOAE included DP-gram registration (L1 = L2 = 70 dB; f2/f1 = 1.22; 1/2 octave) and input/output (I/O) function at 2, 4 and 6 kHz. The glycerol test was regarded as positive in the audiometry if the pure tone threshold improved at least 15 dB at minimum 3 frequencies. Positive result of the glycerol test in DPOAE was judged if DP amplitude increased more than 5dB at 2 or more frequencies in DP-gram and/or DP-threshold lowered at least 10dB in minimum two I/O registrations. In the subjects with Meniere's disease, 11 positive and 9 negative glycerol tests in audiometry and 10 positive and 10 negative DPOAE glycerol tests were obtained. In the reference group, one audiometric glycerol test and two DPOAE glycerol tests were regarded as positive. Much conformity, making 85%, between audiometric and DPOAE tests results is observed. The dynamics of the parameter changing in the consecutive test hours was also similar in both pure tone audiometry and DPOAE. These studies suggest that distortion product otoacoustic emission could be useful in diagnostics of Meniere's disease and would be a valuable diagnostic tool as an objective examination.