感音神经性聋人和正常人纯音刺激脑功能区BOLD-fMRI研究

目的:利用血氧水平依赖效应功能磁共振成像(blood oxygenation level dependent-functional magnetic resonance imaging,BOLD- fMRI)观察正常人和感音神经性聋人在纯音刺激时脑听觉中枢的兴奋情况。比较两组间的差异。方法:正常人和聋人受试者各30名。功能成像采用组块设计。声音刺激用1000Hz纯音,强度(sound pressure level,SPL)140dB,持续时间500ms,刺激间隔500ms, 刺激施加频率1Hz。结果:正常人接受纯音刺激激活脑区有:两侧颞横回、颞平面前极、颞平面、外侧裂周围的中央前回、中央后回、颞上回(除颞横回、颞平面前极、颞平面以外的部分)、缘上回、额下回、以及两侧枕叶和小脑半球。聋人纯音激活脑区与正常人相似。对正常人和聋人各脑区的激活强度行t检验,表现为正常人激活强度显著高于聋人的脑区有:两侧颞横回、颞平面前极及额下     

感音性聋和正常人纯音刺激磁源成像研究

感音性聋的听觉研究具有很大的理论和临床价值。磁源成像（magnetic source imaging，MSI）是一种新兴的脑功能成像方法，其通过脑磁图（magnetoencephalography，MEG）测量脑神经电流产生的生物磁场而获得神经元兴奋的信息，并与核磁共振解剖图像叠加进行空间定位。本研究用MSI观察纯音刺激时正常人和感音性聋患者听觉中枢兴奋的差异。     

感音神经性聋患者听觉皮层BOLD-fMRI研究

目的利用血氧水平依赖的功能磁共振成像（blood oxygenation level dependent functional magnetic resonance imaging,BOLD—fMRI）技术观察感音神经性聋患者纯音刺激时大脑听觉皮层激活情况,探讨感音神经性聋的中枢客观检查方法。方法对22例单侧中重度感音神经性聋患者（耳聋组）和15例健康志愿者（对照组）行听觉刺激BOLD-fMRI检查,比较两组纯音刺激时听觉皮层激活的体积和信号强度。结果对照组纯音刺激单耳时,对侧听觉皮层激活体积和信号强度明显大于同侧（P〈0．01）,表现为对侧半球传导优势;耳聋组刺激健侧时健侧听觉皮层激活体积和信号强度大于患侧,但差异无统计学意义（P〉0．05）。结论感音神经性聋患者纯音刺激健耳时对侧听觉半球传导优势消失,其听觉皮层可能发生了结构重塑。     

成人感音神经性聋的听觉稳态反应反应阈与纯音听阈

目的探讨成人感音神经性聋的听觉稳态反应（auditory steady-state responses,ASSR）反应阈与纯音听阈的关系。方法选择中国医科大学附属一院耳鼻咽喉科门诊感音神经性聋的成人患者,分别进行纯音听力测试、ASSR检查,比较ASSR在0.5、1、2、4 kHz频率处的反应阈与纯音听阈的相关性及按听力损失程度比较两者的差值。结果 ASSR反应阈与纯音听阈在各频率处的相关系数分别为0.840、0.905、0.886、0.924;随着感音神经性听力损失的加重二者的差值明显缩小。随着频率的增加,两者的差值明显缩小。结论成人感音神经性聋ASSR反应阈与纯音听阈有显著相关性,随着听力损失的加重,ASSR反应阈愈接近纯音听阈,ASSR作为成人感音神经性聋听力定量诊断的客观方法有很大的临床应用价值。     

正常人及单侧感音神经性聋患者听觉皮层的fMRI研究

目的:利用功能磁共振成像技术研究正常人及单侧长期感音神经性聋患者调幅音刺激任务时听觉皮层的激活,探讨单侧长期感音神经性聋患者听觉皮层优势半球的变化及可能存在的功能重组.方法:对11例健康受试者及21例单侧长期重度感音神经性聋患者分别进行正弦调幅音任务下的功能磁共振扫描,实验刺激声音为500 Hz的载波频率,8 Hz的正弦调幅音.正常对照组分别左、右耳呈现;耳聋组于健耳呈现.采用事件相关Sparse设计采集数据以减少扫描噪音,运用SPM2软件对数据进行统计学分析,得到脑功能活动的图像.结果:正常人组单耳刺激时,对侧听觉皮层激活容积及激活强度均明显大于同侧,表现为明显的对侧半球优势;耳聋组健耳刺激时,双侧听觉皮层均有激活,但仍为对侧优势.结论:听觉中枢具有可塑性,单侧感音神经性聋患者听觉皮层存在着结构重组.     

听觉中枢功能状态对老年感音神经性听障患者听力语言康复的影响

目的探究听觉中枢功能状态对老年感音神经性听障患者听力语言康复的影响。方法选取我院2018年1月~2020年8月诊治的老年感音神经性听障患者109例,分别进行纯音测听、助听听阈测试、皮层听觉诱发电位测试及言语识别测试。以55 dB声压级(sound pressure level,SPL)下皮层听觉诱发电位P1是否全部引出波形分为A组(引出波形,n=47)和B组(未引出波形,n=62);比较两组患者纯音测听、助听听阈结果和言语识别率,分析助听听阈与听觉诱发电位P1波潜伏期、幅值的相关性。结果A组患者纯音听阈显著高于B组(P<0.05);A组在低频、中频、高频的助听听阈值均显著低于B组(P<0.05)。配戴助听器后两组患者的言语识别率均增加,且A组显著高于B组(P<0.05)。P1波幅值随着刺激强度增强逐渐降低,助听听阈随着引出P1的刺激强度增强逐渐提高。助听听阈与幅值呈显著负相关(P<0.05),与P1波潜伏期无相关性(P>0.05)。结论皮层听觉诱发电位与助听听阈测试结果具有相关性。     

功能性磁共振研究感音神经性聋的听皮层功能

感音神经性聋（sensorineural hearingloss,SNHL）是临床常见病和多发病,SNHL患者的听皮层能发生可塑性改变。近年来有关听觉的功能性磁共振成像（functionalmag netic resonanceim—age,fMRI）研究报道日益增多,它可以反映听皮层功能状态和可塑性变化。本文综述了fMRI的工作原理,影响大脑听皮层活动的因素以及运用fMRI研究SNHL患者听觉中枢的可塑性。     

单侧感音神经性耳聋患者低频振幅功能磁共振研究

目的应用低频振幅分析方法来观察长期右侧感音神经性耳聋患者静息态脑功能磁共振的改变。方法采集19例中重度右侧感音神经性耳聋患者以及20名正常听力志愿者的静息态磁共振血氧水平依赖(blood oxygenationlevel dependent,BOLD)数据采集,对BOLD数据进行后处理以获得低频振幅波动(amplitude of low-frequency fluctua-tion,ALFF)图像,并比较两组间ALFF信号的差异性。结果右侧耳聋组较正常听力对照组ALFF增加且差异具有统计学意义(P<0.05,AlphaSim校正)的脑区包括在双侧颞上中回(双侧颞横回与双侧颞极)、双侧岛叶、双侧钩回、右海马旁回以及小脑前叶。右侧耳聋组较正常听力对照组ALFF减低且差异具有统计学意义(P<0.05,AlphaSim校正)的脑区包括右侧颞中回后部。结论右侧感音神经性耳聋患者相关脑区的脑功能活动水平与正常听力人群的不同提示了耳聋后脑代偿性功能改变的存在。     

感音神经性聋患者听觉动态范围的主观测试

目的了解感音神经性聋患者平均听阈、不适阈和听觉动态范围。方法将2460例(4720耳)感音神经性聋患者分为男女两大组,每组分别按<30岁、30～60岁、>60岁分为三小组,分别进行纯音气导听阈、不适阈、听觉动态范围测试分析,测试结果以方差分析和LSD方法进行统计学处理。结果全部患耳0.5～4kHz平均听阈为73.00±21.07dB HL,平均不适阈为115.50±8.15dB HL,平均听觉动态范围为45.30±20.50dB。对男女性各组听阈、不适阈和听觉动态范围进行方差分析并用LSD方法进行两两比较差异无统计学意义(P>0.05)。男性在500、1000Hz的不适阈各组之间差异有显著统计学意义(P<0.05),女性左耳250、500Hz各组不适阈之间差异有显著统计学意义(P<0.05)。相关分析显示各频率听阈与不适阈、年龄与听阈、年龄与不适阈,年龄与听觉动态范围之间无相关性。结论听力门诊就诊的听障人士多为重度听力损失。不适阈一般不会超过116dB HL。听觉动态范围明显缩小。     

感音神经性聋的功能磁共振

感音神经性聋是临床常见病和多发病，近年来有关听觉的功能磁共振（functional magnetic resonance imaging，fMRI）研究报道日益增多，显示其潜在和广阔的临床应用前景，本文综述了感音神经性聋的听觉传导通路及听皮质的解剖学和感音神经性聋的磁共振功能成像的应用。     

多频稳态诱发电位评估中度感音神经性聋儿童的应用

目的探讨多频稳态听觉诱发电位评估儿童中度感音神经性聋的可靠性。方法所有患者经纯音测听（PTA）检查筛选出中度感音神经性聋30例5～6岁儿童（共40耳），然后口服10％水合氯醛镇静睡眠后，行多频稳态听觉诱发电位（ASSR）检测，其阈值与纯音听阂阈值进行比较，分析不同频率处听力阈值分布情况及其相关性。结果分别比较语言频率ASSR阂值与纯音听闽阈值，结果显示，0．5kHz处相关性较差，其差值为2-18dB，而在4kHz处相关性最好。结论可以应用多频稳态听觉诱发电位评估中度感音神经性聋儿童的听力阈值，但需要注意0．5kHz处的相关性差异。     

Systemic hypotension and the development of acute sensorineural hearing loss in young healthy subjects

BACKGROUND: Sudden sensorineural hearing loss (SSHL) is an acute disorder whose origin is often unclear. A vascular disorder may be a causative factor. OBJECTIVE: To determine whether hypotension influences the genesis of SSHL in healthy subjects. DESIGN: To investigate the role of a 24-hour blood pressure (BP) profile in a population of young subjects with SSHL from January 1, 1996, to December 31, 1999, by a nonrandomized controlled trial. SETTING: The Ear, Nose and Throat Section of the Department of Surgical and Anaesthesiological Sciences and the Department of Internal Medicine, S. Orsola Hospital, University of Bologna, Bologna, Italy. PATIENTS: The study population consisted of 23 untreated healthy patients diagnosed as having SSHL compared with 20 age- and sex-matched normotensive control subjects. Both groups underwent 24-hour BP monitoring, and their BP profiles were analyzed and compared with routine BP values. The data were analyzed with the Statistical Package for the Social Sciences, version 7.1, and the results are expressed as mean +/- SD. MAIN OUTCOME MEASURES: The mean BP values were expected to be lower in the study population. RESULTS: The average clinic and ambulatory BP values were significantly lower in patients with SSHL, for systolic (clinic, P =.004; ambulatory BP, P =.02) and diastolic (clinic, P =.03; ambulatory BP, P =.03) values. The occurrence of persistent hypotension (the presence of >2 consecutive recordings of systolic BP of < or =105 mm Hg and/or diastolic BP of < or =60 mm Hg) was increased in the population with SSHL. CONCLUSION: Systemic hypotension must be considered as the possible cause responsible for the development of SSHL in young healthy subjects.     

Auditory steady-state responses to multiple simultaneous stimuli in children with functional or sensorineural hearing loss

The goal of our study was to identify the role of auditory steady-state responses for hearing assessment in patients with functional hearing loss. The study design was to compare auditory steady-state response thresholds and standard pure-tone audiometry thresholds between patients with functional or sensorineural hearing loss. Subjects comprised 16 patients (24 ears) with functional hearing loss and 17 patients (24 ears) with sensorineural hearing loss. Differences and correlations between auditory steady-state response thresholds and standard pure-tone audiometry thresholds at 500, 1,000, 2,000 and 4,000 Hz were evaluated. In children with functional hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds were significantly different at all frequencies and were not significantly correlated. In patients with sensorineural hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds did not differ significantly at any frequencies and were significantly correlated. Auditory steady-state responses may have principal role in the assessment of auditory brainstem acuity, particularly at low frequencies in patients with functional hearing loss.     

成人感音神经性聋听觉稳态诱发反应阈值与纯音听阈值比较

目的：测定成人感音神经性聋患者听觉稳态诱发反应（ASSR）和纯音听阈值,为临床诊断提供客观依据。方法：选成人感音神经性聋患者33例（65耳）,行ASSR阈值纯音听测试。结果：ASSR、纯音听阈值对比有统计学意义,听阈有显著相关性,0．5、1．0、2．0、4．0kHz频区间相关系数分别为：0．769、0．772、0．743、0．756。ASSR阈值较行为阈值高,ASSR阈值与纯音听阈间差值多在3．0～10．0dB HL之间。在0．5、1．0、2．0、4．0kHz频区间分剐为：4．77、8．83、6．49、3．67dB HL,随频率增高,两者的差异有缩小趋势。结论：成人感音神经性聋患者ASSR阈值与纯音听阈间对比有统计学意义,通过测试ASSR阈值可推断出被检查者纯音听阈的阈值。