Transient evoked otoacoustic emissions in the elderly

The purpose of this study was to analyse the changes in transient evoked otoacoustic emissions (TEOAEs) with age. We studied 232 subjects above 60 years of age with a battery of audiological tests, including TEOAEs Our criterion for the presence of TEOAEs was based on a cut-off at overall wave reproducibility 55% or overall response level 4 dB SPL. The prevalence of TEOAEs in left ears was 55.6%. No TEOAEs were found in subjects with a pure-tone average (PTA) above 40 dB HL. In the subgroup with TEOAEs, a significant decrease in overall wave reproducibility with age was found. We compared 45 normal-hearing elderly subjects with TEOAEs with a control group of 20 normal-hearing young adults The elderly had significantly lower mean overall response levels and mean overall wave reproducibility. Average hearing level was significantly higher in the elderly than in controls We conclude that the prevalence of TEOAEs decreases with age, and that the overall response level and overall reproducibility decrease with age. This decrease may not be seen in isolation from the increase in hearing threshold level.     

Auditory pathway in rheumatoid arthritis. A comparative study and surgical perspectives

CONCLUSION: Rheumatoid arthritis (RA) patients present with both conductive and sensorineural deafness. OBJECTIVE: To evaluate the prevalence and features of hearing impairment in patients with RA. MATERIAL AND METHODS: A total of 28 RA patients underwent a rheumatological evaluation, including determination of rheumatoid factor, protein 2-glycoprotein I level and the Lee index. An audiological assessment consisting of pure-tone audiometry (PTA) and determination of auditory brainstem responses (ABRs) and transient evoked otoacoustic emissions (TEOAEs) was performed. The results were compared with those of 28 age- and sex-matched healthy subjects. Four selected RA patients underwent stapedectomy; PTA and TEOAEs were evaluated 6 months postoperatively. RESULTS: Increased air conduction thresholds at 250, 500 and 1000 Hz were found in RA subjects in comparison to controls (p<0.001). RA patients showed higher air-bone gaps in PTA (p<0.05) and an increased Wave I latency in ABRs (p=0.03). Decreased reproducibility (p<0.001) and amplitude (p<0.001) of TEOAEs were found in RA subjects in comparison to controls. A significant correlation between disease duration and echo amplitude was noticed (r=0.389). After stapedectomy, a reduction in the air-bone conduction gap (11 vs 2 dB HL) was noticed; no significant difference in TEOAEs was found.     

Identification of neonatal hearing impairment: summary and recommendations

OBJECTIVES: This article summarizes the results of a multi-center study, "Identification of Neonatal Hearing Impairment," sponsored by the National Institutes of Health. The purpose of this study was to determine the performance characteristics of three measures of peripheral auditory system status, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABR), applied in the neonatal period in predicting hearing status at 8 to 12 mo corrected age. DESIGN: The design and implementation of this study are described in the first two articles in this series. Seven institutions participated in this study; 7179 infants were evaluated. Graduates of the neonatal intensive care unit and well babies with one or more risk factors for hearing loss were targeted for follow-up testing using visual reinforcement audiometry (VRA) at 8 to 12 mo corrected age. Neonatal test performance was evaluated using the VRA data as the "gold standard." RESULTS: The major results of the study are described in the nine articles preceding this summary article. TEOAEs in response to an 80 dB pSPL click, DPOAEs in response to L1 = 65 and L2 = 50 dB SPL and ABR in response to a 30 dB nHL click performed well as predictors of permanent hearing loss of 30 dB or greater at 8 to 12 mo corrected age. All measures were robust with respect to infant state, test environment and infant medical status. No test performed perfectly. CONCLUSIONS: Based on the data from this study, the 1993 National Institutes of Health Consensus Conference-recommended protocol-an OAE test followed by an ABR test for those infants failing the OAE test-would result in low referral rate (96 to 98%). TEOAEs for 80 dB pSPL, ABR for 30 dB nHL and DPOAEs for L1 = 65 dB SPL and L2 = 50 dB SPL perform well in predicting hearing status based on the area under the relative operating characteristic curve. Accuracy for the OAE measurements are best when the speech awareness threshold or the pure-tone average for 2.0 kHz and 4 kHz are used as the gold standard. ABR accuracy varies little as a function of the frequencies included in the gold standard. In addition, 96% of those infants returning for VRA at 8 to 12 mo corrected age were able to provide reliable ear-specific behavioral thresholds using insert earphones and a rigorous psychophysical VRA protocol.     

Effects of Piezosurgery® on the cochlear outer hair cells

Conclusions. The absence of audiologic side effects highlights the reduced trauma of the piezoelectric cut, demonstrates the superiority of the Piezosurgery® device in terms of safety and protection of anatomical structures and confirms its applicability in all the otologic techniques tested. Objectives. The aim of the present study was to estimate the effect of Piezosurgery® on the cochlea and in particular on the cochlear outer hair cells. Patients and methods. We selected 60 patients with a history of otologic surgery with Piezosurgery®. Before and 6 months after surgery, all the patients underwent the following instrumental examinations: pure-tone audiometry, tympanometry, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs) and auditory brainstem response (ABR). Results. Piezosurgery® showed its safety on the inner ear and in particular on the cochlear outer hair cells: for each instrumental examination (pure-tone audiometry, tympanometry, TEOAE, DPOAEs and ABR), no patients presented postoperative worsening.     

Is the Presence of Transient Evoked Otoacoustic Emissions in Ears With Acoustic Neuroma Significant

One hundred sixty-eight patients admitted for acoustic neuroma removal were involved in this study. In all cases, the size of the tumor and the presence or absence of tinnitus and vertigo or dizziness were evaluated. Investigated functional procedures included bilateral measures of pure-tone audiometry (PTA), auditory brainstem response (ABR), electronystagmography (ENG), and transient evoked otoacoustic emissions (TEOAEs). Thirty-five patients (21%) had normal preoperative TEOAEs in the affected ear, whereas 133 patients (79%) failed to show reproducible responses. The aims of this study were 1. to evaluate what distinguishes patients with preoperative TEOAEs in the pathological ear (group A) from those who had no TEOAE (group B); and 2. to determine in cases of attempted hearing preservation whether preoperative TEOAE presence in the neuroma ear (group C) was predictive of postoperative hearing preservation compared with the group of patients without TEOAEs (group D). The presence of vertigo or dizziness was significantly less frequent, the age was lower, and preoperative mean PTA loss in both ears was lower in group A compared with group B. Frequency of the other studied parameters and ABR threshold were similar in both groups. When hearing preservation was attempted, the mean preoperative PTA loss of group C patients was lower in both ears compared with group D. However, postoperative mean PTA loss did not significantly differ in the two groups. In group C, the percentage of hearing preservation (66.6%) was significantly higher than the percentage of deafness (33.4%), whereas in group D the percentage of postoperative preserved audition and deafness did not significantly differ (respectively 44.4% and 55.6%). The findings suggest that 1. TEOAEs in ears with acoustic neuromas are found in younger patients with a lower preoperative mean PTA loss and are accompanied by fewer functional complaints, perhaps because preserved TEOAEs indicate a better preservation of inner ear vasculature; and, 2. along with radiological and electrophysiological investigations, TEOAE presence in the pathological ear could provide an additional criterion or predictive factor for the successful outcome of attempted hearing-conservation surgery in ears with acoustic neuromas.     

Audiologic presentation of cerebellopontine angle cholesteatoma

OBJECTIVE: The aim of this study was to examine the audiologic presentation of patients with cerebellopontine angle (CPA) cholesteatoma. DESIGN: Retrospective case review. SETTING: Neuro-otologic tertiary referral centre. METHODS: The study population consisted of 11 patients with CPA cholesteatomas. The patients underwent a standard audiologic investigation in the preoperative setting, which consisted of pure-tone audiometry, speech audiometry, and auditory brainstem response (ABR). MAIN OUTCOME MEASURES: The audiologic parameters that were analyzed were the pure-tone threshold, pure-tone average (PTA), and speech discrimination scores (SDSs). The morphology and latency of the ABR were evaluated. In addition, the clinical and radiologic presentations of the lesions were reviewed. RESULTS: The mean PTA in the diseased ear was 22.6 dB HL (SD 18.2), whereas in the contralateral ear, it was 19.1 dB HL (SD 19.6). In 4 patients, the hearing loss was asymmetric, with the diseased ear being the worse ear. The mean SDS was 82.28% in the affected ear and 95.28% in the contralateral ear. ABR was abnormal in 9 of 10 cases (90%), with only the affected ear being abnormal in 4 cases. In the other 5 cases, the ABR was bilaterally abnormal. CONCLUSIONS: CPA cholesteatomas are very slow-growing lesions that involve the eighth cranial nerve. The paucity and insidious onset of symptoms mean that the diagnosis is often late, permitting the lesions to reach impressive dimensions at the time of diagnosis. Although magnetic resonance imaging represents the gold standard in the diagnosis of these lesions, ABR proved to be of value in the assessment of the auditory pathway, especially in those patients referred with a vague symptomatology and with normal hearing.     

Identification of neonatal hearing impairment: evaluation of transient evoked otoacoustic emission, distortion product otoacoustic emission, and auditory brain stem response test performance

OBJECTIVES: The purpose of this study was to compare the performance of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABRs) as tools for identification of neonatal hearing impairment. DESIGN: A total of 4911 infants including 4478 graduates of neonatal intensive care units, 353 well babies with one or more risk factors for hearing loss (Joint Committee on Infant Hearing, 1994) and 80 well babies without risk factor who did not pass one or more neonatal test were targeted as the potential subject pool on which test performance would be assessed. During the neonatal period, they were evaluated using TEOAEs in response to an 80 dB pSPL click, DPOAE responses to two stimulus conditions (L1 = L2 = 75 dB SPL and L1 = 65 dB SPL L2 = 50 dB SPL), and ABR elicited by a 30 dB nHL click. In an effort to describe test performance, these "at-risk" infants were asked to return for behavioral audiologic assessments, using visual reinforcement audiometry (VRA) at 8 to 12 mo corrected age, regardless of neonatal test results. Sixty-four percent of these subjects returned and reliable VRA data were obtained on 95.6% of these returnees. This approach is in contrast to previous studies in which, by necessity, efforts were made to follow only those infants who "failed" the neonatal screening tests. The accuracy of the neonatal measures in predicting hearing status at 8 to 12 mo corrected age was determined. Only those infants who provided reliable, monaural VRA test results were included in the analysis. Separate analyses were performed without regard to intercurrent events (i.e., events between the neonatal and VRA tests that could cause their results to disagree), and then after accounting for the possible influence of intercurrent events such as otitis media and late-onset or progressive hearing loss. RESULTS: Low refer rates were achieved for the stopping criteria used in the present study, especially when a protocol similar to the one recommended in the National Institutes of Health (1993) Consensus Conference Report was followed. These analyses, however, do not completely describe test performance because they did not compare neonatal screening test results with a gold standard test of hearing. Test performance, as measured by the area under a relative operating characteristic curve, were similar for all three neonatal tests when neonatal test results were compared with VRA data obtained at 8 to 12 mo corrected age. However, ABRs were more successful at determining auditory status at 1 kHz, compared with the otoacoustic emission (OAE) tests. Performance was more similar across all three tests when they were used to identify hearing loss at 2 and 4 kHz. No test performed perfectly. Using either the two- or three-frequency pure-tone average (PTA), with a fixed false alarm rate of 20%, hit rates for the neonatal tests, in general, exceeded 80% when hearing impairment was defined as behavioral thresholds > or =30 dB HL. All three tests performed similarly when a two-frequency (2 and 4 kHz) PTA was used as the gold standard; OAE test performance decreased when a three-frequency PTA (adding 1 kHz) was used as the gold standard definition. For both PTA and all three neonatal screening measures, however, hit rate increased as the magnitude of hearing loss increased. CONCLUSIONS: Singly, all three neonatal hearing screening tests resulted in low refer rates, especially if referrals for follow-up were made only for the cases in which stopping criteria were not met in both ears. Following a protocol similar to that recommended in the National Institutes of Health (1993) Consensus Conference report resulted in refer rates that were less than 4%. TEOAEs at 80 dB pSPL, DPOAE at L1 = 65, L2 = 50 dB SPL and ABR at 30 dB nHL measured during the neonatal period, and as implemented in the current study, performed similarly at predicting behavioral hearing status at 8 to 12     

Establishing normal hearing with the dichotic multiple-frequency auditory steady-state response compared to an auditory brainstem response protocol

OBJECTIVE: To determine the clinical usefulness of the dichotic multiple-frequency (MF) auditory steady-state response (ASSR) technique for estimating normal hearing compared to a 0.5-kHz tone burst and broadband click auditory brainstem response (ABR) protocol in a sample of adults. MATERIAL AND METHODS: A comparative experimental research design was selected in order to compare estimations of normal hearing obtained with the dichotic ASSR technique at 0.5, 1, 2 and 4 kHz with a 0.5-kHz tone burst and broadband click ABR protocol. The recording times required for each procedure were also compared. Normal-hearing subjects (n = 28) were selected according to immittance values within normal limits and pure-tone behavioural thresholds of < 25 dB HL across frequencies. RESULTS: The dichotic MF ASSR estimated normal hearing to be, on average, 30-34 dB HL across the range 0.5-4 kHz. The mean estimate of normal hearing for 0.5 kHz using tone burst ABRs was 30 dB nHL and the mean click ABR threshold was 16 dB nHL, i.e. 14-18 dB better than the ASSR thresholds. The dichotic MFASSR technique recorded 8 thresholds (4 in each ear) in a mean time of 23 min. The ABR protocol recorded 4 thresholds (2 in each ear) in a mean time of 25 min. CONCLUSION: Both the dichotic MF ASSR and ABR protocols provided a time-efficient estimation of normal hearing. There was no significant difference between the tone burst ABR and MF ASSR techniques in terms of estimation of normal hearing at 0.5 kHz. The dichotic MF ASSR technique proved more time-efficient by determining more thresholds in a shorter time compared to the ABR protocol.     

Lesion site in sudden deafness: study with electrocochleography and transiently evoked otoacoustic emission

We examined electrocochleogram (ECochG) and transiently evoked otoacoustic emission (TEOAE) on five cases of sudden sensorineural hearing loss which had no abnormalities detected on diagnostic imagings and showed complete recovery of hearing. At the initial examination, three cases showed a broadened wave 1 with prolonged latency in the auditory brainstem response (ABR) at 90 dB HL. The ECochG AP showed a broad waveform, low amplitude, and high threshold. CM threshold, although increased, was relatively well preserved compared with hearing threshold measured with conventional pure-tone audiometry. The thresholds in TEOAE examination were similar to those for CM and preserved better when compared with pure-tone audiometric thresholds. These findings suggest that the location of the disorder in these three cases involved not only the cochlea but also the retrocochlear auditory pathway. The other two cases showed normal ABR waveforms at 90 dB HL at the initial examinations. ECochG examination showed that a normal AP in one case and a smaller amplitude AP, an elevated threshold, and normal waveform of AP in the other ear. CM thresholds coincided with the conventional audiometry thresholds. These findings suggest that hearing loss in these two cases involved primarily the sensory hair cells.     

Auditory pathway in rheumatoid arthritis. A comparative study and surgical perspectives

Conclusion. Rheumatoid arthritis (RA) patients present with both conductive and sensorineural deafness. Objective. To evaluate the prevalence and features of hearing impairment in patients with RA. Material and methods. A total of 28 RA patients underwent a rheumatological evaluation, including determination of rheumatoid factor, protein 2-glycoprotein I level and the Lee index. An audiological assessment consisting of pure-tone audiometry (PTA) and determination of auditory brainstem responses (ABRs) and transient evoked otoacoustic emissions (TEOAEs) was performed. The results were compared with those of 28 age- and sex-matched healthy subjects. Four selected RA patients underwent stapedectomy; PTA and TEOAEs were evaluated 6 months postoperatively. Results. Increased air conduction thresholds at 250, 500 and 1000 Hz were found in RA subjects in comparison to controls (p<0.001). RA patients showed higher air–bone gaps in PTA (p<0.05) and an increased Wave I latency in ABRs (p=0.03). Decreased reproducibility (p<0.001) and amplitude (p<0.001) of TEOAEs were found in RA subjects in comparison to controls. A significant correlation between disease duration and echo amplitude was noticed (r=0.389). After stapedectomy, a reduction in the air–bone conduction gap (11 vs 2 dB HL) was noticed; no significant difference in TEOAEs was found.     

Hearing evaluation in chronic renal failure children

Chronic renal failure (CRF) causes a lot of systemic side-effects, among them: neurological and otological complications. In present study hearing evaluation was made in young patients, using distortion product otoacoustic emissions (DPOAEs) and auditory brainstem responses (ABR). THE AIM OF STUDY: (1) objective assessment of hearing organ activity in CRF children, (2) localization of hearing organ part involved in CRF, (3) establishing best parameters of ipsilateral stimulation in DPOAEs for clinical use. MATERIALS AND METHODS: Hearing acuity was assessed in 22 CRF children ranging in age from 9 to 17 years and 18 healthy children ranging in age from 10 to 18 years. At first pure tone audiometry and tympanometry were evaluate. Only patients with normal middle ear condition and hearing threshold better than 30 dB HL were put forward further investigations. Objective assessment of hearing condition included: (1) DPOAEs using DP-gram format. Two simultaneous pure-tone signals (primaries) were presented to the ear at two different frequencies (f1 and f2, where f2 > f1) and the 2f1-f2 were analyzed. Five pairs of non equal level and L2 were used L1 and L2: panel A1: L1 = 65 and L2 = 60 dB SPL, panel A2: L1 = 63 and L2 = 55 dB SPL, panel A3: L1 = 59 and L2 = 45 dB SPL, panel A4: L1 = 55 and L2 = 35 dB SPL, panel A5: L1 = 51 and L2 = 25 dB SPL; (2) ABR investigation using click stimulus, at 90 dB nHL level. Wave I, III, V latencies and intervals I-III, III-V, I-V were evaluated. Our results reviled significantly lower mean DPOAEs amplitudes in CRF children when compare to healthy children, at all frequencies measured. No differences in ABR evaluation were observed. Most optimal DPOAEs parameters in clinical use seem to be panel A1, A2 and A3 of level L1 and L2.     

Transiently evoked otoacoustic emissions as a prognostic indicator in idiopathic sudden hearing loss

Idiopathic sudden sensorineural hearing loss (ISHL) remains a controversial topic. So far, there are no proven objective auditory factors to establish prognosis. Otoacoustic emissions reflect the functional integrity of the outer hair cells. The aim of this study was to assess the presence of transiently evoked otoacoustic emissions (TEOAEs) in the early stages of ISHL cases as a prognostic indicator. Thirty patients hospitalized for ISHL were included in the study. All patients underwent pure-tone audiometry (PTA) and TEOAE recordings on the admission day and at least three measures on the subsequent eight days. The audiometric threshold improvement at each frequency was correlated with the TEOAE parameters on each measure. Finally, the presence of TEOAEs on early examination was correlated with PTA threshold improvement. Twenty-three out of 30 patients experienced hearing recovery. Fourteen of the recovered patients had recordable TEOAEs or acceptable TEOAE peak amplitudes in some frequency bands on the first two measures, despite having audiometric thresholds greater than 40 dB HL. It thus seems that TEOAEs might serve as a clinical tool for prediction of recovery in ISHL cases.     

Cochlear receptor (microphonic and summating potentials, otoacoustic emissions) and auditory pathway (auditory brain stem potentials) activity in auditory neuropathy

OBJECTIVE: To define both auditory nerve and cochlear receptor functions in subjects with auditory neuropathy (AN). DESIGN: We tested 33 AN subjects (66 ears) and compared them with 21 healthy subjects (28 ears). In AN subjects, the average pure-tone (1, 2, and 4 kHz) threshold loss was 57 dB HL. Click stimuli were used to elicit transient evoked otoacoustic emissions (TEOAEs), cochlear microphonics (CMs), and auditory brain stem responses (ABRs). Both cochlear and ABR potentials were recorded from surface electrodes (vertex-ipsilateral mastoid) using averaging procedures. The amplitudes and latencies of CMs and ABRs and the amplitude of the TEOAEs were analyzed. RESULTS: CM amplitudes recorded from normal ears decreased as a function of subject age. CMs recorded from AN subjects fell within the normal age-adjusted range in 60% of the subjects and were >2 SEEs (standard error of estimate) above the age-adjusted normal regression in 40% of the subjects. TEOAEs were absent in 19 (30%) AN ears (bilaterally in eight, and unilaterally in three subjects) and were present in 44 ears. In AN subjects, correlations among CM amplitude, TEOAE amplitude, and pure-tone average thresholds were not significantly related. CM amplitudes were not significantly different whether TEOAEs or ABRs were present or absent. The ABR was present in 21% of AN subjects and consisted of a low-amplitude Wave V without a preceding Wave I. Measures of CM amplitude and PTA hearing loss were not significantly different in those AN ears with a preserved ABR compared with ears with absent ABRs. Summating potentials to transient click stimuli were of small amplitude (<0.1 microV) and detectable in approximately 50% of the AN and healthy control subjects limiting formal analysis of summating potentials. CONCLUSIONS: In a significant proportion of AN subjects, we found abnormalities of cochlear receptor function, including elevated CM amplitudes and absence of TEOAEs. These two abnormalities occurred independently of each other. A low amplitude Wave V of the ABR was found in approximately one-fifth of AN subjects, evidence that neural synchrony can be partially preserved in some subjects with this disorder.     

Comparison of TEOAE with Play audiometry for screening hearing problems in children

To evaluate the usefulness of transiently evoked otoacoustic emissions (TEOAEs) for hearing screening of children at around 3 years of age, measurements were done together with Peep show test in a group of 47 children (n=93 ears). A stimulus sound of 30 dB nHL was used as the screening intensity for the TEOAE measurement. All measurements were done with awake subjects. Twenty seven ears, all of which were revealed to have normal hearing (within 20 dB HL, assessed by Peep show test) and tympanograms, showed positive TEOAE results. Furthermore, TEOAEs were sensitive to the presence of middle ear conductive impairment, showing negative results. We conclude that, compared with Play audiometry, TEOAE measurements can not yield quantitative results, but can yield qualitative results for determining the presence of hearing impairment without sedative induced sleeping in this critical age of children.     

DPOAE otoemission in patients with tinnitus and normal hearing

The goal of our study was analysis of characteristic interrogation, audiometry and distortion products otoacoustic emission in patients with normal hearing and complaining of tinnitus. We examined the group of 24 ill patients with hearing threshold up till 25 dB HL and with tinnitus and the control group of 18 with no audiological complains. All the patients were made tonal audiometry and the discomfort level as well as tinnitus frequency and intensity were evaluated. For each ear separately, we examined DPAOE of DP-gram function with resolving power of half the octave and the fine structure on the level of stimulation L1 = L2 = 70 dB. In the group of patients average time of tinnitus was 1.5 year. Average hearing threshold in patients with tinnitus was 18 dB HL for air conduction and 11 dB HL for bone conduction, average discomfort threshold--93 dB HL. In the control group hearing threshold was comparatively 16 dB and 10 dB HL and average discomfort threshold--95 dB HL. In the tinnitus group 8 patients (21%) complained of hyperacusis. The differences between the two groups in DP-gram were observed mainly in high frequencies (higher than 3000 Hz). In DP-gram fine structure in the group of patients with tinnitus we noted wider span of otoemission decreases (over the octave) compared to control group. In the tinnitus group among 20 examined ears with decreases of otoacoustic emission DP--fine structure only in 6 patients (30%) the frequency of tinnitus given by the patient was overlapping with the frequency for which decreases of otoemission were observed. In both groups we observed decreases of DPOAE for some frequencies but in the patients with tinnitus we noticed the lack of otoacoustic emission in wider span of frequencies, mainly in higher frequencies compared to controls.     

外伤所致传导性耳聋的诊断与手术治疗(附20例报告)

目的 分析外伤所致传导性耳聋的症状体征、听力学表现及影像学特点,总结诊断要点和手术治疗效果.方法 回顾性分析解放军总医院2008年1月～2011年3月收治的具有明确外伤史、鼓膜完整的传导性听力下降患者20例.每位患者均进行详细病史询问、临床检查、听力测试和影像检查.行鼓室探查术,根据患者听骨链损伤的不同类型,行听骨链重建术.术后1～3个月复查纯音听力,比较术前和术后的纯音听阈,总结分析手术治疗效果.结果 本组20例患者,手术探查听骨链发现砧骨移位14例,包括砧镫关节脱位、锤砧关节分离以及二者兼具的听骨链损伤,锤骨移位且粘连固定2例,镫骨足弓骨折2例,砧骨长脚骨折1例,镫骨底板自前庭窗脱出1例;其中3例砧骨移位患者术中可见面神经明显水肿.根据鼓室探查情况行相应的听骨链重建术,15例行自体听骨雕凿后的听骨链重建术,1例行砧镫关节复位术,4例行人工听骨植入术,3例合并面瘫患者行听骨链重建术的同时行面神经减压术.术后1～3个月随访,患者自觉听力提高,纯音测听示言语频率内气导平均听阈恢复至30±11 dB,平均气骨导差为18±10 dB.伴有面瘫患者的面神经功能恢复至HBⅠ级.结论 有外伤史的患者如有听力下降,应行全面细致的耳科检查、听力学检查和高分辨颞骨CT扫描,如纯音测听气导听阈下降且存在明显的气骨导差,或颞骨CT显示听骨链形态异常,应考虑系听骨链中断引起的传导性耳聋.应根据听骨链损伤的不同类型,重建听骨链,恢复患者听力,合并面瘫者,同时行面神经探查减压手术.     

老年性痴呆患者的听觉损害

OBJECTIVE: To evaluate the pure tone hearing threshold and word recognition score of senile dementia of the Alzheimer's disease (AD) patients, and to analyze the relationship between hearing loss and the cognition impairment. METHODS: Pure tone audiometry, word recognition score (WRS), acoustic immittance and auditory brainstem response (ABR) are used to evaluate the auditory function of 43 patients with AD and 50 subjects of the control group. The confounding factors are controlled. RESULTS: The average age of 43 dementia patients was 72.7 +/- 6.4, and 69.7% was female. Bilateral hearing thresholds are similar in all subjects. All indices but Mini-mental scale of equastionnaire (MMSE) of patients and control group were not statistically different. There was no significant difference in pure tone audiometry (PTA), PTA2 (dB HL, mean +/- s) and WRS (%, mean +/- s) between the two groups (P > 0.05), therefore the hearing threshold of AD group (PTA = 26.3 +/- 8.5, PTA2 = 29.1 +/- 8.7, WRS = 85.5 +/- 15.5) is lower than that of control group (PTA = 23.2 +/- 10.6, PTA2 = 26.2 +/- 11.8, WRS = 87.6 +/- 16.8). No significant difference was found between the two groups in audiometry reliability, acoustic immittance and ABR (P < 0.05). CONCLUSION: No significant difference was found between the peripheral hearing dysfunction of AD patients and that normal elderly people, i.e., PTA, PTA2 and WRS were not related to MMSE.     

Prevalence of auditory neuropathy/synaptopathy in a population of children with profound hearing loss

OBJECTIVE: To examine the prevalence of auditory neuropathy/synaptopathy (AN/AS) in a cohort of children with profound hearing loss. METHODS: From 1997 until 2004, 5190 children, aged 1-15 years, whose hearing ability was uncertain or who had risk factors for hearing impairment were investigated with subjective and objective hearing tests. Three thousand four hundred and fifteen from these children were screened for AN/AS using pure-tone audiometry, impedance measurement, transient evoked otoacoustic emissions (TEOAE) and click-evoked auditory brainstem responses (ABR). RESULTS: From 3415 patients who participated in an ABR and TEOAE assessment, 379 children showed absent or elevated (> or = 80 dB nHL) ABR thresholds. Within this group we found 32 cases with evidence of AN/AS via visible TEOAE and/or cochlear microphonics (CM) coupled with absent ABR. In the remaining 3036 children, AN/AS, could be ruled out by means of detectable ABR-thresholds and coherent findings in pure-tone audiometry and TEOAE assessment. This results in a prevalence of AN/AS of 0.94% within the group at risk for hearing loss, compared to 8.44% among profoundly hearing impaired children. CONCLUSION: This study shows that AN/AS is a common finding in the population of hearing impaired infants. In the majority of our AN/AS children (50%, n=16), an early audiological diagnosis was made under the age of 12 months. Therefore, clinicians and other health care professionals should generally be sensitised for AN/AS in infants, so that an appropriate treatment can promptly be initiated. Further research on clinical and pathophysiological aspects is necessary to better identify and manage patients suffering from AN/AS.     

聋校学生中听神经病的调查研究

目的：获得南京聋人学校在校学生中听神经病的患病情况,并对其发病特征作初步探讨。方法：358名学生接受了耳科检查、声导抗及瞬态诱发性耳声发射（TEOAE）筛查,对通过TEOAE筛查的学生进行病史分析纯音测听、声导抗、诊断型TEOAE、DPOAE、ABR、ENG以及VEMP等全面的听力和前庭功能评估。结果：在可行听神经病评估的323名学生行TEOAE筛查时,1名学生单耳、2名学生双耳显示“通过”,经进一步检查,符合听神经病诊断。结论：听神经病并非罕见,在聋校中亦有发生,对其及早识别和科学干预,此类学生可能避免进入聋校,回归主流社会。     

甲状腺功能异常导致恐声症——对《恐声症鉴别和患病率》一文的验证

目的 分析1例甲状腺功能异常导致恐声症患者的病因机制、临床特征和听力学特点.方法 对患者连续1年的甲状腺功能及听力学检查结果 (包括纯音听阈及不舒适阈、声导抗、耳声发射、听性脑干反应)进行分析,观察患者恐声症与甲状腺功能变化的相关性,并进行颞骨CT、耳蜗内听道水成像核磁共振、甲状腺彩超、心脏彩超及生化检查.结果 甲状腺功能亢进(血清游离甲状腺素FT4升高、高灵敏度血清促甲状腺素3rd-TSH降低)时,听阈正常,但听觉过敏发生,不舒适阈降低,双耳各个频率受累,尤其不舒适阈4000 和8000 Hz分别为30和35 dB HL(右耳),30和25 dB HL(左耳),最少相差仅10 dB.而当甲状腺功能减低(3rd-TSH降低)时,同样出现听觉过敏,不舒适阈也很接近正常听阈.而镫骨肌反射阈无降低,与听阈之差>60 dB.耳声发射、电反应测听未见异常.结论 患者连续1年的听力学检测结果 证明患者甲状腺功能异常是发生恐声症的原因之一,提示甲状腺功能异常与听觉不舒适阈降低具有相关性.甲状腺功能异常可能导致内耳微循环缺血而诱发恐声症.