新生儿与成人瞬态诱发耳声发射差异的频谱特性分析

目的 比较新生儿与成人瞬态诱发耳声发射(TEOAE)的差异,并分析其频谱特性.方法 以短声刺激分别对120名通过听力筛查的新生儿(男58,女62)和32名平均纯音听阈(听力级)在20 dB以内的成年人(男15,女17)行TEOAE检测,对于测试结果 行频谱分析和半倍频程分析.结果 ①新生儿组TEOAE总强度(声压级,下同)为(15.18±4.39)dB,高于成人组的(9.51±4.12)dB,差异具有统计学意义(t=9.303,P<0.05).②新生儿的频带重复率、频带重复率非0比例、频带信噪比检出率及频带信噪比在第1频带(0.8 kHz)最低,在3.2 kHz最大;而成人在第5频带(4.0 kHz)处最低,在1.5 kHz最大.③新生儿与成人最大频带信噪比强度差为7.09 dB,二者出现的频率位置相差约1.7 kHz.④半倍频程分析显示新生儿TEOAE最大能量为(10.50±5.09)dB,在2828 Hz处,而成人为(2.84±5.33)dB,在1414 Hz处;二者最大反应在强度上相差7.66 dB,出现的频率位置相差1414 Hz.⑤成人1.5 kHz区的TEOAE信号最强,之后其信噪比随频带增高而降低,而新生儿信噪比却呈现随频带增高而增强的特征;从第1频带到第5频带,新生儿与成人TEOAE强度的差值随频带增高也逐渐增大.结论 成人TEOAE总强度低于新生儿.新生儿频带信噪比及半倍频程能量反应峰的分布频率及反应强度均高于成人.     

学龄期听力正常儿童瞬态诱发耳声发射的特征及测试体会

目的 探讨学龄期听力正常儿童瞬态诱发耳声发射(TEOAE)的特征及测试方法.方法 对20例(男女各10例)听力正常的学龄期儿童行TEOAE检测,分析其特点.结果 ①学龄期儿童的TEOAE总强度为13.11±4.13 dB SPL,其中女性为14.16±4.24 dB SPL,男性为11.76±3.69 dB SPL,女性高于男性2.40 dB,但差异无统计学意义(P=0.091).TEOAE总重复率为86.43%±8.78%,A&B值为13.38±3.93 dB SPL,A-B值为3.55±2.80 dB;②学龄期儿童TEOAE频带信噪比(SNR)在1.5 kHz频带最高,之后随频率增加而降低,在4 kHz频带SNR最低.结论 学龄期儿童TEOAE的测试噪声及频带SNR的分布与成人接近,TEOAE反应强度高于成人,尤其在较高频带区.     

足月正常新生儿自发性耳声发射特性分析

目的探讨足月新生儿自发性耳声发射(spontaneous otoacoustic emission,SOAE)的特性。方法采用丹麦尔听美公司Capella全功能耳声发射仪,对147例(236耳)通过瞬态诱发耳声发射(TEOAE)筛查的足月新生儿进行SOAE测试,分析SOAE的检出率、反应幅值、反应峰值以及频率分布特性。结果 1147例236耳中,SOAE总检出率为56.77%(134/236),其中女婴检出率69.23%(90/130)明显高于男婴(41.51%,44/106)(P<0.05),右耳检出率(64.17%,77/120)明显高于左耳(49.14%,57/116)(P<0.05)。2SOAE平均幅值为11.78±8.36dB SPL,其中男婴11.73±8.25dB SPL,女婴11.81±8.43dB SPL;左耳11.97±8.56dB SPL,右耳11.65±8.22dB SPL;无性别和耳间差异(P>0.05)。3SOAE频率集中分布于3 212~3 718 Hz,其中男婴2 930~3 409Hz,女婴3 353~3 863Hz;左耳3 212~3 718Hz,右耳3 151~3 638Hz;男婴的频率分布低于女婴(P<0.01)。4SOAE反应峰值均数为3.70±2.75个/耳,其中男婴3.86±2.87个/耳,女婴3.62±2.70个/耳;左耳3.70±3.02个/耳,右耳3.70±2.55个/耳;无性别和耳间差异(P>0.05)。结论足月新生儿SOAE检出率女婴高于男婴,右耳高于左耳,频率分布趋于高频,反应呈现多峰的特点,并且检出率及频率分布特性在女婴中更明显。     

基层医院新生儿听力筛查方法与评定标准的建立

目的 :探讨新生儿听力筛查的最佳方法与相关标准。方法 :应用Cepella耳声发射仪对 12 77例(2 5 5 4耳 )新生儿作瞬态诱发耳声发射 (TEOAE)测试。以 4个频带中 3个频带信噪比≥ 3dB为通过标准。结果 :通过率为 89.4%,测试时间以产后 2d以上为佳。结论 :TEOAE是新生儿听力筛查的首选方法 ,频带信噪比≥ 3dB为最适当的筛查标准。     

正常新生儿瞬态诱发耳声发射

本文对20名正常新生儿在出生后1～5天每天进行一次瞬态诱发耳声发射(Transientevoked otoacoustic emissions,TEOAE)测试.结果表明,随着新生儿天龄的增加,其TEOAE检出率及反应幅值逐步提高.新生儿1～2天的检出率显著低于后几天,至出生后第3天,TEOAE检出率可达97.4%,反应幅值也趋于稳定,提示应用TEOAE进行新生儿听力筛选时,其天龄至少应在3天或3天以上.对第5天的TEOAE反应进行统计,发现其频谱范围主要在1～4kHz,反应幅值显著高于正常听力青年人,性别差异对新生儿TEOAE无显著性影响.     

SISI联合TEOAE在噪声性听力损失筛查中的应用

目的 探讨短增量敏感指数(SISI)测试及瞬态诱发耳声发射(TEOAE)在噪声性听力损失筛查中的意义。方法 50例纯音听阈正常并有噪声暴露史的受试者作为噪声组，另外50例未接受噪声暴露的纯音听阈正常者作为对照组，两组平均年龄分别为19.58±1.03、19.90±1.20岁。两组分别行气导纯音听阈、SISI、TEOAE检测，分析两组间的结果差异。结果 噪声组和对照组0.25～8 kHz气导纯音听阈均小于20 dB HL,差异无统计学意义(P>0.05)。噪声组各频率SISI均高于对照组，差异有显著统计学意义(P<0.01)。噪声组TEOAE波形总体相关率为92.32%±1.99%,对照组为97.92%±0.49%(P<0.05);噪声组反应幅值为16.00±1.04 dB SPL,对照组为20.27±0.70 dB SPL(P<0.05);噪声组信噪比为12.66±1.55 dB,对照组为20.95±0.89 dB(P<0.01)。SISI 6 kHz与TEOAE 3.5～4.5 kHz频段信噪比负相关(P<0.05)。结论 高频率SISI联合提高筛...     

感音神经性聋成人不同刺激声ASSR反应阈与纯音听阈的相关性分析

目的探讨调制声听性稳态反应(ASSR)、 CE-Chirp ASSR用于评估感音神经性聋成人客观听力的价值。方法对78例(131耳)感音神经性聋成人同时进行纯音听阈和调制声ASSR、 CE-Chirp ASSR测试,比较0.5~4 kHz各频率纯音听阈与调制声ASSR、CE-Chirp ASSR反应阈的相关性及差值。结果 0.5、1、2、4 kHz CE-Chirp ASSR反应阈与纯音听阈的相关系数(分别为0.77、0.73、0.80、0.88)均高于调制声ASSR反应阈与纯音听阈的相关系数(分别为0.64、0.61、0.78、0.84),调制声ASSR、CE-Chirp ASSR反应阈与纯音听阈均具有显著相关性(圴为P<0.01);0.5~4 kHz CE-Chirp ASSR反应阈和纯音听阈的差值(分别为8.09±4.74、10.76±5.86、7.44±7.95、6.11±9.14 dB)均明显小于调制声ASSR反应阈和纯音听阈间的差值(分别为14.31±6.38、13.85±6.25、17.17±6.29、13.58±4.35 dB),差异均有统计学意义(均为P<0.05)。结论 CE-Chirp ASSR快捷可靠,较调制声ASSR能更好地评估感音神经性聋成人的听力。     

正常人中枢掩蔽测试结果分析

目的 :通过对一组耳科正常青年人进行中枢掩蔽测试 ,探讨其发生机制及其对听力学检查所产生的影响。方法 :分别测试有无对侧掩蔽声 (CAS)时的纯音气导听阈 ,比较其在相同频率不同强度的CAS时听阈的变化 ,即中枢掩蔽效应 (CME)的大小 ;同时测试相同强度不同频率CAS时CME的大小。结果 :CME具有频率特异性及强度特异性 ,中频 1kHz、2kHz时 ,其CME较低频及高频大 ,其中以频率为 2kHz时最明显 ;CAS强度在6 0dBHL以下时 ,CME随强度增加而增大 ,在 6 0dBHL时 ,2kHz处CME达 (11.5 3± 4 .38)dB ,CAS >70dBHL时 ,则出现过度掩蔽。结论 :因CME的存在 ,纯音听阈测试中 ,如所用CAS >4 0dBHL时 ,则需对测试结果进行修正 ;当CAS强度为 6 0dBHL时 ,CAS在 2kHz处产生大于 10dB的CME ,可用于对伪聋的鉴别     

纯音听阈正常老年人畸变产物耳声发射特征

目的探讨纯音听阈正常老年人畸变产物耳声发射(DPOAE)特征。方法对纯音听阈正常的青年对照组39例和老年组30例分别行DPOAE检测,比较两组500～8 000Hz各频率DPOAE的检出率和幅值差异。结果老年组DPOAE检出率在3kHz及以下频率与青年组无明显差异(P>0.05),在4、6、8kHz处均明显低于青年组(P<0.05);老年组DPOAE检出率随频率增加而降低,0.5～3kHz DPOAE检出率高于4～8kHz,其中8kHz检出率最低,其次是6kHz和4kHz;老年组与青年组DPOAE幅值的频率特点基本一致,在中低频率幅值较高,在4kHz及以上频率明显降低;老年组各频率DPOAE幅值均低于青年组(P<0.05),差值平均约5.4dB,6、8kHz差值更大,分别为6.75及9dB。结论纯音听阈正常的老年人在4kHz及以上频率DPOAE幅值明显下降,说明该频率段外毛细胞功能减弱,且该现象青年时已开始显现,非老年人特有。     

性别、耳别及测试时间对新生儿瞬态诱发耳声发射的影响

瞬态诱发耳声发射(transient evoked otoacoustic emission,TEOAE)是由短声(click)或短纯音(tone-burst)诱发、短暂延迟后在外耳道记录到的音频能量。由于其客观、快速、无创的特点,被广泛地应用于新生儿听力筛查。在以TEOAE为主的新生儿听力筛查中,筛查通过率受测试时间、新生儿性别和耳别的影响。研究表明,出生后38天婴儿的听力筛查通过率高于出生1周内的新生儿[1],女婴通过率     

背景噪声对新生儿瞬态诱发耳声发射的影响

目的 分析背景噪声对新生儿瞬态诱发耳声发射(TEOAE)的影响.方法 对122例通过听力筛查的新生儿(244耳,女62例,男60例)分别以短声刺激行TEOAE检测,用quick TEOAE模式,叠加次数大于100次.并以背景噪声分组,比较安静组与噪声组之间TEOAE差异.结果 ①新生儿TEOAE的背景噪声为(33.94...     

Identification of neonatal hearing impairment: transient evoked otoacoustic emissions during the perinatal period

OBJECTIVES: 1) To describe transient evoked otoacoustic emission (TEOAE) levels, noise levels and signal to noise ratios (SNRs) for a range of frequency bands in three groups of neonates who were tested as a part of the Identification of Neonatal Hearing Impairment multi-center consortium project. 2) To describe the relations between these TEOAE measurements and age, test environment, baby state, and test time. DESIGN: TEOAEs were measured in 4478 graduates of neonatal intensive care units (NICUs), 353 well babies with at least one risk indicator, and 2348 well babies without risk factors. TEOAE and noise levels were measured for frequency bands centered at 1.0, 1.5, 2.0, 3.0, and 4.0 kHz for a click stimulus level of 80 dB SPL. For those ears not meeting "passing" stopping criteria at 80 dB pSPL, a level of 86 dB pSPL was included. Measurement-based stopping rules were used such that a test did not terminate unless the response revealed a criterion SNR in four out of five frequency bands or no response occurred after a preset number of averages. Baby state, test environment, and other test factors were captured at the time of test. RESULTS: TEOAE levels, noise levels and SNRs were similar for NICU graduates, well babies with risk factors and well babies without risk factors. There were no consistent differences in response quality as a function of test environment, i.e., private room, unit, open crib, nonworking isolette, or working isolette. Noise level varied little across risk group, test environment, or infant state other than crying, suggesting that the primary source of noise in TEOAE measurements is infant noise. The most significant effect on response quality was center frequency. Responses were difficult to measure in the half-octave band centered at 1.0 kHz, compared with higher frequencies. Reliable responses were measured routinely at frequencies of 1.5 kHz and higher. CONCLUSIONS: TEOAEs are easily measured in both NICU graduates and well babies with and without risk factors for hearing loss in a wide variety of test environments. Given the difficulties encountered in making reliable measurements for a frequency band centered at 1.0 kHz, its inclusion in a screening program may not be justified.     

Transient-Evoked Otoacoustic Emissions in a Representative Population Sample Aged 18 to 25 Years: Emisiones otoacüAsticas evocadas por transitorios en una muestra representativa de población con edades entre 18 y 25 años

Transient-evoked otoacoustic emissions (TEOAEs) were obtained from 688 ears of a group of 345 young adults aged 18 to 25 years, using the Otodynamics ILO88 in the standard, non-linear mode. Normative data for TEOAEs obtained from 186 otologically normal (ON) ears are presented. In 5 ON ears, there was no recordable response, despite hearing threshold levels better than 20 dB. The main factors affecting the TEOAE level were (1) gender, where females had larger responses on average than males; (2) tym-panometric measures, where ears with entirely normal tympanometric measures had larger responses than those with minor tympanometric abnormalities; (3) click stimulus intensity measured in the ear canal, which correlated positively with TEOAE level; and (4) hearing threshold level at 0.5 kHz, which correlated negatively with amplitude. There was also a small effect of social noise exposure in the 2-kHz region of the TEOAE, where the response was lower in those subjects exposed to significant social noise.     

Transient-evoked otoacoustic emissions in a representative population sample aged 18 to 25 years

Transient-evoked otoacoustic emissions (TEOAEs) were obtained from 688 ears of a group of 345 young adults aged 18 to 25 years, using the Otodynamics ILO88 in the standard, non-linear mode. Normative data for TEOAEs obtained from 186 otologically normal (ON) ears are presented. In 5 ON ears, there was no recordable response, despite hearing threshold levels better than 20 dB. The main factors affecting the TEOAE level were (1) gender, where females had larger responses on average than males; (2) tympanometric measures, where ears with entirely normal tympanometric measures had larger responses than those with minor tympanometric abnormalities; (3) click stimulus intensity measured in the ear canal, which correlated positively with TEOAE level; and (4) hearing threshold level at 0.5 kHz, which correlated negatively with amplitude. There was also a small effect of social noise exposure in the 2-kHz region of the TEOAE, where the response was lower in those subjects exposed to significant social noise.     

瞬态诱发耳声发射检测职业性听力损伤的可行性研究

目的 :探讨瞬态诱发耳声发射 (TEOAE)检测职业性听力损伤的可行性及临床应用价值。方法 :选择 90例 (180耳 )噪声暴露工人为实验总组 ,按噪声暴露时间长短又分为 1、2、3组 ;另选 11例 (2 2耳 )正常听力青年人作为对照组 ,行纯音听阈和TEOAE测试。结果 :各实验组纯音听阈值明显高于对照组 ,TEOAE总重复率、幅值和信噪比及各频段重复率、幅值和信噪比明显低于对照组 (P <0 .0 5或P <0 .0 1)。实验 1、2、3组间比较 ,随着噪声接触时间的增加 ,各频率点纯音听阈提高 ,TEOAE总重复率、幅值和信噪比及各频段重复率、幅值和信噪比变小 ,在 2 .5 0～ 3.5 0kHz和 3.5 0～ 4 .5 0kHz频段最明显。结论 :用TEOAE检测职业性听力损伤是可行的 ,有临床应用价值 ,最敏感频段为 2 .5 0～ 3.5 0kHz和 3.5 0～ 4 .5 0kHz频段。     

Neonatal screening of deafness: evoked otoacoustic emissions or acoustic distortion products?]

Transiently evoked otoacoustic emissions (TEOAE) allows an auditory screening in neonates above 30 dB and between 2 kHz to 4 kHz. Another type of otoacoustic emissions, the distortion product (DP) allows a similar screening and provides more specific frequency information over a broader frequency range, including frequencies below 2 kHz and above 4 kHz. The goal of this study was to determine 1) the interest of distortion product in comparison with TEOAE in a auditory screening program in neonates; 2) The predictive value of information extracted from otoacoustic emissions recordings, on frequential parameters of distortion product (DP). In this prospective study, TEOAE and DP were successively recorded in 20 neonates (34 ears) with risk of hearing impairment, using the ILO92 software and hardware. When TEOAs were no detectable (9/34), the DPs were no detectable neither (10/34). When TEOAs were detectable, the Dps carried more specific frequency information above 1 kHz in 52 to 80% of the patients. DP amplitudes have been quantitatively correlated with TEOA energy bands. Correlations between DP and TEOA have been objectivized for DP2.5 and DP4 with OE2, and for DP4 and DP6 with OE5. The correlation predictive value was above 85%. In conclusion, this study demonstrated that analysis of TEOA spectrums procures frequential information without requiring DP recordings.     

自发性耳声发射与耳蜗传出调控的关系探讨

OBJECTIVE: To study the relationship between spontaneous otoacoustic emissions(SOAE) and efferent control of cochlea and their clinical significance. METHODS: SOAE, transient evoked otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE) and contralateral white noise (60 dB SPL) suppression of TEOAE and DPOAE experiments were conducted in 312 ears of 95 patients with retrocochlear impairment and/or MOCS dysfunction and 64 normal young adults. RESULTS: MOCS dysfunction was shown in 126 ears of 65 patients (130 ears) with auditory neuropathy, 2 ears of 2 patients with unilateral acoustic neuroma, 4 ears of 2 patients with hyperacusis, 14 ears of 26 patients(48 ears) with normal hearing level in unilateral or bilateral tinnitus. Stronger EOAE could be recorded in total 146 ears with MOCS dysfunction at any pure tone hearing level. SOAE could be recorded in 126 of 146 ears (86.3%) with MOCS dysfunction and 44 of 128 ears (34.3%) with normal hearing. SOAE of ears with MOCS dysfunction was mainly at frequencies from 0.693 to 3.055 kHz and SOAE of normal ears was at frequencies from 1.135 to 2.746 kHz. Average value of maximum amplitude of SOAE spectrum (-3.4 +/- 6.4) dB SPL was significantly greater than that in normal ears (-6.8 +/- 7.8) dB SPL (P < 0.01). The major frequency range of SOAE (0.693-3.055 kHz) in MOCS dysfunction ears was essentially consistent with that of efferent suppression in normal ears (0.7-3 kHz). CONCLUSION: The modulation of the cochlear active mechanisms by MOCS mainly presents in the low- and mid-frequency regions, these frequencies correspond to the frequency range of SOAE. Stronger SOAE indicates pathophysiological significance. There is a clear clinical relationship between SOAE and the efferent modulation of the cochlea.     

Contralateral suppression of otoacoustic emissions in neonates

The effect of contralateral acoustic stimulation on transient evoked otoacoustic emissions (TEOAEs) was used to investigate the activity of the medial olivocochlear bundle in neonates. TEOAEs were bilaterally recorded, with and without contralateral noise, in 120 full-term neonates without risk for hearing loss. Otoacoustic emission recordings were carried out using the Otodynamic ILO88 system quickscreener non-linear mode, and the contralateral stimulation was presented at 60 dB SPL delivered by CD player. The results revealed a significant (p<0.01) contralateral suppression of TEOAE response amplitude: 2.32 dB in females and 3.28 dB in males. This study shows that the suppression effect is present in 88.5% of neonates, with a gender difference (greater suppression in males) and frequency effect, suggesting a functional maturation of the medial olivocochlear bundle in the studied population.     

纯音听阈正常的耳闷患者诱发性耳声发射分析

目的:对纯音听阈正常的耳闷患者进行诱发性耳声发射分析,以早期发现这些患者的耳蜗损害.方法:采用丹麦Madsen公司Capella耳声发射仪对纯音听阈正常的耳闷患者43例(72耳,耳闷组)及正常人30例(60耳,对照组)分别进行TEOAE及DPOAE检测,记录和分析各频率DPOAE的检出率、幅值,TEOAE的通过率、反应波信噪比、波形重复性及各频带反应波信噪比和重复性.结果:①DPOAE检出率仅在0.50、0.75 kHz两频点上耳闷组明显低于对照组(P＜0.05),其余各频率点差异均无统计学意义(P＞0.05);②TEOAE通过率对照组为100%,耳闷组为90.28%,2组比较差异有统计学意义(X2=6.16,P＜0.05);③与对照组相比,纯音听阈正常的耳闷患者各频率DPOAE的幅值、TEOAE的反应波信噪比、波形重复性及各频带反应波信噪比和重复性均降低,差异有统计学意义(P＜0.05或P＜0.01).结论:部分纯音听阈正常的耳闷患者已存在耳蜗外毛细胞的损害,利用诱发性耳声发射的方法可在其听力损失出现之前早期发现此类病变.