正常新生儿和婴儿的短音听性脑干反应和听觉稳态反应

目的 建立听力正常婴儿短音听性脑干反应(tone-pip ABR)和听觉稳态反应(auditorysteady state response,ASSR)反应阈的正常参考值,研究其听觉发育的生物学规律,并比较两种听力检测技术的频率特性.方法 选取0～6月龄听力正常婴儿80例(160耳),按月龄分为四组:新生儿组、42 d组、3月龄组和6月龄组,每组20例(40耳),男女例数均等,分别记录其短声ABR的潜伏期及在0.25、0.5、1、2、4、8 kHz频率范围内tone-pip ABR和ASSR的反应阈.结果 在70 dB正常听力级短声刺激下,短声ABRⅠ、Ⅲ、Ⅴ波潜伏期、Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期随月龄增加逐渐缩短,波Ⅰ于42 d前、波Ⅲ于3个月前发育变化显著.tone-pip ABR波形与短声ABR相似,Ⅰ、Ⅲ、Ⅴ波潜伏期随频率增加逐渐缩短,波形分化逐渐清晰.不同频率、不同月龄tone-pip ABR和ASSR反应阈差异具有统计学意义(P值均＜0.05).除0.25 kHz外,其余频率tone-pip ABR反应阈均低于ASSR.不同月龄tone-pip ABR和ASSR听力曲线形状相似.结论 0～6月正常婴儿tone-pip ABR的潜伏期和波间期随月龄增加逐渐缩短,而反应阈无明显变化.tone-pip ABR和ASSR均有稳定的频率特异性,tone-pip ABR反应阈低于ASSR,可能更接近主观纯音听阈.     

婴幼儿短纯音与短声诱发的听性脑干反应初探

目的分析婴幼儿短纯音诱发的听性脑千反应（tone burst click auditory brain stem response, TB-ABR）与短声诱发的听性脑千反应（click auditory brain stem response, C-ABR）阈值的相关性,以探讨TB—ABR在婴幼儿客观听力评估中的临床应用价值。方法对2007年1月-2009年1月,新生儿听力筛查通过且C—ABR阈值正常者27例（54耳）,以短纯音为刺激声,进行ABR波V反应阈值及潜伏期测试,并与C-ABR作差异与相关性分析。结果本组27例（54耳）婴幼儿中完成4个频率TB-ABR测试的共27例（54耳）,0．5、1、2、4kHz TB—ABR波V反应阈值分别为（40．0±11．6）dBnHL、（36．7±9．0）dBnHL、（27.2±6．7）dBnHL和（25．9±6．3）dB nHL,明显高于C-ABR阈值（17．8±6．4）dBnHL（P〈0．05）,TB-ABR波V反应阑值随着刺激声频率的升高而下降,潜伏期随着刺激声频率的升高而缩短。0．5、1、2及4kHz1BABR反应阈与GABR反应阈的线性相关系数分别为0.53、0．60、0.67、0．72,存在直线正相关关系（P〈0．01）。结论婴幼儿TB-ABR和C-ABR反应阈之间存在相关性,且高频相关性优于低频,TB-ABR可作为一种具有频率特异性的婴幼儿客观听力评估方法。     

Inaccuracies in the measurement of auditory brainstem response data in normal hearing and cochlear hearing loss

In a test-retest experiment inaccuracies in the measurement of the peak latencies and threshold of the auditory brainstem response were determined for a group with normal hearing and for a group with cochlear hearing loss. The inaccuracy of the auditory brainstem response threshold is less than 4 dB in both groups. The inaccuracy in latency was measured as a function of stimulation level. In both groups the latency inaccuracy of peak V varies from 0.1 ms at levels well above threshold to 0.2 ms near the response threshold. Analysis of variance showed that in subjects with normal hearing the intra- and interindividual variabilities of the peak V latencies contribute about equally to the total variance at all stimulation levels. The implications that these findings have for the determination of the horizontal shift of the latency-intensity curve are discussed.     

脑干肿瘤切除术中的听性脑干反应分析

目的 探索脑干肿瘤手术中听性脑干反应（ＡＢＲ）变化规律及其监护作用。方法 对５例脑干肿瘤手术患者,从术前、术中至术后进行了ＡＢＲ的动态观察,对术中监护记录的４００余份ＡＢＲ的潜伏期、振幅和波形分化的资料进行分析和统计学处理。结果 术中牵拉、分离、挤压均可引起ＡＢＲⅠ、Ⅲ和Ｖ波潜伏期延长,振幅降低,波形分化差等改变,其中３例动态变化指标好,呈可逆性变化,均康复出院。另２例术后潜伏期持续延长、波形分化     

Prediction of auditory brainstem wave V latency as a diagnostic tool of sensorineural hearing loss

The lesion location (cochlear vs. retrocochlear) of sensorineural hearing loss may be differentiated with a diagnostic index (delta V), which is calculated from the wave V latency of the monaurally evoked auditory brainstem response (ABR), and from the pure-tone hearing threshold at 2 and 4 kHz. The delta V values obtained from 80 recruiting ears have proven to correlate linearly to the amount of the hearing loss, hence allowing to define appropriate confidence boundaries for cochlear hearing losses. In contrast, the delta V values obtained from 32 ears of patients with retrocochlear lesions--cerebellopontine angle (CPA) tumors--were all found to exceed the 95% upper confidence limits projected for cochlear lesions, thus giving a 100% rate of true results in the detection of retrocochlear pathology. These results, providing an ABR parametric model for the cochlear hearing loss, suggest a diagnostic strategy for the early detection of CPA tumors based on the exclusion of a cochlear hearing loss.     

Normative auditory brainstem response data for hearing threshold in the rabbit

In an experimental study, we determined the physiological hearing threshold of the rabbit in order to use these data as normative values for further experimental investigations. The aim was to use different acoustic stimuli (click and tone-pip stimuli) with different frequency spectra for air and bone conduction (BC) in order to obtain further information about the optimal form of stimulus when recording auditory evoked potentials in the rabbit. For the investigation, we used 46 female New Zealand rabbits weighing 3.2-4.4 kg and aged 6 months. The equipment used to record brainstem auditory evoked potentials was the Nicolet Viking IV P System (Nicolet Biomedical, Inc.). In accordance with the experimental set-up, the measurements took place under intubation anesthesia, with a total of four repeat measurements performed on each ear at different times. Tone-pip and click stimuli with varying intensities of stimulus, transmitted via air conduction and BC, were applied. The I-IV waves proved the most stable for both stimulus modalities. They were registrable in 98.7% of cases, whereas only 30.2% of the V waves could be recorded. Values averaged from all measurements made throughout the study yielded a potential threshold of 34.8 dB peak equivalent (p.e.) SPL for the click stimulus, 13.8 dB p.e. SPL for the tone-pip stimulus at 8 kHz and 34.2 dB p.e. SPL for the click stimulus transmitted via BC. With regard to latencies, the results indicated a good reproducibility through different stimuli with acceptable standard deviations. The values for physiological hearing threshold obtained here can serve as normative data in subsequent experimental animal studies.     

A slow wave auditory brainstem response to clicks in a case of high frequency hearing loss

A slow component of the auditory brainstem response (BSER) to broad band clicks was revealed in a case of high frequency hearing loss. The latency, morphology, and threshold level characteristics of the response resembled those for the slow wave response (SWR) to 500 Hz tone pips. The SWR to clicks appeared to be initiated by the cochlear partition below 2 kHz and was unmasked by a hearing loss at 2 kHz and above. With click stimuli at intensities above the 2 kHz hearing thresholds, wave V dominated the response to clicks, thus supporting the evidence that wave V is initiated from the high frequency region of the cochlear partition. Caution is advised in interpreting threshold studies using click BSERs, as the SWR may be mistaken for a delayed wave V.     

正常豚鼠听性脑干反应与听性稳态反应的对比

目的 比较正常豚鼠听性脑干反应(ABR)和听性稳态反应(ASSR)阈值的差异,为利用豚鼠进行听力学研究提供理论依据.方法 选正常听力豚鼠12只(24耳),在戊巴比妥钠镇静状态下,分别行ABR和ASSR测试.ABR为click刺激声,刺激率为11.1次/s,记录ABR的Ⅱ渡反应阈值.ASSR载波频率(CF)为0.5、1、2、3、4、6 kHz,调制频率(MF)为154 Hz,记录各载频的反应阅值.结果 正常豚鼠ASSR反应阈值高于ABR反应阈值,CF:0.5.4 kHz时.ABR与ASSR阈值间有统计学差异(P<0.01);CF=6 kHz时,两阈值间无统计学差异(P>0.05).结论 正常豚鼠ABR与ASSR阈值间存在较大差值,但ABR与6 kHz的ASSR阈值间无显著差异.故对豚鼠进行听阈评估时,要注意两者间由于ASSR载波频率不同所引起的差异.     

Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing

Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy. metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group (p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I-III, III-V and I-V was not significant (p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies (p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients.     

Auditory brainstem evoked responses in insulin-dependent (ID) and non-insulin-dependent (NID) diabetic subjects with normal hearing

Hearing impairment has been reported to be one of the late complications of diabetes mellitus (DM), and the frequency varies. Previous data suggest that auditory brainstem potentials deteriorate long before the hearing impairment appears in patients with DM. Delay in neural conductance along the auditory pathway due to DM was assessed by means of auditory brainstem response (ABR) in 43 patients with normal hearing in a controlled study. Patients were classified according to age, presence of neuropathy, metabolic control, and duration and type of DM. ABR recordings revealed that absolute latencies of waves I, III and V were prolonged significantly in the diabetic group when compared to the control group ( p < 0.05). When two diabetic groups (insulin-dependent and non-insulin-dependent) were compared with each other, the difference between the latency of wave I and the inter-peak latencies of I–III, III–V and I–V was not significant ( p > 0.05). However, the difference between the latencies of waves III and V in the two diabetic groups was statistically significant. The duration of diabetes, blood glucose level and age were not associated with prolonged ABR latencies ( p > 0.05). Prolongation of latency of ABR in patients with DM should alert us to possible damage to the auditory nerve, and close follow-up is needed in these patients.     

Prediction of frequency-specific hearing threshold using chirp auditory brainstem response in infants with hearing losses

Objectives

To investigate the clinical usefulness of the LS-chirp auditory brainstem response for estimation of behavioral thresholds in young children with mild to severe hearing losses.

Methods

68 infants (136 ears) aged 6–12 months (mean age = 9.2 months) with bilateral mild to severe hearing losses were studied at Children's Hospital of Fudan University. In all cases, the children were referred for LS-chirp ABR and visual reinforcement audiometric (VRA) measurements. The low-frequency band chirp (LF-chirp) thresholds (frequency band = 0.1–0.85 kHz) were compared to the average VRA thresholds (frequency band = 0.25–0.5 kHz), whereas the high-frequency band chirp (HF-chirp) thresholds (frequency band = 1–10 kHz) were compared to the average VRA thresholds (frequency band = 1–4 kHz) using statistical correlation coefficient values.

Results

The LS-chirp ABR thresholds are very close to behavioral hearing levels. The mean differences between chirp-ABR and VRA thresholds were within 5 dB HL for all measurements. The smallest mean threshold difference (<3 dB HL) was obtained for the severe hearing loss group. The correlation coefficient values (r) were 0.97 at low-frequency and high-frequency bands. For each carrier frequency, the best correlations between chirp-ABR thresholds and VRA thresholds were obtained at VRA frequency of 0.25 kHz/LF-chirp (r = 0.98) and VRA frequency of 1 kHz/HF-chirp (r = 0.98).

Conclusions

This study demonstrates the effectiveness using chirp-ABR predicted frequency-specific thresholds, especially of low and middle frequencies. LS-chirp ABR thresholds determined behavioral thresholds in patients with severe hearing losses were better than for mild hearing losses. The use of a chirp-ABR testing ensures higher sensitivity and accuracy than that of auditory stead-state evoked response (ASSR) for measuring frequency-specific thresholds in young children.     

Frequency-specific auditory brainstem response analysis of young normal, aged normal and aged alcohol-addicted rats

Normative data for frequency-specific (+/- 100 Hz) auditory brainstem response (ABR) thresholds were determined in 60 normal healthy 3-month-old, 5 normal 22-month-old and 6 alcohol-addicted 22-month-old Sprague Dawley rats. The highest degree of auditory sensitivity was in the range of 12-20 kHz. These frequencies showed significant mean differences between the 3-month-old and the old normal rats. In contrast, alcohol-addicted old rats did not reveal any significant threshold changes as compared with either normal old or 3-month-old rats.     

Comparison of threshold estimation in infants with hearing loss or normal hearing using auditory steady-state response evoked by narrow band CE-chirps and auditory brainstem response evoked by tone pips

Objective: The objective of this study is to compare air-conduction thresholds obtained with ASSR evoked by narrow band (NB) CE-chirps and ABR evoked by tone pips (tpABR) in infants with various degrees of hearing loss. Design: Thresholds were measured at 500, 1000, 2000 and 4000?Hz. Data on each participant were collected at the same day. Study sample: Sixty-seven infants aged 4 d to 22 months (median age?=?96 days), resulting in 57, 52, 87 and 56 ears for 500, 1000, 2000 and 4000?Hz, respectively. Results: Statistical analysis was performed for ears with hearing loss (HL) and showed a very strong correlation between tpABR and ASSR evoked by NB CE-chirps: 0.90 (n?=?28), 0.90 (n?=?28), 0.96 (n?=?42) and 0.95 (n?=?30) for 500, 1000, 2000 and 4000?Hz, respectively. At these frequencies, the mean difference between tpABR and ASSR was ?3.6?dB (±?7.0), ?5.2?dB (±?7.3), ?3.9?dB (±?5.2) and ?5.2?dB (±?4.7). Linear regression analysis indicated that the relationship was not influenced by the degree of hearing loss. Conclusion: We propose that dB nHL to dB eHL correction values for ASSR evoked by NB CE-chirps should be 5?dB lower than values used for tpABR.     

Phase spectral analysis of auditory brainstem response in cats

In order to apply the phase spectral analysis of auditory brainstem response (ABR) to the clinical diagnostic test, the following studies in cats were performed. At first, the phase spectra of normal ABRs were investigated under adequate stimulus intensities. In addition the component synchrony measures (CSM) of ABRs were calculated at each stimulus level. Moreover the waveforms and phase spectra of ABRs were investigated before and after the destructions of cochlear nerve and brainstem auditory pathways in cats. The results were as follows; (1) In normal ABRs, the phase spectra were mainly composed of three frequency components at 0-300Hz (component A), 300-900Hz (component B) and 900-1500Hz (component C). The CSMs of component A represented the degree of synchrony for a slow component of the ABR and the CSMs of components B and C represented the degree of synchrony for a fast component. (2) A decrease in stimulus intensity resulted in a decrease in each average of the CSMs of the three components. (3) A greater decrease of the CSM occurred if ipsilateral destruction was performed in a peripheral lesion. Lesions of the auditory pathway were followed by a decrease of the CSM of component C to contralateral stimulation. These results suggest that the phase spectral analysis of ABRs has significant clinical value in the detection of brainstem lesions.     

Evaluation of an automated auditory brainstem response in a multi-stage infant hearing screening

An automated auditory brainstem response (AABR) method, the Maico MB-11 with BERAphone^®, has been developed for hearing screening in newborns. The aim of this study was to test the validity of this automated ABR screening method in a multistage newborn hearing screening (NHS). We applied a “five level” protocol using transient evoked otoacoustic emission (TEOAE), AABR-MB-11 with BERAphone^® and conventional auditory brainstem response (ABR). TEOAE, AABR, and conventional ABR testing were performed by ENT specialists experienced in neonatal screening techniques. Among the 8,671 newborns tested (males 3,889; females 4,782), only 42 newborns were lost to follow-up and the final false-positive rate was of 0.03%. Our experience highlights that for the neonatal period, conventional auditory brainstem response is the most reliable method for assessing the hearing level and minimizing the false-positive rate. Although AABR (performed by ENT specialists experienced in neonatal screening techniques) is easy to use, fast and with a good compliance, the device is unable to provide accurate and certain diagnosis on the degree of hearing loss to allow a proper treatment.     

多频稳态诱发电位和听性脑干反应对感音神经性聋儿童客观听阈的评估

目的比较多频稳态诱发电位(MASSR)与短纯音听性脑干反应(Tb-ABR)对感音神经性聋儿童客观听阈的评估。方法对37名感音神经性聋儿童分别测试MASSR反应阈、Tb-ABR反应阈和行为听阈,参照行为听阈,比较MASSR反应阈和Tb ABR反应阈对行为听阈评估的准确性。结果MASSR反应阈、Tb-ABR反应阈和行为听阈之间均有较高的相关性。二者在频率为2、4kHz时,对行为听阈的评估具有相似的准确性;但在频率为0.5、1kHz时,MASSR的准确性较Tb ABR的准确性高。结论MASSR和Tb-ABR均可用作感音神经性聋儿童言语频率客观听阈的评估,但MASSR在低频(0.5、1kHz)时较Tb-ABR的准确性高。     

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

OBJECTIVE: Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS: From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS: The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS: Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.     

Interaction of click intensity and cochlear hearing loss on auditory brain stem response wave V latency.

Auditory brain stem responses (ABRs) to 95, 80, 60, 40, and 30 dB nHL clicks were retrospectively studied from 103 patients (194 ears) with various degrees of cochlear impairment. Hearing loss and sample size were balanced across gender. Results indicate that the slope of the wave V latency versus 4000 Hz hearing loss function doubles as click intensity is decreased from 80 (0.01 msec/dB HL) to 60 nHL (0.02 msec/dB HL). Overall results indicate a slope increase of 0.0004 msec for each decibel decrease in click intensity from 95 to 30 dB nHL. Intersubject variability increased with increased hearing loss and/or decreased stimulus intensity. The effects of hearing loss on wave V latency are minimal, and intersubject variability is less if high-intensity clicks (greater than or equal to 95 dB nHL) are used. No differences in the effects of hearing loss on wave V latency were seen between males and females. Latency corrections for cochlear hearing loss should, therefore, consider stimulus intensity.     

DPOAE与高刺激率ABR在听力正常耳鸣患者中的应用价值

目的 观察分析听力正常的耳鸣患者畸变产物耳声发射(DPOAE)与高刺激率听性脑干反应(ABR)检测的特征,探讨其在耳鸣评估中的应用价值。 方法 选取耳鼻咽喉科门诊听力正常的青年耳鸣患者31例(46耳)为耳鸣组,另外选取听力结果正常的青年无耳鸣者25例(50耳)为正常对照组,分别进行纯音听阈测定、声导抗测听、DPOAE和高低刺激率ABR的检测,对比两组受试者DPOAE各频检出率和信噪比以及高低刺激率ABR各波潜伏期(PL)、波间期(IPL)、波幅以及两种刺激速率下的潜伏期和波间期差值(△PL和△IPL)。 结果 DPOAE各频检出率两组无显著性差异;信噪比在8 kHz,耳鸣组较对照组降低,差异有统计学意义(P<0.05);高低刺激率ABR结果中,不同刺激速率下两组Ⅰ、Ⅲ、Ⅴ波波幅差异均无统计学意义;高刺激速率下,耳鸣组Ⅰ~Ⅴ IPL较对照组延长,差异有统计学意义(P<0.05),两种刺激速率下,耳鸣组Ⅰ△PL较对照组缩短,差异有统计学意义(P<0.05),耳鸣组Ⅴ△PL、Ⅰ~Ⅴ△IPL较对照组延长,差异有统计学意义(P<0.05)。 结论 DPOAE与高刺激率ABR可作为诊断耳鸣的一种客观检查方法,其对耳鸣的早期评估有重要的应用价值;增加ABR刺激速率,可提高耳鸣检测的敏感性。     

Clinical evaluation of the vector algorithm for neonatal hearing screening using automated auditory brainstem response

A novel auditory brainstem response (ABR) detection and scoring algorithm, entitled the Vector algorithm is described. An independent clinical evaluation of the algorithm using 464 tests (120 non-stimulated and 344 stimulated tests) on 60 infants, with a mean age of approximately 6.5 weeks, estimated test sensitivity greater than 0.99 and test specificity at 0.87 for one test. Specificity was estimated to be greater than 0.95 for a two stage screen. Test times were of the order of 1.5 minutes per ear for detection of an ABR and 4.5 minutes per ear in the absence of a clear response. The Vector algorithm is commercially available for both automated screening and threshold estimation in hearing screening devices.