人工耳蜗和助听器同时使用的听觉事件相关电位研究

目的探讨人工耳蜗和助听器同时使用者的听觉事件相关电位(ERP)的变化,对人工耳蜗和助听器同时使用所产生的2耳听效果进行客观评价。方法分别在同时使用人工耳蜗和助听器(CI&HA)及单独使用人工耳蜗(CI)两种状态下测定ERP的主要成分P300、N200和N100的潜伏期及P300振幅。结果CI&HA时P300的平均潜伏期为(388.96±62.61)ms,N200为(267.00±45.43)ms,N100为(94.58±9.10)ms,P300平均振幅为(13.69±3.26)μV;CI时P300的平均潜伏期为(412.08±54.32)ms,N200为(289.21±37.40)ms,N100为(99.38±13.15)ms,P300平均振幅为(12.23±2.97)μV。P300平均潜伏期和N200平均潜伏期在CI&HA时较CI时缩短,差异有统计学意义。结论2耳同时使用声音处理方式完全不同的人工耳蜗和助听器,中枢处理过程并不拮抗,能够得到2耳听效果。     

老年性聋患者听觉事件相关电位特征分析

目的 初步研究老年性聋患者的听觉事件相关电位(auditory event-related potential,AERP)失匹配负波(mismatch negativity,MMN)和P300的变化特征.方法 采用oddball刺激序列,对20例健康青年志愿者(对照组)、20例老年听力正常者(老年听力正常组)和20例老年性聋患者(老年性聋组)进行AERP测试,在阅读状态下获得MMN波形,在集中注意力计数状态下获得P300波形,比较三组MMN、P300波形的潜伏期和波幅.结果 老年性聋组MMN潜伏期为187.38±29.63 ms,与老年听力正常组(160.10±23.21 ms)和对照组(148.22±19.30 ms)相比明显延长(P<0.01),老年听力正常组潜伏期与对照组比较差异有统计学意义(P<0.05),三组MMN波幅差异无统计学意义(P>0.05);老年性聋组P300潜伏期为369.83±27.09,较老年听力正常组(332.89±25.60 ms)和对照组(318.51±22.32 ms)明显延长(P<0.01),三组P300波幅差异无统计学意义(P>0.05).结论 老年性聋患者听觉中枢功能受损,认知功能减退,MMN、P300可作为评估老年性聋患者听觉中枢功能、认知功能的客观检查方法.     

中青年OSA H S患者缺氧程度与认知功能损害的相关性研究

目的探讨青年OSAHS患者缺氧程度与认知功能的相关性。方法选取OSAHS患者63例,年龄18～44岁。根据OSAHS患者的低氧血症程度,将患者分为轻度组20例（最低SaO2≥85％）,中度组24例（最低SaO265％～84％）,重度组19例（最低SaO2〈65％）;对照组25例（正常人：AHI〈5）。均进行事件相关电位P300、多导睡眠图（polysomnogram,PSG）和简易智能精神状态检查量表（mini-mental state examination,MMSE）检测。结果①OSAHS患者轻度、中度、重度三组P300潜伏期分别为326．1&#177;12．7、346．9&#177;19．1、334．9&#177;18．3ms,与对照组311．9&#177;18．3ms比较差异均有统计学意义（皆P〈0．05）,0SAHS轻、中度组与重度组之间差异均有统计学意义（P〈0．01或P〈0．05）,但轻度组和中度组患者之间差异无统计学意义（P=0．095）;②重度组中因最低血氧持续时间的不同P300潜伏期不同：最低血氧持续时间4～60秒组潜伏期为338．12&#177;13．7ms,最低血氧持续时间61～140秒组潜伏期为354．74&#177;16．7HiS,差异有统计学意义（P=0．031）;③以上各组P300波幅之间比较差异无统计学意义;④所有患者MESS得分均在正常范围内,但部分得分稍低,重度组与对照组得分比较差异有统计学意义（RA-Ra=9．91,P=0．003）。结论OSAHS患者普遍存在认知功能障碍,可以最低血氧程度及其持续时间初步评估认知功能损害的程度。     

纯音听阈正常的言语交流障碍患者听觉事件相关电位分析

目的初步探讨纯音听阈正常的言语交流障碍患者听觉事件相关电位的特征。方法因听觉障碍尤其在噪声环境下言语理解困难的患者10例作为患者组,正常对照组为性别、年龄匹配的无听力及交流障碍的健康志愿者20例,所有患者及志愿者纯音听阈、鼓室导抗图、畸变耳声发射(DPOAE)及听性脑干反应(ABR)检测均无异常。两组分别在安静和噪声背景下行128导联言语刺激音的听觉事件相关电位(event-related potentials,ERP)检测,比较两组的ERP成分P1-N1-P2和失匹配负波(mismatch negativity,MMN)的潜伏期和波幅。结果安静背景下,两组均能诱出P1-N1-P2和MMN,患者组MMN潜伏期为221.8±23.9 ms,较正常对照组(200.4±28.1 ms)延长(P<0.05);噪声背景下,2名患者的P1-N1-P2及MMN不能分辨;患者组及对照组的MMN潜伏期分别为267.1±27.8和233.4±25.8 ms,差异有显著统计学意义(P<0.01);在安静及噪声背景下,P1-N1-P2潜伏期及波幅、MMN的波幅两组比较差异均无统计学意义(P>0.05)。结论纯音听阈正常的言语交流障碍患者MMN的潜伏期明显延长,提示其中枢处理能力可能下降。     

老年人听觉功能特点分析

目的 研究老年人群听觉功能老化的特点。方法 采用纯音测听、言语识别、镫骨肌反射、听性脑干反应、脑认知功能及P300听觉事件相关电位等多种方法,测试三部分老年人群。结果与青年组相比,老年人纯音听敏度减退;言语识别率下降,中枢听觉认知功能减退,镫骨肌反射阚有不同程度提高、重振耳数随耳聋加重而增多;听性脑干反应各波间期无变化;P300认知电位波潜伏期延长,波辐下降。结论 老年人听觉功能老化特点,表现出听觉系统从耳蜗末梢到听觉中枢具有泛发性退变,此点应引起老年听力康复工作的重视。     

疏波和密波短声诱发的动作电位潜伏期差对梅尼埃病的诊断价值

目的　探讨疏波和密波短声诱发的动作电位 (actionpotential,AP)潜伏期差对梅尼埃病的诊断价值。方法　采用鼓膜电极耳蜗电图描记术 ,对 5 0例正常听力耳和不同听力损失程度和听力图类型的梅尼埃病 90耳及其他原因感音神经性聋 6 0耳分别记录了疏波和密波短声AP潜伏期 ,并对其计算得出的差值进行分析。结果　梅尼埃病组疏波和密波短声诱发的AP潜伏期差 (0 30± 0 15 )ms( x±s,下同 )明显高于正常对照组 (0 18± 0 0 7)ms和其他感音神经性聋组 (0 2 0± 0 10 )ms ,(P值均 <0 0 1) ;梅尼埃病组轻度和中度聋组AP潜伏期差高于中重度聋组 (P <0 0 1) ;低频型和高频型患者高于平坦型 (P <0 0 1)。正常组和其他感音神经性聋组比较差异无显著性意义。感音神经性聋组AP潜伏期差异常率为 4/6 0 (6 7% ) ,梅尼埃病组 5 8/90 (6 4 0 % )。结论　梅尼埃病患者中疏波和密波短声诱发的AP潜伏期差可出现异常增大 ,这一客观参数可能有助于临床诊断     

老年性痴呆患者的听觉损害

目的　确定老年性痴呆患者 (seniledementiaoftheAlzheimer′sdisease ,AD)有无周围性听功能障碍及其与认知障碍的关系。方法　利用纯音测听、言语识别率、声导抗、听觉脑干反应检测AD患者 43例 ,健康老年人 50例 ,评定受试者测听可信度 ,统计测试结果 ,并将上述结果同受试者简易精神状态量表 (mini mentalscaleofequastionnaire ,MMSE)得分进行对照分析 ,寻找二者之间的关系。结果　受试者两耳间周围听力差异无显著性 ,以右耳听力结果 ( x±s)进行统计。AD组纯音听阈为 (2 6 3± 8 5)dBHL和 (2 9 1± 8 7)dBHL ,言语识别率为 (85 5± 5 5) % ;对照组纯音听阈为 (2 3 2± 1 0 6)dBHL和 (2 6 2± 1 1 8)dBHL ,言语识别率为 (87 6± 6 8) %。虽然AD组周围听功能检查结果低于对照组 ,但无统计学意义 (P >0 0 5)。测听可信度、声导抗和ABR阈值两组间差异无显著性 (P >0 0 5)。结论　老年性痴呆患者纯音听阈和言语识别率与老年聋相似 ,其周围听功能障碍与MMSE认知量表得分无关。     

神经心理量表联合事件相关电位对中、重度阻塞性睡眠呼吸暂停低通气综合征患者轻度认知功能障碍的评价

目的通过神经心理量表和事件相关电位中的P300检测评价中、重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的轻度认知功能障碍(MCI)。方法对多导睡眠呼吸监测(PSG)确诊的中重度OSAHS患者30例(患者组)、志愿者20例(对照组),分别以蒙特利尔认知评估量表(Mo CA)评分判断参加者是否存在MCI,并行Epworth嗜睡量表(ESS)和事件相关电位中的P300检测,PSG检查记录呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(LSa O2)、夜间平均血氧饱和度(MSa O2)和血氧饱和度低于90%的时间占整个睡眠时间的百分比(CT90%)、氧减指数(ODI)、呼吸性微觉醒指数(RMI)和睡眠结构。分别比较患者组与对照组的各项指标,相关分析Mo CA评分与各项指标和P300相关参数的相关性。结果与对照组比较,中、重度OSAHS患者年龄和受教育年限差异无统计学意义,BMI和ESS评分明显增加,Mo CA总评分明显降低,M o CA亚项分析中记忆/延迟回忆评分明显降低,AHI明显增加,LSa O2和MSa O2明显降低,CT90%增加,ODI和RMI指数明显增加,浅睡眠(S1、S2期)延长、深睡眠(S3、S4期)及快动眼睡眠期(REM)减少;在P300检测中,Cz、C3、C4、Pz点P300潜伏期明显延长,直线相关分析Mo CA亚项中记忆/延迟回忆评分与ESS、AHI、MSa O2、Cz、C3、C4点潜伏期无相关性,与LSa O2正相关,与RMI、ODI、CT90%与Pz点潜伏期和Fz点波幅负相关,Pz点P300潜伏期及Fz点P300波幅对Mo CA评分影响较大。结论中、重度OSAHS患者存在MCI,OSAHS患者的记忆功能变化是由夜间微觉醒所致。P300检测可作为评价OSAHS患者认知功能障碍的电生理指标之一,结合M o CA评分能对OSAHS患者认知能力及时测评。     

听觉事件相关电位的晚期辨别负波成分研究进展

听觉事件相关电位(auditory event related po-tential,AERP)通过给予声音刺激诱发大脑做出反应,探测大脑对声音刺激的早期注意加工和分辨能力,是研究听觉认知的重要工具,其潜伏期为 50～750 ms,属于长潜伏期诱发电位[1].临床上为实用起见,将诱发电位分为外源性刺激相关电位和内源性刺...     

梅尼埃病听力损失程度和类型对短声诱发的SP/AP比值的影响

目的 :探讨耳蜗电图 (ECoch G)在梅尼埃病诊断中听力损失程度和类型 ,对交替短声诱发的负性总和电位 (SP)与动作电位 (AP)比值 (SP/ AP)的影响。方法 :采用鼓膜电极耳蜗电图描记术 ,对梅尼埃病 90耳 (梅尼埃病组 )和其他原因感音神经性聋 6 0耳 (感音神经性聋组 )及正常听力 5 0耳 (正常对照组 )记录了 AP和 SP各参数 ,对结果进行对照分析。结果 :AP潜伏期 3组差异无显著性 ,AP振幅正常对照组高于梅尼埃病组和感音神经性聋组 (P <0 .0 5 ) ,SP振幅正常对照组高于感音神经性聋组 (P <0 .0 1)而低于梅尼埃病组 (P <0 .0 1)。SP/ AP振幅比值梅尼埃病组 (48.0 9± 14 .38) % ,明显高于感音神经性聋组 (2 0 .0 2± 15 .0 0 ) %和正常对照组 (2 3.85±8.0 5 ) % ,(均 P <0 .0 1)。梅尼埃病组 SP/ AP比值与主观纯音听阈呈正相关 (r =0 .5 6 0 1,P <0 .0 1) ,其异常率为 73%。梅尼埃病不同听力损失组中 ,SP/ AP比值轻度耳聋组低于中度和中重度组 (均 P <0 .0 1) ,后两组差异无显著性意义 (P >0 .0 5 )。低频型低于平坦型 (P <0 .0 5 ) ,高频型和前两型相比差异无显著性意义。结论 :SP/ AP振幅比值异常增大有助于梅尼埃病的临床诊断 ,在一定范围内随听阈提高而增大 ,必须有足够的残余听力才能记录质量好的图形。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.