耳科学

多种残疾合并听力损失儿童佩戴助听器后行为测听的改变，人工耳蜗植入术中EABR检测的应用，听神经瘤患者前庭诱发肌源性电位的特征，改良Contour试验测试正常听力与感音神经性听力损失儿童响度增长。     

不同程度感音神经性听力损失儿童的Chirp-ASSR测试结果分析

目的 观察不同程度感音神经性听力损失儿童Chirp声听性稳态反应(Chirp auditory steady-state responses,Chirp-ASSR)的特点,探讨Chirp-ASSR测试的临床意义.方法 对136例(272耳)5～10岁不同程度感音神经性听力损失儿童进行纯音听阈测试(pure tone audiometry,PTA)和Chirp-ASSR测试,根据500、1 000、2 000和4 000 Hz的平均听阈,将受试者分为四组,即20～dB HL组、40～dB HL组、60～dB HL组和≥80dB HL组,比较不同程度感音神经性听力损失儿童各频率纯音听阈与Chirp-ASSR反应阈的相关性.结果 ①纯音听阈≥80 dB HL组的Chirp-ASSR反应阈值比纯音听阈值高,差异有统计学意义(P＜0.05).②PTA和Chirp-ASSR的相关系数γ随着听力损失程度加重而逐渐降低,随着测试频率的增加有增大的趋势,在500 Hz和4 000 Hz之间差异有统计学意义(P＜0.05).结论 Chirp-ASSR有频率特异性,能够较好的反映听力水平,特别在轻度、中度和重度感音神经性听力损失患者中更明显.     

65耳全耳道式助听器（CIC）验配及其效果的分析

全耳道式助听器(Complete in Canal,CIC)具有对感音神经性耳聋高频听力损失补偿佳、听觉分辨效果好等特点,其体积与隐蔽性更是其它助听器所不能相比拟的,故越来越受到耳聋患者的欢迎.自1996年9月～1997年3月我所耳模与耳道式助听器实验室先后对61例感音神经性耳聋患者65耳验配、装置了CIC.现将验配、装置方法与装置前后听力改善情况总结报告如下.     

频域信息在感音神经性听力损失患者普通话声调感知中的作用

目的 探讨言语频域包络信息和精细结构信息对听力正常和感音神经性听力损失人群汉语普通话声调识别的作用.方法 采用线性预测编码技术对具有相同音节但不同声调的单音节字进行频域包络与精细结构的分离,将具有相同音节不同声调的单音节字的频域包络信息进行互换,合成128个新的具有来自于不同声调的频域包络和精细结构信息的“单音节字”.利用这些“单音节字”测试20名听力正常人与48例感音神经性听力损失患者(20例中度、20例中重度及8例重度)的声调感知能力.利用SPSS 15.0软件进行统计分析.结果 听力正常受试者99.7％的声调识别基于频域精细结构信息,中度至重度听力损失患者基于频域精细结构感知声调的识别率分别为97.7％,96.3％和83.0％.各组受试者均未依靠频域包络信息识别声调.三组听力损失患者依靠频域精细结构识别声调的能力均与听力正常受试者存在差异(x2=59.2,P＜0.001).感音神经性听力损失患者利用频域精细结构信息识别声调的能力与其听力损失程度呈负相关关系(r=-0.643,P＜0.001).结论 频域精细结构信息在普通话声调识别中起主要作用,精细结构存在时,频域包络信息对声调识别不起作用.感音神经性听力损失患者利用频域信息感知声调的模式与听力正常人群相似,伴随听力损失程度加重,其利用频域精细结构信息感知声调的能力缓慢降低.     

耳蜗死区对感音神经性听力损失患者言语识别能力的影响

目的 探究耳蜗死区在感音神经性听力损失(sensorineural hearing loss,SNHL)患者中的存在情况及其对言语识别能力的影响.方法 采用纯音听阈测试筛选出41例(81耳)感音神经性听力损失患者,经均衡噪声阈值测试将患者分为有耳蜗死区组(35耳)和无耳蜗死区组(46耳),分别进行言语识别阈(SRT)和言语识别率(SDS)测试,分析81耳耳蜗死区的分布及其对言语识别能力的影响.结果 41例(81耳)感音神经性听力损失患耳中有35耳(43.21％,35/81)存在耳蜗死区,其中轻度SNHL患耳耳蜗死区检出率为0(0/11),中度SNHL患耳耳蜗死区检出率为24.1％(7/29),重度SNHL患耳耳蜗死区检出率为66.7％(24/36),极重度SNHL患耳耳蜗死区检出率为80.0％(4/5),不同听力损失程度耳耳蜗死区检出率差异有统计学意义(P＜0.05);高频耳蜗死区(16耳)明显多于低频耳蜗死区(8耳),但两者的言语识别能力差异无统计学意义(P＞0.05);有耳蜗死区患者的言语识别阈及言语识别率分别为61.63±16.76 dB HL,86.35％±12.03％,无耳蜗死区的患者分别为75.54±9.56 dBHL,64.97％±20.84％,二者间差异有统计学意义(P＜0.05).结论 听力损失越重,耳蜗死区检出率越高;高频耳蜗死区较低频常见,且存在耳蜗死区的感音神经性听力损失患者言语识别能力明显低于无耳蜗死区的患者.     

既往存在感音神经性听力损失突发性聋患者临床特征与疗效分析

目的探讨既往存在感音神经性听力损失突发性聋患者临床特征与疗效。方法对61例(63耳)既往存在感音神经性听力损失突发性聋患者的临床资料进行系统性分析,包括临床表现、疗效评估等,与同期收入院的既往不存在感音神经性听力损失突发性聋患者资料对比,分析发病和影响疗效的高危因素,总结该病发生、发展及预后的特点。结果既往存在和不存在感音神经性听力损失突聋患者的性别、现患耳侧别、病程差异无统计学意义(P值均>0.05),发病年龄差异具有统计学意义(P<0.05)。既往存在和不存在感音神经性听力损失突聋患者的听力曲线类型、听力损失程度差异无统计学意义(P值均>0.05),既往存在感音神经性听力损失突聋患者总有效率低于既往不存在感音神经性听力损失突聋患者总有效率,差异有显著统计学意义(χ²=6.915,P=0.009),既往存在感音神经性听力损失突聋患者痊愈率低于既往不存在感音神经性听力损失突聋患者痊愈率,差异无统计学意义(χ²=0.221,P=0.638)。结论既往存在感音神经性听力损失突聋患者病因复杂,疗效较差,应加大研究制定个性化的诊疗方案。     

儿童突发性感音神经性听力损失的诊治体会

对18例20耳8～14岁突发性感音神经性听力损失患儿的临床资料进行了总结和分析,结果表明儿童突发性感音神经性听力损失发病与首诊之间病程较长,部分患儿有上感、流行性腮腺炎病史,可能和听力损失发生有关.儿童突发性感音神经性听力损失治疗效果类似于成人患者,而全聋者疗效差.东菱克栓酶同样适于治疗儿童突发性感音神经性听力损失且疗效和安全性较好,无明显的出血倾向和其它并发症.     

巨细胞病毒感染肺炎婴幼儿听力检测结果分析

目的 探讨人巨细胞病毒(human cytomegalovirus,HCMV,简称CMV)感染肺炎婴幼儿的听力学特点.方法 以确诊为CMV感染肺炎婴幼儿(CMV感染组)115例(230耳)为研究对象,并选取同期非CMV感染肺炎婴幼儿(非CMV感染组)115例(230耳)以及健康婴幼儿115例(230耳)(对照组),分别进行听性脑干反应(auditory brainsen response,ABR)、声导抗测试,比较三组的结果及听力随访情况.结果 CMV感染组50耳(21.74％)、非CMV感染组34耳(14.78％)、健康对照组17耳(7.39％)ABR波V阈值＞30 dB nHL(P＜0.05);CMV感染组感音神经性听力损失检出率(16.96％,39/230)高于非CMV感染组(6.52％,15/230)和健康对照组(1.74％,4/230) (P＜0.05);CMV感染组(8.70％,20/230)、非CMV感染组(12.17％,28/230)声导抗异常耳均高于健康对照组(2.61％,6/230),CMV感染组、非CMV感染组组间差异无统计学意义(P＞0.05);随访3年,CMV感染组有3例感音神经性听力损失者听力恢复正常,各组其余感音神经性听力损失患儿听力无改善,各组传导性听力损失者均恢复正常.结论 CMV感染肺炎婴幼儿感音神经性聋发病率高,CMV感染肺炎容易导致中耳功能异常引起ABR反应阈升高;对于CMV感染肺炎婴幼儿需要行综合听力学检测且长期随访.     

不同类型听力损失伴耳鸣患者间隔感知特征分析

目的间隔感知测试是一项反映受试者听觉灵敏度的临床测试。本研究主要是对不同类型及程度的听力损失伴耳鸣患者进行间隔感知测试,包括在噪声中的间隔测试及500Hz、1000Hz、2000Hz频率的间隔阈值测试,并探索听力损失及耳鸣对间隔感知测试结果的影响。方法本研究选取听力正常者20例(40耳),听神经病患者15例(30耳),其中有耳鸣患者18耳,无耳鸣患者12耳。感音神经性聋患者36例(45耳),其中有耳鸣患者28耳,无耳鸣患者17耳。对所有受试者进行时域和频域间隔感知测试,并对其中的耳鸣患者进行耳鸣评估测试。结果①AN组间隔感知阈值显著高于听力正常组和感音神经性聋组(P<0.01)。②感音神经性聋组中,听损程度≤60dB患者的间隔感知显著小于听损程度>60dB的患者(P<0.01)。③将500Hz、1000Hz、2000Hz频率下的间隔感知测试结果进行组间比较均有显著性差异(P<0.01)。④对听神经病患者和感音神经性聋患者分别进行有耳鸣组和无耳鸣组分析,时域和频域间隔感知测试结果显示,有耳鸣组和无耳鸣组均无显著性差异(P>0.05)。⑤不同类型的耳鸣声在感音神经性聋患者中的间隔感知无显著性差异(P>0.05)。结论间隔感知测试结果与有无耳鸣无关,与耳鸣声类型无关,与听力损失程度及病变部位有关。     

单侧极重度感音神经性听力损失患者试戴BAHA结果分析

目的:了解单侧极重度感音神经性听力损失患者佩戴骨导助听器BAHA的获益情况。方法:对16例单侧极重度感音神经性听力损失患者进行BAHA的纯音助听听力测试,双耳在裸耳状态下声场安静环境中的言语识别阈测试和MHINT测试,比较未助听与助听后的结果。结果:BAHA对患耳侧来的声源有较好的阈值补偿作用,但对于在安静和噪声中的言语识别阈无明显提升作用。结论:根据该研究和患者的感受,反馈BAHA对于单侧极重度听力损失的获益不大。患者选配前需要进行相关测试了解获益情况,再决定是否植入或佩戴BAHA。尚需要进一步了解单侧极重度感音神经性听力损失患者长期佩戴BAHA后的获益情况。     

Prevalence of middle ear pathologies in children with bilateral sensorineural hearing loss

OBJECTIVES: In poor countries, hearing aids are too expensive for sensorineural hearing loss (SNHL) children's parents to offer for their children. These children may have middle ear problem, this will aggravate the level of hearing loss which may lead to delay in their ability to speak. This study is to highlight the prevalence of middle ear pathology in SNHL children. METHODS: Two hundred children with bilateral sensorineural hearing loss (SNHL) were selected in our study from the outpatient clinic of ENT department of Sohag University Hospital, Egypt. Children were classified into three categories according to their middle ear status. They were normal middle ear, middle ear with unhealthy tympanic membrane or otitis media with intact drum and chronic suppurative otitis media with perforation. RESULTS: Seventy percent of cases were normal, 25% had middle ear problem with intact tympanic membrane and 5% had chronic suppurative otitis media with perforation. CONCLUSION: Thirty percent of SNHL children have middle ear pathology which aggravate the degree of hearing loss. Regular evaluation of SNHL children to treat those having middle ear pathology medically and/or surgically and this may help those having no ability to have hearing aids to learn language early.     

Prognostic indicators for sensorineural hearing loss in temporal bone histiocytosis

Objective

Our review aims: (1) to highlight the suspicion of sensorineural hearing loss (SNHL) in temporal bone Langerhans’ cell histiocytosis (LCH); (2) to assess the evolution of SNHL in this pathology; (3) to identify radiologic findings of the otic capsule invasion by LCH; (4) to determine prognostic factors for SNHL in temporal bone LCH.

Methods

We performed a literature review through MEDLINE for SNHL in temporal bone LCH related articles that were published between 1954 and 2008. We identified 12 related studies of which 18 patients were noted. We also added our case to this series. The information from the reports was analyzed to characterize the clinical and demographic data and to focus on the sensorineural hearing aspect of the disease and on the damage of the semicircular canals (SCC) and the cochlea.

Results

Ten percent of patients with temporal bone LCH presented SNHL. The mean age of patients is 3.5 years among children and 35.5 years among adults. Male to female ratio is 1:1.14. There were 13 unilateral cases, 6 bilateral cases and 1 case of multisystemic histiocytosis. Cochlea and SSCs were involved in 4 and 20 temporal bones, respectively. The lateral SCC is the most frequently eroded canal. In 23 ears hearing level was reported: 15 ears had a SNHL and the remaining was a mixed or a conductive hearing loss type. 10 ears suffered from a profound hearing loss and none of them improved after treatment regardless otic capsule affected structures. In all cases of normal hearing, moderate hearing loss and severe hearing loss before treatment cochlea have not been affected. However a single or two semicircular canals invasions have been noted. Where it is reported (15 out of 25 temporal bone) there was a radiological healing of the otic capsule lesion after treatment. Remineralization occurs 6 months after treatment.

Conclusion

In LCH, hearing loss level before treatment can be considered as a prognostic indicator for hearing in response to treatment. Even though bone mineralization is essential for a hearing improvement, radiological healing is not a prognostic factor for better hearing level after treatment.     

Assessing growth of loudness in children by cross-modality matching

This study examined the clinical feasibility, validity, and reliability of loudness growth assessment using cross-modality matching (CMM) between line length and loudness in 16 children 4 to 12 years old with normal hearing or bilateral sensorineural hearing losses ranging from moderate to severe in degree. Eight adult listeners with normal hearing were used as a comparison group. Loudness growth functions and real-ear measures were obtained for 500-Hz and 2,000-Hz narrowband noise stimuli for each individual. No significant differences were found between the loudness slope values for the adults and children with normal hearing. Loudness growth functions of the children with sensorineural hearing loss were significantly steeper (larger) than the slopes obtained from children with normal hearing. The numeric slope value of the loudness growth function became larger and more variable as children's hearing threshold increased and differed for children with similar thresholds. The loudness functions obtained for retested participants at two different test sessions were highly correlated. Real-ear measurements revealed that for equivalent input stimulus levels, significantly higher stimulus levels were present in the ear canals of children versus adults. Although adults and children with normal hearing had similar overall rates of loudness growth, discrete points along the loudness growth function were judged to be louder by the children. This preliminary study suggests that measures of loudness growth using CMM between line length and loudness are feasible, valid, and reliable in children with normal hearing or sensorineural hearing loss. The individual variability noted in slope values for children with hearing loss attests to the importance of subjective assessments of loudness. The protocol used in this study may have potential as a clinical tool for selecting and fitting amplification technology for children with hearing loss as young as 6 years.     

Sensorineural hearing loss in Nigerian children with sickle cell disease

AIM: To study the prevalence and pattern of sensorineural hearing loss (SNHL) in Nigerian children with sickle cell disease (SCD). MATERIALS: Fifty-two children with SCD were assessed. Otologic examination and audiometric tests were performed. There were 36 males and 16 females. Their age ranged from 6 to 19 years. RESULT: Seven children had hearing impairment. After hemoglobin categorization, all the SCD patients were found to belong to the homozygous (HbSS) group. There were no HbSC nor other variants detected. Prevalence of SNHL was 13.4% in these patients but the general population prevalence rate found in a control group was 6.2%. CONCLUSION: SCD has many organ manifestations and complication among which is sensorineural hearing loss. Regular audiologic assessment, counselling and rehabilitation of these patients with hearing aids are recommended.     

A survey on hearing acuity of centenarians in Hainan Province

Objective

This study aimed to investigate hearing acuity of centenarians in Hainan Province and provide basis for interventional considerations.

Magnitude estimation of loudness. III: Performance of selected hearing aid users

Aided and unaided loudness functions for narrow-band noise stimuli were obtained from hearing-impaired listeners with a magnitude estimation procedure. A comparison of aided loudness functions with those obtained from normal-hearing subjects suggests that the hearing aids did not restore normal loudness relations among the spectral components of speech stimuli. Instead, aided loudness functions tend to reflect an interaction between the abnormal loudness growth that frequently characterizes sensorineural hearing loss and the saturation characteristics of the hearing aid.     

Neural correlates of sensorineural hearing loss

Sensorineural hearing loss is characterized by a relatively well defined set of audiological signs and symptoms such as elevated thresholds, abnormally rapid loudness growth, subjective tinnitus, poor speech discrimination, and a reduction in temporal summation of acoustic energy. Knowledge of the underlying neural mechanisms responsible for some of these auditory distortions has progressed substantially within the past 10 yrs as a result of physiological studies on hearing-impaired animals. Some of the important neurophysiological changes relevant to sensorineural hearing loss are reviewed. One important effect associated with sensorineural hearing loss is the broadening of the cochlear filtering mechanism which may influence loudness growth and the perception of complex sounds. The neurophysiological results may also provide new insights in interpreting traditional audiological data and help in developing more refined tests for fitting hearing aids or differentiating patients with sensorineural hearing loss.     

Revisiting loudness measures in children using a computer method of cross-modality matching (CMM)

The test efficiency and reliability of loudness assessment using a computer-controlled method of cross-modality matching (CMM) between line length and loudness was investigated in children 4 to 12 years with normal hearing or mild to severe degrees of sensorineural hearing loss. Adult listeners with normal hearing served as a comparison group. Computer-generated visual and acoustic stimuli were used to derive individual loudness data. Children and adults with normal hearing presented with similar loudness functions, while children with sensorineural hearing loss had steeper functions than their normal-hearing counterparts. Retest data supported reliability of the CMM method with children within the current study and between previous studies performed with a similar, but manual, method. The computer CMM approach proved more time efficient than the manual one, halving the test time. The CMM loudness task in a computerized version may have potential in a research or clinical setting, in particular for individualizing hearing aid fittings with children.     

慢性化脓性中耳炎与感音神经性聋

目的：观察慢性化脓性中耳炎（CSOM）对感音神经性聋（SNHL）的影响。方法：测量135例（168耳）CSOM患者的骨导听阈，并以66例单侧患者的健耳为对照，比较不同类型、不同病程的CSOM的骨导听阈。结果：CSOM各组骨导听阈均值明显高于对照组，且与中耳炎的类型和病程相关。结论：CSOM可引起SNHL，且中耳病变越重，病程越长，听力下降越明显     

急性低频下降型感音神经性听力损失的临床研究

目的：研究急性低频下降型感音神经性听力损失（ALHL）的病因、诊断和治疗方法。方法：选择55例ALHL患者为研究对象,经详细询问病史和耳专科检查后,行纯音测听,声导抗测听和听性脑干反应（ABR）,随机分为泼尼松组和对照组治疗,疗程结束后随访6个月。结果：两组患者多以青年为主,主要症状为耳闷,低音调耳鸣和听力减退,耳科检查无殊。所有患者（55例58耳）纯音听阈示轻到中度低频感音神经性聋,鼓室导抗图“A”型,49耳镫骨肌反射引出,其中40耳Metz试验阳性。受检的45耳中ABR均正常。治疗后泼尼松组效果优于对照组（P〈O．05）。结论：ALHL以突发的低音调耳鸣,听力减退和耳闷为主要表现,常单耳发病,听力学定位诊断提示为蜗性病变,仅累及低频区。本病对皮质类固醇激素有一定的治疗效果。