听性脑干反应联合听觉多频稳态诱发反应在儿童听力筛查和诊断中的应用

目的利用听觉稳态诱发反应（auditory steady state evoked response,ASSER）联合听性脑干反应（auditory brainstem response,ABR）测试对婴幼儿进行听力检测,评价两种方法对婴幼儿听力损伤早期发现及损失程度评估的作用。方法对7 6例（1 5 2耳）畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）复筛未通过的婴幼儿及门诊就诊疑有听力损失的婴幼儿进行ASSER和ABR测试,对结果进行比较。结果7 6例（1 5 2耳）婴幼儿ABR反应阈与ASSER高频反应阈比较,差异无统计学意义（P＆lt;0.0 5）。ABR在最大输出无反应而ASSER测试中各频率能引出反应。结论ASSER联合ABR检查可以更全面的评估婴幼儿的真实听力情况,对ABR无反应的患儿还应进行ASSER测试,有助于全面评估其听力损失程度。     

听性稳态反应与听性脑干反应阈值的比较

目的:通过比较同一组聋儿听性脑干反应(ABR)和听性稳态反应(ASSR)的反应阈值,对ASSR的临床应用价值作出评价。方法:分别记录65例年龄在2.5个月~5.5岁聋儿的ABR及ASSR结果并进行比较及相关分析。结果:本组聋儿ABR反应阈值左右耳分别为(85.82±12.39)和(82.70±14.93)dB nHL;ASSR 4个测试频率的反应阈值左耳为(86.91±16.70)(、90.32±16.11)、(91.02±16.58)、(89.80±17.08)dB HL,右耳为(85.15±18.16)(、89.32±17.76)(、90.41±18.87)(、85.15±17.03)dB HL。ASSR 4个测试频率的反应阈值与ABR结果的相关系数分别为左耳0.622、0.721、0.757、0.714和右耳0.613、0.732、0.795、0.739。结论:ASSR与ABR测试结果有显著的相关性,而ASSR所获得的是分频资料,因此这种测试方法有较高的临床应用价值。     

Evaluation of the brain-stem function by the auditory brain-stem response and the caloric vestibular reaction in comatose patient

The auditory brain-stem response (ABR) and the caloric vestibular reaction (CVR) were investigated in 100 patients in deep coma to evaluate the brain-stem function of these patients precisely and to predict their prognosis accurately. In the first ABR examination, 54 patients showed normal and 46 abnormal ABRs. Among the latter, five showed partial wave disappearance and 21 exhibited no ABRs. Twenty-six of the 30 patients who recovered (87%) showed normal ABRs and 21 of the 57 who died (37%) also exhibited normal latency at that time. On the other hand, all the patients who showed wave disappearance (the absence of or only wave I response) died. Forty of 86 patients who underwent the CVR test showed some reaction. However, 46 patients showed no CVRs even in the first examination. Twenty-two of 26 patients who recovered exhibited some eye movements, while the remaining four showed no reaction at that time. From these results the following statements can be made. If total or partial (wave I) disappearance of the ABR in comatose patients is observed, one can predict a poor prognosis or death. If no reaction is observed in the CVR, however, one cannot always expect a poor prognosis.     

Preoperative and postoperative auditory brain-stem response results for patients with eighth-nerve tumors

Preoperative and postoperative auditory brain-stem response results and audiologic data were reviewed for seven patients whose hearing was preserved after eighth-nerve tumor surgery. Auditory brain-stem response absolute latencies (I, III, and V) and interpeak intervals (I-III, III-V, and I-V) were identified more often postoperatively than preoperatively. Even though postoperative absolute latencies were usually abnormal, the interpeak intervals were usually normal following surgery. Postoperative hearing sensitivity was unchanged or slightly poorer for five of the seven patients, but postoperative speech discrimination was the same or better for six of the seven patients. All three patients having acoustic reflex testing showed improvement postoperatively.     

交叉听力对豚鼠听性脑干反应测试的影响

报告对８只听觉正常的及鼠，观察交叉听力对其耳蜗动作电位和听怀脑干反应测试结果的影响。先手术造成其左耳全聋，然后用四种方法分别记录ＡＢＲ反应阈和Ⅰ波潜伏期。结果发现，术耳虽已全聋，但该侧给声强度达１０ｄＢＨＬ以上时仍可记录到ＡＢＲ，而ＡＰ未能引出，代之出现的却是清晰的ＡＢＲ波形。     

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。     

Effect of tone-burst frequency on fast and slow components of auditory brain-stem response

By means of digital filtering, averaged auditory brain-stem responses (ABR) were divided into slow and fast components with frequency compositions of 50-300 Hz and 400-1 500 Hz, respectively, and the relation of the two components to stimulus frequency was investigated. Tone bursts with a rise-decay time of two periods of the chosen frequency with no plateau (2-0-2) and with a 4 ms rise-decay time with no plateau (8 ms duration) were used as acoustic stimuli. Tone-burst frequencies were 0.5, 1, 2, 4 and 8 kHz at an intensity level of 40 dB nHL. The amplitude ratio of wave V of the fast component to the slow component decreased with decreasing stimulus frequency, and it remained almost unchanged at each stimulus frequency regardless of the rise-decay time of the stimuli. From these results, it became clear that the frequently-mentioned audiometric difficulties for lower frequency stimuli in ABR testing are related mainly to the low amplitude of the fast component for the frequency range below 1.0 kHz. The slow component, with relatively large amplitude for the low-frequency stimuli, is regarded as the most useful index in the ABR for threshold estimation of hearing.     

Early detection of hearing loss in children with cleft palates by brain-stem auditory response

The hearing of 23 children with cleft palates was studied at an early age (before 12 months) and before pharyngoplasty using the electrophysiologic method of auditory brain-stem response. Nineteen children showed important degrees of conduction deafness of 50 or 60 dB. Results were compared with those obtained for a group of normal children tested under the same method before age 6 months. No hearing loss was observed in this group. It is concluded that hearing defects appear at an early age in children with cleft palates and are in direct relationship to the malformation. Hypotheses concerning the etiopathogeny of these hearing losses are proposed.     

缺铁性贫血治疗前后听性脑干反应的变化

目的 :探讨缺铁性贫血导致感音神经性聋的治疗方法及疗效。方法 :将 6 8只 Wistar大鼠分成 3组 :48只通过缺铁饮食制作缺铁性贫血模型 ,缺铁 A组和 B组各 2 4只 ;另设标准对照 C组正常大鼠 2 0只。将 A、B两组进行缺铁饲养 6周 ,检测听性脑干反应 (ABR) ,每组各随机取样 10只检测畸变产物耳声发射 (DPOAE) ,再分别给予铁剂加高压氧治疗和单纯铁剂治疗。结果 :缺铁 Wistar大鼠经 6周饲养 ,较实验前 ABR听觉阈值提高和 波 PL 延长 ,经过两种不同方案治疗 6周 ,均取得明显效果 (P<0 .0 5 ) ,但两组差异无显著性。结论 :对于缺铁性贫血造成感音神经性耳聋 ,早期给予及时的铁剂治疗疗效好 ,而高压氧用于治疗此类耳聋并非必要。     

The influence of exercise-induced temperature elevations on the auditory brain-stem response (ABR)

The influence of exercise on the auditory brain-stem response (ABR) was examined in 16 healthy volunteers (8 female and 8 male). Ipsilateral ABR recordings were obtained before and after exercise on a bicycle ergonometer. The rise of body temperature so generated was 0.5-2.1 degrees C (mean, 1.3 degrees C) as measured in the contralateral external auditory meatus. Latencies of waves III and V (but not wave I) were found to be significantly lower immediately post-exercise (P less than 0.01). The temperature relations of the latency of wave V are described by the regression equation: Latency (ms) = 11.06-0.146 x temp. (degrees C). (The effects on amplitude were not significant, nor were male/female differences.) It is suggested that exercise hyperthermia could be an appropriate model for the evaluation of the ABR in fever.     

Frequency composition of brain-stem auditory evoked potentials

It has been demonstrated by digital filtration and power spectra analysis that main energies of different components of human brain-stem auditory evoked potentials are concentrated in the following frequency bands: 400--1 000 Hz for waves I and II, 100--900 Hz for wave III, and 100--500 Hz for waves IV--VI. The data obtained are compared with those published in Scand Audiol by Terkildsen et al. (1975) and Elberling (1976).     

Abnormalities of the auditory brainstem response in post-meningitic infants and children

The auditory brainstem response (ABR) was recorded in 86 infants and children from 1 month to 14 years of age following episodes of bacterial or viral meningitis. Thirty-two demonstrated some degree of cochlear impairment There was a high incidence of neurological sequellae in these children. Eight children exhibited abnormal changes suggestive of brainstem dysfunction Six of these eight children also had abnormal neurologic examination. Recovery, or at least improvement in the ABR, occurred in six infants who were assessed upon discharge from the hospital, and then again several months post-hospitalization. In each case improvement was attributed to a resolving conductive component.The ABR was found to be effective for identifying hearing impairment and brainstem dysfunction in pediatric patients following central nervous system infection. Objective information, not available from other methods of assessment was obtained.     

Comparison of auditory steady-state response and click-evoked auditory brain response in infants with different types and degrees of hearing loss

Abstract

Background: Auditory steady-state response (ASSR) and click-evoked auditory brain response (c-ABR) have been used for hearing assessment for decades years, the correlation of the two methods and the effects of type and degree of hearing loss (HL) to the correlation in infants younger than 6?months of age are unclear.

Objectives: To compare the correlation of ASSR and c-ABR and then to analyse the effects of type and degree of HL on the correlation in infants younger than 6?months of age.

Material and methods: Retrospective study comparing ASSR thresholds at various frequencies with c-ABR thresholds. 182 ears from 96 infants were assessed and classified according to types and degrees of HL.

Results: The correlation coefficients were: 0.823, 0.864, 0.891, 0.871, 0.908, 0.915 and 0.913 between ASSR thresholds at 0.5, 1, 2, 4, 2–4, 1–2–4, 0.5–1–2–4?kHz and c-ABR thresholds respectively. The correlation coefficients in the group of sensorineural HL (SHL) (r?=?0.763–0.900) were higher than conductive HL (r?=?0.309–0.619) across all frequencies. The coefficients of severe-profound SHL (r?=?0.595–0.790) were higher than mild-moderate SHL (r?=?0.434–0.687) across all frequencies.

Conclusions and significance: ASSR was one valuable cross-check measure by providing frequency specific information in auditory assessment.     

Auditory brain-stem responses in infants with Down's syndrome

Auditory brain-stem responses to clicks were recorded from 38 infants with Down's syndrome at the ages of 3, 6, and 12 months in an attempt to delineate age-dependent and intensity-dependent latency changes in this population. Comparisons were made with 35 normally developing infants at the same age levels. Significant wave V latency differences were observed between groups for both age and intensity, with the group with Down's syndrome showing, in general, shorter absolute wave V latency values across age and steeper latency functions across intensity. The implications of this study are as follows: (1) latency-intensity curves for normally developing infants will not serve adequately as normative values for infants with Down's syndrome, particularly at the age of 12 months, and (2) cochlear function in infants with Down's syndrome may differ from normal infants by the age of 12 months.     

Distribution of auditory response behaviors in normal infants and profoundly multihandicapped children

Responsiveness (yes/no decisions) to sound has been found to be similar for normal infants and profoundly multihandicapped children of comparable developmental ages (Flexer & Gans, 1985). The purpose of this investigation is to extend the comparison of these two groups by examining the distribution of their response behaviors to sound. Ten normal and 10 multihandicapped children were videotaped while various auditory signals were presented. Without knowledge of stimulus type, five judges listed the behaviors that occurred during 24 sound and 24 catch trials for each child. The behaviors were then evaluated as a function of the stimulus parameters of meaningfulness, bandwidth, and intensity. Results revealed that the profoundly multihandicapped children displayed relatively more reflexive than attentive type behaviors and exhibited fewer behaviors per response. The effects of stimulus-type on the numbers and distribution of responses are discussed.     

Auditory-evoked brain-stem responses and auditory disorders in patients with Bell's palsy

Summary Out of 121 patients examined with acute unilateral facial paralysis, 93 were determined to have idiopathic facial palsy (Bell's palsy). The examination included pure-tone and speech audiometry, stapedial reflex recordings, temporal bone radiography and auditory-evoked brain-stem response testing (ABR). If a retrocochlear lesion was suspected, computed tomography or magnetic resonance imaging was performed. Patients with sensorineural hearing loss affecting all frequencies were compared to one group with hearing loss affecting only high frequencies and to another group with ABR findings suggesting a cochlear lesion. No association could be made between the etiology of these pathological results and the concurrent facial paresis. Most of them were probably caused by unrelated disorders of the auditory system. In cases with prolonged inter-peak latencies representing brain-stem responses, abnormal ABRs could be caused by the same pathology as the paralysis. This might well suggest the presence of a neuropathy in both the central auditory system and the facial tracts.     

Long-term audiometric follow-up of click-evoked auditory brainstem response in hearing-impaired infants

Conventional pure-tone thresholds were collected as determined at ages between 4 and 8 years from a group of 163 infants, tested by auditory brainstem response (ABR) in the age range between 1 and 3 years old for objective hearing assessment. The subjects suffered from a variety of degrees and types of sensorineural hearing impairment. The prognostic value of the ABR peak V thresholds in response to 0.1 ms clicks with respect to the behavioural thresholds at octave frequencies from 125 to 8,000 Hz obtained later is evaluated. Correlation between ABR and behavioural thresholds is largest in the 1,000- to 8,000-Hz frequency range. Predicted pure-tone audiograms (mean and SD) were determined for each 10-dB class of ABR thresholds. SDs are in the order of 15 to 18 dB in the 500- to 4,000-Hz range and slightly higher at adjacent frequencies (i.e., somewhat larger than in comparable adult studies). Mean pure-tone thresholds in the 1,000- to 8,000-Hz frequency range are up to 20 dB worse than ABR thresholds, which is opposite to findings in normally-hearing subjects. Thus, with an increasing degree of sensorineural hearing impairment, pure-tone thresholds increase at a significantly higher rate than ABR thresholds. The observation is explained in terms of reduced temporal integration in cochlear hearing loss. ABR thresholds worse than 80 dB nHL are demonstrated to have very limited predictive value with respect to the amount of residual hearing, not only in the low- but also in the high-frequency range. The presence of otitis media during ABR testing is shown to make estimation errors increase to more than 25 dB (SD).     

Prognostic validity of auditory brainstem evoked response screening in newborn infants

The effectiveness of the auditory brainstem evoked response (ABR) test as a screening test for permanent hearing loss in neonates is examined in 32 published studies including 4,945 infants. Follow-up studies validating initial test failure were available for only 658 infants. Significant differences in methodology exist among these studies, and these differences may have affected their outcomes. Despite this problem, data from these studies were pooled, and they revealed that 16.5 per cent of neonates failed the initial ABR test. Of these, 5.1 per cent were later confirmed to be hearing-impaired or otherwise neurologically impaired. This implies that many of the false-positive results occurred in neonates who had transient disorders, such as conductive hearing loss or neurologic abnormalities, at the time of the screening test, or that the pass/fail criterion was too stringent. Lack of data on false-negative results or the rate of correct identification of normal infants makes it impossible to assess the sensitivity of the test accurately. Firm estimates of the prognostic validity of the neonatal ABR screening in identifying the impaired population can be achieved only when the actual impairment rate can be estimated, and when the distributions of ABR latencies and thresholds for both normal and impaired populations are known. These data could be obtained by following groups of high-risk infants longitudinally and by pooling raw ABR data from the normal and impaired populations that are collected using standardized procedures and similar equipment.