耳声发射在重症监护新生儿听力筛查中的应用

目的 探讨重症监护新生儿(NICU)的合适听力筛查方法.方法 用瞬态诱发耳声发射仪(TEOAE),对263例重症监护新生儿进行听力筛查,未通过者1个月后进行复查,仍未通过者将接受脑干诱发电位(ABR)检查,以确定有无听力损失.结果 263例NICU新生儿中,209例通过了第一次OAE筛查,1个月后43例通过了OAE复查,最后11例行ABR检查,5例确诊有不同程度的听力损失.结论 TEOAE和 ABR联合应用的两步筛查法是NICU新生儿听力筛查的可行方法.     

Factors contributing to hearing impairment in patients with cleft lip/palate in Malaysia: A prospective study of 346 ears

ObjectiveTo determine the factors contributing towards hearing impairment in patients with cleft lip/palate.MethodA prospective analysis was conducted on 173 patients (346 ears) with cleft lip and palate (CL/P) who presented to the combined cleft clinic at University Malaya Medical Centre (UMMC) over 12 months. The patients' hearing status was determined using otoacoustic emission (OAE), pure tone audiometry (PTA) and auditory brainstem response (ABR). These results were analysed against several parameters, which included age, gender, race, types of cleft pathology, impact and timing of repair surgery.ResultsThe patients' age ranged from 1–26 years old. They comprised 30% with unilateral cleft lip and palate (UCLP), 28% with bilateral cleft lip and palate (BCLP), 28% with isolated cleft palate (ICP) and 14% with isolated cleft lip (ICL). Majority of the patients (68.2%) had normal otoscopic findings. Out of the 346 ears, 241 ears (70%) ears had passed the hearing tests. There was no significant relationship between patients' gender and ethnicity with their hearing status. The types of cleft pathology significantly influenced the outcome of PTA and ABR screening results (p < 0.001). There was no significant difference between the repaired and unrepaired cleft groups and the outcome of hearing tests. However, hearing improvement occurred when palatal repair was performed at the age of <1year old (OR = 2.37, CI 1.2 = 4.6, p = 0.01).ConclusionMajority of the cleft patients had normal hearing (70%). Hearing threshold varied significantly between the different types of cleft pathology. Surgery conferred no significant impact on the hearing outcome unless surgery was performed at the age of <1 year old.     

正常听力儿童及青年失匹配负波研究

目的探讨正常儿童及正常青年失匹配负波(mismatch negativity,MMN)的特点。方法对29例(58耳)正常听力儿童(7~16岁)及29例(58耳)正常听力青年(18~34岁)采用经典的oddball模式进行MMN检查,标准刺激和偏差刺激分别为1000 Hz和2000 Hz的短纯音,观察两组MMN潜伏期及波幅的特点,并比较两组的差异。结果58例(116耳)受试者均可正常引出MMN波形,正常儿童组MMN平均潜伏期和平均波幅分别为171.23±26.90 ms和3.46±2.30μV,正常青年组分别为177.57±26.61 ms和3.96±2.46μV;两组间MMN潜伏期及波幅均无统计学差异(P=0.072,P=0.11>0.05)。结论7~16岁正常听力儿童及18~34岁正常听力青年组均能引出稳定的MMN波形,且两组间MMN的潜伏期和波幅无明显差异;MMN结果与儿童受试者听觉通路的成熟情况有关,与年龄差异无关。     

Evoked otoacoustic emissions--an approach for monitoring cisplatin induced ototoxicity in children

OBJECTIVES: Cisplatin chemotherapy is associated with an increased risk of ototoxic changes. The incidence of hearing loss after the 1st cisplatin-infusion session is only scarcely mentioned in the international literature. With increasing survival rates, prevention and/or early detection of ototoxicity are important for providing management options. The predictive value of pure-tone audiometry in early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions appear to be more sensitive to cochlear insult than the conventional pure-tone audiometry. The aims of our study was (a) to define the extent of hearing damage in children after the 1st cisplatin-infusion session (50 mg/m(2)); and (b) to compare the efficacy of otoacoustic emissions (transient evoked otoacoustic emissions, distortion-product otoacoustic emissions) with that of pure-tone audiometry as methods of audiological monitoring. METHODS: Baseline audiometric (0.25-8 kHz) and otoacoustic emission testing (transient evoked otoacoustic emissions, distortion-product otoacoustic emissions) was conducted in 19 children, 12 of whom met the criteria for inclusion in the final study. Comparisons were performed between baseline measurements and those recorded after the 1st cisplatin course. Transient evoked otoacoustic emissions were analyzed in terms of emission level and reproducibility as a function of frequency (0.8-4 kHz). Distortion-product otoacoustic emissions were obtained as DP-grams and I/Q functions at 4,6 and 8 kHz. The DP-gram amplitude, the dynamic range and the detection thresholds from the I/Q functions were determined for each child. RESULTS: Threshold changes from baseline were founded to be statistically significant from 4-8 kHz in 50% of the children (P<0.01). Transient evoked otoacoustic emissions revealed a significant decrease in the emission level and in the reproducibility at the highest frequency tested (4 kHz, P<0.01), reflecting the results seen in pure-tone audiometry. Distortion-product otoacoustic emissions demonstrated a significant threshold shift, a reduced dynamic range and a decreased amplitude in the frequencies >3 kHz (P<0.05). Furthermore, DP-gram amplitude also reduced significantly at 3 kHz (P<0.05) without any similar change in pure-tone audiometry. CONCLUSIONS: A significant high-frequency hearing loss is identified in children even after one low-dose cisplatin-infusion session. As ototoxicity screening tools DP-grams were extremely sensitive and superior to pure-tone audiometry and/or transient evoked otoacoustic emissions. Their use is recommended for regular monitoring of cochlear function, aiming in prevention of permanent damage. Some suggestions for reducing the potential for cisplatin ototoxicity (chemoprotective agents, gene therapy, inhibition of apoptosis) are also discussed.     

Distortion-product otoacoustic emission: early detection in deferoxamine induced ototoxicity

OBJECTIVE: Deferoxamine therapy in lifelong transfusion-dependent anaemias, as beta-thalassemia major, is associated with an increased risk of ototoxic changes. With increasing survival rates, prevention and/or early detection of ototoxicity are important for providing management options. The predictive value of pure-tone audiometry in early detection of ototoxicity has been questioned, particularly in the higher frequencies. Otoacoustic emissions appear to be more sensitive to cochlear insult than the conventional pure-tone audiometry. The aim of our study was to compare the efficacy of otoacoustic emissions (distortion-product otoacoustic emissions) with that of pure-tone audiometry as method of audiological monitoring. METHODS: Baseline audiometric (0.25-8kHz) and otoacoustic emission testing (distortion-product otoacoustic emissions) was conducted in a group of patients with beta-thalassemia major, 60 of whom met the criteria for inclusion in the study. Comparisons were performed between baseline measurements and those recorded after 20 months. Distortion-product otoacoustic emissions were obtained as DP-grams. The DP-gram amplitude was determined for each child. RESULTS: Threshold changes from baseline were found to be statistically significant from 4 to 8kHz in 68.4% of the subjects (P<0.01). Distortion-product otoacoustic emissions demonstrated a significant threshold shift and a decreased amplitude in the frequencies >3kHz (P<0.05). Furthermore, DP-gram amplitude also reduced significantly at 3kHz (P<0.05) without any similar change in pure-tone audiometry. CONCLUSIONS: As ototoxicity screening tool DP-gram was extremely sensitive and superior to pure-tone audiometry. Their use is recommended for regular monitoring of cochlear function, aiming in prevention of permanent damage.     

机械纺织工人畸变产物耳声发射的临床研究

目的研究畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)在监测和早期发现噪声性聋(noise induced hearingloss,NIHL)方面的应用价值。方法检测160名(285耳)机械纺织工人(其中噪声性聋组125例224耳,有噪声接触史但纯音听阈正常者为对照组,共35例61耳)和75名听力正常人(正常对照组)的鼓室导抗图、镫骨肌反射、纯音听阈及DPOAE,比较三组的DPOAE幅值和引出率。结果①噪声性聋组DPOAE幅值及引出率均较正常对照组明显下降(P<0.05);②对照组与正常对照组比较,对照组的DPOAE幅值在4kHz处、引出率在3~6kHz处明显下降(P<0.05);③随着接触噪声工龄的延长,DPOAE引出率逐渐下降(P<0.05)。结论DPOAE可以客观地监测和早期发现噪声性聋,较纯音测听更有意义。     

先天性外耳和中耳畸形患者的听力学分析

目的探讨不同程度的先天性外、中耳畸形患者的听力学表现。方法对55例(双耳15例,单耳40例,共70耳)先天性外、中耳畸形患者行纯音测听、听性脑干反应(ABR)和颞骨CT检查,其中45耳行外耳或中耳成形术,10耳单纯行耳廓成形术,并结合术中所见按不同程度的畸形分组,比较其听力学改变。结果63耳纯音测听显示为传导性聋,骨导听阈正常,70耳ABR反应阈升高,耳廓和听骨链畸形严重者纯音听阈值大于70dB(其中镫骨和卵圆窗畸形严重者纯音听阈大于80dB),与畸形程度较轻者差异有统计学意义(P<0.05)。乳突气化差、外耳道骨性闭锁者纯音听阈值大于70dB(其中外耳道口处无骨性小凹者纯音听阈值大于70dB),较外耳道、乳突发育好者差异有统计学意义(P<0.05)。结论对先天性外、中耳畸形患者术前进行纯音测听、ABR检查,并结合临床和颞骨CT检查,可初步评估外耳、中耳发育程度,进而指导手术治疗。     

Audiologic results in patients with Moebiüs sequence

OBJECTIVE: Moebiüs sequence is a pathology not very well understood regarding to the hearing status. The main goal of this study was to describe the audiologic findings in children and adolescent who carry Moebiüs sequence. METHOD: Participated in this study 17 children and adolescent, with age ranging from 3 to 13 years old. Prior to the testing, the family answered an interview. It was realized external auditory canal inspection, and the hearing testing (auditory instrumentation, pure tone audiometry, speech audiometry, immittanciometric measures, and otoacoustic emissions) on the participants. RESULTS: The auditory instrumentation evaluation (n=6) was present in all participants. The pure tone audiometry presented normal hearing levels in 75.0% of the tested ears, one ear with conductive hearing loss, two ears with sensory neural hearing loss, and one ear with mixed hearing loss. The tympanometric measures showed Type A tympanograms in 63.0% of the ears, Type B in 11.1%, Type C in 18.5%, and Type As in 7.4%. T the acoustic reflexes measure showed contralateral acoustic reflexes present in 50.0% of the ears, and ipsilateral acoustic reflexes present in 34.6% ears. The OAE results showed presence in 73.0%, for the TOAE, and 76.9% for the DPOAE. CONCLUSION: These results support the idea that there is no audiologic pattern for conductive hearing loss. The majority of the participants presented hearing in the normal range. Care should be taken in drawing conclusions regarding to auditory status of the individual with Moebiüs sequence, but what can be said is that not always those individuals present hearing loss.     

Ototoxic effects of cisplatin in a Sprague-Dawley rat animal model as revealed by ABR and transiently evoked otoacoustic emission measurements

The ototoxic effects of cisplatin in a Sprague–Dawley rat model were evaluated by recordings of auditory brainstem responses (ABR) and transiently evoked otoacoustic emissions (TEOAEs). The ABR responses were evoked from alternating clicks and 8, 10, 12, 16, 20 and 30 kHz tone pips in a range from 40 to 100 dB SPL range. The TEOAEs were recorded with a non-linear protocol, and were evoked by a 63.5 dB SPL click stimulus. Twenty five male Sprague–Dawley rats were used in the study, 20 animals were treated with cisplatin (16 mg/kg, body weight) and five animals served as controls. The data showed that 72 h after the cisplatin administration, the TEOAE and ABR variables were significantly altered. The relationship between the ABR and TEOAE variables was shown to be non-linear. The most significant relationships were observed between the TEOAE correlation and the ABR threshold values at 10, 12, and 16 kHz.     

The importance of high-tone audiometry in monitoring for ototoxicity

Summary Early detection of ototoxicity is of vital importance in cases in which ototoxic drugs are administered. Ototoxicity as a result of cis-platinum administration is well documented. Auditory damage may be reduced by changes in dose, drugs or methods of treatment. As ototoxicity appears to be most pronounced in the higher frequencies of sound, any changes can be assessed at an earlier stage by using high-frequency audiometry to test patients at frequencies from 8 to 20 kHz. Our present study demonstrates the utility of monitoring auditory function at frequencies higher than conventionally tested in patients receiving cis-platinum.     

The protective role of tiopronin in cisplatin ototoxicity in Wistar rats

The purpose of this study was to evaluate cisplatininduced ototoxicity and the protective effects of tiopronin. Twenty-four adult Wistar rats served as subjects and were divided into three groups. Eight rats receiving only saline (group A) were used as controls. Eight rats received cisplatin (2 mg/kg) injections (group B) and eight rats received cisplatin and tiopronin (300 mg/kg) (group C) for 8 consecutive days. Both ears of all animals were tested by DPOAE before treatment and on the 4th and 9th days. Seventy-two hours after the final recording session, all animals were killed, and the left cochleas were prepared for electron microscopy and analysed. DPOAE responses were significantly reduced in group B compared to controls ( p_0.05). When tiopronin was added, DPOAE responses were significantly increased compared to those obtained with the administration of cisplatin alone ( p_0.05). The cochleogram showed that tiopronin had a significant protective effect in the basal half and in the lower half of the middle turn. We conclude that tiopronin, a drug effective in protecting against cisplatin nephrotoxicity, is also effective in protecting against cisplatin ototoxicity.     

大连地区217641例新生儿听力筛查结果回顾性分析

目的了解大连地区新生儿听力障碍的发病状况,发现听力筛查过程中存在的主要问题。方法对近5年大连地区出生的新生儿,在出生后3～5天内用畸变产物耳声发射(Disto rtio n pro duct o toacoustic emission,DPOAE)筛查仪进行初筛,初筛不通过者在42天进行复筛,复筛不通过者3个月内进行听觉脑干反应(auditory brainstem response,ABR)、多频听觉稳态反应(auditory steady state response,ASSR)、40Hz相关电位(40Hz-auditory evoked related potentials,40Hz–AERP)、声导抗测听等检查,对患儿进行综合听觉评估。结果 5年时间内大连地区应该筛查新生儿总数233856人,实际筛查217641人,初筛率为93.1%;初筛通过率为90.6%(197254/217641),复筛率为74.3%(漏检率为25.7%,5236/20387),复筛通过率90.5%(12194/15151),复筛不通过2957人;新生儿听力障碍诊治中心接诊2069人,就诊率为70%(2069/2957);确诊为听力障碍373例(607耳),听力障碍发病率为1.71‰;双耳听力障碍234例(轻、中、重、极重度听力障碍发病率分别为0.23‰、0.36‰、0.19‰、0.29‰),单耳听力障碍139例;有45例(45/106)重度-极重度听力障碍患儿6个月内没有确诊,其中9例为初筛不通过而没有进行复筛,36例初筛、复筛均不通过却没有及时就诊。结论大连地区新生儿听力障碍发病率与既往报道类似;完善听力障碍高危儿童的召回制度,提高复筛率和就诊率是减少听力障碍儿童漏诊的关键。     

A comparison of transient-evoked otoacoustic emissions and automated auditory brainstem responses for pre-discharge neonatal hearing screening: Comparación de los emisiones otoacústicas evocadas portransitorios y los potenciales evocados automatizados de tallo cerebral en la identificación auditiva neonatal de pre-egreso hospitalario

The aim of this study was to compare two hearing-screening methods in well newborn infants within the postnatal ward environment prior to discharge. Eighty-one newborn infants underwent one-step hearing screening by measurement of automated auditory brainstem responses (aABRs), using the ALGO-3 screener. These were compared with a further cohort of 81 neonates who underwent two-step screening using transient-evoked otoacoustic emissions (TEOAEs) followed by aABR. The pass rate was 78/81 (96.3%) for the one-step screen, 74/81 (91.4%) for the two-step screen, and 54/81 (66.7%) for TEOAE alone. There was no significant difference between cohorts in time required to complete the screening protocol. We conclude that pre-discharge hearing screening of newborn infants on the postnatal ward is feasible and acceptable. Use of TEOAE alone for pre-discharge screening is associated with an excessively high false-positive rate. At our institution, one-step screening resulted in a lower referral rate compared with a two-step approach. The performance of aABR screening may be affected by prior TEOAE screening.

Sumario

El objetivo de este esludio fue comparar dos métodos de identificación auditiva en neonatos sanos, en el cunero. antes de su egrcso. A 81 neonatos se les realizó una prueba de identificación mediante la medición de potenciales evocados automatizados dc tallo cerebral (aABRs), utihzando el equipo ALGO-3. Estos resultados se eompararon con otra cohorle de 81 neonatos a los que se les efectuaron tanto emisiones otacústicas evocadas por transitorios (TEOAEs) como aABR. El critcrio de respucsta positiva fue 78/81 (96.3%) para la prueba única, 74/81 (91.4%) para las pruebas consecutivas y 54/81 (66.7%) para las TEOAE solas. No hubo diferencia significativa entre cohortes en el tiempo requerido para completar el protocolo de identificación. Concluimos que la identificación auditiva pre-egreso en los neonatos es factible y aceptable. El uso único de TEOAE en la identificatión pre-egreso se asocia a un alto grado de falsos positivos. En nuestra institución, la identificación en un paso resultó en un nivel de referenda más bajo, comparado con el protoeolo en dos pasos. Los resultados de los aABR pucden verse afectados por las pruebas previas con TEOAE.     

Audiological profiling in postmenopausal women with osteoporosis

Objectives

To compare the audiological profiles in postmenopausal women with and without osteoporosis and to study the pattern of hearing loss in osteoporotic patients.

听性稳态反应和短声诱发的听性脑干反应在客观听阈评估中的作用

目的探讨听性稳态反应(auditory steady-state responses,ASSR)和短声诱发听性脑干反应(ABR)在感音神经性聋人群客观听阈评估中的作用及其在耳聋鉴定中的价值。方法对感音神经性聋组(35耳)及正常组(22耳)分别进行纯音听阈、ABR及ASSR测试,并记录0.5、1、2及4kHz ASSR反应阈(dBHL)、纯音听阈(dBHL)及ABR反应阈(dBnHL)。结果正常组在0.5、1、2、4kHz的ASSR反应阈与纯音听阈相比差异无统计学意义(P>0.05),ABR反应阈与各频率纯音听阈差异有显著统计学意义(P<0.05);耳聋组各频率ASSR反应阈与纯音听阈差异无统计学意义(P>0.05),ABR反应阈与0.5kHz纯音听阈差异有统计学意义(P<0.05),与1、2、4kHz纯音听阈差异无统计学意义(P>0.05)。结论ASSR与ABR联合测试是临床工作中用于客观听阈评估的有效方法。     

健听青年颅顶慢反应和短纯音ABR反应阈与纯音听阈的比较

目的 通过比较健听青年颅顶慢反应(slow vertex response,SVR)阈和短纯音听性脑干反应(toneb-urst auditory brainstem response,tb-ABR)阈与纯音听阈(pure tone audiometry,PTA)的关系,探讨SVR和tb-ABR用于听阈评估的价值.方法 对30例健听青年分别进行双耳0.5、1、2、4 kHz频率的tb-ABR、SVR反应阈及PTA测试,比较各频率SVR、tb-ABR反应阈与纯音听阈的差值及其相关性.结果 SVR反应阈与PTA在0.5 kHz频率处的差值最小,为3.59±7.32 dB,在1、2、4 kHz频率的差值分别为6.92±5.07、8.33±6.71、9.83±9.41 dB;tb-ABR反应阈与PTA在4 kHz频率处的差值最小,为14.58±7.24 dB,在0.5、1、2 kHz频率处的差值分别为29.42±6.83、23.25±7.47、16.50±6.43 dB;各频率SVR和tb-ABR反应阈与PTA差异均有统计学意义(均为P<0.05).SVR与PTA在1、2 kHz处有较好相关性(分别为r=0.51,P<0.01和r=0.44,P<0.05);tb-ABR与PTA在4 kHz处有较好相关性(r=0.53,P<0.01).结论 在听力正常的青年人群中,SVR和tb-ABR反应阈均能较好地预估PT A,前者更接近PT A.     

耳声发射和听性脑干反应在高危新生儿听力筛查中的应用

目的 探讨听性脑干反应(auditory brainstem response，ABR)和畸变产物耳声发射(distortion product otoacoustic emissions，DPOAE)应用于高危新生儿听力筛查中的特点、差异和意义。方法 分别应用Amplaid MK22型诱发电位仪和GS160型DPOAE测试仪对200例(400耳)不同病因所致的高危新生儿同时进行DPOAE和ABR检查，将两种方法的检测结果进行比较。结果 在200例(400耳)患儿中，DPOAE的通过率为64％(256／400耳)，ABR的通过率为88．25％(353／400耳)。400耳中DPOAE和ABR测试结果的共同阴性率为61．50％(246／400耳)，共同阳性率为9．25％(37／400耳)。DHOAE测试中假阳性率为74．31％(107／144耳)，假阴性率为3．91％(10／256耳)。结论 DHOAE测试具有方便、快速、无创、灵敏、客观等优点，为较好的新生儿听功能筛查方法，但其只能反映耳蜗功能，同时由于假阳性率较高，对未能通过DPOAE筛选者不能立即作出听力损伤的结论，ABR测试为比较可靠的新生儿听力筛查工具．对高危新生儿进行常规ABR测试是有价值的。因此在高危新生儿听力筛查中ABR和DPOAE检测需相互结合，相互补充，能提高高危新生儿听力筛查的精确性、可靠性，并应跟踪随访。     

畸变产物耳声发射与纯音听阈间测试频率的相关性研究

目的探讨畸变产物耳声发射(DPOAE)测值与纯音听阈值之间的相关性，阐明DPOAE测试频率(f0)与纯音听阈测试频率之间的对应关系。方法选正常听力人20倒(40耳)，蜗性聋病人100例(179耳)进行纯音听阈和DPOAE测试。用相关分析的统计方法计算出DPOAE测值与纯音听阈值之间的相关系数。结果DPOAE测值与纯音听阈值之间有负相关关系。f0为0．5、0．75、1．0．1．5、2．0、3．0、4．0、6．0、8．0kHz时的DPOAE测值与测试频率分别为1．0、1．0、1．0、2．0．3．0、3．0、4．0、6．0、8．0kHz时的纯音听阈值之间有相对最大的负相关系数。f0为0．5、0.75、1．0、1．5、2．0、3．0、4．0、6．0、8．0kHz时所对应的量相关纯音听阈测试频率分别为0．75、1．0、1．5、2．0、2．5、3．5、5．0、6．0、8．0kHz。结论DPOAE测值与纯音听阈值之间有负相关关系，且DPOAE测试频率与纯音听阈测试频率间存在一定的对应关系。     

新生儿监护病房儿童听力筛查及诊断结果分析

目的对在耳鼻喉科听力诊断中心进行听力诊断评估,并且有新生儿监护病房住院史婴幼儿的听力筛查及诊断结果进行比较分析,旨在评价目前所用听力筛查方法的有效性。方法选取有新生儿监护病房住院史并于耳鼻咽喉科进行听力诊断评估的婴幼儿,分析其自动听性脑干反应(AABR)及畸变产物耳声发射(DPOAE)筛查资料,并与诊断型听性脑干反应(ABR)的结果进行对比分析。结果本组同时完成DPOAE、AABR筛查及诊断型ABR测试,并且资料完整保存者共89例177耳。DPOAE筛查未通过率为45.8%,AABR筛查的未通过率为46.3%。两种筛查方法的一致率为64.4%。AABR的假阴性率为27.9%,DPOAE为16.3%,联合使用两种筛查方法时其假阴性率为4.7%。诊断型ABR测试异常共26例43耳(24.3%),其中轻度听力损失22耳,中度7耳,重度3耳,极重度11耳,听力损失为双侧者17例,单侧者9例,双侧听力损失患者中双耳听力损失程度对称者12例,不对称者5例。本组确诊听力损失婴幼儿中存在的高危因素包括:新生儿重症监护病房(NICU)住院超过5天;早产儿呼吸窘迫综合征;机械通气48h以上;出生体重低于1500g;新生儿窒息(Apgar评分1分钟0~4分或5分钟时0~6分);高胆红素血症胆红素水平达到换血要求;颌面部畸形(小耳、外耳道闭锁或畸形、腭裂);细菌性脑膜炎。结论使用AABR或AABR与DPOAE联合筛查可用于NICU新生儿的听力筛查,有新生儿听力损失高危因素的婴幼儿有转诊进行听力诊断评估的指证。