多频稳态诱发电位评估中度感音神经性聋儿童的应用

目的探讨多频稳态听觉诱发电位评估儿童中度感音神经性聋的可靠性。方法所有患者经纯音测听（PTA）检查筛选出中度感音神经性聋30例5～6岁儿童（共40耳），然后口服10％水合氯醛镇静睡眠后，行多频稳态听觉诱发电位（ASSR）检测，其阈值与纯音听阂阈值进行比较，分析不同频率处听力阈值分布情况及其相关性。结果分别比较语言频率ASSR阂值与纯音听闽阈值，结果显示，0．5kHz处相关性较差，其差值为2-18dB，而在4kHz处相关性最好。结论可以应用多频稳态听觉诱发电位评估中度感音神经性聋儿童的听力阈值，但需要注意0．5kHz处的相关性差异。     

多频稳态诱发电位测试

在清醒及睡眠状态下 ,分别测试了正常听力儿童组和成人组的多频稳态诱发反应。结果显示 ,作为一种客观测试方法 ,多频稳态诱发电位的频率特性高 ,客观性好 ,得到的客观听力学资料较全面。为保证结果准确 ,测试应在睡眠状态下进行 ,阈值处的刺激应进行重复以避免假阳性     

多频稳态诱发电位测试

在清醒及睡眠状态下，分别测试了正常听力儿童组和成人组的多频稳态诱发反应，结果显示，作为一种客观测试方法，多频稳态诱发电位的频率特性高，客观性好，得到的客观听力学资料较全面，为保证结果准确，测试应在睡眠状态下进行，阈值处的刺激应进行重复以避免假阳性。     

多频稳态诱发电位单频刺激与多频刺激测试结果的观察比较

目的 研究正常听力青年人多频稳态诱发电位单频刺激与多频刺激所记录到的反应阈,比较在4个测试频率得到的两种反应阈是否有差异。方法　分别对30例听力正常的年轻人进行纯音测听、多频稳态诱发电位多频刺激和单频刺激测试,记录0.5k、1k、2k、4 kHz的测试结果,并对结果进行统计学处理。结果 听力正常青年人多频稳态诱发电位单频刺激与多频刺激的反应阈除0.5kHz处有显著差异(p<0.001)外,1k、2k、4 kHz三个频率均无显著差异,两种刺激方式下得到的反应阈与纯音听阈的差距在15～25dB。结论 多频稳态诱发电位有较好的频率特性,可用来预测纯音听力图,临床应用时在0.5kHz处用单频刺激获得的阈值比多频刺激更接近纯音听阈。     

声场中记录的听性稳态助听反应阈与行为测试助听听阈的相关性

目的 应用多频听觉稳态反应(ASSR)Chirp刺激信号在声场中测试助听反应阈,观察其阈值与行为测试助听听阈的相关性,探讨多频听觉稳态反应Chirp刺激信号声场测试评估助听器补偿效果的临床意义.方法 选取22例(39耳)重度感音神经性听力损失、已配戴助听器的患儿(听障组)和16例(32耳)听力正常儿童(对照组)为研究对象.应用国际听力Eclipse EP25型多频稳态诱发电位仪及美国GSI-61型听力计,分别对听障组在声场中使用两种仪器测试助听听阈;对对照组进行裸耳行为听阈与声场中听觉稳态反应阈测试.结果 在0.5、1、2、4 kHz处,听障组ASSR助听反应阈与行为助听听阈的相关系数分别为0.65、0.68、0.77和0.82,P值均<0.01,显示两种测试结果有相关性;对照组裸耳行为听阈与声场中记录的听觉稳态反应阈在0.5、1、2、4 kHz配对t检验均呈显著差异(P<0.01),ASSR声场反应阈高于行为听阈20～30 dB HL.结论 应用多频听觉稳态反应Chirp刺激信号声场测试进行助听器补偿效果评估在临床上具有可行性.     

本刊2004年度省聋康系统优秀论文评选活动揭晓

本刊讯由《中国听力语言康复科学杂志》社与中国残疾人康复协会听力语言康复专业委员会共同举办的《中国听力语言康复科学杂志》2004年度省聋康系统优秀论文评选活动已经圆满结束。经过专家委员会的认真评选,以下论文分获一、二、三等奖:"一等奖:《多稳态诱发电位单频刺激与多频刺激测试结果的观察比较》(2004年第6期);作者:钟志茹、陶征、邹建华、邱素梅;单位:广东省残疾人康复中心。"二等奖:《聋儿助听效果的影响因素》(2004年第2期);作者:黄文新;单位:江西省聋儿康复中心。"三等奖:《感音神经性聋幼儿多频稳态诱发电位反应阈值与行为测听…     

5000例新生儿耳聋基因携带者全外显子序列检测结果分析

目的 探讨GJB2和SLC26A4耳聋基因突变携带者携带另一个致病突变的可能性及其临床听力学特点。方法 选取2019年1月～2021年12月济宁地区5000名GJB2和SLC26A4耳聋基因突变新生儿携带者,其中GJB2全外显子序列检查2912例,SLC26A4全外显子序列检查2088例,对全外显子序列检查后携带另一个致病位点的新生儿均做听力学检查,包括听性脑干反应（ABR）、畸变产物耳声发射（OAE）、声导抗（acoustic immittance）、多频稳态诱发电位（ASSR）和小儿行为测听等,出生后6个月和12个月分别进行听力随访。结果 101例新生儿携带另一个致病位点,出生后3个月做听力诊断,6个月和12个月进行随访并检查,最后共30例确诊为不同程度的耳聋,74例听力正常。GJB2全外显子序列检测87例,其中听力正常67例、听力异常20例、轻度聋13例、中度聋2例、极重度聋5例。SLC26A4全外显子序列检测14例,听力正常4例,轻度聋3例,中度聋2例,重度或极重度耳聋5例。结论 GJB2和SLC26A4致病位点携带者进行全外显子序列检查是必要的,对检测出另一个致病位点的婴幼儿...     

职业性噪声性聋与mtDNA缺失关系的探讨

目的 探讨线粒体DNA(mitochondrial DNA,mtDNA)缺失在噪声性聋发病中的可能作用.方法 在265名从事噪声作业的青年工人中,根据纯音听阈测试结果,分为语频听力损失组和语频听力正常组,其中自愿进入研究的语频听力损失组(A组)25人,双耳言语频率(500、1 000、2 000 Hz)听阈均值≥26 dB HL;在语频听力正常人群中随机抽取27人作为语频听力正常组(B组),两组分别抽取外周血,提取白细胞DNA,应用PCR方法检测mtDNA4977缺失情况.结果 A组mtDNA4977缺失检出率20%(5/25),B组mtDNA4977缺失检出率为0(0/27),A组mtDNA4977缺失检出率明显高于B组(P＜0.05).结论 mtDNA4977缺失可能在噪声性聋的发病中起重要作用,     

单侧听力障碍对3岁以下婴幼儿言语能力发育的影响

目的了解单侧听力障碍对3岁以下婴幼儿言语能力发育的影响。方法19名3岁以下的单侧听力障碍婴幼儿,均为上海市新生儿普遍性听力筛查中发现并在出生后6个月内经听力学评估确诊为单侧耳聋,其中轻度聋10名,中度及以上程度聋9名,听力正常婴幼儿32名作为对照组。采用Gesell发育量表进行言语能力测试,并将两组结果进行统计学分析。结果各组言语发育商(developmental quotient,DQ)分别为:中度及以上程度聋组为103.44±20.83,轻度聋组为91.10±26.95,正常对照组为91.84±15.85,各组间言语发育商差异无统计学意义。结论在不使用助听设备的情况下,单侧听力障碍在言语发育初期(3岁之前)对婴幼儿言语能力没有明显的影响。     

浅谈多频稳态诱发电位的原理和临床应用(英文)

在过去的十年里,使用快速和客观电生理听觉测试的需求日渐增强,在新生儿听力筛查方面的应用更是如此。短声和纯音短声脑干诱发电位用于筛查和临床诊断已在全球得到广泛使用。而多频稳态诱发电位作为一种新的测试手段开始得到关注,将给我们提供一种新的测试婴幼儿频率相关听力的快速技术。     

Auditory steady-state responses for estimating moderate hearing loss

The auditory steady-state response (ASSR) has gained popularity as an alternative technique for objective audiometry but its use in less severe degrees of hearing loss has been questioned. The aim of this study was to investigate the usefulness of the ASSR in estimating moderate degrees of hearing loss. Seven subjects (12 ears) with moderate sensorineural hearing loss between 15 and 18 years of age were enrolled in the study. Forty-eight behavioural and ASSR thresholds were obtained across the frequencies of 0.5, 1, 2, and 4 kHz. ASSR thresholds were determined using a dichotic multiple frequency recording technique. Mean threshold differences varied between 2 and 8 dB (±7–10 dB SD) across frequencies. The highest difference and variability was recorded at 0.5 kHz. The frequencies 1–4 kHz also revealed significantly better correlations (0.74–0.88) compared to 0.5 kHz (0.31). Comparing correlation coefficients for behavioural thresholds less than 60 and 60 dB and higher revealed a significant difference. Eighty-six percent of ASSR thresholds corresponded within 5 dB of moderate to severe behavioural thresholds compared to only 29% for mild to moderate thresholds in this study. The results confirm that the ASSR can reliably estimate behavioural thresholds of 60 dB and higher, but due to increased variability, caution is recommended when estimating behavioural thresholds of less than 60 dB, especially at 0.5 kHz.     

Auditory steady-state responses for children with severe to profound hearing loss

OBJECTIVE: To investigate the clinical usefulness of the dichotic single-frequency auditory steady-state response (ASSR) for estimation of behavioral thresholds in children with severe to profound congenital sensorineural hearing loss. DESIGN: A comparative experimental research design was selected to compare behavioral and ASSR thresholds for the sample. Behavioral pure-tone audiometry served as the criterion standard. SETTING: Hearing Clinic, Department of Communication Pathology, University of Pretoria, Pretoria, South Africa. PATIENTS: A referred sample of 10 patients (20 ears), 5 girls and 5 boys aged 10 to 15 years (mean age, 13 years 4 months), with severe to profound sensorineural hearing impairment. MAIN OUTCOME MEASURES: The difference, and correlation, between 160 pure-tone behavioral and ASSR thresholds at 0.5, 1, 2, and 4 kHz. RESULTS: Mean differences between ASSR and behavioral thresholds were 6 dB for 0.5 kHz and 4 dB for 1, 2, and 4 kHz, with standard deviations varying between 8 and 12 dB. No significant differences (P<.05) were observed between ASSR and behavioral thresholds, except at 0.5 kHz, and Pearson correlation coefficients varied between 0.58 and 0.74 across the evaluated frequencies, with best correlation at 1 kHz and worst at 0.5 kHz. CONCLUSIONS: The ASSR thresholds provided reliable estimations of behavioral thresholds for children with severe to profound hearing loss and indicated an increased sensitivity for more profound hearing loss.     

Comparison of pure tone audiometry and auditory steady-state responses in subjects with normal hearing and hearing loss

The objective of this study is to compare pure tone audiometry and auditory steady-state response (ASSR) thresholds in normal hearing (NH) subjects and subjects with hearing loss. This study involved 23 NH adults and 38 adults with hearing loss (HI). After detection of behavioral thresholds (BHT) with pure tone audiometry, each subject was tested for ASSR responses in the same day. Only one ear was tested for each subject. The mean pure tone average was 9 ± 4 dB for NH group and 57 ± 14 for HI group. There was a very strong correlation between BHT and ASSR measurements in HI group. However, the correlation was weaker in the NH group. The mean differences of pure tone average of four frequencies (0.5, 1, 2, and 4 kHz) and ASSR threshold average of same frequencies were 13 ± 6 dB in NH group and 7 ± 5 dB in HI group and the difference was significant (P = 0.01). It was found that 86% of threshold difference values were less than 20 dB in NH group and 92% of threshold difference values were less than 20 dB in HI group. In conclusion, ASSR thresholds can be used to predict the configuration of pure tone audiometry. Results are more accurate in HI group than NH group. Although ASSR can be used in cochlear implant decision-making process, findings do not permit the utilization of the test for medico-legal reasons.     

Multiple auditory steady-state responses in children and adults with normal hearing, sensorineural hearing loss, or auditory neuropathy

OBJECTIVES: We tested the clinical effectiveness of multiple auditory steady-state responses (ASSRs) for the objective assessment of hearing thresholds in patients with and without hearing loss, candidates for cochlear implants, and children with auditory neuropathy. METHODS: The study sample included 29 subjects with sensorineural hearing loss (SNHL), 18 candidates for cochlear implants, 11 subjects with auditory neuropathy, and 18 subjects with normal hearing thresholds. Behavioral hearing thresholds and ASSRs to carrier frequencies of 0.5, 1, 2, and 4 kHz were obtained. Special care was taken to minimize possible aliasing and high-intensity multiple stimulation effects. Differences and correlations between the ASSRs and the behavioral thresholds were determined. RESULTS: The ASSR estimation of behavioral thresholds in the normal-hearing group was elevated, whereas very close predictions were found for the SNHL group. The correlations between the two measures ranged from 0.86 at 0.5 kHz carrier frequency to 0.94 at 2 kHz. In the cochlear implant candidates and the auditory neuropathy group, the ASSR thresholds generally overestimated the behavioral audiogram. In these groups the number of detected ASSRs was higher than the number of behavioral responses, especially for the high-frequency carrier stimuli. CONCLUSIONS: Multiple ASSRs may reliably predict the behavioral threshold in subjects with SNHL and may serve as a valuable objective measure for assessing the hearing threshold across different frequencies in candidates for cochlear implants and children with auditory neuropathy.     

Using multi-stimulus auditory steady state response to predict hearing thresholds in high-risk infants

The purpose of this study was to investigate whether multi-stimulus auditory steady-state responses were capable of estimating hearing thresholds in high-risk infants. A retrospective chart review study. Three tertiary referral centers. Infants born between January 2004 and December 2006 who met the criteria for risk factors of congenital hearing loss were enrolled in the study. While under sedation, the multi-stimulus auditory steady-state response was used to determine multi-channel auditory steady-state response thresholds for high-risk infants younger than 13 months. Conditioned play audiometry was then applied to these children at 23–48 months of age to obtain pure tone audiograms. Auditory steady-state response thresholds and pure tone thresholds were then compared. A total of 249 high-risk infants were enrolled in the study. 39 infants were lost during follow-up. The remaining 216 infants completed both examinations. The Pearson correlation coefficients (r) between the ASSR levels and pure tone thresholds were 0.88, 0.94, 0.94 and 0.97 at 500, 1,000, 2,000 and 4,000 Hz, respectively. The strength of the relationship between the auditory steady-state responses and pure tone thresholds increased with more severe degrees of hearing loss and higher frequencies. We conclude that initial multichannel ASSR thresholds measured under sedation are highly correlated with pure tone thresholds obtained 2 or 3 years later. ASSR can be used to predict the frequency-specific hearing thresholds of high-risk infants and can provide information for early hearing intervention.     

Evaluation of residual hearing in cochlear implants candidates using auditory steady-state response

Conclusion: The correlations between behavioral and auditory steady-state response (ASSR) thresholds were significant at 500, 1000, 2000, and 4000 Hz. ASSR presented high sensitivity and specificity in the detection of residual hearing in cochlear implant candidates when compared with warble-tone audiometry. Objectives: To assess residual hearing in cochlear implant candidates by comparing the electrophysiological thresholds obtained in dichotic single-frequency ASSR with behavioral thresholds at 500, 1000, 2000, and 4000 Hz. Methods: This was a comparative study between ASSR and warble-tone audiometry thresholds in 40 cochlear implant candidates (80 ears) before cochlear implantation with bilateral severe-to-profound sensorineural hearing loss. Results: Thresholds were obtained in 62.5% of all frequencies evaluated in warble-tone audiometry and in 63.1% in the ASSR. ASSR sensitivity was 96% and specificity was 91.6%. Mean differences between behavioral and ASSR thresholds did not reach significance at any frequencies. Strong correlations between behavioral and ASSR thresholds were observed in 500, 1000, and 2000 Hz and moderate in 4000 Hz, with correlation coefficients varying from 0.65 to 0.81. On 90% of occasions, ASSR thresholds were acquired within 10 dB of behavioral thresholds.     

Prediction of hearing thresholds: Comparison of cortical evoked response audiometry and auditory steady state response audiometry techniques

The present study evaluated how well auditory steady state response (ASSR) and tone burst cortical evoked response audiometry (CERA) thresholds predict behavioral thresholds in the same participants. A total of 63 ears were evaluated. For ASSR testing, 100% amplitude modulated and 10% frequency modulated tone stimuli at a modulation frequency of 40Hz were used. Behavioral thresholds were closer to CERA thresholds than ASSR thresholds. ASSR and CERA thresholds were closer to behavioral thresholds at higher frequencies than at lower frequencies. Although predictions based on CERA thresholds are slightly more accurate than ASSR thresholds, the differences may not be clinically significant, particularly when the degree of individual variations is considered. Prediction of hearing thresholds became more accurate when hearing loss increased. Due to variations in prediction across participants, a single correction factor cannot be used. Other factors must be considered in selecting whether to use CERA or ASSR in predicting behavioral thresholds.     

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.     

Prediction of hearing thresholds: comparison of cortical evoked response audiometry and auditory steady state response audiometry techniques

The present study evaluated how well auditory steady state response (ASSR) and tone burst cortical evoked response audiometry (CERA) thresholds predict behavioral thresholds in the same participants. A total of 63 ears were evaluated. For ASSR testing, 100% amplitude modulated and 10% frequency modulated tone stimuli at a modulation frequency of 40Hz were used. Behavioral thresholds were closer to CERA thresholds than ASSR thresholds. ASSR and CERA thresholds were closer to behavioral thresholds at higher frequencies than at lower frequencies. Although predictions based on CERA thresholds are slightly more accurate than ASSR thresholds, the differences may not be clinically significant, particularly when the degree of individual variations is considered. Prediction of hearing thresholds became more accurate when hearing loss increased. Due to variations in prediction across participants, a single correction factor cannot be used. Other factors must be considered in selecting whether to use CERA or ASSR in predicting behavioral thresholds.     

Estimations of auditory sensitivity for young cochlear implant candidates using the ASSR: preliminary results

This paper presents preliminary results obtained with the use of the auditory steady-state response (ASSR) technique as part of a cochlear implant candidacy assessment protocol for infants. Fifteen infants (30 ears), between 10 and 60 months of age, with severe-to-profound hearing loss participated in the study. ASSR measurements were performed for 0.5, 1, 2 and 4 kHz at intensities up to 120–128 dB HL. The ASSR thresholds were obtained in 74% of the measurements, and exceeded the maximum auditory brainstem response (ABR) intensity output in 91% of cases and the maximum free-field behavioral intensity output in 84% of cases. Eighty-seven per cent of ASSR threshold measurements were measured at intensities of 100 dB HL or higher, and almost half (47%) were measured at intensities of 115 dB HL and higher. Preliminary results indicate that absent ABR and behavioral thresholds do not preclude the possibility of residual hearing, making the ASSR a primary source of information regarding profound levels of hearing loss.