脑性瘫痪患儿听性脑干反应及多频稳态听性反应分析

目的：通过听性脑干诱发反应（ABR）及听性稳态反应（ASSR）分析，探讨脑性瘫痪（脑瘫）患儿的听力障碍及脑干听通道功能变化。方法：采用美国GSIAudera听性脑干反应及听性稳态诱发电位测试仪，测试脑瘫患儿52例104耳。对照组为同龄健康儿童19例38耳。结果：脑瘫组患儿的ABR各波潜伏期及峰间潜伏期均较对照组明显延长；脑瘫组ASSR结果以轻度低频听力损失为著，并且各频率听力损失的平均值非常接近。结论：ABR和ASSR同时应用，为脑瘫患儿听力损失进行定性定量诊断提供了客观的测试方法。     

听力损失儿童短纯音听性脑干反应与行为测听结果比较

目的 探讨听力损失儿童短纯音听性脑干反应(tbABR)与行为测听(behavioral audiometry,BA)的相关性.方法 回顾性分析91例听力损失儿童tbABR和BA测试结果,根据各频率tbABR最大刺激100 dB nHL有无反应,将91例(163耳)听力损失儿童分为有反应组(1个或以上频率有反应100耳)...     

听性稳态反应——临床应用中的问题及展望

纵观电反应测听的历史发展过程,我们在用听性脑干反应（auditory brainstem response,ABR）或听神经复合动作电位（compound action potential,CAP）等电生理指标测试听功能时,始终存在着一个似乎不可调和的矛盾：想寻求既能使神经冲动同步化好,又能满足频率特异性,即能反映耳蜗各圈功能的刺激声,这是很难做到的.但为了达到上述目标，听力学家们仍一直在做两个方面的努力：     

感音神经性聋患儿的听功能综合评估

目的探讨听力测试组合（ABR＋ASSR＋声场环境中的行为测听）在感音神经性聋患儿残余听力评估中的应用价值。方法48名（96耳）感音神经性聋患儿中能配合纯音测听的患儿19人（38耳）设为PTA组,进行纯音测听及ASSR检测;不能配合纯音测听的患儿29人（58耳）设为BA组,进行声场环境中的行为测听（behavior audiometry,BA）、ABR及ASSR检测。结果①PTA组0．5、1、2、4kHz各频率ASSR反应阈与纯音听阈显著相关（P〈0．01）,各频率相关系数分别为0．75、0．76、0．76、0．83,建立本实验室的ASSR—PTA直线回归方程;②BA组23耳ABR无反应但仍可引出ASSR,而ASSR无反应耳ABR均未能引出;BA组29例患儿中ASSR检测反应较好耳（29耳）在0．5～4kHz四个频率上,ASSR可测得83个反应阈值,行为测听可测得89个反应阈值,综合ASSR和行为测听可以得到96个反应阈值。结论与单项听力测试方法相比,听力测试组合（行为测听＋ABR＋ASSR）能为更小年龄、听力损失更重的患儿进行残余听力的评估,同时能对双侧耳间听力差异、各频率的听力损失程度进行评估,为听力损失病变的定位判断提供参考。     

感音神经性聋儿童听性稳态反应与行为听阈相关性分析

目的：分析感音神经性聋儿童听性稳态反应（auditory steady－state response,ASSR）与行为听阈的相关性。方法63例（126耳）重度或极重度感音神经性听力损失儿童,年龄0．5～6岁,按年龄分为 A 组（0．5～1．0岁,21例）,B 组（1．1～3．0岁,21例）,C 组（3．1～6．0岁,21例）;分别进行 ASSR 及小儿行为听阈测试,A 组采用行为观察测听（BOA）,B 组采用视觉强化测听（VRA）,C 组采用游戏测听（PA）,采用 SPSS17．0统计软件分析二种检查结果的相关性。结果①ASSR 反应阈与行为听阈在0．5、1、2和4 kHz 处的相关系数分别为0．75、0．76、0．76、0．83,呈极显著相关（P ＜0．01）。②小儿行为听阈值通常比 ASSR 反应阈值低,随着频率的增高,两者间差距缩小。③A 组（相关系数0．70）各频率 ABR 反应阈与行为听阈相关性均较 B（相关系数0．78）、C（相关系数0．83）组低。结论0．5～6．0岁感音神经性聋儿童 ASSR 与行为听阈值均有良好的相关性,ASSR 可预测感音神经性聋儿言语频率的客观听阈,为低龄儿童及难以检测行为听力的患儿验配助听器提供参考。     

听性稳态反应

在介绍听性稳态反应（auditory steady-state response,ASSR）之前,首先介绍一下几个相关概念,以方便后面的叙述.     

非镇静听性脑干反应临床应用有效性分析

目的验证非镇静听性脑干反应(non-sedated auditory brainstem response,ABR)技术在成人和儿童临床应用的有效性。方法对10名成人(20耳)及8名儿童(16耳)进行非镇静听性脑干反应、传统听性脑干反应及纯音听力测试(成人组),得到不同阈值范围,并进行三者的相关性分析。结果 Spearman’s rho相关分析显示成人受试者非镇静听性脑干反应阈值和行为测听阈值显著相关(r=0.82;P<0.01)。魏克森(Wilcoxon)讯号等级分析显示儿童组非镇静与镇静听性脑干反应阈值差异无统计学意义(Z=1.24;P=0.22)。Spearman’s rho相关分析显示儿童与成人受试者非镇静和镇静听性脑干反应阈值显著相关(r=0.82～0.96;P<0.05)。结论非镇静ABR技术可以有效地应用于成人和儿童;该技术适用于不适合使用镇静药物或不愿意接受镇静的受试者。     

听性脑干反应的频谱分析

听性脑干反应的频谱分析朱帆三，徐邦荃，林家瑞听性脑干反应（Ａｕｄｉｔｏｒｙｂｒａｉｎｓｔｅｍｒｅｓｐｏｎｓｅ，ＡＢＲ）是给声刺激后，从头皮记录到听觉神经系统在传递信息过程中所产生的生物电信号。它是一种无损伤、客观测试初级听觉神经系统功能及评价听力的有...     

儿童频率特异性chirp听性稳态反应与行为测听的相关性

目的采用chirp信号作为声刺激进行听性稳态反应(auditory steady-state response,ASSR)测试,观察chirp-ASSR反应阈值与纯音听阈阈值的相关性,探讨chirp-ASSR客观听力检测在儿童临床听力评估中的价值。方法选取2012年6月至2013年2月中山大学附属第六医院听力中心检测的儿童共40例(共74耳)作为研究对象,在0.5kHz、1.0kHz、2.0kHz和4.0kHz处进行chirp-ASSR和纯音听阈测试,并对结果进行统计学分析。结果 40例接受测试的儿童年龄4-13岁,平均年龄7.7岁。纳入研究的74耳包括男48耳,女26耳;右34耳,左40耳;正常听力59耳,听力损失轻度4耳、中度6耳、重度5耳。0.5-4kHz频率chirp-ASSR反应阈与纯音听阈的相关系数r分别为0.812、0.884、0.842、0.892;chirp-ASSR反应阈经过校正后所得的各频率预估听阈与纯音听阈值更加接近。结论 chirp-ASSR作为一种具有频率特异性的客观测听技术,能够较好的反映儿童真实的听力水平。     

铅中毒对学龄儿童听性脑干反应的影响

目的 观察铅中毒对学龄儿童听觉神经系统的损害。方法 对100例无神经系统阳性体征的铅中毒儿童进行听性脑干反应、纯音测听及畸变产物耳声发射检测，并将其分为补钙组和未补钙组，观察治疗前后的听性脑干反应、纯音测听及畸变产物耳声发射的变化，同时与50例年龄性别相匹配的血铅正常儿童进行对比分析。结果 治疗前铅中毒组和正常组听性脑干反应比较：铅中毒组Ⅴ波潜伏期较正常组延长，差异有统计学意义（t=3．21，P〈0．01），Ⅰ、Ⅲ波潜伏期较正常组延长，但差异无统计学意义（前者t=2．06，P〉0．05，后者t=1．64，P〉0．05）。铅中毒组Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期较对照组延长，差异有统计学意义（前者t=7．30，P〈0．01，后者t=3．14，P〈0．01），Ⅰ～Ⅲ波间期较对照组延长，但差异无统计学意义（t=0．91，P〉0．05）。铅中毒组Ⅰ、Ⅲ、Ⅴ波波幅均低于正常组，差异有统计学意义（Ⅰ波-t=3．20，P〈0．01，Ⅲ波：t=3．31，P〈0．01，Ⅴ波：t=3．41，P〈0．01）。补钙组、未补钙组及血铅正常组治疗半年前后比较：3组听性脑干反应各指标在治疗前后均无统计学意义（P〉0．05）。纯音测听及畸变产物耳声发射检测前后差异均无统计学意义（P值均〉0．05）。结论 铅中毒可以引起神经系统的亚临床损害，补钙对治疗后ABR无显著改变，ABR对于早期发现铅中毒对神经系统损害有一定的价值。     

骨导听性脑干反应测试

听性脑干反应(ABR)由于其客观性、无创、不需受试者主动配合、不受镇定剂影响等优点,已被作为一种可靠的听力检测工具,广泛应用于婴幼儿及特殊人群的听力评估.然而人们大多进行气导ABR测试来获取大概的气导听力,但其结果不能区分听力损失的类型.尤其对于那些不能很好配合纯音测听的人群,如先天性外耳道闭锁和中耳炎的患儿、智力缺陷人群,确定其听力损失类型一直存在一些阻碍.因此,骨导ABR的检测对于这部分人群就显得尤其重要,但其为什么一直没有得到广泛应用呢?这是一个值得我们深入探讨的话题,本文就骨导ABR的机制、方法和应用进行初步探讨.     

Logon诱发听性脑干反应

为了解Logon诱发听性脑干反应的频率特异性,在文中以2～8kHz Logon及短声作为刺激声信号,来观察0.25～8kHz纯音听力正常青年人及听力曲线表现为4kHz“V”型下降,而2kHz及8kHz听阈正常青年人的听性脑干反应.结果示听力正常青年人高强度各频率Logon刺激均可引出分化很好的包括5个反应波的波形,其中I、Ⅲ波检出率最高为100%,Ⅳ、Ⅴ波常融合为一个波;听性脑干反应阈4kHz及8kHz较2kHz略低,Ⅰ波潜伏期随频率升高而缩短,Ⅲ波潜伏期缩短轻微,Ⅴ波潜伏期各频率差异无显著性意义,各波波间期随频率升高而延长.听力曲线表现为4kHz“Ⅴ”型下降,而2kHz及8kHz听阈正常的青年人,短声听性脑干反应阈、各波潜伏期、波间期均无明显异常,而4kHz Logon刺激听性脑干反应阈显著升高,2、8kHz Logon刺激听性脑干反应阈基本正常,Logon刺激听性脑干反应阈与纯音听阈线性相关.因此可以认为2～8kHz Logon刺激诱发听性脑干反应具有频率特异性,可做为相应频率听觉敏度测试的客观指标.     

Clinical Comparison of the Auditory Steady-State Response with the Click Auditory Brainstem Response in Infants

Objectives

Our goal was to determine the effectiveness of using the auditory steady state response (ASSR) as a measure of hearing thresholds in infants who are suspected of having significant hearing loss, as compared with using the click-auditory brainstem response (C-ABR).

Methods

We retrospectively analyzed the audiologic profiles of 76 infants (46 boys and 30 girls, a total of 151 ears) who ranged in age from 1 to 12 months (average age: 5.7 months). The auditory evaluations in 76 infants who were suspected of having hearing loss were done via the C-ABR and ASSR. In addition, for reference, the mean ASSR thresholds were compared to those of 39 ears of infants and 39 ears of adults with normal hearing at 0.5, 1, 2, and 4 kHz.

Results

The highest correlation between the C-ABR and ASSR thresholds was observed at an average of 2-4 kHz (r=0.94). On comparison between the hearing of infants and adults at 0.5, 1, 2, and 4 kHz, the mean ASSR threshold in infants was 12, 7, 8, and 7 dB higher, respectively, than that in adults.

Conclusion

ASSR testing may provide additional audiometric information for accurately predicting the hearing sensitivity, and this is essential for the management of infants with severe to profound hearing loss.     

高危新生儿的听性脑干反应结果分析

目的探讨高胆红素血症、早产低体重和缺氧三个因素对新生儿听性脑干反应(auditorybrainstemresponse,ABR)结果的差异性。方法选取在本院听力中心行ABR检查的高危新生儿607例(1214耳),分为高胆红素血症组394例(788耳)、早产低体重组122例(244耳)和缺氧组29例(58耳),合并多种高危因素组62例(124耳),对以上组的ABR结果进行分析比较。结果高胆红素血症组、早产低体重组、缺氧组、合并多种高危因素组的ABR异常率分别为27.79%、36.07%、34.48%、38.71%。高胆红素血症组的异常率和早产低体重组比较有统计学差异(P<0.05),和缺氧组比较无统计学差异(P>0.05),早产低体重组的异常率和缺氧组比较无统计学差异(P>0.05),合并多种高危因素组的异常率和高胆红素血症组比较有统计学差异(P<0.05),和早产低体重组及缺氧组相比均无统计学差异(P>0.05)。结论这三种高危因素中,早产低体重新生儿听力损失发病率较高,程度也较重。另外合并多种高危因素的新生儿听力损失的几率和程度仅较高胆红素血症组的新生儿高。     

Aging and the Auditory Brain Stem Response

30 elderly subjects, 30 young subjects with comparable sensorineural hearing losses and 30 normally hearing subjects were evaluated to examine the interaction of advanced age and high-frequency hearing loss upon the auditory brain stem response. Hearing loss plus age accounts for greater deterioration of auditory brain stem response waveforms than hearing loss alone. Comparison of interpeak latencies revealed no consistent pattern of lengthened latency due to aging.     

Chloral Hydrate to Study Auditory Brainstem Response

Chloral Hydrate (CH) is a sedative and hypnotic drug used in pediatric procedures owing to the low depressive effect it has on the respiratory and cardiac systems.AimTo assess the efficacy of the drug in performing ABR and to systematize its use.Materials and MethodsA prospective cross-sectional study with 41 children without history of heart or lung disease. The initial dose of CH at 10% was 50mg/Kg, with a boost dose of 6mg/Kg administered 30 minutes later in cases in which there was no sedation. Drug effectiveness was established by sleep induction by 1 hour after the administration of the initial dose. Sleep occurrence was correlated with doses (50mg or 56mg/Kg), age, weight and gender.ResultsAll the 41 children who participated in the study took 50mg/kgof the agent and 23 of them slept within 30 minutes, 2 had respiratory complications, 16 had the 6mg/Kg boost dose and 13 fell asleep after 30 minutes. The 56 mg/kg dose presented a statistically significant effect on sleep induction (p<0.05) when compared to the 50mg/kg dose.ConclusionCH produced a satisfactory effect with 50 mg/Kg dose plus 6mg/kg up to one hour after administration. Complications can occur regardless of the dose used.     

Auditory Brainstem Response at the Detection Limit

Specific predictions regarding the level dependence of auditory evoked responses near the detection limit were made in a companion modeling study (Lütkenhöner, J Assoc Res Otolaryngol 9:102–121, 2008). Here, these predictions are experimentally tested for auditory brainstem responses (ABR) to Gaussian-shaped 4-kHz tone pulses (full width at half maximum = 0.5 ms) that were presented at sound levels close to the subjective threshold. In the average of over about one million stimulus repetitions (repetition period = 16 ms), the amplitude of ABR wave V showed a smooth transition from a proportional to a logarithmic growth with increasing sound intensity. The latter type of growth corresponds to a linear increase with respect to sound level measured in decibels. Alternatively, the ABR amplitude near the detection limit may be considered a linear function of sound pressure, although—according to the model—this is only an approximation. Data and model are consistent with the view that a sensory threshold does not exist for the auditory modality, in accordance with signal detection theory. Even so, the model may be used to define a quasithreshold that is comparable to the subjective threshold.