基于医院信息化管理网络下的听力诊断系统的研发与临床应用

目的调研在医院信息系统下建立临床听力诊断系统基本功能需求,分析作为医院子系统与医院信息系统集成建设存在的问题并确立要实现的目标。方法通过对临床听力诊断业务的整体评价和分析,确定与医院信息系统集成的标准与方法;通过文献查询和专家咨询了解系统研发现状及研发经验、工作流程,同时采集信息化建设所需的各种信息和数据资料。结果临床听力医学中心业务现状及目前面临的主要问题包括:耳聋患者基本信息不能与HIS系统共享;听力学资料手工绘制并以纸质方式保存,数据资料不能实时调阅、录入及综合分析;目前约有十余种不同类型的听力设备需要入网,系统将采用C/S(Client/Server)和B/S(Browser/Server)协同工作的结构设计。需求内容主要包括:听力设备入网软硬件配置现状与需求、安全性需求、听力报告单数据管理模块功能需求,数据输出格式需求、测试结果统计分析需求等。结论研发MCCAIS是提高临床听力医学中心工作效率与质量、促进科研与教学发展的需要。通过需求分析确定了信息系统研发的方向,可从根本上保证工作的进度和质量,是有序建设信息化系统的重要措施,也是购买、测试、实施、验收研发软件的重要依据。     

中国听力学教育二十年发展巡礼

随着近年蓬勃发展的人工耳蜗技术和新生儿听力筛查等防聋治聋工作的崛起,听力学这个名词逐渐被人们认识和接受,听力学相关技术走进了寻常百姓的生活,和千千万万大众发生了千丝万缕的联系,而承载着培养听力学专门人才的听力学教育项目在其中的重要性不言而喻。听力学教育的本质是为社会培养专业的听力学工作者,从而为广大有听力服务需求的群众提供专业化的帮助。从大的范围讲,听力服务可涵盖世界人口的全部和全过程,人类从呱呱坠地到衰老离去,每时每刻都在与外界接触,这一切离不开我们特有的感觉器官以及人类特有的听觉言语沟通;具体来讲,听力学服务更体现在对听力障碍者的服务中。我国有听力言语残疾人口2780万,其中多数人可通过有效的听力学技术和服务重返主流社会[1]。然而我国听力学专业人才屈指可数,受教育程度参差不齐,这种情况制约了广大群众受益于听力学服务的程度,也严重阻碍了听力学行业的发展,因此在我国开展正规的听力学工作和培养大批从事于听力学工作的专业人才势在必行,发展听力学事业要从教育抓起[1]。     

Physiology and phenomenology of tinnitus: Implications for treatment

We examine a contrast in understanding tinnitus and how this impacts on treatment approaches. First, a physiological account of tinnitus is described based on disinhibition and cortical remapping following injury at the receptor level, the analog for tinnitus being the ‘phantom limb pain’ phenomenon. Secondly, an experimental model of tinnitus is reviewed that relies on inference from conditioning animal behaviour. Arising from this, a role for conditioning in people distressed by tinnitus has been proposed, based on the unfounded premise that, for humans, tinnitus is a neutral stimulus, the distress being due to association with other stressful events. We critique this because we believe it influences approaches to tinnitus treatment. Finally, the phenomenology of tinnitus in the human case is analysed, with its nature illuminated via a series of distinctions with hearing impairment. Tinnitus can be intrinsically stressful for some people. Understanding this emphasizes the need to involve concepts and treatment in the area of clinical psychology. A flexible coalition between clinical audiologists and clinical psychologists is proposed as fruitful for tinnitus and related rehabilitation.     

Outcome measurement for patients receiving hearing aid services

OBJECTIVE: The purpose of this paper is to describe a useful patient report outcome measure for a hearing aid program that can be completed annually, with limited staff resources, and can be used to document performance excellence. STUDY DESIGN AND METHODS: The International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire was mailed to all patients receiving new hearing aids and rehabilitative services during a 1 year period at Mayo Clinic (Rochester, MN). The data were analyzed to assess outcomes. RESULTS: Overall, patients reported a high level of satisfaction and an improved quality of life. The results compared favorably with published norms and with the previous year's results. CONCLUSION: The IOI-HA was implemented easily with little incremental cost. An annual project such as the one described can be used to demonstrate to administrators, patients, and payers that the clinic's rehabilitative hearing aid services have positive outcomes and that program quality is being monitored.     

桥小脑角占位性病变的临床听力学表现

本文总结了经CT或MRI证实以及部分经手术证实的101例桥小脑角占位性病变的纯音测听，听性脑干反应（ABR），耳蜗电图（ECochG）以及前庭功能的表现。结果显示：ABR多表现为Ⅰ～Ⅴ间或延长（＞45ms），仅Ⅰ波存在或ABR各波均消失。未见波Ⅴ幅度小于波Ⅰ。当肿物较大时，可见时测ABR异常。极重度聋患者（35．5％），仍可引出异常ABR波形，故仍不可忽视ABR检查；听力轻度下降，甚至正常考ABR仍有改变。AP出现率随肿物增大而降低，－SP／AP比值≥0．4，可能是继发性伤及耳蜗所致。5例ABR表现正常者仍有半规管功能低下。提示前庭功能检查对桥小脑均占位性病变的诊断具有一定参考意义，临床应将ECochG和前庭功能检测列为诊断桥小脑角占位性病变的参考指标。     

畸变产物耳声发射在唇腭裂婴幼儿听力检查中的应用

目的探讨唇腭裂婴幼儿畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）的特点,并将其与听性脑干反应（auditory brainstem response,ABR）阂值检查的结果加以对照,以探讨DPOAE在这类患儿听力检查中的应用价值。方法DPOAE检查63例（126耳）,年龄2个月-42个月,平均11.83个月。其中单纯腭裂组（以下简称腭裂组）23例（46耳）,腭裂并发唇裂及牙槽裂组（以下简称唇腭裂组）30例（60耳）,单纯唇裂组（以下简称唇裂组）10例（20耳）,每耳均检查8个频率,若2-5kHz4个频点有≥3个频点通过即为该耳通过。在上述患儿中,ABR阈值检查腭裂组17例（34耳）,唇腭裂组10例（20耳）,唇裂组6例（12耳）,以能重复引出V波的最小刺激强度为ABR阈值。结果DPOAE检查：腭裂组通过7耳,未通过39耳,通过率为15.22％;唇腭裂组通过6耳,未通过54耳,通过率为10.00％;唇裂组通过18耳,未通过2耳,通过率为90％。统计分析腭裂组与唇腭裂组无显著差异,而腭裂组与唇裂组,唇腭裂组与唇裂组均有显著差异。ABR阈值检查统计分析结果与DPOAE一致。将各组DPOAE通过率与ABR正常率进行比较,腭裂组及唇腭裂组中二者无差异（P〉0.05）,虽然唇裂组中二者有差异（P〈0.05）,但唇裂组ABR阈值反应的听力下降较轻（均≤50dB nHL）。从总体趋势上说,DPOAE与ABR阈值检查在检测的结果上是一致的。结论唇腭裂患儿DPOAE和ABR检测结果一致,与ABR相比,DPOAE具有快速、简便、易实施等特点,因此DPOAE可以作为唇腭裂婴幼儿听力检查的手段,但仍需进一步结合ABR及其他相关的听力检查,以明确听力损害的程度和类型。     

A comparative historical and demographic study of the neuromodulation management techniques of deep brain stimulation for dystonia and cochlear implantation for sensorineural deafness in children

Cochlear implants for sensorineural deafness in children is one of the most successful neuromodulation techniques known to relieve early chronic neurodisability, improving activity and participation. In 2012 there were 324,000 recipients of cochlear implants globally.

Effects of subchronic inhalation exposure to an organophosphorus insecticide compound containing dichlorvos on wistar rats’ otoacoustic emissions

IntroductionConsidering that previous studies suggest that pesticides may cause hearing disorders in humans, as well as the lack of studies proving the specific mechanisms of injury and the difficulty of separating concomitant etiological factors of the hearing damage, such as noise and vibration, it is important to develop studies using animal models to elucidate the effects of exposure to those substances isolated from other hearing damage etiologies.ObjectiveTo evaluate if the exposure to a dichlorvos based organophosphorus insecticide may induce ototoxicity.Methods36 male Wistar rats were assigned to 3 groups (12 rats/group): control (exposed to water), positive control (treated with cisplatin to induce hearing damage) and experimental (exposed to dichlorvos based organophosphorus insecticide). The amplitude of distortion product otoacoustic emissions in the frequencies of 4, 6, 8, 10 and 12 kHz was evaluated before and after exposure, as well as systemic toxicity signs, body mass gain and plasma cholinesterase. Open field and plus maze tests were performed in 24 rats: experimental (n = 8), control (n = 8) and positive control group (n = 8 introduced new rats to induce anxiolytic activity) to evaluate the locomotor activity and anxiety, respectively.ResultsThere was no significant change in body mass gain and plasma cholinesterase in the dichlorvos based organophosphorus insecticide group, however, the animals showed transient piloerection, depression and dyspnea during exposure. The behavior was not affected in any group. The frequencies of 8 and 10 kHz were significantly affected bilaterally in the insecticide group, which also showed a significant difference of the control in 10 kHz on the right and 8 and 10 kHz on the left ear.ConclusionSubchronic inhalation exposure to dichlorvos based organophosphorus insecticide induced ototoxicity in the cochlear function of rats without relevant systemic toxicity.     

84例爆震性耳聋听力学分析

目的：分析暴震性耳聋的听力学改变,指导临床积极治疗。方法：对８４例爆震性耳聋行纯音测听及声阻抗测定。结果：感音神经性及混合性耳聋分别占３３．３％和３３．９％;听力曲线以水平下降、斜坡下降和陡坡下降为主;鼓室功能曲线“Ａ”型占多数达５８．９％;蹬骨肌反射同侧刺激引出同侧占５８．３％,对侧刺激引出同侧占４４％。结论：爆炸冲击波和脉冲波对内耳损伤严重,呈不可逆改变;对中耳结构影响相对较小。