畸变产物耳声发射在伪聋筛查中的应用

目的：探讨畸变产物耳声发射(DPOAE)在伪聋筛查中的临床应用价值。方法：分别对伪聋组(17耳)、正常对照组（20耳）和感音神经性聋组（32耳）进行DPOAE检测,并进行比较。结果：伪聋组和正常对照组DPOAE的平均检出率分别为96. 47％和97. 00％,两组比较差异无统计学意义(P＞0.05);感音神经性聋组的平...     

Pseudohypacusis in childhood and adolescence is associated with increased gray matter volume in the medial frontal gyrus and superior temporal gyrus

Pseudohypacusis is a somatoform disorder characterized by hearing loss with discrepancies between pure-tone audiometry and auditory brainstem response (ABR), but the underlying neuronal mechanisms remain unclear. Using voxel-based morphometry (VBM) with magnetic resonance (MR) imaging for 14 unmedicated, right-handed patients and 35 healthy control subjects, we investigated whether functional hearing loss was associated with discernible changes of brain morphology. Group differences in gray matter volume (GMV) were assessed using high-resolution, T1-weighted, volumetric MR imaging datasets (3T Trio scanner; Siemens AG) and analyzed with covariant factors of age, sex, socioeconomic status (SES), and total GMV, which was increased by 27.9% in the left medial frontal gyrus (MFG) (Brodmann area 10) (p = .001, corrected cluster level) and by 14.4% in the right superior temporal gyrus (STG) and the adjacent middle temporal gyrus (MTG) (BA42 to 21) (p = .009, corrected cluster level) in patients with pseudohypacusis. The GMV in the right STG (BA42) and verbal intelligence quotient (IQ) were correlated significantly with the Wechsler Intelligence Scale for Children – Third Edition (WISC-III) (ß = ?.57, p < .0001) and level of SES (ß = ?.55, p < .0001). The present findings suggest that the development of the auditory association cortex involved in language processing is affected, causing insufficient pruning during brain development. We therefore assert that differences in the neuroanatomical substrate of pseudohypacusis subjects result from a developmental disorder in auditory processing.     

客观测听技术在鉴别伪聋中的临床应用

目的探讨聋人运动员伪聋鉴别客观、有效的测听方法。方法运用畸变产物耳声发射技术（distortion product otoacoustic emission,DPOAE）对聋人运动员进行听力初筛,初筛通过者再行中耳声导抗测试,应用声镫骨肌反射客观性推算其听敏度。对伪聋检查结果有异议的运动员和需做听神经病鉴别的运动员,再行脑干电反应测昕。结果初筛855人共有5名运动员8耳通过耳声发射检查,DPOAE耳通过率为0．47％,人通过率为0．58％。复查中耳声导抗测试3人4耳引出镫骨肌反射且阈值正常。脑干电反应测昕2人反应阈正常,2人反应阈≥100 dB nHL。结论耳声发射、中耳声导抗测试和脑干电反应测听可作为聋人运动员伪聋鉴别客观、有效的测听方法。     

言语识别阈(SRT)在伪聋鉴别中的临床意义

目的探讨言语识别阈(speech recognition threshold，SRT)在伪聋鉴别中的临床意义。方法对外伤后自述听力下降的139名患者进行综合听力测试，以综合测试的结果与SRT判断伪聋的结果比较。结果SRT诊断伪聋敏感性达84％，特异性达94％，准确性为89％。结论SRT诊断伪聋简便易行、特异性高、可靠性好，值得推广。     

法医学中伪聋鉴定的常用方法

伪聋即装聋,在法医学鉴定工作中常会遇到一些伤者在耳外伤或头颅外伤后涉及"刑事责任"或"赔偿损失"等问题,为达到个人目的,故意伪装成耳聋,而客观上其听觉系统正常或仅有轻微损害。因此,听功能损伤的鉴定是此类案件鉴定的关键。常用的听功能鉴定方法包括纯音听阈测试、言语识别阈测试、响度优势测试、听性脑干反应、畸变产物耳声发射、瞬态诱发耳声发射、多频稳态诱发电位等。但每种方法都有优缺点,在鉴定工作中应将几种方法结合应用,综合评价听力损失程度。     

Unilateral pseudohypacusis in children

Pseudohypacusis is a condition where there is hearing loss without any organic etiology. Though this condition has been reported long before, the literature exists mainly in the form of case reports. An interesting aspect of pseudohypacusis is of patients presenting with unilateral pseudohypacusis. In children, there often exist underlying psychological factors related to the occurrence of this condition. This condition is usually suspected when there is discrepancy in audiometric testing. The authors hereby report a child of unilateral pseudohypacusis presenting with psychological stressors, along with an overview of the management of such conditions.     

Auditory steady-state responses to multiple simultaneous stimuli in children with functional or sensorineural hearing loss

The goal of our study was to identify the role of auditory steady-state responses for hearing assessment in patients with functional hearing loss. The study design was to compare auditory steady-state response thresholds and standard pure-tone audiometry thresholds between patients with functional or sensorineural hearing loss. Subjects comprised 16 patients (24 ears) with functional hearing loss and 17 patients (24 ears) with sensorineural hearing loss. Differences and correlations between auditory steady-state response thresholds and standard pure-tone audiometry thresholds at 500, 1,000, 2,000 and 4,000 Hz were evaluated. In children with functional hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds were significantly different at all frequencies and were not significantly correlated. In patients with sensorineural hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds did not differ significantly at any frequencies and were significantly correlated. Auditory steady-state responses may have principal role in the assessment of auditory brainstem acuity, particularly at low frequencies in patients with functional hearing loss.