颞叶癫痫患者的中枢听功能初探

目的采用汉语最低听觉功能测试（minimal auditory capabilities inchina，MACC）中背景噪声下言语测听法（speech-perception-in-noise test，SPIN），评价颞叶癫痫患者的中枢听觉功能。方法对9例经脑电图和MRI、CT检查后神经内科确诊的颞叶癫痫患者，进行SPIN、听性脑干反应（auditory brainstem response，ABR）测试。选择19例年龄、性别相匹配的健康人做对照组，进行SPIN测试。所有受试者均经询问病史、耳科检查及纯音测听、声导抗测定除外传导、感音神经性及混合性聋，且纯音听阈均在25dB以内。SPIN测试材料中测试言语和噪声材料，采用独立声道录制，通过预实验选择测试信噪比（S／N）为-25dB。测试时，每受试句均朗读2次，并对2次的结果分别进行记录和比较。结果在ABR测试中，癫痫患者仅V波潜伏期左耳较右耳延长，且差异有统计学意义（P〈0．05），余各波潜伏期及波间期差异均无统计学意义（P〉0．05）；在SPIN测试中，健康对照组第1次聆听左右耳间得分比较，差异无统计学意义（P〉0．05），第2次聆听时，差异有统计学意义（P〈0．05）；颞叶癫痫患者左右耳间得分比较，第1次和第2次聆听的差异均无统计学意义（P〉0．05），而颞叶癫痫患者无论在单耳、双耳聆听以及第1次和第2次聆听的SPIN得分，与健康对照组相比，差异均有统计学意义（P〈0．01）。由于9例癫痫患者中有3例为右侧颞叶病变，余为双侧颞叶病变，故未对左、右侧颞叶病变与左、右利手的关系可能对实验造成的影响进行统计分析。结论本组颞叶癫痫患者在纯音测听、ABR检查无明显异常，而SPIN测试言语识别率明显低于对照组，差异有统计学意义，证明颞叶癫痫患者具有中枢听功能障碍，同时提示SPIN是一项敏感、无创的中枢听觉功能检查方法，建议临床上将其作为听处理套查方法之一。

Primary investigation of central auditory function in patients with temporal lobe epilepsy

OBJECTIVE: To investigate the function of central auditory, Speech-perception-in-noise test (SPIN test) was used to assess that whether temporal lobe epilepsy patients have central auditory processing disorders. METHODS: Four audiological test were performed in 9 patients with temporal lobe epilepsy and 19 age-matched normal hearing persons as controls, which include pure tone audiometry, acoustic immittance measurement, ABR (auditory brainstem response) and SPIN test. All the temporal lobe epilepsy patients were performed by CT or MRI and diagnosed by the neurologists prior to the test. The testing metiarals of speech and noise in SPIN test was recorded in independent tracks and the S/N was identified by -25 dB by pre-experiment. In the test, every words were read twice and both the results were recorded. RESULTS: In the ABR test, only wave V latency showed longer values in the left ear, other waves like I, III and inter-peak intervals hadn't shown significant statistical differences in both ears of temporal lobe epilepsy patients. However, in the SPIN test, there's no significant statistical differences in both left and right ears of the controls by the first-time hearing (P = 0.107), and the differences showed by the second-time hearing (P = 0.048); but in the comparition of both ears in temporal lobe epilepsy patients, both time of hearing showed no significant statistical differences with P = 0.174 and P = 0.163. In additional, the SPIN recognition score of the temporal lobe epilepsy patients, whether in the fist or second time hearing, whether in the monaural or binaural modals, presented significant statistical differences compared to the controls (P = 0.000). CONCLUSIONS: There was no statistically significant difference in pure tone audiometry and ABR test for all the groups. But the speech recognition score obtained from SPIN test of temprol lobe epilepsy patients is lower than the normal persons, which has statistically significant difference. (P < 0.001) Then we can come to the conclusion that Temporal lobe epilepsy patients had central auditory dysfunctions and SPIN test is a sensitive way to assess this abnormal.