脑干听觉诱发电位与畸变产物耳声发射在听觉通路损伤患儿中的应用研究

目的　采用客观听力检测技术 ,分析听觉通路病损患儿的临床听力学特点 ,评价感音神经性聋患儿的蜗性及蜗后病变特征。方法　对感音神经性聋患儿共 310例 (5 0 0耳 ,年龄 1个月至 6岁 ,平均 2 4 2个月 )进行临床分析 ,其中中枢神经系统 (CNS)病变伴听力障碍 10 5例 (2 0 5耳 ) ,将其分为核黄疸 脑瘫组、额叶发育不良组和其他中枢性病变 3组。同年龄段对照组 6 0例 (10 4耳 )。同时检测脑干听觉诱发电位 (BAEP)和畸变产物耳声发射(DPOAE) ,对比不同组别间BAEP波V阈值及DPOAE各自的特点、同一组间不同BAEP波V阈值耳DPOAE的变化特征。结果　 (1)全组感音神经性聋患儿中有CNS病变者比例较高 (10 5例 2 0 5耳 /310例 5 0 0耳 )。 (2 )CNS病变患儿中核黄疸 脑瘫组可见严重的蜗后性听力损失 ,耳蜗功能也轻度受累 ;额叶发育不良组仅出现轻度蜗后听力损失 ;其他中枢性病变一般不累及耳蜗功能。 (3)蜗性听力损失者 ,BAEP波V阈值达 6 0nHLdB时 ,DPOAE幅值明显下降 ;达 70nHLdB以上者 ,DPOAE幅值严重下降或消失。结论　CNS病变伴感音神经性聋患儿听力障碍表现为多样性 ,临床上需联合听力专科采用不同客观听力检测技术进行综合评估 ,才能作出正确诊断。

The application of brainstem auditory evoked potential and distortion product otoacoustic emissions in the children with sensorineural hearing loss

Objective To explore the clinical and audiological characteristics of sensorineural hearing loss (SHL) with pathological changes in both cochlea and retrocochlear in children and evaluate the relationship between SHL and the lesions in central nervous system (CNS).Methods Three hundred and ten cases (500ears) of SHL collected were studied.All of them were tested using both brainstem auditory evoked potential (BAEP) and distortion product otoacoustic emissions (DPOAE).Results (1)The rate of SHL with CNS lesions was very high (105 cases 205 ears/310 cases 500 ears) in study group.(2)The children who suffered from cerebral palsy caused by kemictems usually had serious hearing loss,which belonged to retrocochlear nerve lesion,while their cochlea function was injured slightly.The children suffered from external hydrocephalus had only slight acoustic nerve lesion at retrocochlear,and children with other CNS lesions usually had no change of cochlea function.(3)In the cases of SHL resulted from cochlea lesion,the amplitudes of DPOAE decreased obviously when the threshold of wave V of BAEP was up to 60nHLdB,and the seriously decreased or disappeared when the threshold of wave V of BAEP was up to 70nHLdB.Conclusion The lower age children suffered from SHL are usually complicated with CNS lesions.The audiological characteristics are very different.They need to test with both BAEP and DPOAE or other relative techniques.