短纯音及切迹噪声掩蔽的短纯音ABR对感音神经性听力损失成年人纯音听阈的评估

Estimation of Puretone Thresholds of Sensorineural Hearing Loss Adults Using Auditory Brain Stem Responses to Tone Burst and Tone Burst in Notched Noise

邹琦娟;倪道凤;商莹莹;李奉蓉;

1:首都医科大学附属北京同仁医院耳鼻咽喉头颈外科

2:中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科

摘要
目的比较感音神经性听力损失成年人短纯音及两种不同强度切迹噪声掩蔽短纯音诱发的听性脑干反应(auditory brain stem response,ABR)反应阈与纯音听阈的关系,以选取频率特异性更好的ABR声刺激信号。方法对38例(45耳)经纯音听阈测试诊断为感音神经性听力损失的成年人分别进行短纯音(上升/下降时间各2.5个周期,无平台)ABR(tb-ABR)测试及以较短纯音强度低25 dB(A强度)和15 dB(B强度)切迹噪声对短纯音进行同侧掩蔽的ABR(分别简称amtb-ABR和bmtb-ABR)测试,分析三种ABR反应阈与纯音听阈的关系。结果各频率tb-ABR、amtb-ABR和bmtb-ABR反应阈与纯音听阈的相关系数均大于0.8;500、1 000、2 000、4 000Hz四个频率三种ABR反应阈与纯音听阈之差的均值均小于10 dB,其中,500 Hz tb-ABR反应阈最接近纯音听阈,其它3个频率bmtb-ABR反应阈最接近纯音听阈;在陡降型听力损失患者中,bmtb-ABR反应阈与纯音听阈更接近。结论 tb-ABR、amtb-ABR及bmtb-ABR反应阈均可用于估计纯音听阈,一般情况下,可用tbABR反应阈预估纯音听阈;特定情况下,不同测试频率可选用不同的声信号;而对于陡降型听力损失患者,bmtbABR反应阈预估纯音听阈更为准确。
关键词
短纯音;切迹噪声;听性脑干反应;纯音听阈;感音神经性听力损失
基金项目(Foundation):
卫生行业科研专项项目任务单元子课题资助(201202005)
作者
邹琦娟;倪道凤;商莹莹;李奉蓉;
参考文献

1商莹莹,王素菊,编译,倪道凤,审校.婴幼儿听力评估指南[J].听力学及言语疾病杂志,2014,22:442.

2 British Columbia Early Hearing Program(BCEHP)Audiology Assessment Protocol.2012.http://www.phsa.ca/Agencies And Services/Services/BC Early Hearing/For Professionals/Resources/Protocds-Standards.htm.

3 邹琦娟,倪道凤,李奉蓉,等.耳科正常成人短纯音及切迹噪声掩蔽短纯音诱发的ABR比较[J].听力学及言语疾病杂志,2010,18:108.

4 商莹莹,倪道凤,李奉蓉,等.气骨导短音ABR在听力正常成年人中的特性[J].中国耳鼻咽喉头颈外科,2007,14:239.

5 商莹莹,倪道凤,徐春晓,等.感音神经性听力损失成年人短音诱发的听性脑干反应阈研究[J].听力学及言语疾病杂志,2008,16:113.

6 李雪蕾,白燕,周媛,等.0~6岁听力正常儿童短纯音听性脑干反应的研究[J].听力学及言语疾病杂志,2012,20:166.

7 Picton TW,Stapells DR,Campbell KB.Auditory evoked potentials from the human cochlea and brainstem[J].The Journal of Otolaryngology,1981,10(supple 9):1.

8 Folsom RC,Wynne MK.Auditory brain stem responses from human adults and infants:restriction of frequency contribution by notched-noise masking[J].J Acoust Soc Am,1986,80:1057.

9 Stapells DR,Picton TW,Durieux-Smith A,et al.Thresholds for short-latency auditory-evoked potentials to tones in notched noise in normal-hearing and hearing-impaired subjects[J].Audiology,1990,29:262.

10 Picton TW,Ouellette J,Hamel G,et al.Brain stem evoked potentials to tone pips in notched noise[J].J Otolaryngol,1979,8:289.

11 Hang AX,Holly PAR,Teagle HFB,et al.Is"No Response"on diagnostic auditory brainstem response testing an indication for cochlear implantation in children[J].Ear and Hearing,2015,36:8.