老年性聋患者噪声下言语识别能力的评估

Hearing in Noise Test for Older Adults with Age-related Hearing Loss

孙靖雯;黄治物;陈建勇;梅玲;李蕴;任燕;沈敏;张勤;吴皓;

1:上海交通大学医学院附属新华医院耳鼻咽喉头颈外科

2:上海交通大学医学院耳科学研究所

摘要
目的评估老年性聋患者噪声下言语识别能力,探讨年龄、听力损失程度、认知功能对噪声下言语识别能力的影响。方法以90例60岁以上老年性聋者为受试者,按年龄分为三组,6069岁(44例88耳)、7069岁(44例88耳)、7079岁(32例64耳)、>79岁(14例28耳),完成纯音听阈测试、普通话噪声下言语测试(Mandarin hearing in noise test,MHINT)及简易智能精神状态量表(mini-mental state examination,MMSE)评估,分别获得0.5、1、2、4kHz平均听阈、MHINT自适应信噪比及MMSE量表总得分;分析年龄、平均听阈、自适应信噪比及MMSE量表得分之间的相关性。结果 1平均听阈、MHINT信噪比随年龄增长而提高,不同年龄组间的平均听阈、MHINT信噪比差异有统计学意义(P<0.01);2不同程度听力损失组间的MHINT信噪比差异显著(P<0.01),控制认知得分的情况下其差异仍然有统计学意义(P<0.01),且平均听阈与MHINT信噪比具有显著的直线相关性(r=0.326,P<0.01),随着受试者平均听阈提高,MMSE得分下降,二者有直线相关性(r=-0.187,P<0.05);3MHINT信噪比与MMSE量表得分具有相关性(r=-0.201,P<0.01),认知功能减退组(<27分)的MHINT信噪比平均值较认知功能正常组(2779岁(32例64耳)、>79岁(14例28耳),完成纯音听阈测试、普通话噪声下言语测试(Mandarin hearing in noise test,MHINT)及简易智能精神状态量表(mini-mental state examination,MMSE)评估,分别获得0.5、1、2、4kHz平均听阈、MHINT自适应信噪比及MMSE量表总得分;分析年龄、平均听阈、自适应信噪比及MMSE量表得分之间的相关性。结果 1平均听阈、MHINT信噪比随年龄增长而提高,不同年龄组间的平均听阈、MHINT信噪比差异有统计学意义(P<0.01);2不同程度听力损失组间的MHINT信噪比差异显著(P<0.01),控制认知得分的情况下其差异仍然有统计学意义(P<0.01),且平均听阈与MHINT信噪比具有显著的直线相关性(r=0.326,P<0.01),随着受试者平均听阈提高,MMSE得分下降,二者有直线相关性(r=-0.187,P<0.05);3MHINT信噪比与MMSE量表得分具有相关性(r=-0.201,P<0.01),认知功能减退组(<27分)的MHINT信噪比平均值较认知功能正常组(2730分)显著增加(P<0.01);不同听力损失程度组中,认知功能正常组与减退组之间MHINT信噪比差异无统计学意义(P>0.05)。结论噪声下言语测试可用于老年人听觉功能评估,老年性聋者的年龄、听力损失程度、认知功能与噪声下言语识别能力之间相互影响,评估老年人听觉功能时应考虑认知功能的影响。
关键词
老年性聋;噪声下言语测试;年龄;纯音听阈;认知功能
基金项目(Foundation):
十二五国家科技支撑计划项目(2012BAI12B00)资助
作者
孙靖雯;黄治物;陈建勇;梅玲;李蕴;任燕;沈敏;张勤;吴皓;
参考文献

1 Parham K,McKinnon BJ,Eibling D,et al.Challenges and opportunities in presbycusis[J].Otolaryngol Head Neck Surg,2011,144:491.

2 Gates GA,Mills JH.Presbycusis[J].Lancet,2005,366:1111.

3 Wilson BH.Adding speech-in-noise testing to your clinical protocol:why and how[J]?Hear J,2004,57:10.

4 Vermiglio AJ.The american english hearing in noise test[J].Int J Audiol,2008,47:386.

5 American Speech-Language-Hearing Association,Panel on Audiological Assessment Guidelines for audiological screening.http://www.asha.org/public/hearing/testing.

6 Jack Katz,原著.韩德民,主译.临床听力学[M].第5版.人民卫生出版社,2006.72~73.

7 Mitchell AJ.A meta-analysis of the accuracy of the minimental state examination in the detection of dementia and mild cognitive impairment[J].J Psychiatr Res,2009,43:411.

8 彭丹涛,许贤豪,刘江红,等.简易智能精神状态检查量表检测老年期痴呆患者的应用探讨[J].中国神经免疫学和神经病学杂志,2005,12:187.

9 Summers V,Makashay MJ,Theodoroff SM,et al.Suprathreshold auditory processing and speech perception in noise:hearing-impaired and normal-hearing listeners[J].J Am Acad Audiol,2013,24:274.

10 Bakent D.Speech recognition in normal hearing and sensorineural hearing loss as a function of the number of spectral channels[J].J Acoust Soc Am,2006,120(5Pt 1):2908.

11 Cacciatore F,Napoli C,Abete P,et al.Quality of life determinants and hearing function in an elderly population:osservatorio geriatrico campano study group[J].Gerontology,1999,45:323.

12 Lin FR,Metter J,O'Brien RJ,et al.Hearing loss and incident dementia[J].Arch Neurol,2011,68:214.

13 Humes LE,Coughlin M,Talley L.Evaluation of the use of a new compact disc for auditory perceptual assessment in the elderly[J].J Am Acad Audiol,1996,7:419.

14 Anderson S,Kraus N.Sensory-cognitive interaction in the neural encoding of speech in noise:a review.[J]J Am Acad Audiol,2010,21:575.

15 Anderson S,Schwoch TW,Clark AP,et al.A dynamic auditory-cognitive system supports speech-in-noise perception in older adults[J].Hearing Research,2013,300:18.

16 Wong PC,Ettlinger M,Sheppard JP,et al.Neuroanatomical characteristics and speech perception in noise in older adults[J].Ear Hear,2010,31:471.

17 Wilson RH.Clinical experience with the words-in-noise test on 3430veterans:comparisons with pure-tone thresholds and word recognition in quiet[J].J Am Acad Audiol,2011,22:405.

18 Gates GA,Feeney MP,Higdon RJ.Word recognition and the articulation index in older listeners with probable age-related auditory neuropathy[J].J Am Acad Audiol,2003,14:574.

19 Lazard DS,Vincent C,Venail F,et al.Pre-,per-and postoperative factors affecting performance of postlinguistically deaf adults using cochlear implants:a new conceptual model over time[J].PLoS One,2012,7:e48739.

20 Walden TC,Walden BE.Predicting success with hearing aids in everyday living[J].J Am Acad Audiol,2004,15:342.