小儿听神经病患者ASSR检测结果分析

The Analysis of Auditory Steady-state Responses(ASSR)Result of the Auditory Neuropathy(AN)Children

史伟;王秋菊;刘志成;

1:首都医科大学生物医学工程学院

2:解放军总医院耳鼻咽喉头颈外科耳内科解放军耳鼻咽喉研究所

摘要
目的探讨小儿听神经病患者的听性稳态反应(auditory steady-state response,ASSR)特征及临床应用价值。方法研究对象为30例(60耳)诊断为双侧听神经病的患儿(观察组),其ABR双侧100dB nHL未引出反应,DPOAE和耳蜗微音电位(CM)均可引出,中耳功能正常。另选择30例(60耳)诊断为双侧极重度感音神经性聋的患儿为对照组,其ABR双侧100dB nHL未引出反应,DPOAE和CM均未引出,中耳功能正常。应用美国智听IHS ASSR系统对两组患儿进行ASSR测试,刺激声为调幅调制声,载波频率分别为500、1 000、2 000和4000Hz,调制频率分别为77103Hz,耳机型号为ER-3A插入式气导耳机。比较两组患儿各频率ASSR反应阈。结果观察组500、1 000、2 000和4 000Hz ASSR反应阈分别为81.1±12.5、84.6±13.0、74.7±13.2和62.7±8.3dB nHL,对照组各频率ASSR反应阈分别为90.8±5.9、104.3±6.4、106.9±4.9和108.2±10.3dB nHL,观察组各频率ASSR反应阈均低于对照组,差异有显著统计学意义(P<0.01)。结论虽然小儿听神经病患者ABR测试不能引出反应,但ASSR仍可引出反应,且其反应阈低于极重度感音神经性聋患儿;ASSR可引出反应的听神经病患儿可能可以排除听神经缺失的病变。
关键词
听性稳态反应;听神经病;听性脑干反应;耳声发射;耳蜗微音电位
基金项目(Foundation):
国家自然科学基金重大国际合作项目(81120108009);国家自然科学基金青年科学基金项目(81100719)联合资助
作者
史伟;王秋菊;刘志成;
参考文献

1 Herdman AT,Stapells DR.Auditory steady-state response thresholds of adults with sensorineural hearing impairments[J].International Journal of Audiology,2003,42:237.

2 Rance G,Rickards FW,Cohen LT,et al.The automated prediction of hearing thresholds in sleeping subjects using auditory steady-state evoked potentials[J].Ear Hear,1995,16:499.

3 Rance G,R ickards FW.Prediction of hearing threshold in infants using auditory steady-state evoked potentials[J].J Am Acad Audiol,2002,13:236.

4 Haenens WD,Dhooge I,Maes L,et al.The clinical value of the multiple-frequency 80-Hz auditory steady-state response in adults with normal hearing and hearing loss[J].Archives of Otolaryngology-Head and Neck Surgery,2009,135:496.

5 Tomlin D,Rance G,Graydon K,et al.A comparison of 40Hz auditory steady-state response(ASSR)and cortical auditory evoked potential(CAEP)thresholds in awake adult subjects[J].International Journal of Audiology,2006,45:580.

6 Canale A,Lacilla M,Cavalot AL,et al.Auditory steadystate responses and clinical applications[J].Eur Arch Otorhinolaryngol,2006,263:499.

7 Tlumak AI,Rubinstein E,Durrant JD.Meta-analysis of variables that affect accuracy of threshold estimation via measurement of the auditory steady-state response(ASSR)[J].International Journal of Audiology,2007,46:692.

8 VanMaanen A,Stapells DR.Comparison of multiple auditory steady-state responses(80versus 40Hz)and slow cortical potentials for threshold estimation in hearingimpaired adults[J].International Journal of Audiology,2005,44:613.

9 Haenens WD,Vinck BM,Maes L,et al.Determination and evaluation of clinically efficient stopping criteria for the multiple auditory steady-state response technique[J].Clinical Neurophysiology,2010,121:1 267.

10 Swanepoel D,Erasmus H.Auditory steady-state responses for estimating moderate hearing loss[J].European Archives of Oto-Rhino-Laryngology,2007,264:755.

11 Luts H,Desloovere C,Wouters J.Clinical application of dichotic multiple-stimulus auditory steadystate responses in high-risk newborns and young children[J].Audiol Neuro Otol,2006,11:24.

12 Alaerts J,Luts H,Vandun B,et al.Latencies of auditory steady-state responses recorded in early infancy[J].Audiol Neuro Otol,2010,15:116.

13 VanderWerff KR,Brown CJ.Effect of audiometric configuration on threshold and suprathreshold auditory steady‐state responses[J].Ear Hear,2005,26:310.

14 Firszt JB,Gaggl W,Runge-Samuelson CL,et al.Auditory sensitivity in children using the auditory steady-state response[J].Arch Otolaryngol Head Surg,2004,130:536.

15 Calil DB,Lewis DR,Fiorini AC.Findings of the Auditory Steady State Response in children with normal hearing[J].Distúrbios da Comunicaao,2006,18:391.

16 Stueve MP,O’Rouke C.Estimation of hearing loss in children:comparison of auditory steady state response,auditory brainstem response and behavioral test methods[J].Am J Audiol,2003,12:125.

17 Luts H,Desloover C,Kumar A,et al.Objective assessment of frequency‐specific hearing thresholds in babies[J].Int J Pediatr Otorhinolaryngol,2004,68:915.

18 Rance GB,David E,Cone-Wesson B,et al.Clinical findings for a group of infants and young children with auditory neuropathy[J].Ear Hear,1999,20:238.

19 李兴启,史伟,孙勍.听神经病[M].见:李兴启,孙建和,杨仕明,等,主编.耳蜗病理生理学.北京:人民军医出版社,2011.263~282.

20 黄丽辉,倪道凤,李晓璐,等译.婴幼儿听神经病谱系障碍诊断和处理指南——婴幼儿听神经病诊断及处理指南研讨会制订(2008年,意大利.科莫)[J].听力学及言语疾病杂志,2012,20:64.

21 闻雨婷,祝威,李兴启.耳蜗外毛细胞及其传出系统与听觉传入[J].国际耳鼻咽喉头颈外科杂志,2007,31:50.

22 郗昕,韩东一,李兴启.小儿听神经病或听同步不良患者耳蜗植入术前的电生理评估[J].中华耳鼻咽喉头颈外科杂志,2006,41:956.

23 王锦玲,宦怡,高磊,等.耳蜗神经发育异常的小儿听神经病[J].听力学及言语疾病杂志,2009,17:129.