感音神经性聋患儿的听功能综合评估

Audiologic Comprehensive Evaluation of Sensorineural Deafness in Children

蒋璐;冯永;柳炯;梅凌云;贺楚峰;

1:中南大学湘雅医院耳鼻咽喉科教研室

摘要
目的探讨听力测试组合(ABR+ASSR+声场环境中的行为测听)在感音神经性聋患儿残余听力评估中的应用价值。方法48名(96耳)感音神经性聋患儿中能配合纯音测听的患儿19人(38耳)设为PTA组,进行纯音测听及ASSR检测;不能配合纯音测听的患儿29人(58耳)设为BA组,进行声场环境中的行为测听(behav-ior audiometry,BA)、ABR及ASSR检测。结果①PTA组0.5、1、2、4 kHz各频率ASSR反应阈与纯音听阈显著相关(P<0.01),各频率相关系数分别为0.75、0.76、0.76、0.83,建立本实验室的ASSR-PTA直线回归方程;②BA组23耳ABR无反应但仍可引出ASSR,而ASSR无反应耳ABR均未能引出;BA组29例患儿中ASSR检测反应较好耳(29耳)在0.54 kHz四个频率上,ASSR可测得83个反应阈值,行为测听可测得89个反应阈值,综合ASSR和行为测听可以得到96个反应阈值。结论与单项听力测试方法相比,听力测试组合(行为测听+ABR+ASSR)能为更小年龄、听力损失更重的患儿进行残余听力的评估,同时能对双侧耳间听力差异、各频率的听力损失程度进行评估,为听力损失病变的定位判断提供参考。
关键词
听性稳态反应;听性脑干反应;行为测听;听力测试组合
基金项目(Foundation):
国家863计划(2007AA02Z445);; 国家自然科学基金(30470954、30671150);; "十一五"国家攻关计划(2007BA118B13);; 高等学校博士学科点专项基金(20060533043)资助
作者
蒋璐;冯永;柳炯;梅凌云;贺楚峰;
参考文献

1 Gorga MP,Neely ST,Hoover BM,et al.Determining the up-per li mits of sti mulation for auditory steady-state responsemeasurements[J].Ear Hear,2004,25:302.

2 Vander Werff KR,Brown CJ.Effect of audiometric configura-tion on threshold and suprathreshold auditory steady-stateresponses[J].Ear and Hearing,2005,26:310.

3许军,史波宁,陈淑飞,等.多频稳态诱发反应应用于中度以上聋儿听力评估的临床分析[J].中国眼耳鼻喉科杂志,2008,8:94.

4 Aoyagi M,Suzuki Y,Yokota M,et al.Reliability of 80-Hzamplitude modulationfollowing response detected by phase co-herence[J].Audiol Neurootol,1999,4:28.

5 Lins OG,Picton TW,Boucher BL,et al.Frequency-specificaudiometry using steady-state responses[J].Ear Hear,1996,17:81.

6 Joong HA,Lee HS,Ki m YJ,et al.Comparing pure-toneauditory and auditory steady-state response for the measure-ment of hearing loss[J].Otolaryngology-Head and NeckSurgery,2007,136:966.

7 Vander Werff KR,Brown CJ,Gienapp BA,et al.Comparisonof auditory steady-state response and auditory brainstemre-sponse thresholds in children[J].J Am Acad Audiol,2002,`13:227.

8 Lins OG,Picton PE,Picton TW,et al.Auditory steady-state responses to tones amplitude-modulated at 80~110 Hz[J].J Acoust Soc Am,1995,97:3 051.

9 Herdman AT,Stapells DR.Auditory steady-state responsethresholds of adults with sensorineural hearing i mpairments[J].Int J Audiol,2003,42:237.

10 Mason S,Garnham C,Hudson B.Electric response audio-metryin young children before cochlear i mplantation:Ashortlatency component[J].Ear Hear,1996,17:537.

11 Nong DX,Ura M,Owa T,et al.An acoustically evokedshort latency negative response in profound hearing loss pa-tients[J].Acta Otolaryngol,2000,120:960.

12兰兰,于黎明,陈之慧,等.短潜伏期负反应诊断前庭水管扩大的意义[J].听力学及言语疾病杂志,2006,14:241.