相反极性短声所记录的耳蜗微音电位在小儿听神经病诊断中的应用

Clinical Application of the Cochlear Microphonics Evoked by Clicks with Reversed Polarity in the Diagnosis of Auditory Neuropathy in Infants and Young Children

莫玲燕;刘辉;陈静;黄丽辉;

1:首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科中心

2:首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科中心

3:首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科中心

4:首都医科大学附属北京同仁医院耳鼻咽喉-头颈外科中心 北京100730

摘要
目的比较听力正常和ABR缺失儿童相反极性短声所记录的耳蜗微音电位(cochlear microphonics,CM)和DPOAE,以探讨它们在小儿听神经病中的诊断价值。方法根据短声ABR阈值、DPOAE和声导抗测试等结果,将受试儿分为听力正常及ABR缺失两组。听力正常组由短声ABR阈值≤30dB nHL、DPOAE正常的54名受试儿(91耳)组成,年龄为143月龄,平均为8月龄(中位数4月龄)。ABR缺失组由短声ABR100dB nHL无反应的93名(158耳)受试儿组成,年龄为243月龄,平均为8月龄(中位数4月龄)。ABR缺失组由短声ABR100dB nHL无反应的93名(158耳)受试儿组成,年龄为267月龄,平均22月龄(中位数18月龄)。测试状态为水合氯醛镇静睡眠。ABR的刺激声为短声,极性为疏波和密波,刺激速率为19.3次/秒,耳机为ER-3A插入式耳机。听力正常组ABR的分析强度为80dBnHL,ABR缺失组为100dBnHL。结果听力正常组除6耳(6.6%)在80dBnHL未记录到明显的CM外,其余85耳(93.4%)均记录到CM,其时程为0.89±0.19ms。ABR缺失组中24耳记录到CM,其中有12耳(6人)(7.6%)DPOAE正常,有12耳(5人双耳,2人单耳)(7.6%)未记录到DPOAE,该组CM时程为2.61±0.72ms。听神经病在所有ABR缺失病例中的发病率为13.98%。结论CM是一种可靠的评价内耳外毛细胞功能的指标,与DPOAE相比,不易受到其它病理状态的影响。如果不进行CM的测试,可能会将一部分听神经病误诊为耳蜗性听力损失,因此建议对于双耳ABR最大输出无反应、而未记录到DPOAE的婴幼儿病例行CM检查,以避免听神经病的漏诊。
关键词
耳蜗微音电位;耳声发射;听神经病;听性脑干反应
基金项目(Foundation):
作者
莫玲燕;刘辉;陈静;黄丽辉;
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