听力筛查未通过婴儿的中耳功能与ABR、ASSR及DPOAE检测结果的相关性分析
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摘要
目的分析听力筛查未通过婴儿的听力学诊断结果,探讨其中耳功能对听性脑干反应(ABR)、听性稳态反应(ASSR)及畸变产物耳声发射(DPOAE)检测结果的影响。方法回顾性分析238例(406耳)听力筛查未通过婴儿的ABR、ASSR、DPOAE、1 000 Hz鼓室声导抗检测结果,以1 000 Hz鼓室导抗图有正峰为中耳功能正常,无峰为中耳功能异常,分析中耳功能与ABR、ASSR及DPOAE结果的相关性。结果 238例406耳中,1 000 Hz鼓室导抗图正常236耳,异常170耳;ABR反应阈正常215耳,异常191耳;行ASSR检查的340耳中,ASSR反应阈正常184耳,异常156耳;ABR反应阈异常的191耳DPOAE均未引出,正常的215耳中,DPOAE通过116耳,未通过99耳。中耳功能正常组与异常组之间ABR反应阈正常或异常耳数分布差异无统计学意义(P>0.05);听力正常组在500 Hz ASSR反应阈中耳功能异常组高于正常组(P<0.05),中度听力损失组2 000 Hz和4 000 Hz处ASSR反应阈中耳功能异常组低于中耳功能正常组(P<0.01),重度听力损失组仅4 000 Hz ASSR反应阈中耳功能异常组低于正常组(P<0.05);中耳功能正常组DPOAE通过率高于中耳功能异常组,差异有统计学意义(P<0.01)。结论本组听力筛查未通过婴儿的中耳功能正常与否对ABR反应阈无明显影响,对不同频率ASSR反应阈有影响,且对不同阈值者影响频率不同;中耳功能正常者DPOAE通过率高。
Objective To investigate the relationship between the middle ear functions and auditory status(including ABR, ASSR and DPOAE results) in a group of infants who did not pass the neonatal hearing screening.Methods A retrospective study investigated the auditory results of ABR, ASSR, DPOAE and 1 000 Hz tympanometry among the 406 ears of 238 infants who did not pass the neonatal hearing screening. The subjects were divided into 2 groups based on the 1 000 Hz tympanograms: the peak tympanogram group(deemed to have normal middle ear functions) and the flat tympanogram group(regarded as resulting from middle ear dysfunction). We analyzed the effects of middle ear functions on the results of ABR, ASSR and DPOAE.Results The numbers of subjects with normal results of ABR, ASSR, DPOAE and 1 000 Hz tympanometry were 215, 184, 116 and 236 respectively. The numbers of subjects with abnormal results of the 4 tests above were 191, 156, 99 and 170 respectively. T-test failed to display statistic difference of ABR threshold between the 2 groups(P>0.05). However, the results of ASSR at 500 Hz(in normal hearing infants according to the average threshold of 4 frequencies of ASSR), 2 000 Hz(in moderate hearing loss infants) and 4 000 Hz(in moderate hearing loss infants) had statistic differences between the 2 groups(P<0.05). Furthermore, Chi-square test displayed that the middle ear function statistically significantly impacted on the DPOAE passing rates(P<0.05).Conclusion The middle ear functions had statistically significant effects on ASSR results among the low-to-mid frequency range and the passing rate of DPOAE in infants. However, there was no correlation between the middle ear functions and ABR results.
Objective To investigate the relationship between the middle ear functions and auditory status(including ABR, ASSR and DPOAE results) in a group of infants who did not pass the neonatal hearing screening.Methods A retrospective study investigated the auditory results of ABR, ASSR, DPOAE and 1 000 Hz tympanometry among the 406 ears of 238 infants who did not pass the neonatal hearing screening. The subjects were divided into 2 groups based on the 1 000 Hz tympanograms: the peak tympanogram group(deemed to have normal middle ear functions) and the flat tympanogram group(regarded as resulting from middle ear dysfunction). We analyzed the effects of middle ear functions on the results of ABR, ASSR and DPOAE.Results The numbers of subjects with normal results of ABR, ASSR, DPOAE and 1 000 Hz tympanometry were 215, 184, 116 and 236 respectively. The numbers of subjects with abnormal results of the 4 tests above were 191, 156, 99 and 170 respectively. T-test failed to display statistic difference of ABR threshold between the 2 groups(P>0.05). However, the results of ASSR at 500 Hz(in normal hearing infants according to the average threshold of 4 frequencies of ASSR), 2 000 Hz(in moderate hearing loss infants) and 4 000 Hz(in moderate hearing loss infants) had statistic differences between the 2 groups(P<0.05). Furthermore, Chi-square test displayed that the middle ear function statistically significantly impacted on the DPOAE passing rates(P<0.05).Conclusion The middle ear functions had statistically significant effects on ASSR results among the low-to-mid frequency range and the passing rate of DPOAE in infants. However, there was no correlation between the middle ear functions and ABR results.
引文
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12 郝文洋,商莹莹,倪道凤,等.正常新生儿宽频声导抗能量吸收率及其可重复性研究[J].听力学及言语疾病杂志,2016,24:10.
2 倪道凤.婴幼儿分泌性中耳炎[J].中国医学文摘耳鼻咽喉科学,2007,22:11.
3 江载芳,申昆玲,沈颖,等.褚福堂实用儿科学(第8版) [M].北京:人民卫生出版社,2015.426～427.
4 商莹莹,倪道凤,刘世琳.低频和高频探测音鼓室声导抗测试在婴儿中耳功能诊断中的作用[J].中华耳鼻咽喉头颈外科杂志,2006,47:326.
5 Mina P,Kyu-Hee H,Hyunseo J,et al.Usefulness of 1000-Hz probe tone in tympanometry according to age in Korean infants[J].Otorhinolaryngology,2015,79:42.
6 孙喜斌,刘志敏.残疾人残疾分类和分级《听力残疾标准》解读[J].听力学及言语疾病杂志,2015,23:105.
7 黄丽辉,刘莎,莫玲燕,等.新生儿听力筛查及婴幼儿听力损失确诊影响因素[J].听力学及言语疾病杂志,2008,16:376.
8 李兴启,王秋菊.听觉诱发反应及应用(第2版) [M].北京:人民军医出版社,2015.89～91.
9 黄丽辉,韩德民,刘莎,等.未通过听力筛查的婴幼儿听力追踪分析[J].中华耳鼻咽喉头颈外科杂志,2005,40:643.
10 顾瑞,韩东一,翟所强,等.临床听力学(第二版)[M].北京:中国协和医科大学出版社,2008.139～268.
11 黄孟捷,郑芸,王恺.宽频声导抗测试[J].临床耳鼻咽喉头颈外科杂志,2010,24:620.
12 郝文洋,商莹莹,倪道凤,等.正常新生儿宽频声导抗能量吸收率及其可重复性研究[J].听力学及言语疾病杂志,2016,24:10.