常频听阈正常的噪声暴露者耳蜗电图表现
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摘要
目的探讨耳蜗电图对噪声导致的隐性听力损失的早期诊断价值。方法选取36例18～40岁的常频听阈正常受试者,其中18例有噪声暴露史的工人作为噪声暴露组,18例无噪声暴露史的正常受试者作为对照组,分别行纯音听阈测试(常频+高频)、噪声下言语测试以及耳蜗电图测试,比较各组检查结果。结果噪声暴露组和对照组18、20 kHz听阈检出率分别为55.6%、33.3%和88.9%、88.3%,噪声暴露组低于对照组,差异有统计学意义(P<0.05);10、12.5 kHz平均听阈分别为11.94±15.16、16.39±20.87 dB HL和3.89±15.20、6.94±20.87 dB HL,噪声暴露组高于对照组(P<0.05);言语测试结果示噪声暴露组和对照组信噪比损失平均值分别为4.62±2.52 dB和1.44±2.90 dB,噪声暴露组高于对照组(P<0.01)。耳蜗电图测试结果示,噪声暴露组SP/AP振幅比在96和90 dB nHL刺激强度下高于对照组,差异有统计学意义(P<0.05),SP/AP面积比在96 dB nHL刺激强度下高于对照组,差异有统计学意义(P<0.05)。结论高强度刺激下(96 dB nHL)耳蜗电图SP/AP振幅比和面积比对噪声导致的隐性听力损失检测有一定的参考价值。
Objective To explore the application value of electrocochleography(EcochG) to the early detection of noise-induced hidden hearing loss(NIHHL).Methods Normal hearing subjects aged between 18 and 40 were selected to participate in the experimental study. Among them eighteen noise-exposed workers with the average age of 28.83±3.49 years and eighteen non-noise exposed as the control subjects, with the average age of 21.56±3.42 years, were recruited for this study. The data of normal and high-frequency audiometric assessments, speech-in-noise tests and EcochG at better ear were collected from all the subjects.Results The results from the both noise-exposed and control groups were compared. The differences in detection ratio were 55.6% and 88.9%, at 18 kHz, respectively, and at 20 kHz, 33.3% and 88.3%, respectively. The mean hearing thresholds at 10 kHz with an average threshold of 11.94±15.16 dB HL, 3.89±15.20 dB HL, respectively and at 12.5 kHz, the average threshold of 16.39±20.87 dB HL, 6.94±20.87 dB HL, respectively, were significant between the noise-exposed and control groups. The speech recognition ability of the noise group decreased compared to the control group with the mean signal-to-noise ratio loss as 4.62±2.52 dB, 1.44±2.90 dB, respectively. There were significant differences between the two groups(P=0.002<0.01).In EcochG, the amplitude ratio of SP/AP of noise-exposed group was significantly higher than that of the control group using supra-threshold stimuli at the levels of 96 and 90 dB nHL. With regard to the area ratio of SP/AP, there was a significant difference between two groups at the stimulus intensity of 96 dB nHL.Conclusion The EcochG with high-threshold stimulus at 96 dB nHL may be a useful method for early diagnosis of NIHHL.
Objective To explore the application value of electrocochleography(EcochG) to the early detection of noise-induced hidden hearing loss(NIHHL).Methods Normal hearing subjects aged between 18 and 40 were selected to participate in the experimental study. Among them eighteen noise-exposed workers with the average age of 28.83±3.49 years and eighteen non-noise exposed as the control subjects, with the average age of 21.56±3.42 years, were recruited for this study. The data of normal and high-frequency audiometric assessments, speech-in-noise tests and EcochG at better ear were collected from all the subjects.Results The results from the both noise-exposed and control groups were compared. The differences in detection ratio were 55.6% and 88.9%, at 18 kHz, respectively, and at 20 kHz, 33.3% and 88.3%, respectively. The mean hearing thresholds at 10 kHz with an average threshold of 11.94±15.16 dB HL, 3.89±15.20 dB HL, respectively and at 12.5 kHz, the average threshold of 16.39±20.87 dB HL, 6.94±20.87 dB HL, respectively, were significant between the noise-exposed and control groups. The speech recognition ability of the noise group decreased compared to the control group with the mean signal-to-noise ratio loss as 4.62±2.52 dB, 1.44±2.90 dB, respectively. There were significant differences between the two groups(P=0.002<0.01).In EcochG, the amplitude ratio of SP/AP of noise-exposed group was significantly higher than that of the control group using supra-threshold stimuli at the levels of 96 and 90 dB nHL. With regard to the area ratio of SP/AP, there was a significant difference between two groups at the stimulus intensity of 96 dB nHL.Conclusion The EcochG with high-threshold stimulus at 96 dB nHL may be a useful method for early diagnosis of NIHHL.
引文
1 Christopher J, Lack DB, Garreth P. Perceptual consequences of “hidden” hearing loss[J]. Trends in Hearing, 2014,18:1.
2 Liberman MC, Epstein MJ, Cleveland SS, et al. Toward a differential diagnosis of hidden hearing loss in humans[J]. PLoS One, 2016,11:1.
3 Plack CJ, Leger A, Prendergast G, et al. Toward a diagnostic test for hidden hearing loss[J]. Trends Hear, 2016, 20:1.
4 Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss[J]. The Journal of Neuroscience,2009, 29:14077.
5 Sergeyenko Y, Lall K, Liberman MC, et al. Age-related cochlear synaptopathy: an early-onset contributor to auditory functional decline[J]. J Neurosci, 2013,33:13686.
6 Mulders WHAM, Chin IL, Robertson D. Persistent hair cell malfunction contributes to hidden hearing loss[J]. Hearing Research, 2018, 361:45.
7 Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model[J]. The Journal of Neuroscience, 2011, 31:13452.
8 Lobarinas E, Salvi R, Ding D. Insensitivity of the audiogram to carboplatin induced inner hair cell loss in chinchillas[J]. Hearing Research, 2013, 302:113.
9 Wang Y, Hirose K, Liberman MC. Dynamics of noise-induced cellular injury and repair in the mouse cochlea[J]. J Assoc Res Otolaryngol,2002,3:248.
10 Furman AC, Kujawa SG, Liberman MC. Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates[J]. J Neurophysiol,2013,110:577.
11 Liberman LD, Suzuki J, Liberman MC. Dynamics of cochlear synaptopathy after acoustic overexposure[J]. J Assoc Res Otolaryngol, 2013,16:205.
12 Ferraro JA, Krishnan G. Cochlear potentials in clinical audiology[J]. Audiol Neurootol, 1997, 2:241.
13 Ferraro JA, Durrant JD. Electrocochleography in the evaluation of patients with Meniere's disease/endolymphatic hydrops[J]. Journal of the American Academy of Audiology, 2006, 17:45.
2 Liberman MC, Epstein MJ, Cleveland SS, et al. Toward a differential diagnosis of hidden hearing loss in humans[J]. PLoS One, 2016,11:1.
3 Plack CJ, Leger A, Prendergast G, et al. Toward a diagnostic test for hidden hearing loss[J]. Trends Hear, 2016, 20:1.
4 Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss[J]. The Journal of Neuroscience,2009, 29:14077.
5 Sergeyenko Y, Lall K, Liberman MC, et al. Age-related cochlear synaptopathy: an early-onset contributor to auditory functional decline[J]. J Neurosci, 2013,33:13686.
6 Mulders WHAM, Chin IL, Robertson D. Persistent hair cell malfunction contributes to hidden hearing loss[J]. Hearing Research, 2018, 361:45.
7 Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model[J]. The Journal of Neuroscience, 2011, 31:13452.
8 Lobarinas E, Salvi R, Ding D. Insensitivity of the audiogram to carboplatin induced inner hair cell loss in chinchillas[J]. Hearing Research, 2013, 302:113.
9 Wang Y, Hirose K, Liberman MC. Dynamics of noise-induced cellular injury and repair in the mouse cochlea[J]. J Assoc Res Otolaryngol,2002,3:248.
10 Furman AC, Kujawa SG, Liberman MC. Noise-induced cochlear neuropathy is selective for fibers with low spontaneous rates[J]. J Neurophysiol,2013,110:577.
11 Liberman LD, Suzuki J, Liberman MC. Dynamics of cochlear synaptopathy after acoustic overexposure[J]. J Assoc Res Otolaryngol, 2013,16:205.
12 Ferraro JA, Krishnan G. Cochlear potentials in clinical audiology[J]. Audiol Neurootol, 1997, 2:241.
13 Ferraro JA, Durrant JD. Electrocochleography in the evaluation of patients with Meniere's disease/endolymphatic hydrops[J]. Journal of the American Academy of Audiology, 2006, 17:45.