不同类型听力损失伴耳鸣患者间隔感知特征分析
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摘要
目的间隔感知测试是一项反映受试者听觉灵敏度的临床测试。本研究主要是对不同类型及程度的听力损失伴耳鸣患者进行间隔感知测试,包括在噪声中的间隔测试及500Hz、1000Hz、2000Hz频率的间隔阈值测试,并探索听力损失及耳鸣对间隔感知测试结果的影响。方法本研究选取听力正常者20例(40耳),听神经病患者15例(30耳),其中有耳鸣患者18耳,无耳鸣患者12耳。感音神经性聋患者36例(45耳),其中有耳鸣患者28耳,无耳鸣患者17耳。对所有受试者进行时域和频域间隔感知测试,并对其中的耳鸣患者进行耳鸣评估测试。结果①AN组间隔感知阈值显著高于听力正常组和感音神经性聋组(P<0.01)。②感音神经性聋组中,听损程度≤60dB患者的间隔感知显著小于听损程度>60dB的患者(P<0.01)。③将500Hz、1000Hz、2000Hz频率下的间隔感知测试结果进行组间比较均有显著性差异(P<0.01)。④对听神经病患者和感音神经性聋患者分别进行有耳鸣组和无耳鸣组分析,时域和频域间隔感知测试结果显示,有耳鸣组和无耳鸣组均无显著性差异(P>0.05)。⑤不同类型的耳鸣声在感音神经性聋患者中的间隔感知无显著性差异(P>0.05)。结论间隔感知测试结果与有无耳鸣无关,与耳鸣声类型无关,与听力损失程度及病变部位有关。
Objective Gap detection is a clinical evaluation which reflects the subject's hearing sensitivity. By testing gap detection in noise and gap detection thresholds at 500, 1000 and 2000 Hz in patients with different types and degrees of hearing loss with or without tinnitus, this study aims to study effects of hearing loss and tinnitus on gap detection ability. Methods Twenty subjects(40 ears) with normal hearing, 15 patients(30 ears) with auditory neuropathy and36 patients(45 ears) with sensorineural hearing loss were selected. Tinnitus was reported in 18 ears among patients with auditory neuropathy, and in 28 ears among patients with sensorineural hearing loss group. Gap detection was tested at500, 1000 and 2000 Hz and in noise. Tinnitus was evaluated in patients with tinnitus. Results ① Temporal gap detection thresholds were significantly higher in patients with auditory neuropathy than in the other two groups(P<0.01). ② In patients with sensorineural hearing loss, temporal gap detection thresholds were lower when hearing loss was ≤60 dB nHL than when hearing loss was >60 dB nHL(P<0.01). ③ Gap detection threshold at 500, 1000 and 2000 Hz showed significant differences among the three groups. ④ For patients with auditory neuropathy or sensorineural hearing loss, gap detection at 500, 1000 and 2000 Hz and gap in noise showed no significant differences in ears with tinnitus from those without(P>0.05). ⑤ Gap in noise and gap detection at 500, 1000 and 2000 Hz showed no significant differences among various types of tinnitus in patients with sensorineural hearing loss(P>0.05). Conclusion Gap detection appears to be independent on the presence of tinnitus or its types. It does, however, seem to be related to the degree of hearing loss and its underlying pathology.
Objective Gap detection is a clinical evaluation which reflects the subject's hearing sensitivity. By testing gap detection in noise and gap detection thresholds at 500, 1000 and 2000 Hz in patients with different types and degrees of hearing loss with or without tinnitus, this study aims to study effects of hearing loss and tinnitus on gap detection ability. Methods Twenty subjects(40 ears) with normal hearing, 15 patients(30 ears) with auditory neuropathy and36 patients(45 ears) with sensorineural hearing loss were selected. Tinnitus was reported in 18 ears among patients with auditory neuropathy, and in 28 ears among patients with sensorineural hearing loss group. Gap detection was tested at500, 1000 and 2000 Hz and in noise. Tinnitus was evaluated in patients with tinnitus. Results ① Temporal gap detection thresholds were significantly higher in patients with auditory neuropathy than in the other two groups(P<0.01). ② In patients with sensorineural hearing loss, temporal gap detection thresholds were lower when hearing loss was ≤60 dB nHL than when hearing loss was >60 dB nHL(P<0.01). ③ Gap detection threshold at 500, 1000 and 2000 Hz showed significant differences among the three groups. ④ For patients with auditory neuropathy or sensorineural hearing loss, gap detection at 500, 1000 and 2000 Hz and gap in noise showed no significant differences in ears with tinnitus from those without(P>0.05). ⑤ Gap in noise and gap detection at 500, 1000 and 2000 Hz showed no significant differences among various types of tinnitus in patients with sensorineural hearing loss(P>0.05). Conclusion Gap detection appears to be independent on the presence of tinnitus or its types. It does, however, seem to be related to the degree of hearing loss and its underlying pathology.
引文
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10 Himanshu Kumar Sanju,Vaishnavi Bohra,Sujeet Kumar Sinha.Speech evoked auditory brainstem response and gap detection threshold in middle-aged individual[J].Eur Arch Otorhinolaryngol,2017(274):2041-2048.
11王洪阳,齐悦,关静,等.听神经病谱系障碍患者的耳鸣特征分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(8):712-715.Wang HY,Qi Y,Guan J et al.Characteristics of tinnitus in patients with auditory neuropathy spectrum disorders[J].Clinical journal of otolaryngology,head and neck surgery,2015,29(8):712-715.
12 Jastreboff,PJ,Brennan,JF,Sasaki CT.An animal model for tinnitus[J].Laryngoscope,1988,98:280-286.
13 Bauer CA,Brozoski TJ,Rojas R,et al.Behavioral model of chronic tinnitus in rats.Otolaryngol[J].Head Neck Surg,1999,121,457-462.
14 Lobarinas E,Sun W,Cushing R,et al.A novel behavioral paradigm for assessing tinnitus using schedule-induced polydipsia avoidance conditioning(SIP-AC)[J].Hearing Res,2004,190,109-114.
15 Kizawa K,Kitahara T,Horii A,et al.Behavioral assessment and identification of a molecular marker in a salicylate-induced tinnitus in rats[J].Neurosci,2010,165:1323-1332.
16 G.Rance,C.McKay,D.Grayden,Perceptual characterization of children with auditory neuropathy[J],Ear and hearing,2004,25(1):34-46.
17 Campolo J,Lobarinas E,Salvi R.Does tinnitus“fill in”the silent gaps?[J].Noise Health,2013,15(67):398-405.
18 Boyen K,Ba?kent D,van Dijk P.The Gap Detection Test:Can It Be Used to Diagnose Tinnitus?[J].Ear&Hearing,2015,36(4):138-145.
2 Zeng FG.,Oba S.,Garde S.,Sininger Y.,et a1.Temporal and speech processing deficits in auditory neuropathy[J].Neuroreport,1999,10(16):3429-3435.
3 Starr A,Picton TW,Sininger Y,et al.Auditory Neuropathy[J].Brain,1996.
4 Hood,Linda J.Auditory neuropathy:What is it and what can we do about it?[J].Hearing Journal,1998,51(8):10,12-13,16-18.
5 Michalewski H J,Starr A,Nguyen,et al.Auditory temporal processes in normal-hearing individuals and in patients with auditory neuropathy[J].Clin Neurophysiol,2005,116(3):669-680.
6王硕,董瑞娟,王媛,等.听神经病谱系障碍患者时域间隔感知能力的研究[J].听力学及言语疾病杂志,2015,23(4):335-337.Wang S,Dong RJ,Wang Y,et al.The study of gap detection in patients with auditory neuropathy spectrum disorders[J].Journal of audiology and speech disorders,2015,23(4):335-337.
7 Rance,G,Beer,D.E.,Cone-Wesson,B.et al.Clinical findings for a group of infants and young children with auditory neuropathy[J].Ear Hear,1999,20:238-252.
8刘冬鑫,王硕.时域间隔感知能力测试在听力学中的应用[J].中华耳鼻咽喉头颈外科杂志,2015,50(5):432-435.Liu DX,Wang S.Application of time-domain interval perception test in audiology[J].Chinese journal of otorhinolaryngology head and neck surgery,2015,50(5):432-435.
9 Yi Shen.Gap detection and temporal modulation transfer function as behavioral estimates of auditory temporal acuity using band-limited stimuli in young and older adults[J].Journal of Speech,Language,and Hearing Research:JSLHR,2014,57(6):2280-2292.
10 Himanshu Kumar Sanju,Vaishnavi Bohra,Sujeet Kumar Sinha.Speech evoked auditory brainstem response and gap detection threshold in middle-aged individual[J].Eur Arch Otorhinolaryngol,2017(274):2041-2048.
11王洪阳,齐悦,关静,等.听神经病谱系障碍患者的耳鸣特征分析[J].临床耳鼻咽喉头颈外科杂志,2015,29(8):712-715.Wang HY,Qi Y,Guan J et al.Characteristics of tinnitus in patients with auditory neuropathy spectrum disorders[J].Clinical journal of otolaryngology,head and neck surgery,2015,29(8):712-715.
12 Jastreboff,PJ,Brennan,JF,Sasaki CT.An animal model for tinnitus[J].Laryngoscope,1988,98:280-286.
13 Bauer CA,Brozoski TJ,Rojas R,et al.Behavioral model of chronic tinnitus in rats.Otolaryngol[J].Head Neck Surg,1999,121,457-462.
14 Lobarinas E,Sun W,Cushing R,et al.A novel behavioral paradigm for assessing tinnitus using schedule-induced polydipsia avoidance conditioning(SIP-AC)[J].Hearing Res,2004,190,109-114.
15 Kizawa K,Kitahara T,Horii A,et al.Behavioral assessment and identification of a molecular marker in a salicylate-induced tinnitus in rats[J].Neurosci,2010,165:1323-1332.
16 G.Rance,C.McKay,D.Grayden,Perceptual characterization of children with auditory neuropathy[J],Ear and hearing,2004,25(1):34-46.
17 Campolo J,Lobarinas E,Salvi R.Does tinnitus“fill in”the silent gaps?[J].Noise Health,2013,15(67):398-405.
18 Boyen K,Ba?kent D,van Dijk P.The Gap Detection Test:Can It Be Used to Diagnose Tinnitus?[J].Ear&Hearing,2015,36(4):138-145.