短声听性脑干反应结合单频刺激听性稳态反应在感音神经性聋患者听力评估中的应用
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摘要
目的探讨短声听性脑干反应(click-evoked auditory brainstem response,c-ABR)结合单频刺激听性稳态反应对感音神经性聋患者听力评估的作用。方法以183例(366耳)感音神经性聋患者为研究对象,其中轻度聋49例(听阈图平坦型23例、非平坦型26例)、中度聋47例(平坦型22例、非平坦型25例)、重度聋45例(平坦型20例、非平坦型25例)、极重度聋42例(平坦型20例、非平坦型22例),分别行纯音听阈、多频刺激听性稳态反应(multiple auditory steady-state response,m-ASSR),以及0.5、1.0 kHz单频刺激听性稳态反应(single-ASSR,s-ASSR)、c-ABR检查;对结果行单因素方差分析及线性相关分析。结果 183例在0.5 kHz处s-ASSR反应阈较m-ASSR反应阈更接近纯音听阈,且差异有统计学意义(P<0.05);平坦型感音神经性聋患者c-ABR(2～4 kHz)和s-ASSR(0.5、1.0 kHz)与纯音听阈之间有更好的相关性,而非平坦型感音神经性聋患者0.5 kHz s-ASSR及1.0、2.0、4.0 kHz m-ASSR与纯音听阈相关性更好。结论听阈图为平坦型感音神经性聋患者采用c-ABR结合s-ASSR评估听力更可靠;非平坦型者则采用s-ASSR结合m-ASSR更可靠。
Objective To investigate the reliability of click-evoked auditory brainstem response(c-ABR) combined with single-frequency auditory steady-state response(s-ASSR) on hearing evaluation in sensorineural deafness patients.Methods A total of 183 patients with sensorineural hearing loss(366 ears),and 49 were mild hearing loss with 23 flat audiograms and 26 non-flat type; 47 were moderate with 22 flat and 25 non-flat type; 45 were severe loss with 20 flat and 25 non-flat type, and 42 were profound hearing loss with 20 flat and 22 non-flat. These patients were tested for hearing thresholds,m-ASSR,0.5, 1.0 kHz s-ASSR,c-ABR. The data were analyzed by SPSS 18.0 for regression analysis and other statistical analysis.Results The s-ASSR response threshold at 0.5 kHz was closer to the pure tone threshold than the m-ASSR threshold. The difference was statistically significant. For the hearing configurations, c-ABRs combined s-ASSRs were better correlated with the pure tone hearing thresholds for the non-flat type while s-ASSRs combined m-ASSRs were better correlated with pure tone hearing threshold.Conclusion c-ABR combined s-ASSR is more reliable to test flat hearing loss, and s-ASSR combined m-ASSR is more reliable to test non-flat type hearing loss.
Objective To investigate the reliability of click-evoked auditory brainstem response(c-ABR) combined with single-frequency auditory steady-state response(s-ASSR) on hearing evaluation in sensorineural deafness patients.Methods A total of 183 patients with sensorineural hearing loss(366 ears),and 49 were mild hearing loss with 23 flat audiograms and 26 non-flat type; 47 were moderate with 22 flat and 25 non-flat type; 45 were severe loss with 20 flat and 25 non-flat type, and 42 were profound hearing loss with 20 flat and 22 non-flat. These patients were tested for hearing thresholds,m-ASSR,0.5, 1.0 kHz s-ASSR,c-ABR. The data were analyzed by SPSS 18.0 for regression analysis and other statistical analysis.Results The s-ASSR response threshold at 0.5 kHz was closer to the pure tone threshold than the m-ASSR threshold. The difference was statistically significant. For the hearing configurations, c-ABRs combined s-ASSRs were better correlated with the pure tone hearing thresholds for the non-flat type while s-ASSRs combined m-ASSRs were better correlated with pure tone hearing threshold.Conclusion c-ABR combined s-ASSR is more reliable to test flat hearing loss, and s-ASSR combined m-ASSR is more reliable to test non-flat type hearing loss.
引文
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4 钟志茹,陶征,邹建华.多频稳态诱发电位单频刺激与多频刺激测试结果的观察比较[J ].中国听力语言康复科学杂志,2004(7):33.
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9 曾国庆,饶英华,谢希翔,等.单频刺激声听觉稳态反应在感音神经性聋患者诊断中的应用[J].中国听力语言康复科学杂志,2017,15:410.
10 Korczak PA,Stapells DR. Effects of sensorineural hearing loss and personal hearing aids on cortical event-related potential and behavioral measures of speech-sound processing[J].Ear and Hearing,2005,26:165.
11 Rance G,Roper R,Symons L,et al. Hearing threshold estimation in infants using auditory steady-state responses [J].Am Acad Audiol,2005,16:291.
12 Lins OG,Picton PE,Picton TW, et al. Auditorysteady-state responses to tones amplitude-modulated at 80-110 Hz[J].Acoustical Society of America,1995,97:3051.
13 李倩庆,宋江顺,刘文婷,等.听性脑干诱发反应结合单刺激听觉稳态诱发反应对正常青年人纯音听阈测听相关性研究[J].临床耳鼻咽喉头颈外科杂志,2013,27:877.
14 王涛,华清泉,黄治物,等.多频听性稳态反应评估听力正常青年人纯音听阈的探讨[J].听力学及言语疾病杂志,2005,13:156.
15 Lin YH,Ho HC,Wu HP, et al. Comparison of auditory steady-state responses and auditory brainstem responses in audiometric assessment of adults with sensorineural hearing loss[J].Auris Nasus Larynx,2009,36:140.
16 Picton TW,Van Roon P,John MS, et al. Multiple auditory steady state responses(80-101 Hz):effects of ear,gender, handedness,intensity and modulation rate[J].Ear Hear,2009,30:100.
2 Picton TW, Van RP, John MS. Multiple auditory steady state responses (80～101 Hz) :effects of ear, gender, handedness, intensity and modulation rate[J] . Ear Hear,2009,30:100.
3 员根远,贺德生, 陈蕊玲,等.正常青年人多频稳态反应阈值的测试[J].听力学及言语疾病杂志,2007,15:70.
4 钟志茹,陶征,邹建华.多频稳态诱发电位单频刺激与多频刺激测试结果的观察比较[J ].中国听力语言康复科学杂志,2004(7):33.
5 谢景华,宋江顺,高雄辉,等.多频稳态诱发电位与纯音听阈的相关性研究[J].中国听力语言康复科学杂志,2005(5):18.
6 Vander KR, Brown CJ,Gienapp BA,et al.Comparison of auditory steadyst ate response thresholds in children[J ] . Am Acad Audito1,2002,1:227.
7 White KR. The current status of EHDI programs in the United States[J] . Ment Retard Dev Disabil Res Rev,2003,9:79.
8 卢云云,原红艳,赵晶旭,等.多频稳态反应及其应用[J].听力学及言语疾病杂志, 2005,13:60.
9 曾国庆,饶英华,谢希翔,等.单频刺激声听觉稳态反应在感音神经性聋患者诊断中的应用[J].中国听力语言康复科学杂志,2017,15:410.
10 Korczak PA,Stapells DR. Effects of sensorineural hearing loss and personal hearing aids on cortical event-related potential and behavioral measures of speech-sound processing[J].Ear and Hearing,2005,26:165.
11 Rance G,Roper R,Symons L,et al. Hearing threshold estimation in infants using auditory steady-state responses [J].Am Acad Audiol,2005,16:291.
12 Lins OG,Picton PE,Picton TW, et al. Auditorysteady-state responses to tones amplitude-modulated at 80-110 Hz[J].Acoustical Society of America,1995,97:3051.
13 李倩庆,宋江顺,刘文婷,等.听性脑干诱发反应结合单刺激听觉稳态诱发反应对正常青年人纯音听阈测听相关性研究[J].临床耳鼻咽喉头颈外科杂志,2013,27:877.
14 王涛,华清泉,黄治物,等.多频听性稳态反应评估听力正常青年人纯音听阈的探讨[J].听力学及言语疾病杂志,2005,13:156.
15 Lin YH,Ho HC,Wu HP, et al. Comparison of auditory steady-state responses and auditory brainstem responses in audiometric assessment of adults with sensorineural hearing loss[J].Auris Nasus Larynx,2009,36:140.
16 Picton TW,Van Roon P,John MS, et al. Multiple auditory steady state responses(80-101 Hz):effects of ear,gender, handedness,intensity and modulation rate[J].Ear Hear,2009,30:100.
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