听性稳态反应在听神经病谱系障碍患儿中的应用价值
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摘要
目的探讨听性稳态反应(ASSR)在畸变产物耳声发射(DPOAE)未通过的听神经病谱系障碍(ANSD)患儿中的应用价值。方法选取2013年3月至2016年10月于安徽省立医院就诊的听神经病谱系障碍患儿16例(中耳功能正常),行DPOAE检查,将5例(10耳)DPOAE检查未通过者设为观察组,11例(22耳)通过者为对照组。采用GSI Audera ASSR系统对两组患儿进行ASSR测试,比较两组患儿在载波频率分别为500 Hz、1 000 Hz、2 000 Hz和4 000 Hz时的ASSR反应阈。结果观察组患儿在500Hz、1 000 Hz频率时,ASSR反应阈分别为(108.0±11.1)dB nHL、(108.5±12.0)dB nHL,均高于对照组的(89.3±27.7)dB nHL、(94.5±23.9)dB nHL,差异均有统计学意义(P<0.05)。在2 000 Hz和4 000 Hz频率时,两组ASSR反应阈差异无统计学意义(P>0.05)。结论 ASSR可较好的检测出听神经谱系障碍患儿听觉反应阀值,当该类患儿检查DPOAE不能通过时,提示低频听力进一步损失,这可能与耳蜗外光细胞发生了频率差异性损伤有关。
Objective To investigate the application value of auditory steady-state response( ASSR) in thosechildren with auditory neuropathy spectrum disorder( ANSD) andfailed distortion product otoacoustic emission( DPOAE). Methods 16 cases of ANSDchildren withnormal middle-ear function,ever treated in our hospital from Mar 2013 to Oct 2016,were enrolled and underwent the DPOAE examination. Among them,5 children( 10 ear) with failed DPOAE were assigned as the study group,and other 11 patients( 22 ear) withnormal DPOAEwere divided into thecontrol group. All children then underwent ASSR tests with the GSI Audera ASSR system,and their response threshold of ASSR at carrier frequency of 500 Hz,1 000 Hz,2 000 Hz and 4 000 Hz were comparedby group. Results In the study group,the ASSR response threshold atfrequency of 500 Hz and 1 000 Hz were( 108. 0 ± 11. 1) dB nHL and( 108. 5 ± 12. 0) dB nHL,respectively,which were significantly higher than those in thecontrol group [( 89. 3 ± 27. 7) dB nHL,( 94. 5 ± 23. 9) dB nHL; P < 0. 05]. But at carrier frequency of 2 000 Hz and 4 000 Hz,the ASSR response thresholdin the two groups were not significantly different( P > 0. 05). Conclusion ASSR can accurately detect the auditory response threshold in children with ANSD. Low-frequency hearing loss was finded in ANSD with DPOAE not passed,which may be related to the frequency differential injury of the outer hair cells of the cochlea.
Objective To investigate the application value of auditory steady-state response( ASSR) in thosechildren with auditory neuropathy spectrum disorder( ANSD) andfailed distortion product otoacoustic emission( DPOAE). Methods 16 cases of ANSDchildren withnormal middle-ear function,ever treated in our hospital from Mar 2013 to Oct 2016,were enrolled and underwent the DPOAE examination. Among them,5 children( 10 ear) with failed DPOAE were assigned as the study group,and other 11 patients( 22 ear) withnormal DPOAEwere divided into thecontrol group. All children then underwent ASSR tests with the GSI Audera ASSR system,and their response threshold of ASSR at carrier frequency of 500 Hz,1 000 Hz,2 000 Hz and 4 000 Hz were comparedby group. Results In the study group,the ASSR response threshold atfrequency of 500 Hz and 1 000 Hz were( 108. 0 ± 11. 1) dB nHL and( 108. 5 ± 12. 0) dB nHL,respectively,which were significantly higher than those in thecontrol group [( 89. 3 ± 27. 7) dB nHL,( 94. 5 ± 23. 9) dB nHL; P < 0. 05]. But at carrier frequency of 2 000 Hz and 4 000 Hz,the ASSR response thresholdin the two groups were not significantly different( P > 0. 05). Conclusion ASSR can accurately detect the auditory response threshold in children with ANSD. Low-frequency hearing loss was finded in ANSD with DPOAE not passed,which may be related to the frequency differential injury of the outer hair cells of the cochlea.
引文
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[2]兰兰,谢林怡,史伟,等.听神经病患者最大言语识别率与主客观听力学特征的相关性分析[J].中华耳科学杂志,2015,13(2):216-223.
[3]李晓璐.婴幼儿听神经病谱系障碍诊断和处理指南[J].听力学及言语疾病杂志.2012,20(1):65-69.
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[5]赵璟,桂晓钟.新生儿听力筛查测试中的影响因素与干预[J].安徽医学,2014,35(12):1702-1704.
[6]黄丽辉,程晓华,张燕梅.婴幼儿听神经病谱系障碍诊断和处理指南[J].听力学及言语疾病杂志,2013,21(3):211-212.
[7]史伟,王秋菊,刘志成.小儿听神经病患者ASSR检测结果的分析[J].听力学及言语疾病杂志,2014,22(2):1-3.
[8]赵建东,武文明,郗昕,等.听神经病患者的多频听觉稳态反应特点[J].听力学及言语疾病杂志,2005,13(2):76-78.
[9]邹建华,邱素梅,钟志茹,等.感音神经性聋幼儿多频稳态诱发电位反应阈值与行为阈值比较[J].中国听力语言康复科学杂志,2004,6(6):30-32.
[10]HAENENS W D,DHOOGE I,MAES L,et al.The clinical value of the multiple frequency 80 Hz auditory steady-state response in adults with normal hearing and hearing loss[J].Arch Otolaryngol Head Neck Surg,2009,135(5):496-506.
[11]许政敏.听性稳态诱发反应在听力异常婴儿的诊断意义[J].中华耳鼻咽喉头颈外科杂志,2005,40(9):648-652.
[12]莫玲燕,韩德民,王琦,等.听力正常成年人同时多频听觉稳态诱发反应研究[J].听力学及言语疾病杂志,2004,12(6):381-384.
[2]兰兰,谢林怡,史伟,等.听神经病患者最大言语识别率与主客观听力学特征的相关性分析[J].中华耳科学杂志,2015,13(2):216-223.
[3]李晓璐.婴幼儿听神经病谱系障碍诊断和处理指南[J].听力学及言语疾病杂志.2012,20(1):65-69.
[4]黄丽辉.婴幼儿听神经病谱系障碍诊断和处理指南—婴幼儿听神经病诊断及处理指南研讨会制订(2008年,意大利,科莫)[J].听力学及言语疾病杂志,2012,20(1):84-85.
[5]赵璟,桂晓钟.新生儿听力筛查测试中的影响因素与干预[J].安徽医学,2014,35(12):1702-1704.
[6]黄丽辉,程晓华,张燕梅.婴幼儿听神经病谱系障碍诊断和处理指南[J].听力学及言语疾病杂志,2013,21(3):211-212.
[7]史伟,王秋菊,刘志成.小儿听神经病患者ASSR检测结果的分析[J].听力学及言语疾病杂志,2014,22(2):1-3.
[8]赵建东,武文明,郗昕,等.听神经病患者的多频听觉稳态反应特点[J].听力学及言语疾病杂志,2005,13(2):76-78.
[9]邹建华,邱素梅,钟志茹,等.感音神经性聋幼儿多频稳态诱发电位反应阈值与行为阈值比较[J].中国听力语言康复科学杂志,2004,6(6):30-32.
[10]HAENENS W D,DHOOGE I,MAES L,et al.The clinical value of the multiple frequency 80 Hz auditory steady-state response in adults with normal hearing and hearing loss[J].Arch Otolaryngol Head Neck Surg,2009,135(5):496-506.
[11]许政敏.听性稳态诱发反应在听力异常婴儿的诊断意义[J].中华耳鼻咽喉头颈外科杂志,2005,40(9):648-652.
[12]莫玲燕,韩德民,王琦,等.听力正常成年人同时多频听觉稳态诱发反应研究[J].听力学及言语疾病杂志,2004,12(6):381-384.