言语声诱发听性脑干反应对隐性听力损失的诊断意义
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摘要
目的探讨言语声诱发听性脑干反应(speech-evoked auditory brainstem response,s-ABR)对早期发现隐性听力损失的临床价值。方法选取纯音听阈正常、无噪声暴露史的正常青年人27例(正常组,年龄21.04±1.04岁,男15例,女12例)和纯音听阈正常、有噪声暴露史的工人15例(工人组,均为男性,年龄27.09±3.05岁),分别进行纯音测听、声导抗和耳声发射测试,通过标准为各频率纯音听阈≤20 dB HL、鼓室导抗图为A型、耳声发射正常,对通过者行s-ABR测试,分析两组间s-ABR各波潜伏期和幅值的差异。结果两组受试者三项测试均通过,正常组女性s-ABR的波V和波A潜伏期均小于正常男性,波A的幅值明显高于正常男性(P<0.05);工人组s-ABR波A、D、O的潜伏期较正常组男性明显延长(P<0.05),两组间波幅差异无统计学意义(P>0.05)。结论对有噪声暴露史但纯音听阈正常者,s-ABR能灵敏及时地发现其听力损失,s-ABR对临床诊断隐性听力损失可能有一定的价值。
Objective To explore the clinical diagnostic values and meaning of s-ABR in the early detection of hidden hearing loss by comparing the results of speech-evoked auditory brainstem response(s-ABR) between normal and noise-exposed workers.Methods Normal young people(21.04±1.04 years) exposed no noise and workers(27.09±3.05 years)exposed to noise were selected for audiological screening tests, including pure tone audiometry, acoustic impedance testing, and otoacoustic emission testing. The screening test criterion for pure tone audiometry was ≤20 dB HL, the tympanogram was A type, and otoacoustic emission results were present. The s-ABR test was used to rescreen those who had passed the initial screening. The differences were then compared in latency and amplitude of each wave of s-ABR between genders in the normal group and between normal and worker groups.Results The wave V and wave A latencies for women were lower than that of men, and the amplitudes of wave A were significantly higher than that of men. There were significant differences between the groups(P<0.05). The latencies of wave A, D, and O in the exposed workers were significantly longer than that of the normal group(P<0.05). There were no differences in wave amplitudes between the two groups.Conclusion s-ABR can well reflect the coding and processing of speech stimuli in the auditory system and detect hidden hearing loss in a sensitive and timely manner. It may have certain value for clinical diagnosis of hidden hearing loss.
Objective To explore the clinical diagnostic values and meaning of s-ABR in the early detection of hidden hearing loss by comparing the results of speech-evoked auditory brainstem response(s-ABR) between normal and noise-exposed workers.Methods Normal young people(21.04±1.04 years) exposed no noise and workers(27.09±3.05 years)exposed to noise were selected for audiological screening tests, including pure tone audiometry, acoustic impedance testing, and otoacoustic emission testing. The screening test criterion for pure tone audiometry was ≤20 dB HL, the tympanogram was A type, and otoacoustic emission results were present. The s-ABR test was used to rescreen those who had passed the initial screening. The differences were then compared in latency and amplitude of each wave of s-ABR between genders in the normal group and between normal and worker groups.Results The wave V and wave A latencies for women were lower than that of men, and the amplitudes of wave A were significantly higher than that of men. There were significant differences between the groups(P<0.05). The latencies of wave A, D, and O in the exposed workers were significantly longer than that of the normal group(P<0.05). There were no differences in wave amplitudes between the two groups.Conclusion s-ABR can well reflect the coding and processing of speech stimuli in the auditory system and detect hidden hearing loss in a sensitive and timely manner. It may have certain value for clinical diagnosis of hidden hearing loss.
引文
1 Plack CJ, Leger A, Prendergast G, et al. Toward a diagnostic test for hidden hearing loss[J]. Trends Hear,2016,20:1.
2 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.
3 李兴启,孙建和,李晖,等.脉冲噪声暴露后豚鼠耳蜗电位及毛细胞形态学实验观察 [J]. 中华耳鼻咽喉科杂志,1991,26:200.
4 Nada NM, Kolkaila EA, Gabr TA, et al. Speech auditory brainstem response audiometry in adults with sensorineural hearing loss[J]. Egyptian Journal of Ear Nose Throat & Allied Sciences, 2016, 17:87.
5 李国庆,吕萍,王秋菊.隐性听力损失的发病机制及听力学表现[J].中华耳科学杂志,2017,15:185.
6 Charles LM, Epstein MJ, Cleveland SS, et al. Toward a differential diagnosis of hidden hearing loss in humans[J]. PLoS One, 2016, 11:1.
7 Stamper GC, Johnson TA. Auditory function in normal-hearing, noise-exposed human ears[J]. Ear Hear, 2015,36:172.
8 Skoe E, Kraus N. Auditory brainstem response to complex sounds: a tutorial[J]. Ear and Hearing, 2010, 31: 302.
9 Johnson KL, Nicol TG, Kraus N. Brain stem response to speech: a biological marker of auditory processing[J]. Ear Hear, 2005, 26:424.
10 Russo N, Nicol T, Musacchia G, et al. Brainstem responses to speech syllables[J]. Clinical Neurophysiology, 2004, 115:2021.
11 Krizman J,Skoe E,Kraus N. Sex differences in auditory subcorticalfunction[J].Clinical Neurophysiology,2012,123:590.
12 Vander Werff KR, Burns KS. Brain stem responses to speech in younger and older adults[J]. Ear Hear, 2011, 32:168.
13 Jalaei B, Zakaria MN, Mohd Azmi MH, et al. Gender disparities in speech-evoked auditory brainstem response in healthy adults[J]. Annals of Otology Rhinology & Laryngology, 2017, 126:290.
14 Hornickel J, Skoe EN. Subcortical laterality of speech encoding[J]. Audiology & Neurotology, 2009, 14:198.
15 符秋养, 梁勇,苏园园,等. 健康青年人言语诱发听性脑干反应的成分及特性[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44:900.
16 Plack CJ, Barker D, Prendergast G. Perceptual consequences of "hidden" hearing loss[J]. Trends Hear,2014,18:1.
17 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.
18 Song JH, Banai K, Russo NM, et al. On the relationship between speech- and nonspeech-evoked auditory brainstem responses[J]. Audiology & Neurotology, 2006, 11:233.
2 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.
3 李兴启,孙建和,李晖,等.脉冲噪声暴露后豚鼠耳蜗电位及毛细胞形态学实验观察 [J]. 中华耳鼻咽喉科杂志,1991,26:200.
4 Nada NM, Kolkaila EA, Gabr TA, et al. Speech auditory brainstem response audiometry in adults with sensorineural hearing loss[J]. Egyptian Journal of Ear Nose Throat & Allied Sciences, 2016, 17:87.
5 李国庆,吕萍,王秋菊.隐性听力损失的发病机制及听力学表现[J].中华耳科学杂志,2017,15:185.
6 Charles LM, Epstein MJ, Cleveland SS, et al. Toward a differential diagnosis of hidden hearing loss in humans[J]. PLoS One, 2016, 11:1.
7 Stamper GC, Johnson TA. Auditory function in normal-hearing, noise-exposed human ears[J]. Ear Hear, 2015,36:172.
8 Skoe E, Kraus N. Auditory brainstem response to complex sounds: a tutorial[J]. Ear and Hearing, 2010, 31: 302.
9 Johnson KL, Nicol TG, Kraus N. Brain stem response to speech: a biological marker of auditory processing[J]. Ear Hear, 2005, 26:424.
10 Russo N, Nicol T, Musacchia G, et al. Brainstem responses to speech syllables[J]. Clinical Neurophysiology, 2004, 115:2021.
11 Krizman J,Skoe E,Kraus N. Sex differences in auditory subcorticalfunction[J].Clinical Neurophysiology,2012,123:590.
12 Vander Werff KR, Burns KS. Brain stem responses to speech in younger and older adults[J]. Ear Hear, 2011, 32:168.
13 Jalaei B, Zakaria MN, Mohd Azmi MH, et al. Gender disparities in speech-evoked auditory brainstem response in healthy adults[J]. Annals of Otology Rhinology & Laryngology, 2017, 126:290.
14 Hornickel J, Skoe EN. Subcortical laterality of speech encoding[J]. Audiology & Neurotology, 2009, 14:198.
15 符秋养, 梁勇,苏园园,等. 健康青年人言语诱发听性脑干反应的成分及特性[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44:900.
16 Plack CJ, Barker D, Prendergast G. Perceptual consequences of "hidden" hearing loss[J]. Trends Hear,2014,18:1.
17 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.
18 Song JH, Banai K, Russo NM, et al. On the relationship between speech- and nonspeech-evoked auditory brainstem responses[J]. Audiology & Neurotology, 2006, 11:233.