外伤性听觉损害听力学评价的临床研究
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摘要
目的： 探讨外伤性听觉损害听力学表现，为临床客观公正定量、定性与定位诊断提供听力学重要依据。
方法： 就我院收治的外伤后主诉听觉障碍者92例113耳，分别进行纯音听阈（PTHT）、声导抗（AI）、40 Hz AERP（40 Hz听觉事件相关电位）、ABR（听性脑干反应）与DPOAE（畸变产物耳声发射）测试，并分别绘制出纯音听阈图与DPOAE听力图。
结果： 92例患者113耳行纯音听阈测试、声导抗、40 Hz AERP、ABR与DPOAE检测，发现器质性聋98耳，占86.73%，其中夸大性聋者38耳，夸大程度＜20dBnHL6耳，20～40dBnHL27耳，＞40dBnHL5耳；非器质性聋13耳，占11.50%，诈聋2耳，占1.77%；98耳器质性听力损失者中，25耳为传导性耳聋，29耳为感音神经性耳聋，44耳为混合性耳聋。外伤后听觉障碍组与正常对照组各频率点DPOAE检出率相比，有显著差异性；两组各频率DPOAE幅值相比也具有显著差异性，且DPOAE幅值与纯音听力图比较有良好的一致性。
结论：纯音测听为主观测听，声导抗是检测中耳及听反射弧的客观测听，ABR是判断外伤性听觉损害的敏感指标，可及时发现听通路损害，DPOAE具有良好的频率特性，可检测耳蜗毛细胞功能状况。多种测试方法联合使用可相互取长补短，结果互相印证，可成为听力损失定性与定量诊断的听力学检测手段。
Objective：To study the expression of auditory using in clinical audiometry on post-traumatic hearing loss.
Methods：92 posttraumatic patients (113 ears) complained hearing loss were treated by our hospital. They were examined by test of pure tone hearing threshold (PTHT), test of acoustic immittance (AI), test of 40Hz auditory event related potentials (40 Hz AERP)， test of auditory brainstem response(ABR) and test of distortion product otoacoustic emission(DPOAE). Then the pure tone audiogram and DPOAE audiogram were drawn.
Results：92 patients (113 ears) were examined by PTHT, AI ， 40 Hz AERP，ABR and DPOAE. It was found that organic deafness was confirmed on 98 ears (86.73%), of which exaggerated hearing loss was 38 ears; nonorganic deafness was confirmed on 13 ears (11.50%)； stimulated deafness was 2 ears(1.77%). 98 organic deafness ears were diagnosed, of which conductive hearing loss was 25ears; sensorineural hearing loss was 29 ears, and mixed hearing loss was 44 ears. Compared the detected DPOAE rate and DPOAE amplitude at different frequencies between the post-traumatic hearing loss group and the normal contrast group. We found that there was a statistical significant difference. Moreover, DPOAE amplitudes were consistent with the pure tone audiogram.
Conclusion：The pure tone audiometry is subjective audiometry. Acoustic immittance is objective audiometry of middle ear or hearing reflex arc. ABR is very sensitive to identify post-traumatic hearing loss, and can detect the injure of hearing system immediately. DPOAE has good frequent specificity. So it can respond the function state of the cochlea outer hair cells. Make up the multiple audiometry into a test battery. The test battery was valuable in evaluation of post-traumatic hearing loss, and can be used extensively as a tool to detect hearing loss.
方法： 就我院收治的外伤后主诉听觉障碍者92例113耳，分别进行纯音听阈（PTHT）、声导抗（AI）、40 Hz AERP（40 Hz听觉事件相关电位）、ABR（听性脑干反应）与DPOAE（畸变产物耳声发射）测试，并分别绘制出纯音听阈图与DPOAE听力图。
结果： 92例患者113耳行纯音听阈测试、声导抗、40 Hz AERP、ABR与DPOAE检测，发现器质性聋98耳，占86.73%，其中夸大性聋者38耳，夸大程度＜20dBnHL6耳，20～40dBnHL27耳，＞40dBnHL5耳；非器质性聋13耳，占11.50%，诈聋2耳，占1.77%；98耳器质性听力损失者中，25耳为传导性耳聋，29耳为感音神经性耳聋，44耳为混合性耳聋。外伤后听觉障碍组与正常对照组各频率点DPOAE检出率相比，有显著差异性；两组各频率DPOAE幅值相比也具有显著差异性，且DPOAE幅值与纯音听力图比较有良好的一致性。
结论：纯音测听为主观测听，声导抗是检测中耳及听反射弧的客观测听，ABR是判断外伤性听觉损害的敏感指标，可及时发现听通路损害，DPOAE具有良好的频率特性，可检测耳蜗毛细胞功能状况。多种测试方法联合使用可相互取长补短，结果互相印证，可成为听力损失定性与定量诊断的听力学检测手段。
Objective：To study the expression of auditory using in clinical audiometry on post-traumatic hearing loss.
Methods：92 posttraumatic patients (113 ears) complained hearing loss were treated by our hospital. They were examined by test of pure tone hearing threshold (PTHT), test of acoustic immittance (AI), test of 40Hz auditory event related potentials (40 Hz AERP)， test of auditory brainstem response(ABR) and test of distortion product otoacoustic emission(DPOAE). Then the pure tone audiogram and DPOAE audiogram were drawn.
Results：92 patients (113 ears) were examined by PTHT, AI ， 40 Hz AERP，ABR and DPOAE. It was found that organic deafness was confirmed on 98 ears (86.73%), of which exaggerated hearing loss was 38 ears; nonorganic deafness was confirmed on 13 ears (11.50%)； stimulated deafness was 2 ears(1.77%). 98 organic deafness ears were diagnosed, of which conductive hearing loss was 25ears; sensorineural hearing loss was 29 ears, and mixed hearing loss was 44 ears. Compared the detected DPOAE rate and DPOAE amplitude at different frequencies between the post-traumatic hearing loss group and the normal contrast group. We found that there was a statistical significant difference. Moreover, DPOAE amplitudes were consistent with the pure tone audiogram.
Conclusion：The pure tone audiometry is subjective audiometry. Acoustic immittance is objective audiometry of middle ear or hearing reflex arc. ABR is very sensitive to identify post-traumatic hearing loss, and can detect the injure of hearing system immediately. DPOAE has good frequent specificity. So it can respond the function state of the cochlea outer hair cells. Make up the multiple audiometry into a test battery. The test battery was valuable in evaluation of post-traumatic hearing loss, and can be used extensively as a tool to detect hearing loss.
引文
魏庆瑶，金济霖，李敏，等．伪聋及夸大性聋的诊断．临床耳鼻咽喉科杂志，1998，2：168．
马丽娟，王翠兰.外伤性聋的ABR及40HzAERP测试. 听力学及言语疾病杂志，2001，9（3）：171.
贾全顺，石建平，崔惠云等. 加味通窍活血汤治疗颅脑外伤性耳聋20例. 中国中医药信息杂志，2002，9（1）：55。
Deguine C, Pulec J L. Temporal bone fracture with conductive hearing loss. Ear Nose Throat J, 1995,74: 218.
Harrison S E, Anand V K. Pediatric temporal bone fractures. Ann Otol Rhinol Laryngol, 2000,109: 988-990.
霍起森，李永宏．外伤性听力障碍的法医学病因分析．皖南医学院学报，1995，14：242~243．
高辉. 脑干听觉诱发电位V波反应阈识别伪聋的价值. 临床脑电学杂志，2000，9（3）：163-164.
Frederick N．Martin．Pseudohypacusis．In：Kaltz S，Ed．Handbook of clinical audiology [M]．4th Ed．Baltimove：Villiams & Wilkins，1994，553~567．
王奇.听觉诱发电位波I起源的实验研究.临床耳鼻咽喉科杂志，1988，2(3)：153.
韩维举，顾瑞，于黎明等.蜗后性听力减退29例病因分析.中华耳鼻咽喉科杂志，2003,38：459-464.
潘映辐.临床诱发电位学[M].第二版. 北京：人民卫生出版社，2002. 350～351.
李秀华，铁艳梅，潘映辐，等. 脑干听觉诱发电位测试参量重要性的探讨[J].临床脑电学杂志，1996，5(3)：139.
Kochhar LK，Deka RC，Kacher SK，et al．Hearing loss after head injury．ENT，1990, 69：537．
Gerald B, Healy MD. Hearing Loss and Vertigo Secondary to Head Injury. N Engl J Med; 1982, 306: 1029.
孙启铮(综述).头部外伤与耳及耳神经的关系.国外医学.耳鼻咽喉科学分册.1983,7：8.
Martin GK，Probst R and Lonsburey—Martin BL．Otoacoustic Emission in human ears：normative findings [J]．Ear and Hearing，1990，11：106．
Stavroulaki P, Nikolopoulos TP, Psarommatis I, et al. Hearing evaluation with distortion–product otoacoustic emissions in young patients undergoing haemo- dialysis [J]. Clin Otolaryngol , 2001,26: 235.
James AL, Mount RJ, Harrison RV. Contralateral suppression of DPOAE measured in real time[J]. Clin Otolaryngol, 2002, 27: 106.
姜泗长，顾瑞主编.临床听力学。北京：北京医科大学中国协和医科大学联合出版社.1999：307.
查定军，黄维国，王锦玲等.初始音强度差对听力正常青年人畸变产物耳声发射的影响[J]. 听力学及言语疾病杂志，2000,8：24.
Attias J, Bresloff I, Reshef I, et al. Evaluating noise emissions[J]. Br J Audiol, 1998, 32: 39.
Kakigi A, Hirakaua H, Harel N. Comparison of distortion-product and transient otoacoustic emissions with ABR threshold shift in with ototoxic damage[J]. Auris Nasus Larynx, 1998, 25: 233.
黄选兆，汪吉宝，主编.实用耳鼻咽喉科学[M].北京：人民卫生出版社，1999.733～756.
马丽娟，王翠兰.外伤性聋的ABR及40HzAERP测试. 听力学及言语疾病杂志，2001，9（3）：171.
贾全顺，石建平，崔惠云等. 加味通窍活血汤治疗颅脑外伤性耳聋20例. 中国中医药信息杂志，2002，9（1）：55。
Deguine C, Pulec J L. Temporal bone fracture with conductive hearing loss. Ear Nose Throat J, 1995,74: 218.
Harrison S E, Anand V K. Pediatric temporal bone fractures. Ann Otol Rhinol Laryngol, 2000,109: 988-990.
霍起森，李永宏．外伤性听力障碍的法医学病因分析．皖南医学院学报，1995，14：242~243．
高辉. 脑干听觉诱发电位V波反应阈识别伪聋的价值. 临床脑电学杂志，2000，9（3）：163-164.
Frederick N．Martin．Pseudohypacusis．In：Kaltz S，Ed．Handbook of clinical audiology [M]．4th Ed．Baltimove：Villiams & Wilkins，1994，553~567．
王奇.听觉诱发电位波I起源的实验研究.临床耳鼻咽喉科杂志，1988，2(3)：153.
韩维举，顾瑞，于黎明等.蜗后性听力减退29例病因分析.中华耳鼻咽喉科杂志，2003,38：459-464.
潘映辐.临床诱发电位学[M].第二版. 北京：人民卫生出版社，2002. 350～351.
李秀华，铁艳梅，潘映辐，等. 脑干听觉诱发电位测试参量重要性的探讨[J].临床脑电学杂志，1996，5(3)：139.
Kochhar LK，Deka RC，Kacher SK，et al．Hearing loss after head injury．ENT，1990, 69：537．
Gerald B, Healy MD. Hearing Loss and Vertigo Secondary to Head Injury. N Engl J Med; 1982, 306: 1029.
孙启铮(综述).头部外伤与耳及耳神经的关系.国外医学.耳鼻咽喉科学分册.1983,7：8.
Martin GK，Probst R and Lonsburey—Martin BL．Otoacoustic Emission in human ears：normative findings [J]．Ear and Hearing，1990，11：106．
Stavroulaki P, Nikolopoulos TP, Psarommatis I, et al. Hearing evaluation with distortion–product otoacoustic emissions in young patients undergoing haemo- dialysis [J]. Clin Otolaryngol , 2001,26: 235.
James AL, Mount RJ, Harrison RV. Contralateral suppression of DPOAE measured in real time[J]. Clin Otolaryngol, 2002, 27: 106.
姜泗长，顾瑞主编.临床听力学。北京：北京医科大学中国协和医科大学联合出版社.1999：307.
查定军，黄维国，王锦玲等.初始音强度差对听力正常青年人畸变产物耳声发射的影响[J]. 听力学及言语疾病杂志，2000,8：24.
Attias J, Bresloff I, Reshef I, et al. Evaluating noise emissions[J]. Br J Audiol, 1998, 32: 39.
Kakigi A, Hirakaua H, Harel N. Comparison of distortion-product and transient otoacoustic emissions with ABR threshold shift in with ototoxic damage[J]. Auris Nasus Larynx, 1998, 25: 233.
黄选兆，汪吉宝，主编.实用耳鼻咽喉科学[M].北京：人民卫生出版社，1999.733～756.