摘要
目的听性稳态诱发反应(auditory steadystat eresponse,ASSR)新技术与视觉强化测听(visionrein for cementaudiometry,VRA)阈值的相关性分析研究,探讨听神经病症侯群及其鉴别诊断。方法10例(20耳)对照组,年龄6～12个月,测得ASSR和VRA的正常阈值。16例(26耳)异常听力组患儿(年龄在3～6个月),根据其所患疾病分为3个亚组:Ⅰ组为早孕感染组5例(8耳),Ⅱ组为窒息缺氧组5例(10耳),Ⅲ组为高胆红素血症组6例(8耳),检测畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)潜伏期、肌反射值与ASSR和VRA及其相关性结果对照。结果Ⅰ组中2例次(2耳次)为单纯疱疹病毒感染。5例次(8耳次)DPOAE消失,4例次(6耳次)ABR波Ⅰ潜伏期延长、ⅠⅤ波间潜伏期缩短,3例次(6耳次)500Hz和1000Hz的镫骨肌反射正常,2例次(2耳次)镫骨肌反射阈偏高,初步推测单纯耳蜗性病变,排除听神经病可能,测得ASSR平均估计阈值与VRA平均阈值具有很好的相关性(r=0.95～0.98)。Ⅱ组中4例次(8耳次)畸变产物耳声发射消失,其中1例次(2耳次)ABR波Ⅰ、波Ⅲ、波Ⅴ消失和肌反射消失,3例次(5耳次)ABR波Ⅰ消失和波Ⅲ及波Ⅴ潜伏期延长,以及肌反射消失。2例次(3耳次)ⅠⅢ波间潜伏期延长,肌反射也消失。推测可能为听神经病症侯群(耳蜗至脑干下听觉传导通路受损)伴有耳蜗功能障碍,测得ASSR平均估计阈值与VRA平均阈值具有较好的相关性(r=0.72～0.84)。Ⅲ组中6例次(8耳次)DPOAE存在,4例次(5耳次)ABR波Ⅰ、Ⅲ、Ⅴ和肌反射消失,2例次(3耳次)ⅠⅤ波间潜伏期延长,镫骨肌反射阈正常偏高,初步分析推测为听神经病症侯群病损在脑干以上,测得ASSR平均估计阈值与VRA平均阈值具有很弱的相关性(r=0.43～0.64),ASSR阈值和VRA阈值不一致,进一步说明这组的病损应该在脑干或皮层。3个亚组的每个频率(0.25、0.5、1、2、4kHz)平均ASSR和VRA阈值差值比较,差异都具有统计学意义(F检验,P<0.05、P<0.01、P<0.01、P<0.05、P<0.05)。结论通过ASSR阈值和VRA阈值相关性技术研究或许可提供诊断及鉴别诊断在各种频率听力障碍婴儿的听神经病症侯群(病变高位)、听神经病症侯群伴有耳蜗功能障碍(病变低位)以及单纯耳蜗性病(非听神经病)。
Objective To investigate the correlation between the auditory steady-state response （ASSR） thresholds and the vision reinforcement audiometry （VRA） thresholds in infants with auditory neuropathy. Methods Ten cases in control group were measured by the ASSR and VRA. Based upon the ABR, DPOAE, and impedance data, as well as the aetiology （infection of the early pregnancy, defect of oxygen in birth and jaundice after birth） , the 16 cases with hearing losses were divided into three groups （ Ⅰ , Ⅱ and Ⅲ ）. ASSR and VRA were examined. Results From the analysis of ABR, DPOAE, and impedance data, the patients with the infection of early pregnancy in group I （5 cases/8 ears） had that the DPOAE were absent（5 cases/8 ears） , the latency of wave Ⅰ of ABR was delay and the interpeak latency of wave Ⅰ -Ⅴ of ABR was short（4 cases/6 ears） , as well as the acoustic reflect thresholds in 500 Hz and 10130 Hz were normal（3 cases/6 ears） and high（2 cases/2 ears）. They were deduced in cochlear lesion. The patients of group Ⅱ with defect of oxygen in birth （5 cases/10 ears） showed that the DPOAEs were absent, the wave I of ABR was absent（5 cases/5 ears）, and the interpeak latency of wave Ⅰ -Ⅲ of ABR was delay （2 cases/5 ears） They were deduced in auditory neuropathy （lesion from the cochlea to the brain-stem）. The patients of group Ⅲ had that the DPOAEs were present（6 cases/8 ears）, the wave Ⅰ/Ⅲ/Ⅴ of ABR and acoustic reflect were absent（4 cases/5 ears）, and the interpeak latency of wave Ⅰ -Ⅴ of ABR was delay （2 cases/5 ears） who were deduced in auditory neuropathy（ from the brain-stem to the subcortical lesion）. Our results showed that the correlation coefficient-ranges between the ASSR thresholds and the VRA thresholds were the 0. 95 - 0. 98 in group Ⅰ , the 0. 72 - 0. 84 in group Ⅱ, and the 0. 43 - 0. 64 in group Ⅲ Comparision of the mean threshold-differences between the ASSR VRA thresholds for group Ⅰ , group Ⅱ, and group Ⅲ for each frequency revealed significant difference（ F test, P 〈0. 05 ,P 〈0. 01 ,P 〈0. 01 ,P 〈 0. 05, P 〈 0. 05 ）. Conclusions The correlation technique between the ASSR thresholds and the VRA thresholds could provide the auditory neuropathy diagnosis and differential diagnosis in infants.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2005年第9期648-652,共5页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
