听力测试组合在听觉障碍鉴定中的应用  

Evaluation of the Hearing Loss in Medicolegal Expertise with Auditory Combination Tests

作　　者：范利华[1] 杨小萍[1] 

机构地区：[1]司法部司法鉴定科学技术研究所,上海200063

出　　处：《法医学杂志》2005年第4期255-258,261,共5页Journal of Forensic Medicine

摘　　要：目的分析不同听力测试方法对听阈评估的作用,探讨组合听力测试在听觉障碍法医学鉴定中的应用。方法对87例外伤后听力损伤者进行听力测试,将纯音听阈测试(PTA)、声导抗、40HzAERP、ABR、ASSR、DPOAEs进行组合。听阈评估采用PTA+ABR+40HzAERP/ASSR,损伤定位采用PTA+声导抗+ABR/40HzAERP+DPOAEs。根据致伤方式的不同,分为头部损伤组和耳损伤组。比较组间DPOAEs阳性率,比较纯音听阈、40HzAERP、ABR及ASSR对听阈评估的作用。结果头部外伤组DPOAEs阳性率明显高于耳损伤组(P<0.05);纯音语频听阈异常耳与40HzAERP语频阈值及ABR比较,纯音语频阈值异常率较40HzAERP及ABR明显高,主、客观听阈明显不符。26耳40HzAERP与ASSR比较,两者在0.5kHz、1kHz、2kHz反应阈均值数相关性较好(r=0.862),ASSR语频均值较40HzAERP低,平均差17dB。结论纯音听阈与ABR、40HzAERP或ASSR组合测试对听阈的评估有互补作用。40HzAERP与ASSR均可以用于语音频率的听阈评估。声导抗、ABR、40HzAERP与DPOAEs多项检查组合,有助于确定损伤部位。Objective To investigate the application of various objective combinative auditory tests in medicolegal experise. Methods 87 hearing impairment subjects （97 ears） involved in injury cases were divided into two groups according to the types of damage： the head trauma group and the ear trauma group. These subjects accepted various combinative auditory tests with pure tone threshold audiometry （PTA）, acoustic impedance audiometry, 40 Hertz Auditory Event-related Potential（40 Hz AERP）, Auditory brainstem response test （ABR）, Auditory mulit-frequency steady-state responses（ASSR）, Distortion product otoacoustic emissions （DPOAEs）. Results The good relationships in threshold can be found between 40 Hertz Auditory Event-related Potential （40 Hz AERP ） and Auditory steady-state responses（ASSR） of 40Hz in these subjects from 0.5-2kHz （r=0.862）. The positive rate of DPOAEs was higher in head trauma group than in the ear trauma group （P〈0.05）. The 40 Hz AERP threshold of language frequency overestimate the ASSR threshold in 26 ears by 17dB. Conclusion The components of the combinative auditory tests complete each other in expertise of hearing impairment. The combinative auditory tests make for determination of the location and cause of the injury, and evaluation of hearing threshold.

关 键 词：听力损伤 头部损伤 听觉障碍 听诱发电位 畸变产物耳声发射 法医听力学 

分 类 号：R764.04[医药卫生—耳鼻咽喉科] D919[医药卫生—临床医学]