单侧听神经病11例听力学特点分析  

Audiological characteristics of unilateral auditory neuropathy:11 cases study

作　　者：王锦玲[1] 石力[1] 高磊[1] 谢娟[1] 韩丽萍[1] 

机构地区：[1]第四军医大学西京医院耳鼻咽喉头颈外科,西安710032

出　　处：《临床耳鼻咽喉头颈外科杂志》2007年第10期436-440,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:研究单侧听神经病(UAN)的听力学特点,以提高对UAN的认识。方法:回顾性分析11例UAN患者的听力学资料,并与双侧AN及正常组进行对照研究。结果:AN患者340例,其中UAN11例,占AN患者3.2%。左耳5例,右耳6例;男4例,女7例,男女之比为1.00∶1.75;年龄5～35岁,平均20岁;病程平均3.1年。患者均诉单侧听力减退,听不清说话6例,伴耳鸣4耳,无眩晕发作。纯音听力图下降型5耳(45.4%),低频上升型4耳(36.4%),平坦型1耳(9.1%),盆型1耳(9.1%);听力损失极重度聋6耳(54.5%),中重度聋3耳(27.3%),中度聋2耳(18.2%)。纯音听阈各频率均值UAN组明显高于双侧AN组,健侧听力图正常。言语识别率患耳差,健耳正常。声导抗患侧声反射消失,健侧引出,1例双耳同侧及交叉部分频率引出。听性脑干反应(ABR)患耳自波Ⅰ起均未引出(>100dBnHL),健耳正常引出。畸变产物耳声发射(DPOAE)引出双侧均正常或基本正常,同正常对照组相比,DP-gram幅值和SNR值在全频(0.5～8.0kHz)降低(P<0.05),以中、高频显著(P<0.01),而低频较双侧AN组明显降低(P<0.01)。4例UAN健耳的对侧声抑制DP-gram幅值下降,患耳的对侧声抑制效应减弱或消失,甚至在5kHz幅值增加较健耳及正常组显著(P<0.05)。7例行眼震电图(ENG)检查,患耳半规管功能减退及麻痹各1例;5例行前庭诱发性肌源性电位(VEMP)检查,双侧未引出1例,引出4例,其中患耳幅值降低2例。结论:UAN的听力学特点与双侧AN基本相同,但UAN以下降型听力图和极重度聋较多见,DPOAE幅值与双侧AN比较全频降低,健耳对侧声抑制明显,患耳对侧声抑制效应减弱或消失。需注意与一般单侧感音神经性聋相鉴别。DPOAE及ABR对诊断、鉴别诊断具重要意义。Objective：To investigate the audiological characteristics in unilateral auditory neuropathy（UAN）. Method：By the retrospective studies, 11 patients which were diagnosed as UAN and biilateral auditory neuropathy （AN） group and control group were measured. Result：By the statistical studies of patients from otology clinic data from January 2001 to September 2006,11 patients （11 ear, 5 left ear and 6 right ear, 3.2%） in 340 AN patients diagnosed as UAN were summarized. Four patients were male and 7 were female in 11 patients（1 ： 1.75）. The average age of 11 patients was 20 years old and the average period of diseases was 3. 1 years. All patients complained of unilateral gradual hearing loss, and 6 patients in all UAN patients can＇t discriminate speech correctly. Four patients complained of tinnitus and none of UAN patients complained of dizziness. The pure tone audiograms of 5 patients in all UAN patients （45.4 % ） were descending curve and those of 4 patients （36.4 % ） were ascending curve. Eleven patients mostly showed severity degree or midrange degree （6 ear, 54. 5%） sensorineual hearing loss. The average pure tone threshold of UAN was obviously higher than the AN group and the speech hearing of UAN is obviously worse, and ABR of all patients was absent, while uninjured side of UAN was normal. Bilateral ears of UAN patients were evoked distortion products otoacoustic emissions. The amplitude of DP-gram and SNR in UAN group was lower obviously （ P 〈0.05） than the normal control group at all frequencies （0.5-8. 0 kHz） and was lower significantly （ P〈0.01） at flat and high-frequency, but was lower obviously （ P 〈0.01） than the AN group at low-frequency. The contralateral suppression effect of DPOAE amplitude in 4 UAN patients of normal ears was suppressed, and that in injured ears was reduced or disappeared, even 0.5kHz increased DPOAE amplitude. ENG and VEMP were observed in 5 UAN patients, and 1 patients shows semicircular canal failure and 1

关 键 词：听神经病 听力检查 诱发电位 听觉 脑干 单侧 听力学测试 听觉脑干反射弧 

分 类 号：R764[医药卫生—耳鼻咽喉科]