迷路震荡致听力损害的临床探讨  

A clinical study on hearing loss caused by labyrinthine concussion

作　　者：邢英姿[1] 路虹[1] 张燕卓[1] 韩海霞[1] 张喜琴[1] 刘砚星[2] 徐鸥[1] 

机构地区：[1]河北医科大学第二医院耳鼻咽喉科,石家庄050000 [2]河北医科大学药理教研室,石家庄050000

出　　处：《中华耳科学杂志》2010年第2期194-199,共6页Chinese Journal of Otology

基　　金：河北省科技支撑计划项目(编号08276101D--35)

摘　　要：目的探讨轻度闭合性颅脑损伤造成的听力学变化特点,为临床诊断与法医学鉴定提供一定的理论依据。方法在临床实践中,选取85例轻度闭合性颅脑损伤患者,经详细询问病史、耳科及神经系统全面检查、颞骨或头颅CT扫描,对纯音测听、声导抗、听性脑干反应及40Hz听觉相关电位检查进行分析研究。结果 (1)轻度闭合性颅脑损伤后听力损害多为感音神经性耳聋,听力损失程度多≤60dB,少数患者听力损失较重或为混合性聋,部分患者可伴耳鸣、眩晕、恶心或短暂呕吐等症状;(2)伤后不同时间的听力损失程度不一,各检查阈值与正常听力组比较均有明显差异(P<0.05),听力损失多在高频区;(3)ABR各波潜伏期、波间期与正常听力组比较,除Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期差异不显著外(P>0.05),其余差异均有显著性(P<0.05)。结论 (1)轻度闭合性颅脑损伤可引起内耳迷路震荡,造成一定程度的高频听力损害和轻微脑干损伤,部分患者伴有前庭功能障碍;在评估或鉴定外伤后听力损伤程度时,还应考虑到伤后不同时期听力变化规律,合理把握鉴定时间,最终做出客观合理的临床诊断或法医学鉴定。(2)ABR与40Hz听觉相关电位检查联合使用,可以互相弥补听力检查中的不足,为临床诊断与法医学鉴定提供一定的理论依据。Objective To study features of audiologic changes caused by mild closed head injury and their utilities in clinical diagnosis and medicolegal assessment. Methods 85 cases of patients with mild closed head injury were identified. Detailed case histories were collected. A series of tests were conducted, including head or temporal bone CT scans, in addition to otology and neurology examinations. Audiologic testing included pure tone audiometry, acoustic immitance, auditory brainstem response （ABR）, and 40 Hz auditory event related potentials （AERP）. Results （1） Most cases showed mild to moderate post-injury sensorineural hearing loss, with a few showing severe or profound sensorineural hearing loss. Some patients had mixed hearing loss. Post-injury clinical manifestations included tinnitus, fullness in the ear, vertigo, nausea/vomiting, etc. （2） The degrees of hearing loss changed along with time, but remained different from normal （P 0.05）. Hearing loss was mostly in the high-frequency range. （3） Except forⅠ-Ⅲ and Ⅰ-Ⅴ intervals, latency and interpeak latency parameters were different from the normal （P 0.05）. Conclusion （1） Mild closed head injury can cause labyrinth concussion, which results in high-frequency hearing loss and brain stem injury. Vestibular dysfunction can happen in some patients. Time factor should be considered when determining post-head injury hearing loss. （2） Our data indicate that combined use of ABR and 40 Hz AERP can improve diagnosis accuracy. Such test results can help provide objective basis in clinical diagnosis and when making medicolegal decisions.

关 键 词：颅脑损伤 迷路震荡 听性脑干反应 纯音测听 40Hz听觉相关电位 

分 类 号：R764.3[医药卫生—耳鼻咽喉科] R651.151[医药卫生—临床医学]