单音节最大言语识别率与纯音听力不成比例下降的判定  

Judgement of disproportionate loss between Mandarin monosyllable discrimination and pure tone hearing thresholds

作　　者：李剑挥[1] 郗昕[1] 赵阳[1] 冀飞[1] 陈艾婷[1] 杨伟炎[1] 

机构地区：[1]解放军总医院耳鼻咽喉头颈外科医院,北京100853

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第7期565-569,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：基金项目：＂十一五＂国家科技支撑计划（2007BAI18B12,2008BAI50B01,2008BAI50B08）;解放军总医院苗圃基金（08MP-11）;中科院自动化所模式识别国家重点实验室开放课题（08-3-1）

摘　　要：目的 建立汉语普通话单音节最大言语识别率与纯音听力不成比例下降的判定标准.方法 对165名确诊为感音神经性聋的患者使用ER-3A插入式耳机分别进行双耳纯音测听和言语测听.以自行编制的言语测听软件播放音位平衡的普通话单音节测听表,每表25个单音节测试项的播放顺序可实现随机.同一耳别始终使用同一张表,以该耳所有纯音测听频率中的最小听阈减去5 dB作为起始测听强度,以5 dB为步距逐渐提高测试强度,获得患者该侧耳的言语识别率-强度（P-I）函数关系,读取最大言语识别率PBmax.根据气导纯音听力图计算三频率平均纯音听阈（pure tone average,PTA）PTA1（0.5、1、2 kHz）、PTA2（1、2、4 kHz）以及四频率平均纯音听阈PTA3（0.5、1、2、4 kHz）;同时计算0.5、1、2 kHz与4 kHz纯音听阈的差值Slope0.5、Slope1、Slope2作为听力图高频走势的指征.利用SPSS10.0统计软件分析PBmax与以上因素的相关性.结果 PBmax与听力图高频走势Slope无相关性,但与纯音听阈呈负相关,尤与PTA3相关性最大（r=-0.595,P=0.000）.基于由PBmax与PTA3所绘制的散点图的下缘,可建立起包含99%观测值的言语识别率下限,其函数表达式为PBmax=100-10×PTA3/11.结论 感音神经性聋患者依据纯音0.5、1、2、4 kHz的平均听阈可确定其言语识别率下限,PBmax得分若低于此界限,则可认定其言语识别率与纯音听力不成比例地下降.Objective To establish the criteria of the disproportionate loss of Mandarin monosyllable discriminative abilities to pure tone hearing thresholds. Methods Total of 165 patients with varying degrees of sensorineural hearing loss were recruited for routine audiological evaluations. The speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via self-made speech audiometric software. The Performance-Intensity（P-I） function for individual ear was obtained by the same list which was administrated in ascending intensities, with 25 monosyllables presenting randomly. The lowest intensity was determined by the lowest pure tone threshold among all audiometric frequencies minus 5 dB.The intensities were increased in 5 dB step until the score was 100% or the intensity was reached to the patient＇s uncomfortable level The PBmax was obtained from the P-I plot. Three parameters about pure tone average hearing thresholds, including PTA1 （average of 0. 5, 1 and 2 kHz）, PTA2 （average of 1, 2 and 4 kHz） and PTA3 （average of 0. 5, 1, 2 and 4 kHz）, as well as three parameters about audiogram slope,including Slope0. 5 （4 kHz minus 0. 5 kHz）, Slope1 （4 kHz minus 1 kHz） and Slope2 （4 kHz minus 2 kHz）,were calculated respectively. The correlations between PBmax and above parameters were analyzed by SPSS10. 0 statistical software. Results The audiogram slopes were not shown any correlation with PBmax,while the pure tone average thresholds, especially PTA3 （r = - 0. 595, P = 0. 000 ） were confirmed to correlate with PBmax. In the scatter plot based on PBmax and PTA3, a linear boundary was constructed encompassing approximately 99% of observed data collected from the sensorineural hearing-impaired.Conclusion Any PBmax score falling below the boundary should be considered with high possibility and disproportionately poor comparision with pure tone hearing thresholds.

关 键 词：听觉丧失 感音神经性 测听法 言语 单音节 汉语 测听法 纯音 

分 类 号：R764[医药卫生—耳鼻咽喉科]