听神经病听力学分析  

Audiological characteristics of auditory neuropathy

作　　者：汪吉宝[1] 段家德[1] 李擎天[1] 黄翔[1] 陈海华[1] 金晶[1] 龚树生[1] 孔维佳[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院耳鼻咽喉科,武汉430022

出　　处：《中华耳鼻咽喉科杂志》2002年第4期252-255,共4页Chinese Journal of Otorhinolaryngology

摘　　要：目的　探讨听神经病的听觉电生理特点。方法　总结了 10例听神经病患者的病史、纯音测听、镫骨肌反射、听性脑干反应 (auditorybrainstemresponse ,ABR)、耳蜗电图、畸变产物耳声发射(distortionproductotoacousticemission ,DPOAE)及对侧白噪声抑制试验、中潜伏期反应和慢皮层反应。 5例患者作了颅脑CT或磁共振成像 (magneticresonanceimaging ,MRI)。结果　患者男女兼有 ,平均年龄为 2 0 3岁 ,10余岁的青少年占多数。 9例主诉双耳听力下降 ,1例双耳鸣。纯音测听示 19耳为轻度至中度的低频下降型感音神经性听力损失 ,听力损失最严重的频率为 0 5kHz或 (和 ) 0 2 5kHz;1耳听力正常。 19耳镫骨肌反射消失 ,1耳纯音测听为上升型曲线者反射阈提高。ABR不能引出或仅出现波Ⅴ或 (和 )波Ⅰ。全部病例均可记录到DPOAE ,但不能被对侧噪声抑制。耳蜗电图示大部分病例动作电位 (actionpotential,AP)消失或振幅很小 ,负总和电位 (negativesummatingpotential,-SP)振幅绝对平均值为 0 5 95 μV ,慢皮层反应皆正常 ,6例测中潜伏期反应 5例正常。CT或MRI无异常发现。 结论听神经病早期纯音测听可正常 ,但其镫骨肌反射和ABR消失或阈值升高 ,其确切病变部位尚不明了 。Objective To study the auditory electrophysiological characteristics of the auditory neuropathy Methods Ten patients were diagnosed as auditory neuropathy The history, pure tone audiometry, stapedial reflex, auditory brainstem response, electrocochleogram, distortion product otoacoustic emission and his contralateral suppression of white noise, middle latency response and slow cortical response were assessed Five patients were investigated with brain CT or MRI Results The patients were of both genders The average age was 20 3 years old and most of them were teenagers Nine patients complained of bilaterally hearing impairment, while one patient who did not complain of hearing loss had a tinnitus of both ears The pure tone audiogram showed a middle or moderate sensorineural hearing loss at low frequencies 0 5 kHz and /or 0 25 kHz in nineteen ears but a normal audiogram in one ear Stapedial reflex was absent in nineteen ears, and threshold elevated in one ear while his pure tone audiogram revealed an ascending curve Auditory brainstem response cannot be recorded or only wave V or/and wave I presented All of the patients were evoked a distortion product OAE, which cannot be suppressed by contralateral white noise Electrocochleogram demonstrated AP absent or very small amplitude in most ear and the -SP amplitude were 0 595μV, while they had a normal slow cortical response but except one patient presented normal middle latency response The findings of CT or MRI were normal Conclusion The pure tone audiogram could preserve unchanged at early stage of auditory neuropathy, but their stapedial reflex and auditory brainstem response are absent or threshold elevated The precise pathologic site of this disorder is yet to be defined, but it may locate in the auditory system below brainstem

关 键 词：听神经病 听力学 感音神经性听觉丧失 听力检查 听觉疾病 

分 类 号：R764.4[医药卫生—耳鼻咽喉科]