不同听力损失类型青年人言语声诱发听性脑干反应与最大言语识别率关系的探讨  

Relationships between electrophysiological characteristic of speech evoked auditory brainstem response and Mandarin monosyllable discriminative ability at different hearing impairment

作　　者：符秋养[1] 梁勇[2] 邹岸[3] 王涛[3] 赵向东[1] 

机构地区：[1]广东省第二人民医院耳鼻咽喉头颈外科,广州510317 [2]南方医科大学附属南方医院耳鼻咽喉头颈外科,广州510515 [3]南方医科大学生物医学工程学院,广州510515

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期247-255,共9页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（61172033）;广东省科技计划项目（2014,41114963067）;广东省医学基金（A2015074）

摘　　要：目的 探讨不同听力损失类型青年人言语声诱发听性脑干反应（speech evoked auditory brainstem response,s-ABR）的电生理特性与最大言语识别率（phonetically balanced maximum,PBmax）之间的相互关系.方法 测试41例（41耳）正常听力、30例（30耳）传导性听力损失和27例（27耳）感音神经性听力损失成年人的PBmax及其对应强度的s-ABR,分析s-ABR主波潜伏期和基频（fundamental frequency,Fo）幅值、第一共振峰（first formant,F1）幅值与PBmax的关系.结果 所有受试者均顺利完成PBmax测试,传导性听力损失者PBmax[（84.3±l7.0）％]与感音神经性听力损失者PBmax[（80.9±17.6）％]差异无统计学意义（P＞0.05）,二者均明显低于听力正常者的PBmax[（94.8±6.1）％],差异具有统计学意义（P值均＜0.05）.以90％＜PBmax≤100％、80％＜PBmax≤90％及PBmax≤80％分组,结果显示随着PBmax降低,不同听力受试者均表现出s-ABR各主波潜伏期逐渐延长,F0幅值和F1幅值逐渐减小.在相同PBmax组,感音神经性听力损失、传导性听力损失及听力正常者s-ABR各主波潜伏期有依次延长的趋势,而Fo、F1幅值也出现依次减小的趋势.对s-ABR的主波潜伏期和F0、F1幅值与PBmax进行相关性分析,结果显示不同听力损失受试者s-ABR主波潜伏期均与PBmax表现出负相关,而F0幅值和F1幅值分别与PBmax表现出强正相关.逐步回归分析方程显示,A波潜伏期、F波潜伏期、Fo幅值及F1幅值对PBmax的影响总和达到了76％,影响从大到小依次为F0幅值、F1幅值、F波潜伏期及A波潜伏期.结论 不同听力损失类型青年人s-ABR电生理特性与PBmax之间有着稳定、密切的相关关系;s-ABR有望成为辅助评估言语识别功能的电生理方法,其电生理特性中的Fo幅值、F1幅值、F波潜伏期及A波潜伏期对PBmax测试结果影响程度较大.Objective To investigate the relationships between electrophysiological characteristic of speech evoked auditory brainstem response（s-ABR） and Mandarin phonetically balanced maximum（PBmax） at different hearing impairment,so as to provide more clues for the mechanism of speech cognitive behavior.Method Forty-one ears in 41 normal hearing adults （NH）,thirty ears in 30 conductive hearing loss patients（CHL） and twenty-seven ears in 27 sensorineural hearing loss patients（SNHL） were included in present study.The speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via speech audiometric software.Their s-ABRs were recorded with speech syllables /da/ with the intensity of phonetically balanced maximum （PBmax）.The electrophysiological characteristic of s-ABR,as well as the relationships between PBmax and s-ABR parameters including latency in time domain,fundamental frequency（F0） and first formant（F1） in frequency domain were analyzed statistically.Results All subjects completed good speech perception tests and PBmax of CHL and SNHL had no significant difference （P 〉 0.05）,but both significantly less than that of NH （P 〈 0.05）.While divided the subjects into three groups by 90% 〈 PBmax ≤ 100%,80% 〈 PBmax ≤ 90% and PBmax ≤ 80%,the results showed that all subjects decreased amplitudes of Fo and F1,and increased latency of feature peaks as PBmax reduced.In the same PBmax group,latency of feature peaks increased and amplitudes of Fo and F1 decreased from SNHL,CHL to NH.All subjects showed strongest significant positive correlation between amplitudes of F0 and F1 with PBmax respectively,as well as significant negative correlation between latencies of all the feature peaks with PBmax.A stepwise regression analysis equation displayed that the sum of latencies of peak A and F,and amplitudes of F0 and F1 attributed to PBmax reached 76%,and their beta coefficient decreased from amplitudes of F0 and amplitudes of F1,latencies of peak F to lat

关 键 词：诱发电位 听觉 脑干 言语识别测验 听觉丧失 

分 类 号：R764[医药卫生—耳鼻咽喉科]