单侧听觉剥夺对声源定位通路影响的研究进展  

Advances in effect of unilateral auditory deprivation on sound localization

作　　者：刘锦峰[1] 戴金升 王宁宇[1] 

机构地区：[1]首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科首都医科大学耳鼻咽喉科学院耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100020

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第2期136-142,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金项目（81271090/H1304）;北京市自然科学基金项目（7162066、7162072）;北京市教委科技计划重点项目（KZ201410025027）

摘　　要：目的单侧聋患者的耳间时间差和强度差信号不足或缺失，可造成其声源定位（ sound localization，SL）能力欠缺和噪声环境下言语理解力下降。单侧聋也会造成中枢听觉独特的结构与功能改变，导致单侧听觉剥夺。由于听觉中枢的可塑性在不同发育阶段存在差异，处于发育早期的听觉中枢具有极强的可塑性，是听觉功能与结构完善的关键期，也是听觉剥夺后中枢适应性改变的敏感期。发生于敏感期的单侧聋会造成听觉通路深层次的神经电生理改变--突触联系的不当建立、皮层功能的跨通道重组等，导致双侧SL通路显著的偏侧性活动。听觉通路偏侧性形成是为了代偿耳间信号的不足，利用健耳完整的耳廓波谱信号来提高SL能力，听觉中枢的重构也是为了提高皮层神经功能区的效用。而这些适应性改变的基础则是不同感觉刺激诱导下的特征性分子及递质的改变。但是单侧聋后的中枢代偿性改变也是一把双刃剑，这种发生于敏感期的代偿，持续到敏感期后便成了听觉康复的重要障碍，患侧听觉恢复后听觉通路的这种偏侧性也难以逆转，造成了目前单侧聋康复干预的困境。因此，为提高对单侧听觉剥夺特点的认识，本文将单侧聋及单侧听觉剥夺的相关内容做一回顾。In patients with single-sided deafness （ SSD ） , the interaural time difference and the interaural level difference signals are insufficient or missing , which result in the lack of sound localization ability and the decrease of speech comprehension in the noise environments .SSD can also cause the morphological and functional changes of the central auditory system , resulting in auditory deprivation .In early stage of the development , the auditory center is more susceptible to ambient environment and auditory inputs.It is a critical period of auditory function and morphological refinement .It is also sensitive period of central adaptability after auditory deprivation . SSD in the sensitive period of development can cause significant laterality activities of bilateral sound localization pathway .Unilateral auditory deprivation can distort tonotopic maps , disrupt the binaural integration , reorganize the neural network and change the synaptic transmission in the primary auditory cortex or sub cortex .In order to compensate for the deficiency of the interaural time difference and interaural level difference cues , the auditory pathway is used to improve the ability of sound source localization by using the spectral-shape cues remaining unchanged .In order to improve the effectiveness of the functional areas of the cortex , auditory center is also reorganized by cross-modal .However , central compensation after SSD is a double-edged sword .If SSD onset in the sensitive period, the laterality of auditory pathway will be continued and difficult to reverse by even long term bilateral hearing in the post-sensitive period.Therefore, in order to improve the understanding of the characteristics of unilateral auditory deprivation , this paper reviewed the evidence for adaptive changes in spatial hearing following a developmental hearing loss in one ear .

关 键 词：听觉丧失 单侧性 听觉剥夺 声定位 神经元可塑性 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]