影响未成年患者伪聋的因素及鉴别方法  

Factors Leading to Malingering in Juvenile Patients and Diagnosis

作　　者：谌国会 于澜[1] 赵立东[1] 尹自芳[1] 吴玉森 王秋菊[1] 王大勇[1] CHEN Guohui;YU Lan;ZHAO Lidong;YIN Zifang;WU Yusen;WANG Qiuju;WANG Dayong(College of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Beijing,China.National Clinical Research Center for Otolaryngologic Diseases,Beijing,China.Chinese PLA Institute of Otolaryngology.Key Lab of Hearing Science,Ministry of Education,China.Beijing Key Lab of Hearing Impairment for Prevention and Treatment,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院耳鼻咽喉头颈外科医学部,国家耳鼻咽喉疾病临床医学研究中心,解放军耳鼻咽喉研究所,聋病教育部重点实验室,聋病防治北京市重点实验室,北京100853

出　　处：《中华耳科学杂志》2020年第2期256-261,共6页Chinese Journal of Otology

基　　金：国家自然科学基金重点项目(81830028,81530032);国家自然科学基金青年项目(81900951,81900950);军队医学科技青年培育计划孵化项目(19QNP058);军队后勤科研计生专项(19JSZ14);北京市自然科学基金青年项目(7204312)联合资助。

摘　　要：目的探究未成年患者伪聋的影响因素及鉴别方法。方法对2014年12月至2019年7月以突聋为首发症状收入院的未成年患者(145例),行主客观听力评估,最后明确诊断。结果根据患者配合情况,经听力学联合检查鉴别出未成年伪聋患者11例,占同期以突聋收治入院患者比例为7.59%(11/145),其中男7例,女4例,男女比例为1.75:1。经单独深度询问后得知伪聋原因明确的有4例(外伤2例,厌学2例),原因不详的有7例。单侧伪聋7例(7耳),双侧伪聋4例(8耳),共计15耳。结论运用听力学主客观综合评估能有效鉴别未成年人伪聋,诊疗中应重视未成年人的心理问题,必要时采取针对性的心理疏导。Objective To identify factors that may lead juvenile patients to fake hearing loss and appropriate approaches to such patients.Methods Both psychoacoustic and objective audiological testing were used to determine the etiology in 145 juvenile patients with sudden deafness as primary complaints who were admitted from December 2014 to July 2019.Results Judging on patient's level of cooperation and based on combined psychoacoustic and objective audiology examination,malingering was identified in 11(7.59%)of the 145 patients,including 7 boys and 4 girls(male to female ratio=1.75:1).Upon further questioning in an isolated setting,clear causes were revealed in 4 cases,including trauma(n=2)and learning-weariness(n=2),while no definite reason could be solicited in the rest 7 cases.Faking involved a total of 15 ears,unilateral in 7 cases(7 ears)and bilateral in 4 cases(8 ears).Conclusion Comprehensive audiologic assessment combining subjective and objective methodologies can be used to effectively identify malingering in juvenile patients.Psychological concerns must be taken into consideration when managing such patients.Targeted psychological counseling should be considered when indicated.

关 键 词：伪聋 突聋 客观测听 纯音测听 言语识别率 

分 类 号：R764[医药卫生—耳鼻咽喉科]