慢性噪声致听损伤患者的前庭功能分析  

The Vestibular Function in Patients with Chronic Noise-induced Hearing Loss

作　　者：郭向东[1] 王庆林 梅祥胜[1] 姚卫杰[1] 杨晓刚[1] Guo Xiangdong;Wang Qinglin;Mei Xiangsheng;Yao Weijie;Yang Xiaogang(The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou,450000,China;不详)

机构地区：[1]河南中医药大学第一附属医院耳鼻喉科,郑州450000 [2]河南医学高等专科学校

出　　处：《听力学及言语疾病杂志》2020年第4期376-379,共4页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金项目(81403439);河南省科技攻关计划(192102310170);河南省中医药科学研究专项课题(2017ZY2061)。

摘　　要：目的探讨慢性噪声损伤对噪声致听损伤患者前庭功能的影响。方法 40例(80耳)慢性噪声致听损伤患者根据2~8 kHz平均听阈分为≤40 dB HL 32耳(A组),≥41 dB HL 48耳(B组),另选择40例年龄和性别相匹配的听力正常无噪声暴露者为对照组,分别进行纯音测听、冷热试验和颈性前庭诱发肌源性电位(cervical vestibular evoked myogenic potential,cVEMP)等检查。结果与对照组相比,噪声性聋组2~8 kHz的平均听阈升高(t=26.478、41.252、42.279、36.258,P<0.05),cVEMP的P13和N23潜伏期延长,P13-N23振幅减小,差异有统计学意义(t=11.194、14.642、-4.804,P<0.05);噪声致听损伤组纯音听阈、cVEMP和冷热试验的异常率分别为100%(80/80)、66.3%(53/80)和26.3%(21/80),对照组分别为0(0/80)、7.5%(6/80)和3.8%(3/80),前者显著高于后者(χ^2=160.000、59.312、15.882,P<0.05);B组cVEMP和冷热试验的异常率分别为83.3%(40/48)和27.1%(13/48),A组分别为40.6%(13/32)和25.0%(8/32),两组cVEMP的异常率差异有统计学意义(χ^2=15.663,P<0.05),而A、B两组冷热试验的异常率差异无统计学意义(χ^2=0.043,P>0.05)。结论慢性噪声致听损伤患者除了耳蜗功能受损外,前庭功能受损的可能性也很大,且内耳下部(耳蜗和球囊)比内耳上部(半规管)更容易受到噪声暴露的影响。Objective To investigate the effect of chronic noise exposure on the vestibular function in patients with noise-induced hearing loss(NIHL). Methods Forty patients with NIHL(noise deafness group) and 40 subjects controls with age-and sex-matched(control group) were enrocled in this study. Audiometry, caloric, and cervical vestibular evoked myogenic potential(cVEMP) tests were examined. According to the WHO classification of hearing impairment, 80 ears in the noise deafness group were divided into two subgroups after calculating the average hearing threshold of 2~8 kHz, ≤40 dB HL 32 ears(group A) and ≥41 dB HL 48 ears(group B). Results There was statistically significant elevated PTA at 2, 4, and 8 kHz in the noise deafness group versus control group(t=26.478,41.252,42.279,36.258,P<0.05). The cVEMP latencies were prolonged and peak to peak amplitude was reduced in the noise deafness group, the difference was statistically significant compared with the control group(t=11.194,14.642,-4.804,P<0.05).The abnormal percentages of the audiometry, cVEMP and caloric tests were 100,66.3% and 26.3% respectively in NIHL patients, which was significantly different from those of control group(χ^2=160.000,59.312,15.882,P<0.05), and the abnormal rates of these three tests had a significant decreasing trend(χ^2=94.847,P<0.05). The abnormal rates of cVEMP and caloric tests were 83.3% and 27.1% in group B and 40.6% and 25.0% in group A. The abnormal rates of cVEMP in the two groups were statistically significant(χ^2=15.663,P<0.05) and there was no statistically significant difference in the abnormal rate of caloric tests(χ^2=0.043,P>0.05). Conclusion In addition to cochlear damage, chronic noise exposure may damage the vestibular system, and the pars inferior(cochlea and saccule) is more vulnerable to noise exposure than the pars superior(semicircular canals).

关 键 词：噪声性聋 冷热试验 前庭诱发肌源性电位 球囊 椭圆囊 

分 类 号：R764.433[医药卫生—耳鼻咽喉科]