耳蜗微音电位在诊断婴幼儿听神经病中的应用  

Cochlea Microphonics in the Diagnosis of Auditory Neuropathy in Infants and Young Children

作　　者：黄薇[1] 黄爱萍[1] 孙倩 许敏 宋英鸾[1] 耿江桥[1] 李红霞[1] 温鑫[1] 朱庆文[2] HUANG Wei;HUANG Aiping;SUN Qian;XU Min;SONG Yingluan;GENG Jiangqiao;LI Hongxia;WEN Xin;ZHU Qingwen(Department of Otorhinolaryngology,Hebei Provincial Children’s Hospital,Hebei 050031;Department of Otorhinolaryngology,Second Hospital of Hebei Medical University,Hebei 050000)

机构地区：[1]河北省儿童医院耳鼻咽喉科,河北050031 [2]河北医科大学第二附属医院耳鼻咽喉二科,河北050000

出　　处：《中华耳科学杂志》2020年第4期713-717,共5页Chinese Journal of Otology

基　　金：京津冀基础研究合作专项,编号:H2018316006;河北省医学科学研究课题,编号:20190805。

摘　　要：目的通过分析比较婴幼儿听力正常组,听神经病(AN)组和极重度感音神经性聋组在耳蜗微音电位(CM),耳声发射(OAE)的引出率以探讨经表皮电极测得耳蜗微音电位在诊断婴幼儿听神经病中的应用价值。方法选取年龄3月龄至36月龄的婴幼儿,根据听力结果和影像学检查的结果综合分析,其中听力正常组50人100耳,AN组25人49耳,极重度感音神经性聋组40人75耳,比较三组研究对象的耳声发射和耳蜗微音电位的引出率有无统计学意义。结果OAE在听力正常组中的引出率是91%,在AN组中的引出率是75.5%,在极重度感音神经性聋组中的引出率是0;CM在听力正常组中的引出率是96%,在AN组中的引出率是100%,在极重度感音神经性聋组的引出率是0;分别进行OAE和CM的引出率的两两比较,听力正常组与AN组在OAE的引出率无统计学差异(P=0.531>0.05),听力正常组与AN组CM的引出率也无统计学差异(P=0.578>0.05),而AN组与极重度神经性聋组以及听力正常组与极重度神经性聋组OAE和CM的引出率差异均具有统计学意义(P=0.00<0.05)。结论CM和OAE都是评价耳蜗外毛细胞功能的客观听力学检查方法,由于CM可避免中耳功能的影响,因此在婴幼儿听力检查中比OAE更精准,尤其是当ABR在100nHL未引出或严重异常时,CM应当作为一项常规的检查项目来诊断婴幼儿听神经病。Objective To evaluate the value of cochlea microphonics in the diagnosis of auditory neuropathy in infants and young children by comparing otoacoustic emissions(OAE)and cochlea microphonics(CM)in children with normal hearing,auditory neuropathy(AN)or profound sensorineural hearing loss(SNHL).Methods Children from 3 months to 36 months with normal hearing(n=50,100 ears),AN(n=25,49 ears)or profound SNHL(n=40,75 ears),as diagnosed by audiological and imaging results,were tested for their OAEs and CMs.Results The rate of successful OAE extraction was 91%in children with normal hearing,77.5%in those with AN and 0 in those with profound SNHL.The rate of successful CM extraction in the three groups was 96%,100%and 0,respectively.Both the OAE and CM extraction rates were not statistically different when compared between the normal hearing and AN groups(P=0.531>0.05 and P=0.578>0.05,respectively),but showed statistically significant differences between the AN and profound sensorineural hearing loss groups(P=0.000<0.05).Conclusion OAEs and CMs are objective audiological tests to evaluate cochlear outer hair cells function,with CMs being more robust than DPOAEs.In infants and young children showing no or severely abnormal ABRs at 100 dB nHL,CMs can be routinely used for the diagnosis of auditory neuropathy.

关 键 词：听神经病 婴幼儿 耳声发射 耳蜗微音电位 听性脑干反应 

分 类 号：R764[医药卫生—耳鼻咽喉科]