短声ABR阈值正常婴幼儿的DPOAE和TB-500 Hz ABR反应阈  

Results of DPOAE and TB-500 Hz of Infants with Normal Click ABR Thresholds

作　　者：沈佳丽 汪玮[1] 陈建勇[1] 马孝宝 王璐[1] 孙进 贺宽 张勤[1] 陈向平 杨军[1] SHEN Jiia-li;WANG Wei;CHEN Jian-yong;MA Xiao-bao;WANG Lu;SUN Jin;HE Kuan;ZHANG Qin;CHEN Xiang-ping;YANG Jun

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科/上海交通大学医学院耳科学研究所/上海市耳鼻疾病转化医学重点实验室,上海200092 [2]上海交通大学医学院附属新华医院崇明分院耳鼻咽喉科,上海202150

出　　处：《中国听力语言康复科学杂志》2021年第5期327-330,335,共5页Chinese Scientific Journal of Hearing and Speech Rehabilitation

基　　金：上海交通大学医工交叉重点项目(ZH2018ZDA11);上海交通大学医学院附属新华医院院级临床研究培育基金项目(17CSK03,18JXO04)。

摘　　要：目的探讨分析鼓室图正常、气导短声听性脑干反应(click auditory brainstem response,click-ABR)阈值≤30 dB nHL的婴幼儿畸变产物耳声发射(DPOAE)以及气导500 Hz短纯音听性脑干反应(tone burst-ABR,TB-ABR)的检测结果,为婴幼儿听力损失的早期诊断和评估提供参考。方法选取2018年1月~2020年12月在我科就诊的中耳功能正常且click-ABR阈值≤30 dB nHL的婴幼儿170例共计272耳作为研究对象,对其临床资料进行整理分析。根据click-ABR阈值分为5组,A组:click-ABR阈值≤10 dB nHL;B组:click-ABR阈值为15 dB nHL;C组:click-ABR阈值为20 dB nHL;D组:click-ABR阈值为25 dB nHL;E组:click-ABR阈值为30 dB nHL。根据DPOAE的测试结果分为4~5个频率点通过组、6点通过组与少于4个频率点未通过组,将6点通过组设为对照组,比较4~5个频率点通过组、未通过组与对照组TB-500 Hz ABR的反应阈是否存在差异。结果随着click-ABR阈值增大,DPOAE通过率降低,卡方检验显示总体上5组DPOAE的通过率存在显著差异(χ^(2)=72.56,P=0.000)。采用Boferroni校正法进行组间多重比较,A、B、C3组间显著差异,D、E两组间无显著差异,A、B、C3组与D、E组间存在显著差异(P<0.05)。A、B两组中4~5个频率点通过组的TB-500 Hz ABR阈值与对照组无显著差异(P>0.05),其余各组TB-500 Hz ABR阈值与对照组存在显著差异(P<0.05)。结论当click-ABR阈值≥25 dB nHL时,DPOAE通过率明显降低。对于中耳功能正常且click-ABR阈值≤30 dB nHL的婴幼儿,clcik-ABR≤15 dB nHL但DPOAE未通过以及无论DPOAE是否通过、click-ABR阈值≥20 dB nHL时均需要加做TB-500 Hz ABR评估低频听力。Objective To analyze Distortion Product Otoacoustic Emissions(DPOAE)and Tone Burst 500Hz ABR in Infants with normal tympanograms and click ABR thresholds≤30 dB nHL in order to provide reference for early diagnosis and evaluation in infants with hearing loss.Methods The auditory data in infants with normal tympanogram and click-ABR threshold of≤30 dB nHL who visited our department from January 2018 to December 2020 were selected in this study,with a total of 170 cases(272 ears)being analyzed.According to click ABR thresholds of these infants,they were divided into five groups,namely,group A:≤10 dB nHL,group B:15 dB nHL,group C:20 dB nHL,group D:25 dB nHL and group E:30 dB nHL.According to DPOAE results,they were divided into 4-5 frequency points pass group,full frequency pass group and refer group.The full frequency pass group was set as the control group,and TB-500Hz thresholds in 4-5 frequency points pass group,refer group were compared with the control group.Results Along with the increase of click ABR threshold,the DPOAE pass rate was decreased.There was a significant difference in the pass rate of DPOAE among the five groups(χ^(2)=72.56,P=0.000).There were no significant differences among group A,B and C,and also between group D and E.The differences of TB-500Hz threshold between the control group and the group A and B with 4-5 frequency points pass were not statistically significant(P>0.05),while the differences between the remaining groups and the control group were statistically significant(P<0.05).Conclusion When click ABR threshold was worse than or equal to 25 dB nHL,the DPOAE pass rate decreased significantly.For infants with normal tympanogram and click ABR threshold≤30 dB nHL,if click ABR≤15 dB nHL but DPOAE failed,and whether DPOAE passed or not and click ABR threshold≥20 dB nHL,TB-500 Hz ABR should be added to evaluate low-frequency hearing.

关 键 词：婴幼儿 短声-ABR 短纯音-ABR DPOAE 低频听力 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]