骨导短声ABR在低龄分泌性中耳炎儿童合并感音神经性听力损失诊断中的应用  

Identifying Sensorineural Hearing Loss in Young Children with Otitis Media with Effusion by Applying Bone-Conducted Click ABR

作　　者：汪玮[1] 陈向平 马孝宝 沈佳丽 王璐[1] 贺宽 孙进 杨军[1] WANG Wei;CHEN Xiang-ping;MA Xiao-bao;SHEN Jia-Li;WANG Lu;HE Kuan;SUN Jin;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336-339,347,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(18JXO04);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(17CSK03)。

摘　　要：目的回顾性分析患分泌性中耳炎(OME)的低龄儿童骨导短声听性脑干反应(ABR)测试结果,确定其中合并感音神经性听力损失(SNHL)患耳所占比例,以及听力损失情况。方法选择OME组79例(123耳),正常对照组39例(78耳)。正常对照组骨导短声ABR阈值平均值+2个标准差,定义为"正常骨导阈值";根据此正常值,将OME组分为骨导正常组(阈值≤正常值)、骨导异常A组(正常值<阈值≤45dBnHL)和骨导异常B组(阈值>45dBnHL)。分析OME骨导异常A组与正常对照组间的骨导阈值之间是否具有差异;上述OME3组与正常对照组气导短声ABR阈值间两两比较。结果骨导短声ABR反应阈正常值为≤22.76dBnHL。OME组123耳中46耳(37%)存在骨导阈值异常,其中骨导异常A组33耳,骨导异常B组13耳。A组骨导阈值(30.91±7.01 dB nHL)较正常组(14.03±5.00 dB nHL)显著升高(P<0.05)。与正常对照组相比,OME 3组的气导阈值均显著提高(P<0.05)。OME骨导异常B组的气导阈值(67.69±16.02dBnHL)较A组的气导阈值(48.33±15.09dB n HL)显著提高(P<0.05)。结论本组低龄OME儿童中骨导短声ABR反应阈值异常耳超过1/3,其中反应阈>45 dB nHL耳接近1/3,提示其听力损失中存在有OME相关或非相关的SNHL。合并SNHL的低龄OME儿童气导听力损失程度更为严重。骨导短声ABR反应阈测试确定OME儿童是否合并SNHL具有一定的临床应用价值。Objective This study was aimed to identify sensorineural hearing loss(SNHL)in young children with otitis media with effusion(OME)by applying bone-conducted click ABR.Methods Based on the inclusion criteria,79 children(123 ears)were enrolled in OME group,and 39 children(78 ears)in a normal control group.The average value of ABR threshold of bone conduction in the normal control group was calculated+2 standard deviations,defined as"normal value".According to the normal value,OME group was divided into normal bone conduction group(threshold≤normal value),abnormal bone conduction group A(normal value<threshold≤45 dB NHL)and abnormal bone conduction group B(threshold>45 dB nHL).Whether there was a difference in bone conduction thresholds between OME group A and normal control group was analyzed and the ABR thresholds of bone conduction among three OME groups and normal control group were compared.Results The"normal value"of ABR threshold was≤22.76 dB nHL.In OME group,46 ears(37%)had abnormal bone conduction threshold,including 33 ears in group A and 13 ears in group B.The bone conduction threshold of group A was 30.91±7.01 dB nHL that was significantly higher than that in the normal group(14.03±5.00 dB nHL,P<0.05).Compared with the normal control group,the air conduction threshold of OME three groups were significantly increased(P<0.05).The air conduction thresholds of OME group B was 67.69±16.02 dB nHL that was higher than that in group A(48.33±15.09 dB nHL,P<0.05).Conclusions More than 1/3 of these young OME children had abnormal ABR thresholds,and nearly 1/3 of them had abnormal ABR threshold>45 dB SNHL,suggesting that related OME or unrelated SNHL existed in their hearing loss.The degree of air conduction hearing loss was more serious in the young OME children with SNHL.Bone-conducted click ABR test can be used to determine whether there is SNHL in young OME children.

关 键 词：骨导 听性脑干反应 短声 分泌性中耳炎 儿童 

分 类 号：R764.21[医药卫生—耳鼻咽喉科]