不同发病年龄听神经病患者的听力学转归与随访方案优化  

Auditory Prognosis and Optimized Follow-Up in Relation to Presenting Age in Patients with Auditory Neuropathy

作　　者：谢林怡 王秋菊[2] 熊芬[1,2] 刘志成 XIE Linyi;WANG Qiuju;XIONG Fen;LIU Zhicheng(Capital Medical University,College of Biotechnology,Beijing 100069,China;College of Otolaryngology Head and Neck Surgery,Chinese PLA General Hospital,Beijing,China.National Clinical Research Center for Otolaryngologic Diseases,Beijing 100853,China)

机构地区：[1]首都医科大学生物医学工程学院,北京100069 [2]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,北京100853

出　　处：《中华耳科学杂志》2022年第2期193-198,共6页Chinese Journal of Otology

基　　金：国家自然科学基金重点项目(81830028),国家自然科学基金青年项目(81900951,81900950),国家自然科学基金面上项目(82171130);军队医学科技青年培育计划孵化项目(19QNP058,21QNPY100);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);国家重点研发计划“主动健康和老龄化科技应对”重点专项(2020YFC2005200&2020YFC2005201);解放军总医院医疗大数据分析及应用研究(2019MBD-005)联合资助~~。

摘　　要：目的 分析青少年和成人发病听神经病患者(Auditory Neuropathy, AN)的听力学特征,总结不同发病年龄AN患者的听力转归情况,并对随访方案进行优化。方法 门诊确诊为AN的30例(60耳)成人患者和54例(108耳)青少年患者,分析其首诊及复诊的听力学特征。检测项目包括:纯音测听、言语识别率、声导抗、听性脑干反应(Auditory Brainstem Response,ABR)、畸变产物耳声发射(Distortion Product Otoacoustic Emission, DPOAE)。结果 不同发病年龄AN听力学特征转归情况:(1)纯音听阈:首诊和复诊中成人组的纯音听阈均比青少年组更低;青少年组患者复诊与首诊相比,除250、1000 Hz外,其他频率复诊较首诊升高;成人组患者复诊与首诊相比,除250、2000、4000 Hz外,其他频率复诊较首诊升高;(2)镫骨肌反射引出率:青少年组首诊有9耳(8.3%)部分频率引出,复诊有3耳(2.8%)部分频率引出;成人组镫骨肌反射测试首诊有5耳(8.3%)部分频率引出,复诊有4耳(6.7%)部分频率引出;(3)言语识别率:青少年组复诊相比首诊下降,成人组首复诊无显著差异;(4)ABR:青少年组首诊中有4耳引出反应,成人组首诊中有5耳引出反应,两组患者复诊ABR引出率均下降;(5)DPOAE:两组患者复诊全频引出率降低。结论成人组在首诊和随访中的纯音听阈均比青少年组低,且言语识别率在随访中下降较明显。青少年患者发现听力下降或言语识别不清应及时就诊,以便及时采取干预措施。优化后的随访方案对AN患者的复诊有所帮助,提高了患者的复诊效率以及复诊意愿。Objective To report audiological characteristics of patients with auditory neuropathy(AN) and different onset ages for a better understanding of the audiological prognosis in patients with AN. Methods Adult(n=30, 60ears) and adolescent(n=54, 108 ears) patients with AN were enrolled, and their audiological data at first and follow up visits were collected, including pure tone thresholds, acoustic immitance, speech-discrimination scores(SDS), auditory brainstem responses(ABR) and distortion product otoacoustic emissions(DPOAE). Results Pure tone threshold changes between the initial and follow up visits were significantly different between adult and adolescent patients, with adolescent patients showing no significant changes at 250 and 1000 Hz, whereas adult patients showing no significant changes at 250, 2000 and 4000 Hz. Acoustic reflex(AR) was present in 8.3%(9 ears) in adolescent patients at the first consultation(vs 8.3% [5 ears] in adult patients) and 2.8%(3 ears) at the follow up visit(vs 6.7% [4 ears] for adult patients). SDS showed significant changes between the two visits in adolescent patients, but not in adult patients. At the first consultation ABRs were detectable in 4 ears in adolescent patients and in 5 ears in adult patients. ABR results deteriorated in both in adolescent and adult patients at follow up visits, together with DPOAEs. Conclusion During the development of AN, pure tone thresholds and SDS continue to deteriorate in adolescent patients and should be monitored at regular intervals for timely interventions. An optimized follow-up plan is beneficial to patients with AN and may improve patient satisfaction and willingness for return visits.

关 键 词：青少年 成人 听神经病 听力学特征 随访方案 

分 类 号：R764[医药卫生—耳鼻咽喉科]