儿童听神经病的听力随访研究  

The follow-up study on patients of children with auditory neuropathy

作　　者：谢林怡[1] 熊芬[1] 兰兰[1] 史伟[1] 丁海娜[1] 张娇[2] 王秋菊[2] XIE Linyi;XIONG Fen;LAN Lan;SHI Wei;DING Haina;ZHANG Jiao;WANG Qiuju(Department of Otolaryngology Head and Neck Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing,100853,China;Department of Audiology and Vestibular Medicine,Institute of Otolaryngology,Senior Department of Otolaryngology Head and Neck Surgery,the Sixth Medical Center of Chinese PLA General Hospital,National Clinical Research Center for Otolaryngologic Diseases)

机构地区：[1]解放军总医院第一医学中心耳鼻咽喉头颈外科,北京100853 [2]解放军总医院第六医学中心耳鼻咽喉头颈外科医学部耳鼻咽喉内科、耳鼻咽喉研究所、国家耳鼻咽喉疾病临床医学研究中心

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第3期177-180,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：国家自然科学基金重点项目(No:81830028);国家自然科学基金优秀青年基金项目(No:82222016);国家自然科学基金面上项目(No:82271189、82271171、82171130);军队后勤科研计生专项(No:19JSZ14);解放军总医院医疗大数据分析及应用研究(No:2019MBD-005)联合资助。

摘　　要：目的:分析儿童期发病的听神经病(AN)患儿的听力学特征,总结其听力学特点和转归情况。方法:对58例(108耳)AN患儿进行复诊随访,随访1~10年。检测项目包括行为测听、鼓室图、畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)及耳蜗微音电位(CM)、听觉稳态反应(ASSR)。结果:(1)所有频率的行为测听听阈均未见明显变化(P>0.05);(2)首诊复诊中鼓室图多为A或As型;(3)首诊和复诊DPOAE除750、1000 Hz引出率较低外,其余频率引出率较高,复诊全频引出率降低;(4)首诊中有7耳引出ABR及CM,复诊中有3耳引出ABR及CM;(5)复诊与首诊相比,除500 Hz外其余频率ASSR阈值差异均有统计学意义(P<0.01);(6)4000 Hz处行为测听听阈较ASSR阈值高,其余频率两者间无明显相关性(P>0.05)。结论:儿童期发病的AN患儿听力有变差趋势,DPOAE未引出且ABR未引出或严重异常者,需进行CM测试,避免误诊。应持续监测AN患儿听觉状态与言语交流能力,家长应在平时的生活中注意患儿的行为能力变化,做到定期复诊。Objective: To analyse the audiological characteristics of patients of children with auditory neuropathy(AN) for gaining a better understanding of the audiological characteristics prognosis of patients with AN. Methods: 58 patients(108 ears) of children with AN were enrolled, all of whom had received further consultation within 10 years after the first consultation. Behavioral audiometry test, tympanogram test, distortion product otoacoustic emission(DPOAE), auditory brainstem response(ABR), cochlear microphonics(CM), auditory steady-state response(ASSR) were performed on these patients. Results:(1)There were no significant changes in behavioral audiometry threshold between first and further consultation(P>0.05);(2)Tympanograms were mostly of type A or As;(3)The patients had worse DPOAE results in the further consultation, while the elicitation rate of other frequencies were higher except for the lower elicitation rate of 750 Hz and 1000 Hz;(4)There were 7 ears that had present ABR and CM in the first consultation, while three ears had present ABR and CM in the further consultation;(5)Except for 500 Hz, other frequency thresholds of ASSR in the further consultation were statistically significant compared with those in the first consultation(P<0.01);(6)The threshold of behavioral audiometry at 4000 Hz was higher than that of ASSR, and there was no obvious correlation between the other frequencies(P>0.05). Conclusion: There is a tendency of hearing deterioration in patients of children with AN. Patients with no DPOAE elicitation and no ABR elicitation or serious abnormalities need CM test to avoid misdiagnosis. The hearing status and speech communication ability of patients should be continuously monitored. Parents should pay attention to the changes in the behavioral ability of the children in daily life and make regular subsequent visits.

关 键 词：儿童 听神经病 听力学特征 

分 类 号：R764.43[医药卫生—耳鼻咽喉科]