老年中耳疾病主客观听力检查结果分析  

Subjective and Objective Hearing Examination in Elderly Patients with Middle Ear Diseases

作　　者：王燕 李楠[1,2] 李世博 何雅琪 陈琪 赵立东 冀飞 WANG Yan;LI Nan;LI Shibo;HE Yaqi;CHEN Qi;ZHAO Lidong;JI Fei(Department of Otolaryngology,Head and Neck Surgery,The Sixth Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100853,China;National Clinical Medical Research Center for Otolaryngology Diseases,Beijing 100853,China;The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042)

机构地区：[1]中国人民解放军总医院第六医学中心耳鼻咽喉头颈外科医学部,北京100853 [2]国家耳鼻咽喉疾病临床医学研究中心,北京100853 [3]重庆医科大学附属第一医院,重庆400042

出　　处：《中华耳科学杂志》2023年第2期162-169,共8页Chinese Journal of Otology

基　　金：国家重点研发计划项目(2020YFC2005200);军队装备建设军事计量项目(145BZB210027026X);国家耳鼻咽喉疾病临床医学中心开放课题(202200010);2022年首都卫生发展科研专项重点攻关课题(首发2022-1-2023)。

摘　　要：目的分析60岁以上老年中耳疾病患者主客观听力检查结果及听力损失情况,并进行特征性描述。方法收集门诊老年中耳疾病患者2976例,平均年龄67.65±6.04岁。其中60~70岁组共2241例,71-80岁组共609例,>80岁组共126例。获得完整的纯音测听结果(气导120~8000Hz、骨导250~4000Hz)4117耳,声导抗测试2117耳,听性脑干反应测试114耳。并比较不同性别及年龄组对听力测试结果的影响。结果所有患者中听力处于正常范围但有传导成分存在111例,轻度听力损失861例,中度听力损失759例,中重度听力损失624例,重度听力损失309例,极重度听力损失117例,完全听力损失52例,单侧聋143例。患者听力曲线类型主要表现为上升型和缓降型,不同性别及不同年龄组间的患者的听力曲线类型分布存在显著性差异(P<0.001)。声导抗测试A型449耳(21%),Ad型100耳(5%),As型69耳(3%),B型587例(28%),C型802耳(38%),因术后改变等原因未引出鼓室图110耳(5%);声反射引出情况与鼓室图不同分型之间存在显著性差异(P<0.001)。听性脑干反应测试结果显示Ⅰ、Ⅲ、Ⅴ波引出率分别为60.53%、62.28%及84.21%。Ⅰ、Ⅲ、Ⅴ波潜伏期为1.69±0.2ms、3.96±0.2ms及5.88±0.27ms,Ⅰ-Ⅲ波间期为2.26±0.14ms,Ⅲ-Ⅴ波间期为1.92±0.2ms,Ⅰ-Ⅴ波间期为4.17±0.2ms。结论60岁以上老年传导聋患者纯音听阈气骨导差在250Hz和4000Hz处最大,其中气导听阈高频下降最明显,随着年龄的增长缓降型和陡降型听力图占比增大。ABR潜伏期延长,波间期变化较小。Objective To report results of subjective and objective hearing examination in elderly patients(over 60 years old)with middle ear diseases.Methods Elderly patients with middle ear diseases(n=2,976,average age=67.65±6.04 years,60-70 years=2,241,71-80 years=609,>80 years=126)received pure tone audiometry(4,117 ears),acoustic immittance test(2,117 ears)and auditory brainstem response test(114 ears).Results related to different gender and age groups were compared.Results Normal hearing with air-bone gap was identified in 111 cases,mild hearing loss in 861 cases,moderate loss in 759 cases,moderate to severe loss in 624 cases,severe loss in 309 cases,profound loss in 117 cases,and complete loss in 52 cases.Hearing loss was unilateral in 143 cases.The main pattern of hearing loss were ascending and shallow descending with significantly different gender and age distributions(P<0.001).Tympanogram was type A in 449 ears(21%),Ad in 100 ears(5%),As in 69 ears(3%),B in 587 cases(28%),and C in 802 ears(38%),with significant differences in acoustic reflex detection with different tympanogram types(P<0.001).The detection rate of auditory brainstem response waves I,III and V was 60.53%,62.28%and 84.21%,with their average latencies at 1.69±0.2 ms,3.96±0.2 ms and 5.88±0.27 ms and I-III,III-V and I-V intervals being 2.26±0.14 ms,1.92±0.2 ms and 4.17±0.2ms,respectively.Conclusion In patients over 60 years of age with conduction deafness,air bone threshold gap was the largest at 250 and 4000 Hz,with air conduction thresholds showing most elevation in high frequency.With the increase of age,shallow and steep descending audiograms become more common,with prolonged ABR latencies but minimal change in inter-wave intervals.

关 键 词：老年聋 中耳疾病 听力学分析 

分 类 号：R764[医药卫生—耳鼻咽喉科]