职业噪声暴露听力正常人耳蜗突触损伤的研究  

A Study on Cochlear Synaptic Damage in Normal Hearing Individuals Exposed to Occupational Noise

作　　者：王翩 毛杭泽 彭逹 郑书坤 赵乌兰[1] WANG Pian;MAO Hangzhe;PENG Da;ZHENG Shukun;ZHAO Wulan(Zhejiang Chinese Medical University,Hangzhou 310053,China)

机构地区：[1]浙江中医药大学,杭州310053

出　　处：《中华耳科学杂志》2024年第1期72-76,共5页Chinese Journal of Otology

基　　金：美国国立失聪和其他沟通障碍研究院项目(NIDCD/NIH,1R01DC015990-01);浙江中医药大学校级科研基金项目(2021ZZ05);浙江中医药大学横向课题项目(2018-HT-143)。

摘　　要：目的探究职业噪声暴露下的不同听力学检查方法,对发现常频听力正常人群耳蜗突触损伤的临床意义,为噪声性耳蜗突触病变的研究提供参考。方法选取2021年4月—2022年4月浙江中医药大学健康体检者104例(104耳)为研究对象,按照噪音强度分为接噪组和对照组,每组52例。接噪组接受高强度噪声暴露,对照组接受非噪声暴露,采用纯音测听、噪声下言语测听、畸变产物耳声发射、言语声诱发听性脑干反应4种听力学测试,分析两组各测试结果差异和测试间的相关性。结果对照组在9~16 kHz纯音听阈显著好于接噪组,差异有统计学意义(P<0.01);接噪组噪声下言语测听信噪比损失显著高于对照组,差异有统计学意义(P<0.05);两组畸变产物耳声发射在4~10 kHz比较,差异有统计学意义(P<0.05);两组言语诱发听性脑干反应V、A、O波潜伏期比较,差异有统计学意义(P<0.01),V/A斜率比较,差异有统计学意义(P<0.05)。对照组快速傅里叶变换F1幅值显著高于接噪组,差异有统计学意义(P<0.05);PTAEHF和D波潜伏期与DPmean呈负相关,除了E波其余各波潜伏期均与V/A斜率负相关。结论职业噪声暴露导致可能的耳蜗突触损伤表现为PTAEHF升高,畸变产物耳声发射信噪比下降,噪声下言语识别能力的下降和言语诱发听性脑干反应潜伏期的延迟,联合测试可以提高发现的准确性并及时干预。Objective To identify audiological assessment methods effective in detecting cochlear synaptic damage in normal hearing population exposed to occupational noise for further study of this condition.Methods Individuals undergoing routine health examination at the Zhejiang Traditional Chinese Medicine University from April 2021 to April 2022(n=104,104 ears)were recruited and grouped based on their noise exposure history,including among 52 factory workers exposed to high intensity noise(noise-exposed group)and 52 controls.Pure tone audiometry(PTA)thresholds,speech in noise(SIN),distortion product otoacoustic emissions(DPOAEs)and speech-evoked auditory brainstem responses(s-ABRs)were collected and compared between the two groups,and the correlation among the tests analyzed.Results PTA thresholds over 9-16 kHz were better in the control group than in the noise-exposed group(P<0.01).Signal/noise ratio loss in SIN was greater in the noise-exposed group than in the control group(P<0.05).DPOAE differences between the two groups were statistically significant for 4-10 kHz(P<0.05).Differences in latencies of s-ABR waves V,A and O(P<0.01),V/A slope(P<0.05),and F1 amplitude(P<0.05)were also statistically significant between the two groups.PTAEHF and D wave latency were negatively correlated with DPmean.Latencies of all waves,except wave E,were negatively correlated with V/A slope.Conclusion Potential cochlear synaptic damage caused by occupational noise exposure can be manifested as elevated PTAEHF,deteriorated SNR in DPOAEs,deteriorated SIN performance,and delayed s-ABR latencies.Multimodality assessment can improve the accuracy of detection for timely intervention.

关 键 词：耳蜗突触病 噪声暴露 畸变产物耳声发射 言语声诱发听性脑干反应 频率跟随反应 

分 类 号：R135[医药卫生—劳动卫生]