多种听力学检测方法在未引出听性脑干反应患儿诊断中的价值  

The Value of Various Audiometric Testing Methods in the Diagnosis of Children with Non Elicited Auditory Brainstem Response

作　　者：彭丹丹[1] 张金慧[1] 李晓华[1] 叶放蕾[1] Peng Dandan;Zhang Jinhui;Li Xiaohua;Ye Fanglei(Department of Otology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院耳科,郑州450052

出　　处：《听力学及言语疾病杂志》2024年第3期245-248,共4页Journal of Audiology and Speech Pathology

基　　金：国家自然科学基金(81700905)。

摘　　要：目的探讨多种听力学检测方法在听性脑干反应(ABR)最大输出未引出患儿的听力学诊断中的应用价值。方法回顾性分析69例(138耳)ABR最大强度未引出患儿的临床资料,年龄42天到5岁,平均1岁6个月,鼓室导抗图均为A型或正向单峰,声反射均未引出,影像学检查内耳无畸形。69例患儿均进行ABR、耳蜗微音电位(CM)、畸变产物耳声发射(DPOAE)和听性稳态反应(ASSR)测试。结果69例138耳中,8例16耳(11.59%)记录到CM,其中10耳(7.25%)记录到DPOAE,0.5、1、2、4 kHz ASSR反应阈值分别为83.2±13.1、82.9±13.0、75.3±12.4、63.1±9.1 dB nHL,结合其他检查结果诊断为听神经病。余61例(122耳)CM和DPOAE均未引出,0.5、1、2、4 kHz的ASSR引出率分别为82.3%、81.9%、76.9%、60.2%,其中20耳ASSR各频率均未引出,102耳至少一个频率引出,0.5、1、2、4 kHz ASSR反应阈分别为93.2±6.1、99.8±7.0、105.4±5.4、108.2±9.8 dB nHL,诊断为极重度感音神经性聋。结论对于ABR最大输出强度未引出的患儿,CM和/或DPOAE引出且ASSR各频率反应阈低于感音神经性聋患儿,有助于听神经病的诊断;CM和DPOAE均未引出有助于极重度感音神经性聋的诊断,ASSR测试有助于评估其残余听力。Objective To investigate the application value of multiple audiological testing methods in the audiological diagnosis of children with no response at maximum output intensity of auditory brainstem response(ABR).Methods We retrospectively studied the clinical data of 69 cases(138 ears)of children with no ABR response with maximum intensity,aged 42 days to 5 years old,with an average of 1 year and 6 months.The tympanogram showed type-A or positive single peak,and acoustic reflex was absent.Imaging examination showed no malformation of the inner ear.All 69 children underwent ABR,cochlear microphonic potential(CM),distortion product otoacoustic emissions(DPOAE),and auditory steady-state response(ASSR)tests.Results Among 69 cases(138 ears),8 cases(11.59%)recorded CM in 16 ears,of which 10 ears(7.25%)recorded DPOAE.The ASSR response thresholds at 0.5,1,2,and 4 kHz were 83.2±13.1,82.9±13.0,75.3±12.4,and 63.1±9.1 dB nHL,respectively.Combined with other examination results,these subjects were diagnosed with auditory neuropathy.The CM and DPOAE responses of the remaining 61 cases(122 ears)were absent,and the extraction rates of ASSR at 0.5,1,2,and 4 kHz were 82.3%,81.9%,76.9%,and 60.2%,respectively.Among them,20 ears of ASSR were absent at all frequencies,and 102 ears had responses in at least one frequency.The response thresholds of ASSR at 0.5,1,2,and 4 kHz were 93.2±6.1,99.8±7.0,105.4±5.4,108.2±9.8 dB nHL,respectively.These subjects were diagnosed with profound sensorineural hearing loss.Conclusion For children with no ABR response at maximum output intensity,while CM and/or DPOAE responses are present and ASSR frequency response thresholds are lower than those with sensorineural hearing loss are helpful in the diagnosis of auditory neuropathy.Neither CM nor DPOAE response is helpful in the diagnosis of profound sensorineural hearing loss,and ASSR testing is helpful in evaluating residual hearing.

关 键 词：听性脑干反应 耳蜗微音电位 畸变产物耳声发射 听性稳态反应 残余听力 

分 类 号：R764.04[医药卫生—耳鼻咽喉科]