儿童单侧听神经病的识别  

Recognition of unilateral auditory neuropathy in children

作　　者：李颖[1] 林智涵 王雪瑶 杨扬[1] 张晓 周怡[1] 金欣[1] 郑之芃 史吉峰 王雪彤 白杰 郭丽宁 刘海红[1] Li Ying;Lin Zhihan;Wang Xueyao;Yang Yang;Zhang Xiao;Zhou Yi;Jin Xin;Zheng Zhipeng;Shi Jifeng;Wang Xuetong;Bai Jie;Guo Lining;Liu Haihong(Department of Otorhinolaryngology Head and Neck Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing Key Laboratory for Pediatric Diseases of Otolarynology Head and Neck Surgery,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院耳鼻咽喉头颈外科、儿童耳鼻咽喉头颈外科疾病北京市重点实验室,北京100045

出　　处：《中华耳鼻咽喉头颈外科杂志》2024年第5期447-454,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市自然科学基金(7232059);北京市科技新星计划交叉合作课题(20220484211);高层次公共卫生技术人才建设专项(2022-3-016);首都卫生科研专项(2022-1-2023)。

摘　　要：目的:对比分析单侧听神经病(unilateral auditory neuropathy,UAN)与单侧聋(single-sided deafness,SSD)患儿听力学评估结果,获得UAN临床听力学特征,为儿童UAN的鉴别诊断提供有效依据。方法:回顾性分析2015年5月至2023年6月于首都医科大学附属北京儿童医院就诊的UAN和SSD患儿的听力学及影像学评估结果。UAN患儿共17例,其中男10例、女7例,平均年龄4.7岁;SSD患儿共43例,其中男27例、女16例,平均年龄6.5岁。听力学评估包括听性脑干反应(ABR)、听觉稳态反应(ASSR)、行为测听、耳蜗微音器电位(CM)、畸变耳声发射(DPOAE)和声导抗测试。应用SPSS 27.0统计软件分析两组儿童听力学检测结果及影像学表型差异。结果:①UAN组和SSD组患儿ABR波ⅢL的出现率分别为77.8%和20.9%,组间差异有统计学意义(χ^(2)=8.780,P=0.003)。SSD组250~8000 Hz行为测听阈值均高于UAN组,且500、1000 Hz处差异有统计学意义(P值均<0.05);SSD组500~4000 Hz ASSR阈值均高于UAN组,差异均有统计学意义(P值均<0.05)。②UAN组与SSD组听力损失程度分级均以完全性听力损失为主,SSD组完全性听力损失占比(93.0%,40/43)显著高于UAN组占比(63.6%,7/11),差异有统计学意义(χ^(2)=4.353,P=0.037);UAN组极重度听力损失占比(27.3%,3/11)显著高于SSD组占比(2.3%,1/43)差异有统计学意义(P=0.023)。听力曲线构型方面,UAN组平坦型占比36.4%(4/11)、上升型占比27.3%(3/11)、下降型占比18.2%(2/11)、其他型占比18.2%(2/11),SSD组平坦型占比76.7%(33/43)、下降型占比18.6%(8/43)、上升型占比2.3%(1/43)、其他型占比2.3%(1/43);其中SSD组平坦型占比显著高于UAN组,UAN组上升型占比显著高于SSD组,差异均具有统计学意义(P值均<0.05)。③UAN组影像学评估正常者占比为81.8%(9/11),显著高于SSD组(37.1%,13/35),差异有统计学意义(χ^(2)=6.695,P=0.015)。结论:UAN与SSD患儿在听力学及影像学特征上存在明显差异:UAN患儿ABR波ⅢL出现率显著�Objective This study aimed to compare the audiological characteristics between children with unilateral auditory neuropathy(UAN)and single-sided deafness(SSD)to establish a valid basis for the differential diagnosis of children with UAN.Methods A retrospective analysis was conducted on audiological and imaging evaluations of children with UAN and SSD who were treated at Beijing Children′s Hospital of Capital Medical University between May 2015 and June 2023.There were 17 children with UAN,comprising 10 males and 7 females,with an average age of 4.7 years.Additionally,there were 43 children with SSD,consisting of 27 males and 16 females,with an average age of 6.5 years.Audiological assessments included Auditory brainstem response(ABR),Steady-state auditory evoked potential(ASSR),Behavioural audiometry,Cochlear microphonic potential(CM),Distortino-product otoacoustic emission(DPOAE),and acoustic immittance test.The results of the audiological assessment and imaging phenotypic between the two groups of children were compared and analyzed by applying SPSS 27.0 statistical software.Results(1)The UAN group(77.8%)had a significantly higher rate of ABR wave IIIL than the SSD group(20.9%)(P<0.01).The PA thresholds at 500 Hz and 1000 Hz of children with SSD were higher than those of children with UAN,while the ASSR thresholds at 500 Hz,1000 Hz,2000 Hz,and 4000 Hz of children with SSD were significantly higher than those of children with UAN(P<0.05).(2)The degree of hearing loss in both UAN and SSD children was predominantly complete hearing loss.The percentage of complete hearing loss was significantly higher(χ²=4.353,P=0.037)in the SSD group(93.0%,40/43)than in the UAN group(63.6%,7/11).However,the percentage of profound hearing loss was significantly higher in the UAN group(27.3%,3/11)than in the SSD group(2.3%,1/43)(Fisher′s exact test,P=0.023).In terms of hearing curve configuration,the percentage of flat type was significantly higher in the SSD group(76.7%,33/43)than in the UAN group(36.4%,4/11).The proportion o

关 键 词：听觉丧失 感音神经性 单侧听神经病 单侧聋 听力检查 儿童 

分 类 号：R764[医药卫生—耳鼻咽喉科]