低频波动性听力损失自我检测软件与低压舱治疗的研发和临床应用研究

发布时间：2018-02-06 07:27

本文关键词： 纯音测听听力监测低频波动性感音神经性听力损失低压舱　出处：《中国人民解放军医学院》2015年博士论文　论文类型：学位论文

【摘要】：背景和目的：听力损失是威胁人类健康的最常见疾病之一,是世界性的公共卫生问题。2006年全国第二次残疾人口调查显示,听力言语残疾超过2780万,占残疾人总数的33%,高居各类残疾首位。低频波动性感音神经性听力损失表现为低频听力下降,伴耳闷、耳鸣、眩晕、站立不稳等,是一种内耳性疾病,患者常有听力反复波动主诉,而现有的临床检测手段只能通过患者的主观感受描述和纯音测听结果提供该病的诊断信息,受制于专业的测听隔声室和测听设备。开发一种便携式听力自我检测系统,有利于实时监测听力损失变化,及时准确临床预警,以助于科学临床诊断和诊治。本文研究一在于开发和评估一种新型听力自我检测系统,用以听力损失患者听力自我监测。应用低压舱治疗多种疾病由来已久,特别是文献报道应用低压舱治疗梅尼埃病可能有效,说明压力变化可能对于内耳性疾病产生作用。临床发现一些随访时间较长的低频波动性感音神经性听力损失患者最后发展为梅尼埃病,因此推测低频波动性感音神经性听力损失可能是非典型梅尼埃病的早期阶段。现在普遍认为二者具有共同的内淋巴积水的病理基础,据此,低压舱治疗梅尼埃病的成功经验为内耳性疾病的内科治疗提供了重要的参考和思路。本文研究二在于初步建立低压舱规范治疗方案,并研究低频感音神经性听力损失患者应用低压舱治疗的临床效果。方法：研究一：由笔记本电脑、声卡、耳机以及自制音频转换器组成，，使用Microsoft Office Visio软件编程,建立起便携式听力自我检测系统。系统建立后,先后进行小样本预实验和3次评估实验。实验1为37名(74耳)听力正常人,实验2为40名(80耳)感音神经性听力损失患者,实验3为13名(26耳)听力正常人和37名(74耳)感音神经性听力损失患者,分别进行1次测听室内的纯音测听和2次听力自我检测系统的测试,以测听室内的纯音测听结果为“金标准”,对比250Hz-8000Hz纯音测听与系统自测的听阈,分析听力自我检测系统的准确性和可靠性。研究二：记录飞机起降机舱内压力变化参数。采用低压舱模拟飞机起降对7名正常志愿者影响。应用4个不同低压舱方案治疗低频波动性听力损失志愿者,制定最佳低压舱治疗方案。对20例低频波动感音神经性听力损失患者应用最佳低压舱治疗方案进行治疗,对比分析治疗前后患者纯音测听结果及耳闷堵、耳鸣、颅鸣主观症状程度变化。结果：研究一：建立便携式听力自我检测系统。实验1配对t检验显示,双耳250Hz、 500Hz、8000Hz处自测与纯音测听结果偏差无统计学意义(P0.05),双耳1000Hz、 2000Hz、4000Hz处自测与纯音测听结果有偏差(P0.05)。实验2配对t检验显示，双耳250Hz、500Hz、8000Hz、右耳1000Hz处自测与纯音测听结果偏差无统计学意义(P0.05),左耳1000Hz、双耳2000Hz、4000Hz处自测与纯音测听结果有偏差(P0.05)。实验3在双耳250Hz-8000Hz各频率处2次自测与纯音测听结果之间,One-way ANOVA显示无统计学差异(P0.05),Post-Hoc两两比较显示无统计学差异(P0.05),相关分析结果显示二者具有较高相关性(R0.6,P0.001),100耳中系统灵敏度为97.6%,特异度为98.3%,感音神经性听力损失74耳中系统灵敏度为97.6%,特异度为97%,一致性检验Kappa=0.848 (P0.001)。研究二：起飞约20分钟机舱压力减压到约80kPa,下降约30分钟恢复到正常大气压水平。正常志愿者5例无耳部不适,2例增压期出现耳痛,自行缓解。研究制定的最佳低压舱治疗方案是：以3m/s的速度从正常大气压降至78.6kPa,相当于2.2km海拔气压水平,稳压5min,然后以1m/s的速度增压至89.6kPa,相当于1.1km海拔气压水平,接着再以3m/s速度减压至78.6kPa,稳压5min,继续以1m/s速度增压至89.6kPa,接着还以3m/s速度减压至78.6kPa,稳压5min后,以1m/s的速度恢复至正常大气压。患者在95.1kPa以下,即相当于550m海拔以上气压水平鼻吸管持续吸氧2.5L/min。治疗每日1次,一疗程5次。轻度听力损失需1个疗程,中度听力损失一般需2个疗程,疗程间隔2d。20例患者全身状态良好,无不良反应。听力损失痊愈7例,显效4例,有效1例,无效8例,总有效率为60%。轻度和中度听力损失两组患者听力疗效之间的差别有统计学意义(P0.05)。耳闷堵感痊愈17例,显效0例,有效2例,无效1例,总有效率为95%。耳鸣痊愈7例,显效0例,有效5例,无效8例,总有效率为60%。颅鸣共2例,无效。随访4-6个月,1例治疗有效患者因上呼吸道感染复发耳闷堵感,重复低压舱治疗效果有效。结论：便携式听力自我检测系统自测结果与纯音测听各频率线性相关,二者具有较好的诊断一致性。应用低压舱治疗低频波动性感音神经性听力损失具有较好疗效,尤其是可显著改善患者的耳闷堵感,因其属于无创性治疗方法,所以更具有重要的临床应用价值。
[Abstract]:Background and objective: hearing loss is one of the most common diseases threatening human health, is to show the.2006 public health problem in the world in the second national survey of disabled population, more than 27 million 800 thousand hearing disability, disabled persons accounted for 33% of the total, the highest in all kinds of disabilities. Low frequency sensorineural hearing loss showed low-frequency hearing loss. With aural fullness, tinnitus, vertigo, standing instability, is a kind of inner ear disease, patients often complained of hearing repeated fluctuations, but only clinical existing detection methods through the subjective experience of patients with pure tone audiometry describe and provide diagnostic information of the disease, subject to professional audiometry and sound insulation room test listen to the equipment. Self detection system to develop a portable listening, is conducive to real-time monitoring the changes of hearing loss, timely and accurate early warning, in order to help the clinical diagnosis and treatment of this study is a science. The development and evaluation of self detection system for a new hearing, for patients with hearing loss hearing. Self monitoring application Hypobaric Treatment of many diseases especially long-standing, reported application of hypobaric chamber may be an effective treatment of Meynier's disease, which shows that the pressure changes may have a role in inner ear disease. The clinical findings of some longer follow-up time low frequency sensorineural nerve hearing loss patients developed Meynier's disease, suggesting that low frequency sensorineural hearing loss may be atypical in early stage of Meynier's disease. It is generally believed that the pathological basis, the two have common endolymphatic hydrops which provides an important reference and thinking of medical treatment experience for the treatment of Meynier's disease in hypobaric chamber inner ear disease. This study is to establish two hypobaric standard treatment, and study of low frequency sensorineural The clinical effect of patients with sensorineural hearing loss. Methods: Hypobaric Treatment: a study by the notebook computer, sound card, headset and homemade audio converter, using Microsoft Office Visio software, establish self detection system for portable listening. After the establishment of the system, has small sample pre experiment and 3 assessment experiments. Experiment 1 37 (74 ears) with normal hearing, experiment 2, 40 (80 ears) with sensorineural hearing loss patients, Experiment 3 was 13 (26 ears) with normal hearing people and 37 patients (74 ears) with sensorineural hearing loss patients were 1 times of pure tone audiometry room audiometry and 2 listening self detection system to measure indoor test, listen to the pure tone audiometry as a "gold standard", compared with the 250Hz-8000Hz system and the self testing of pure tone audiometry threshold, analysis of listening self detection system. The accuracy and reliability of the research: two records Aircraft cabin pressure change parameters. Using low pressure chamber simulation of the effects of aircraft movements in 7 normal volunteers. The application of 4 different hypobaric regimen in the treatment of low frequency fluctuation of hearing loss to volunteers, develop the best treatment options. Hypobaric Treatment of 20 patients with low frequency sensorineural hearing loss in patients with the best hypobaric treatment. Comparative analysis of patients before and after treatment with the results of pure tone audiometry and ear stuffy, tinnitus, cranial tinnitus changes in subjective symptoms. Results: the establishment of self detection system for portable listening. Experiment 1 paired t test showed that 250Hz, 500Hz, 8000Hz ears, self testing and the results of pure tone audiometry deviation was not statistically significant (P0.05), ears 1000Hz, 2000Hz, 4000Hz self testing and pure tone test deviation to the results (P0.05). Experiment 2 paired t test showed that 250Hz, 500Hz, 8000Hz, ears, ear 1000Hz self testing with pure tone audiometry. If the deviation was not statistically significant (P0.05), 1000Hz, left ear dichotic 2000Hz, 4000Hz self testing and pure tone test bias to the results (P0.05). In Experiment 3 250Hz-8000Hz between the ears at each frequency 2 times of self testing and the results of pure tone audiometry, One-way ANOVA showed no significant difference (P0.05), Post-Hoc 22 showed no statistical comparison the difference (P0.05), correlation analysis showed that the two have high correlation (R0.6, P0.001). The sensitivity of the system in 100 ears of 97.6%, a specificity of 98.3%, sensitivity of sensorineural hearing loss in 74 ears was 97.6%, the specificity was 97%, the consistency test of Kappa=0.848 (P0.001). Study two: take off about 20 minutes into the vacuum cabin pressure is about 80kPa, decreased by about 30 minutes to return to normal atmospheric pressure. The level of normal volunteers and 5 patients without ear discomfort, 2 cases of pressurization period earache, relieved. The study made the best treatment in hypobaric chamber is: 3 The speed of m/s from normal atmospheric pressure to 78.6kPa, equivalent to 2.2km above sea level pressure level, the regulator 5min, then with 1m/s speed boost to 89.6kPa, equivalent to 1.1km above sea level pressure level, then at the speed of 3m/s decompression to 78.6kPa, 1m/s speed regulator 5min, continue to boost to 89.6kPa, and then at the speed of 3m/s decompression to 78.6kPa 5min, voltage regulator, recovery at a speed of 1m/s to normal atmospheric pressure. The patients in the following 95.1kPa, which is equivalent to 550m above pressure level Straw nasal oxygen 2.5L/min. treatment 1 times a day, a course of 5 times. Mild hearing loss take 1 courses, moderate hearing loss usually takes 2 course of treatment, treatment interval of 2d.20 cases with the body in good condition, no adverse reactions. Hearing loss, 7 cases were cured, 4 cases were cured, 1 cases effective, 8 cases ineffective, the total effective rate was 60%. between mild and moderate hearing loss in two groups of patients with hearing results had statistic difference Meaning (P0.05). The ear stuffy feeling 17 cases were cured, 0 cases markedly effective, 2 cases effective, 1 cases ineffective, the total effective rate was 95%. tinnitus 7 cases were cured, 0 cases markedly effective, 5 cases effective, 8 cases ineffective, the total effective rate was 60%., a total of 2 cases of skull, 4-6 months of follow-up is invalid. In 1 cases, effective treatment for patients with ear stuffy sense of recurrent upper respiratory tract infection, repeated Hypobaric Treatment. Conclusion: portable self hearing detection system self testing results and pure tone audiometry each frequency linear correlation, the two have good consistency diagnosis. The application of Hypobaric Treatment failure has good curative effect low frequency sensorineural nerve hearing loss, especially can significantly improve the patient's ear stuffy feeling, because it is noninvasive treatment method, so it has important value in clinical application.

【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R764.43

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