听性稳态反应不同调频深度对婴幼儿听力检测结果的影响

发布时间：2018-06-13 22:52

本文选题：听性稳态反应 + 参数　；参考：《复旦大学》2010年硕士论文

【摘要】：目的通过对正常及感音神经性听力障碍婴幼儿不同调制方法的听性稳态反应(auditory steady-state responses, ASSR)检测结果的比较,找到最接近婴幼儿行为听阈的ASSR调制方法,以便为听力障碍婴幼儿提供更为可靠的听力学评估,有效地指导诊断和治疗。方法受试者为2009年1月至8月在上海市儿童听力障碍诊治中心进行听力检测的听力正常婴幼儿75名和感音神经性听力障碍婴幼儿60名,月龄为6-36月。所有正常婴幼儿均接受视觉强化测听(visual reinforcement audiometry, VRA)和一种参数设置下的ASSR检测。将ASSR设定三种参数设置方法：调制Ⅰ为单纯调幅调制(amplitude modulation, AM),调幅深度100%；调制Ⅱ为调幅深度100%、调频(frequency modulation, FM)深度10%；调制Ⅲ为调幅深度100%、调频深度15%。受试婴幼儿按随机双盲对照原则进行上述三种调制方法之一的ASSR检测,从而分为Ⅰ(15名,25耳)、Ⅱ(30名,52耳)、Ⅲ(30名,50耳)组。两两比较三组ASSR和VRA阈值之差,明确最接近行为听阈的参数设置方法。感音神经性听力障碍婴幼儿均接受听性脑干反应(auditory brainstem response,ABR)、调制Ⅱ及调制Ⅲ的ASSR检测,以ABR阈值为标准分为轻度(12名,20耳)、中～中重度(18名,30耳)、重度～极重度(30名,56耳)听力障碍三组。分别比较每组婴幼儿调制Ⅱ及调制Ⅲ的ASSR I阂值,明确适合不同程度听力障碍婴幼儿ASSR检测的参数设置方法。结果 1.三组正常听力婴幼儿VRA听阈无差异,具有可比性。三种不同调制方法的ASSR与VRA阈值均有差异,但混合调制ASSR (调制Ⅱ和Ⅲ)与VRA差异较单纯调幅调制(调制Ⅰ)为小。 2.通过方差分析比较三组ASSR阈值,得到三组ASSR 250、500、1000、2000、4000Hz载频的阈值均有统计学差异(F=10.56、16.26、18.99、11.64、9.41,P0.05)。 3.将三组ASSR与VRA阈值分别通过Spearman等级相关分析,得到组I ASSR250-4000Hz载频阈值与相应的VRA阈值相关系数r分别为0.53、0.62、0.59、0.70、0.59,组Ⅱ分别为0.76、0.65、0.65、0.62、0.69,组Ⅲ分别为0.85、0.78、0.75、0.72、0.70；所有rr.005(v)(P0.05),均与行为听阈显著相关,组Ⅲ各相关系数更大。 4.对三组正常听力婴幼儿两两比较ASSR和VRA阈值之差,可见调制Ⅰ的ASSR各载频阈值与VRA之差均明显高于调制Ⅱ及调制Ⅲ与VRA的差值,差异有统计学意义(P0.05)。调制Ⅱ和Ⅲ所得阈值在250、500、1000 Hz载波频率差异明显(P0.05),2000、4000Hz差异不明显(P=0.215,0.058)。 5.比较不同程度感音神经性听力障碍婴幼儿调制Ⅱ及调制Ⅲ的ASSR阈值,可见轻度及中～中重度听力障碍组250、500、1000Hz ASSR阈值受调频深度影响明显(P=0.000,差异有统计学意义),2000及4000Hz阈值受调频深度影响不明显(P=0.056、0.090、0.297、0.339,差异无统计学意义),但调频深度为15%(调制Ⅲ)的ASSR各载频阈值均低于调频深度为10%(调制Ⅱ)的ASSR阈值。 6.重～极重度听力障碍婴幼儿250-4000HzASSR阈值均不受调频深度改变的影响(P=0.422、0.501、0.749、0.888、0.496,差异无统计学意义) 结论 1.在正常听力婴幼儿中,ASSR混合调制所得听阈低于单纯调幅调制的听阈,适当增加混合调制中的调频深度所得听阈有下降,以低频(250、500、1000Hz)影响更明显,更适合婴幼儿ASSR检测。 2.对轻度及中～中重度听力障碍婴幼儿来说,可以采用增加混合调制中调频深度的调制方法行ASSR检测,以降低ASSR阈值,更接近行为听阂。 3.重～极重度听力障碍婴幼儿各载频ASSR阂值均不受一定程度调频深度改变的影响,可以采用系统默认调制方法以节约检测时间。
[Abstract]:objective
By comparing the results of auditory steady-state response (auditory steady-state responses, ASSR) of different modulation methods for infants with normal and sensorineural hearing impairment, we find the ASSR modulation method closest to the infant behavior hearing threshold so as to provide more reliable audiological assessment for hearing impaired infants and to guide the diagnosis effectively. And treatment.
Method
From January 2009 to August, 75 hearing normal infants and 60 children with sensorineural hearing impairment were tested for hearing impairment center in Shanghai from January 2009 to August, and the month was 6-36 months.
All normal infants receive visual intensive audiometry (visual reinforcement audiometry, VRA) and a ASSR test under a parameter setting. ASSR set three parameter setting methods: modulation I is pure amplitude modulation (amplitude modulation, AM), amplitude modulation depth 100%; modulation II is amplitude modulation depth 100%, frequency modulation (frequency modulation, F) M) depth 10%; modulation III was 100% of amplitude modulation depth, and FM depth 15%. was tested by ASSR for one of the three modulation methods according to random double blind control principle, which was divided into 1 (15, 25 ears), II (30, 52 ears), III (30, 50 ears). 22 compared to the difference between the three group and VRA threshold, the parameters closest to the behavioral hearing threshold were defined. Set the method.
Children with sensorineural hearing impairment received auditory brainstem response (auditory brainstem response, ABR), modulation II and modulation III ASSR detection. The ABR threshold was divided into mild (12, 20 ears), medium to moderate to severe (18, 30 ears), severe severe severe (30, 56 ears) hearing impairment in three groups of infants in each group. Modulate the ASSR I threshold of III, and define the parameter setting method suitable for ASSR detection of infants with different degree of hearing impairment.
Result
1. the three groups of normal hearing children have no difference in VRA hearing threshold. The ASSR and VRA thresholds of three different modulation methods are different, but the difference of mixed modulation ASSR (modulation II and III) and VRA is smaller than that of pure amplitude modulation (modulation I).
2. compared the three groups of ASSR threshold by analysis of variance analysis, the threshold of three groups of ASSR 250500100020004000Hz carrier frequency was statistically different (F=10.56,16.26,18.99,11.64,9.41, P0.05).
3. the three groups of ASSR and VRA thresholds were analyzed by Spearman level correlation, and the group I ASSR250-4000Hz carrier frequency threshold and the corresponding VRA threshold correlation coefficient r were 0.53,0.62,0.59,0.70,0.59, group II was 0.76,0.65,0.65,0.62,0.69 and group III was 0.85,0.78,0.75,0.72,0.70 respectively, and all rr.005 (V) were all with behavioral hearing threshold. The correlation coefficient of group III is greater.
4. to three groups of normal hearing children 22 comparison of the difference of ASSR and VRA threshold, it can be seen that the difference of ASSR carrier frequency threshold and VRA of modulation I is significantly higher than modulation II and modulation III and VRA, the difference is statistically significant (P0.05). Modulation II and III threshold in 2505001000 Hz carrier frequency difference is obvious (P0.05), 20004000Hz difference is not It is obvious (P=0.215,0.058).
5. comparing the ASSR threshold of modulation II and modulation III in infants with different degree of sensorineural hearing impairment, the 2505001000Hz ASSR threshold in the mild and medium to moderate severe hearing impairment group was significantly affected by the frequency of frequency modulation (P=0.000, the difference was statistically significant), and the 2000 and 4000Hz threshold were not significantly affected by the frequency of frequency modulation (P=0.056,0.090,0.297,0.339, The difference is not statistically significant. However, the carrier frequency thresholds of ASSR with modulation depth of 15% (modulation III) are lower than those of ASSR with modulation depth of 10% (modulation II).
The 250-4000HzASSR threshold of 6. severe severe hearing impaired infants was not affected by the change of FM depth (P=0.422,0.501,0.749,0.888,0.496, the difference was not statistically significant).
conclusion
1. in normal hearing children, the hearing threshold of ASSR mixed modulation is lower than that of simple amplitude modulation, and the hearing threshold of the mixed modulation is decreased, the influence of low frequency (2505001000Hz) is more obvious, and it is more suitable for infant ASSR detection.
2. for infants with moderate to moderate to moderate to moderate to severe hearing loss, ASSR detection can be used to increase the modulation depth of mixed modulation in order to reduce the ASSR threshold and closer to the behavioral hearing gap.
The carrier frequency ASSR threshold of 3. severe hearing impaired infants is not affected by a certain degree of frequency modulation, and the system default modulation method can be used to save detection time.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.04

【参考文献】