急性低频感音神经性聋听力学特征和诊断研究

发布时间：2018-06-27 12:23

  本文选题：感音神经性耳聋 + 低频　； 参考：《天津医科大学》2010年硕士论文

【摘要】： 目的 分析急性低频感音神经性聋(acute low-frequency sensorineural hearing loss, ALHL)的纯音听阈、声导抗测试、听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)和耳蜗电图(ECochG)的特征,探讨ALHL的临床表现及听力学特征,病因和发病机制及诊断方法,以期避免误诊,提高诊断率。 方法 选取2007年9月～2009年6月天津市第一中心医院耳鼻咽喉头颈外科门诊确诊为ALHL,且测试资料保存完整者46例(47耳),选取正常听力志愿者20例(40耳)为正常对照组,另选取Meniere病组8例(9耳)；听神经病(auditory neuropathy,AN)组7例(14耳)；感音神经性耳聋组18例,其中突发性聋6例(6耳),噪声性聋2例(4耳),药物中毒性聋2例(4耳),不明原因感音神经性聋8例(16耳),作为疾病对照组。对患者详细询问病史,进行仔细的耳科常规检查,常规行纯音听阈、声导抗、ABR、DPOAE、ECochG及CT和／或MRI检查,综合分析各项检查结果,总结ALHL的听力学特征。所得数据采用SPSS for Windows Ver16.0软件进行统计学分析。 结果 1.临床表现：本组46例(47耳)ALHL患者均为无明显诱因急性发病的低频感音神经性听力损失,男16例(34.78%),女30例(65.22%)；发病年龄16-59岁,平均(39.13±11.01)岁；单侧占97.83%(45／46),双侧占2.17%(1／46)。39耳(82.98%,39／47)伴低调耳鸣、耳部堵闷或胀满感。 2.听力学结果 2.1纯音听阈(pure tone threshold, PTT):本组ALHL 46例(47耳)PTT图呈以低频听阈升高为特征的上坡型图。0.125-1 kHz平均听阈为(35.00±8.30)dBHL,2～8kHz平均听阈为(13.62±3.53)dBHL。ALHL患耳与健耳之间、患耳与正常对照组之间在0.125 kHz、0.25 kHz、0.5 kHz及1 kHz处平均听阈差异有显著统计学意义(P0.01),在2kHz、4 kHz和8 kHz处平均听阈差异无统计学意义(P0.05)。 2.2声导抗：ALHL患耳鼓室压图均呈A型曲线,鼓室压和声顺值均在正常范围。在0.5kHz,镫骨肌声反射(acoustic stapedius reflex, AR)引出率为74.47%, Metz重振试验阳性率为65.96%。在1 kHz时,AR引出率为82.98%,Metz重振试验阳性率为14.89%。 2.3听性脑干反应(auditory brainstem response, ABR):ALHL组46例,均双耳受检,均可引出正常ABR波形,各波潜伏期及波间期均在正常范围。 2.4畸变产物耳声发射(distortion product otoacoustic emission, DPOAE):本组ALHL46例(47耳)DPOAE在0.553～1.105kHz的引出率为19.15%,在2.211～8.837kHz的引出率为90.23%。ALHL患耳(47耳)与正常对照组20例(40耳)的DP-gram幅值在0.553kHz、0.783kHz、1.105kHz和2.211kHz处差异有显著统计学意义(P0.01),在4.416kHz、6.250kHz和8.837kHz处差异无统计学意义(P0.05)。 2.5耳蜗电图(Electrocochleogram, ECochG):46例ALHL患者,-SP幅值分别为：患耳(0.50±0.41)μV,健耳(0.28±0.19)μV,其差异有统计学意义(P0.01);-SP/AP比值分别为：患耳0.40±0.17,健耳0.23±0.23,其差异有统计学意义(P0.01)。患耳(47耳)中-SP幅值和-SP/AP比值增大耳数分别24耳(51.06%,24／47)和30耳(63.83%,30／47)。患耳(47耳)与正常对照组(40耳)的-SP幅值和-SP/AP比值差异有显著统计学意义(P0.01)。 结论 1. ALHL急性发病,以单侧发病为主,常伴低调耳鸣、耳部堵闷及胀满感。多发病于中青年,女性多见。 2. ALHL鼓室压图均呈A型曲线,鼓室压和声顺值均在正常范围,AR大多可引出,表明中耳功能正常,ABR正常说明听觉神经传导径路正常。 3. ALHL患者PTT以低频听阈升高为特征,表明其病变仅局限于耳蜗顶周低频区,Metz重振试验阳性表明病变在耳蜗,0.553～1.105kHz DP-gram幅值降低,客观地显示出ALHL伴有耳蜗顶周处轻微的外毛细胞(outer hair cell, OHC)受损,近2／3的患者-SP幅值和-SP/AP比值大于正常人,表明耳蜗膜迷路积水。故ALHL是一种病变局限于耳蜗顶周的,以膜迷路积水为特征,具有一定临床特征的耳蜗疾病。 4. ALHL的诊断应该以低频(0.125～1 kHz) PTT平均阈值≥26 dB HL为依据,以提高ALHL的诊断率,避免漏诊。
[Abstract]:Purpose



The characteristics of pure tone threshold , acoustic immittance test , auditory brainstem response ( ABR ) , distortion product otoacoustic emission ( DPOAE ) , and cochlear electrogram ( EHCG ) in acute low - frequency sensorineural hearing loss ( ALHL ) were analyzed .



method



From September 2007 to June 2009 , the first central hospital in Tianjin was diagnosed as ALHL , and 46 cases ( 47 ears ) were kept intact , 20 cases ( 40 ears ) of normal hearing volunteers were selected as normal controls , and 8 cases ( 9 ears ) were selected .
The auditory neuropathy ( AN ) group was 7 cases ( 14 ears ) .
18 cases of sensorineural deafness group , 6 cases of sudden deafness ( 6 ears ) , 2 cases of sensorineural deafness ( 4 ears ) , 2 cases of sensorineural deafness ( 4 ears ) , 8 cases of unknown reason sensorineural deafness ( 16 ears ) , were used as the disease control group .



Results



1 . Clinical manifestations : 46 cases ( 47 ears ) of ALHL patients had low frequency sensorineural hearing loss , male 16 cases ( 34.78 % ) and female 30 cases ( 65.22 % ) .
The age of onset ranged from 16 to 59 years ( 39.13 卤 11.01 ) years .
The unilateral accounted for 97.83 % ( 45 / 46 ) , the double side accounts for 2 . 17 % ( 1 / 46 ) . 39 ( 82.98 % , 39 / 47 ) with low - tone tinnitus , and the ears were blocked or inflated .



2 . Listen to the mechanical results



The mean threshold of hearing threshold was ( 35.00 卤 8.30 ) dBHL , ( 13.62 卤 3.53 ) dBHL and ( 13.62 卤 3.53 ) dBHL . The mean threshold difference between the affected ear and the normal control group was 0 . 125 kHz , 0.25 kHz , 0.5 kHz and 1 kHz ( P0.01 ) . There was no statistical significance at 2 kHz , 4 kHz and 8 kHz ( P0.05 ) .



The positive rate of acoustic stapedius reflex ( AR ) was 74.47 % and the positive rate of Metz was 65.96 % . At 1 kHz , the positive rate of AR was 82.98 % , and the positive rate of Metz was 14.89 % .



2 . Auditory brainstem response ( ABR ) : 46 cases of ALHL group , both ears were subject to normal ABR , and the latency and interval of each wave were in the normal range .



2.4 Distortion product otoacoustic emission ( DPOAE ) : The lead - out rate of ALHL 46 cases ( 47 ears ) was 19.15 % at 0.553 锝，

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