纯音听阈正常的耳闷患者诱发性耳声发射分析

发布时间：2018-08-16 12:15

【摘要】： 目的感音神经性听力损失病程往往呈现不可逆的过程,听力损失一旦出现,很难恢复到发病前的状态。因此早期发现病变,争取在听力损失出现之前,早期诊断、早期干预就显得尤为重要。本课题正是本着这一目的,研究排除了外耳、中耳、面神经病变的纯音听阈正常的耳闷患者,探讨其是否存在耳声发射(OAE)的异常,以早期发现耳蜗病变。方法选取单纯以耳闷、耳胀满感或压迫感为临床主诉,无耳鸣、眩晕等伴随症状且排除了外耳、中耳及面神经疾患的纯音听阈正常的患者43例(72耳)为耳闷组,并选择与之年龄、性别分布相匹配的同期健康体检者30例(60耳)为对照组。采用丹麦Madsen公司生产的Capella耳声发射仪分别对两组进行瞬态声诱发性耳声发射(TEOAE)及畸变产物耳声发射(DPOAE)检测,记录各频率DPOAE的检出率、幅值,TEOAE的通过率、反应波信噪比、波形重复性及各频带反应波信噪比和重复性,并应用SPSS15.0统计软件进行统计分析。结果 1.耳闷组与对照组4-8 kHz各频率的DPOAE检出率均为100%,其余频率中在0.5 kHz、0.75 kHz、1.0 kHz三频率点上耳闷组的DPOAE检出率明显低于对照组,两组比较差异具有统计学意义(P0.05),其余各频率点差异均无统计学意义(P0.05)。 2.与对照组比较,耳闷组DPOAE幅值在0.5 kHz、0.75 kHz、1.0 kHz、1.5 kHz、2.0 kHz、3.0 kHz、4.0 kHz、6.0 kHz、8.0 kHz各测试频率点上均降低,两组比较差异具有统计学意义(P0.01)。 3.对照组60耳TEOAE通过率为100%(60/60),耳闷组72耳TEOAE通过率为90.28%(65/72),对两组TEOAE通过率进行x2检验,两组比较差异具有统计学意义(x2=6.16,P0.05)。 4.TEOAE反应波的总重复率及0.75～1.25kHz、1.25～1.75kHz、1.75～2.50kHz、2.50-3.50kHz、3.50-4.50kHz各频率带反应波的重复率比较,结果显示两组比较差异具有统计学意义(P0.05或P0.01),可以认为耳闷组TEOAE反应波的总重复率及0.75～1.25、1.25～1.75、1.75～2.50、2.50～3.50、3.50～4.50kHz各频率带反应波的重复率均低于对照组。 5.TEOAE反应波的总信噪比及0.75～1.25、1.25～1.75、1.75～2.50、2.50～3.50、3.50～4.50kHz各频率带反应波的信噪比比较,结果显示两组信噪比比较差异具有统计学意义(P0.01),可以认为耳闷组TEOAE反应波的总信噪比及0.75～1.25、1.25～1.75、1.75～2.50、2.50～3.50、3.50～4.50kHz各频率带反应波的信噪比均低于对照组。结论 1.纯音听阈正常的耳闷患者在临床上并不少见,并不能因为其纯音听阈测试正常就认定其听功能无异常。 2.本研究选取的纯音听阈正常的耳闷患者TEOAE通过率、重复率、信噪比以及DPOAE通过率及幅值均下降,说明部分纯音听阈正常的耳闷患者已存在着早期的耳蜗病变。OAE可在患者纯音听阈出现改变之前,早期发现此类病变。 3.对于这部分纯音听阈正常的耳闷患者,由于其还未出现听力损失,应把重点放在健康教育上,告诫其远离噪声、拒绝耳毒性药物,并注意睡眠,养成良好的作息习惯和生活习惯,并应长期随访,密切注意患者的听力状况。 4.OAE这一快速、无创、客观的听力学检查手段能够敏感地了解内耳外毛细胞的功能状态,尤其在早期发现耳蜗病变方面,其较纯音测听有更大的优势。
[Abstract]:objective
The course of sensorineural hearing loss is often irreversible. Once hearing loss occurs, it is difficult to recover to the state before the onset of the disease. Therefore, it is very important to detect the lesion early and strive for early diagnosis and early intervention before hearing loss. To investigate the presence of abnormal otoacoustic emissions (OAE) in patients with normal pure tone threshold for early detection of cochlear lesions.
Method
Forty-three patients (72 ears) with normal pure-tone hearing threshold without external ear, middle ear and facial nerve disorders were selected as the control group. Thirty healthy subjects (60 ears) matched with their age and sex distribution were selected as the control group. Capella Otoacoustic Emission Instrument produced by en company was used to detect transient acoustic evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) in both groups. The detection rate, amplitude, TEOAE throughput, signal-to-noise ratio (SNR), waveform repeatability and signal-to-noise ratio (SNR) and repeatability of each frequency band of DPOAE were recorded. Statistical analysis was performed.
Result
1. The detection rate of DPOAE was 100% in the ear stuffy group and the control group at 4-8 kHz. The other frequencies were 0.5 kHz, 0.75 kHz and 1.0 kHz. The detection rate of DPOAE in the ear stuffy group was significantly lower than that in the control group. The difference between the two groups was statistically significant (P 0.05).
2. Compared with the control group, DPOAE amplitude in the auricular stuffy group decreased at 0.5 kHz, 0.75 kHz, 1.0 kHz, 1.5 kHz, 2.0 kHz, 3.0 kHz, 4.0 kHz, 6.0 kHz, 8.0 kHz, and the difference between the two groups was statistically significant (P 0.01).
3. The TEOAE passing rate of 60 ears in the control group was 100% (60/60) and that of 72 ears in the auricular distress group was 90.28% (65/72). The passing rate of TEOAE in the two groups was tested by x2 test. The difference between the two groups was statistically significant (x2 = 6.16, P 0.05).
4. The total repetition rate of TEOAE response wave and the repetition rate of each frequency band were 0.75-1.25 kHz, 1.25-1.75 kHz, 1.75-2.50 kHz, 2.50-3.50 kHz, 3.50-4.50 kHz. The results showed that there was significant difference between the two groups (P 0.05 or P 0.01). The total repetition rate of TEOAE response wave in the ear stuffy group was 0.75-1.25, 1.25-1.75, 1.75-2.50 kHz. The repetition rates of the response bands in the frequency bands from 2.50 to 3.50,3.50 to 4.50kHz were all lower than those in the control group.
5. The total signal-to-noise ratio of TEOAE response wave and the signal-to-noise ratio of each frequency band from 0.75 to 1.25, 1.25 to 1.75, 1.75 to 2.50, 2.50 to 3.50, 3.50 to 4.50 kHz showed significant difference between the two groups (P 0.01). It can be considered that the total signal-to-noise ratio of TEOAE response wave and the total signal-to-noise ratio of the ear-tightness group were 0.75 to 1.25, 1.25 to 1.75, 1.75, 1.75 to 2.50, 2.50 and 2.50 kHz respectively. The signal-to-noise ratios of the response bands in the frequency bands from 3.50,3.50 to 4.50kHz were lower than those in the control group.
conclusion
1. The patients with normal pure tone threshold are not uncommon in clinic, and their hearing function can not be judged as normal because of the normal pure tone threshold test.
2. The TEOAE pass rate, repetition rate, signal-to-noise ratio and DPOAE pass rate and amplitude of the patients with normal pure-tone hearing threshold decreased, indicating that some patients with normal pure-tone hearing threshold had early cochlear lesions. OAE can detect these lesions before the change of pure-tone hearing threshold.
3. For these patients with normal pure tone hearing threshold, the emphasis should be put on health education, warning them to stay away from noise, refuse ototoxic drugs, pay attention to sleep, develop good habits and living habits, and should be followed up for a long time, pay close attention to the patient's hearing status.
4. OAE, a fast, noninvasive and objective audiometric method, can sensitively understand the functional status of inner and outer hair cells, especially in early detection of cochlear lesions, it has greater advantages than pure tone audiometry.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764.04

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