不同病因致婴幼儿听力障碍的听力学分析

Application of Audiological Test Battery in Infants with Hearing Disorder

目的 探讨不同病因致婴幼儿听力障碍的特点及其鉴别诊断。方法 30例（60耳）正常听力婴幼儿为对照组，年龄6～24个月，行ABR、ASSR、视觉强化测听（vision reinforcement audiometry，VRA）和声导抗检查。20例（36耳）异常听力患儿（年龄6～24个月）根据其所患疾病分为3个组：Ⅰ组7例为围产期缺氧缺血，Ⅱ组7例为出生时核黄胆，Ⅲ组6例为出生时高胆红素血症，对各组患儿分别行畸变产物耳声发射（distortion-product otoacouslic emission，DPOAE）、耳蜗微音电位（CM）、ABR、ASSR、声导抗和VRA检查，并采用F检验进行数据统计学处理。结果①Ⅰ组所有病例DPOAE和CM存在、鼓室导抗图为A型，ABR异常，其中一部份患儿的Ⅲ-Ⅴ波间期延长，另外1例（2耳）ABR的波Ⅳ与波Ⅴ消失，各频率（0．25、0．5、1、2．4kHz）ASSR平均反应阈明显高于VRA平均阈值，其平均相关系数为r=0．41～0．65。②Ⅱ、Ⅲ组一部份患儿（7耳）CM存在，而DPOAE消失（Ⅱ组6耳、Ⅲ组1耳），ABR的波Ⅴ潜伏期和Ⅰ-Ⅲ波间期延长，其中Ⅱ组的ASSR反应阈较接近VRA阈值，其平均相关系数为r=0．92～0．97，而Ⅲ组两者平均阈值的相关系数为r=0．69～0．86。③3组各频率平均ASSR／VRA阈值差值的差异均有统计学意义。结论 不同病因致婴幼儿听力障碍的听力学检测结果不同，应综合分析，这对于采用何种干预方法以及预测干预效果都有非常重要的意义。

Objectivo To investigate the application of audiological test battery in infants with hearing problem. Mothods Thirty subjects （sixty ears） in control group were assessed with the test battery of ABR,ASSR,VRA and acoustic reflect thresholds. In view of the etiologies, 20 cases were classified into three groups： asphyxia （group Ⅰ）, jaundice（group Ⅱ）,and neonatal hyperbilimbinemia（group Ⅲ）. They were examined by the DPOAE, CM,ABR latency, ASSR,tympanometry and VRA. All data were statistically analyzed. Results For group Ⅰ, DPOAE and CM were present with type A in tympanogram. Some cases displayed delayed wave Ⅲ-Ⅴ peak latency while in one case （two ears） wave Ⅳ and Ⅴ were absent. Mean ASSR thresholds were elevate than the mean VRA thresholds at 0.25,0.5,1,2 and 4 kHz. The mean correlation coefflcient（r） ranges from 0.41 to 0. 65. For group Ⅱ and Ⅲ, some patients （7 ears） had CM clearly whereas DPOAE were absent. Wave V and Ⅰ-Ⅲ interpeak latencies were delayed. For group Ⅱ ASSR thresholds were close to that of VRA （ r = 0.92 - 0.97） and the correlation coefficient （r） ranges from 0.69 to 0.86 between group Ⅰ and group Ⅱ. In comparison, the mean threshold- differences between ASSR and VRA thresholds for groupsⅠ,Ⅱ, and Ⅲ= each frequency were significant （ P 〈 0.05, P 〈 0.01, P 〈 0.01, P 〈 0.05, P 〈 0. 05）. Conclusion The present audiological test battery can properly make differential diagnostic assessments of infant hearing disorders, such as auditory neuropathy and others. It is important to have a better understanding of those tests and their related functions and roles in standard clinic testing.