声导抗与纯音听阈测试在伪聋鉴别诊断中的作用

The application of acoustic immitance and pure tone audiometry in simulated deafness

目的:探讨声导抗与纯音听阈测试在伪聋检查诊断中的作用。方法:采用声导抗测试与纯音听阈测试并辅以心理疏导方法,以自身对侧耳和正常人耳(20例40耳)作对照,对389例外伤后主诉单耳听力损失者进行检查诊断。结果:本组病例中对侧耳纯音听阈各倍频率听阈≤20dBHL,声导抗检查正常。9耳纯音听阈各倍频为30～40dBHL,声导抗示:B型鼓室图,耳咽管闭塞,鼓膜静态声顺值<0.3ml,镫骨肌反射消失,后经鼓膜穿刺抽液确诊为分泌性中耳炎。21耳气导纯音听阈各倍频率听阈50～85dBHL,声反射阈>90dBHL,经听觉脑干诱发电位、耳声发射等客观检查确诊为中重度聋,359耳纯音听阈各倍频率听阈85～100dBHL。声导抗示:A型鼓室图,耳咽管功能正常,鼓膜静态声顺值0.3～1.8ml,声反射阈正常,诊断为伪聋。结论:伪聋在临床上可以通过声导抗与纯音听阈测试进行检查诊断。

Objective. To study the method of distinguishing simulated deafness. Methods.. Acoustic immitance and pure tone audiometry, with psychological leading, were used to examine simulated deafness. The control group was offside and normal ears （20 case, 20 ears）. Results： The threshold of pure tone audiometry of offside ears was no more than 20 dBHL, and acoustic immitance was normal. Nine ears＇ thresholds were 30-40 dBHL, and acoustic immitance showed： type B tympanogram, eustachian tube occlusion, acoustic compliance of tympana1 static state was less than 0. 3 ml, stapedial muscle reflection disappeared. The diagnosis was secretory otitis media through tympanal puncture. Twenty one ears＇ thresholds were 50-85 dBHL, and acoustic reflex threshold was more than 90 dBHL. The diagnosis was moderately severe deafness through objective examinations such as audito- ry brainstem response and otoacoustic emission. Three hundred and fifty nine ears＇ thresholds were 85 - 100 dBHL, and acoustic immitance showed： type A tympanogram, eustachian tube was normal, acoustic compliance of tympanal static state was 0.3-1.8 ml, acoustic reflex threshold was normal. The diagnosis was simulated deafness. Conclusion： Simulated deafness can be examined and diagnosed through acoustic immitance and pure tone audiometry in clinic.