畸变产物耳声发射在唇腭裂婴幼儿听力检查中的应用

Utility of distortion product otoacoustic emissions in hearing assessment for infants and young children with cleft lip and palate

目的探讨唇腭裂婴幼儿畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)的特点,并将其与听性脑干反应(auditory brainstem response,ABR)阈值检查的结果加以对照,以探讨DPOAE在这类患儿听力检查中的应用价值。方法DPOAE检查63例(126耳),年龄2个月～42个月,平均11.83个月。其中单纯腭裂组(以下简称腭裂组)23例(46耳),腭裂并发唇裂及牙槽裂组(以下简称唇腭裂组)30例(60耳),单纯唇裂组(以下简称唇裂组)10例(20耳),每耳均检查8个频率,若2～5kHz4个频点有≥3个频点通过即为该耳通过。在上述患儿中,ABR阈值检查腭裂组17例(34耳),唇腭裂组10例(20耳),唇裂组6例(12耳),以能重复引出Ⅴ波的最小刺激强度为ABR阈值。结果DPOAE检查:腭裂组通过7耳,未通过39耳,通过率为15.22%;唇腭裂组通过6耳,未通过54耳,通过率为10.00%;唇裂组通过18耳,未通过2耳,通过率为90%。统计分析腭裂组与唇腭裂组无显著差异,而腭裂组与唇裂组,唇腭裂组与唇裂组均有显著差异。ABR阈值检查统计分析结果与DPOAE一致。将各组DPOAE通过率与ABR正常率进行比较,腭裂组及唇腭裂组中二者无差异(P>0.05),虽然唇裂组中二者有差异(P<0.05),但唇裂组ABR阈值反应的听力下降较轻(均≤50dBnHL)。从总体趋势上说,DPOAE与ABR阈值检查在检测的结果上是一致的。结论唇腭裂患儿DPOAE和ABR检测结果一致,与ABR相比,DPOAE具有快速、简便、易实施等特点,因此DPOAE可以作为唇腭裂婴幼儿听力检查的手段,但仍需进一步结合ABR及其他相关的听力检查,以明确听力损害的程度和类型。

Objective To compare distortion product otoaeoustic emission （DPOAE） with auditory brainstem responses （ABR） in infants and young children with cleft lip and palate to investigate potential utility of DPOAE in hearing assessment in such patients. Methods DPOAEs were tested in 63 2-42 months （mean 11.83 months） old infants and young children （126 ears） with cleft lip and palate, Of these patients, 23 had simple cleft palate （46 ears, Group A）, 30 had combined cleft lip and palate （60 ears, Group B ）, and 10 had simple cleft lip （20 ears, Group C ）. The （f1×f2）^1/2 was defined as the DPOAE test frequencies and 8 such frequencies were tested. Presence of DPOAEs at 3 or more test frequencies between 2-5 kHz was considered a pass of the test. ABRs were also tested in some patients （34 ears from Group A, 20 ears from Group B and 12 ears from Group C）. Results DPOAE pass rate was 15.22%, in Group A,10.00% in Group B and 90% in Group C, respectively. The difference in DPOAE pass rate and ABR threshold were sta- tistically significant between groups A and C, and between groups B and C, but not so between groups A and B. When compared to the rate of normal ABRs, the DPOAE pass rate showed no statistically significant difference in groups A and B （P 〉 0.05）, but was different from the normal ABR rate in group C （P 〈0.05）. However, the general trends were comparable between the two rates. Conclusion Compared with ABRs, DPOAEs are a relatively easy and rapid test, with consistent results. The comparable results between DPOAE and ABR tests suggest that DPOAEs can be a useful method for heating assessment in young patients with cleft lip and palate. However, to further classify and quantify hearing impairment, other hearing tests should also be considered.