听性脑干反应与畸变产物耳声发射检测在听神经病诊断中的表现和意义

Auditory brainstem response and distortion product otoacoustic emissions for the diagnosis of auditory neuropathy

目的分析听神经病患者的听性脑干反应与畸变产物耳声发射特征,探讨该类听力学检测方法在听神经病诊断中的意义。方法回顾性研究本科确诊为听神经病的患者37例,比较分析其听性脑干反应与畸变产物耳声发射检测结果,探索其诊断意义。结果本组患者中,3例5耳(双耳病变2例,单耳病变1例)可引出Ⅴ波,阈值70～90dBSPL,其余患耳ABR各波均未引出(刺激声强>100dBSPL)。无论纯音听阈损失程度轻重如何,所有患者的DPOAE均全部引出。在各个频率点上,DPOAE的DP-gram幅值左、右耳间的差异均无统计学意义(P>0.10)。结论听神经病的主要病变部位可能位于听神经传入通路,或伴有脑干内侧橄榄耳蜗系统的传出神经通路病变。

Objective To explore the feasiability of auditory brainstem response （ABR） and distortion product otoacoustic emissions （DPOAEs） in the diagnosis of auditory neuropathy （AN） on the basis of summarization on the characteristics of ABR and DPOAEs among a group of cases with AN. Methods A retrospective study was carried out in a group of 37 patients with AN, treated in our Hospital reent years, to explore theie implications in the diagnosis of AN via a comparative analysis on theie detected results of ABR and DPOAEs. Results In this group of cases, wave. V could be determined from ABR recodings of the lesion ears at the stimulating level range from 70- 90 dB SPL among 3 cases （5 ears in total, with 2 cases with the lesion in both sides and 1 with the lesion in one side）, while no any waves were detected from the other cases, even though with the stimulating sound intensity increased to 100 dB SPL. In contrast, DPOAEs were recoded from all these lesion ears, no matter how was their severity of hearing loss, but with no significant differences in the DP-gram amplitudes between both ears of any cases at any points of frequencies （P〉0.05）. Conclusions It is suggested from this study that the main lesion of AN may be localized on the afferent pathway of the acoustic nerve, or may company with some conditions on the efferent nerve pathway of medial olivocochlear system in the brain stem as well.