听神经病患者普通话单音节识别错误模式分析

Analysis of improper pattern of Mandarin monosyllable recognition test among the patients with auditory neuropathy

目的分析听神经病（auditoryneumpathy，AN）患者单音节识别测试的错误模式，总结AN患者在言语识别障碍方面的特点，探讨单音节言语识别测试对于AN诊断的作用。方法AN患者16例，共32耳；根据听力图曲线分为两个亚组：上升型听力组（15耳）和非上升型听力组（17耳）。感音神经性聋患者22例（共32耳）作为对照组。使用自行编制的言语测试材料在较高的测试强度下进行单侧单音节识别测试，记录每个测试耳的单音节识别得分和错误模式。错误模式分为8种：仅声母错、仅韵母错、仅声调错、声母错＋韵母错、声母错＋声调错、韵母错＋声调错、声韵调全错、无反应。结果AN患者单音节总体识别得分低于感音神经性聋患者（P〈0．001）。上升型听力的AN患者其单音节识别率、声母、韵母、声调识别率与对照组感音神经性聋患者差异无统计学意义；非上升型听力的AN患者单音节识别率、声母、韵母、声调识别率均低于感音神经性聋患者（P值均〈0．001）。AN患者与感音神经性聋患者的单音节识别错误模式构成比差异具有统计学意义（P〈0．001），前者涉及声调识别的错误所占比例较大。上升型听力AN患者单音节识别率和声母、韵母、声调识别率均高于非上升型听力AN患者（P值均〈0．001）。上升型听力AN患者与非上升型听力AN患者的单音节识别错误模式构成比差异具有统计学意义（P〈0．001），前者涉及声调和韵母的识别错误所占比例较大。结论普通话四声识别能力差是AN患者区别于感音神经性聋患者的一个重要特征。上升型听力AN患者与非上升型听力AN患者在单音节识别率、韵母和声调错误所占比例等方面存在特征性差异。心理物理测试对AN的诊断具有潜在的重要作用。

Objective To analyze the improper pattern in mandarin monosyllable recognition test among the patients with Auditory Neuropathy（AN） in order to work out the common characteristics in speech recognition which might be suitable for diagnosis of AN. Methods Sixteen AN patients （32 ears） were studied and 22 patients（32 ears）with sensorineural hearing loss （SNHL） were set for control. In accordance with audiogram pattern, all subjects were then divided into the up-type hearing（ 15 ears） and non up-type hearing（ 17 ears） groups. All 64 ears were tested in high intensity by mandarin monosyllable test material which we have developed before. Monosyllable performance scores from testing ears and improper patterns were recorded respectively. Eight improper patterns were then defined as follows： consonant only, vowel only, tone only, consonant and vowel, consonant and tone, vowel and tone, all phonemes and no response. Results The score of patients with AN was lower than those patients with SNHL in monosyllable recognition test（P 〈 0. 001 ）. No significant difference was found between subgroup of up-type hearing loss and SNHL group in percentage correct scores of monosyllables, consonants, vowels, and tones statistical/y（P 〉 0.05 ）, but significant lower score was found in subgroup of non up-type hearing loss compared with SNHL group in these 4 percentage scores concerned （ P 〈 0. 001 ）. Chi square test presented a significant difference in improper pattern proportion between AN and SNHL groups （ P 〈 0. 001 ）, which could be related to more proportional tone recognition in the former＇s incorrect items. Improper pattern proportions between two AN subgroups presented a significant difference statistically （ P 〈 0. 001 ） , which could be related to a larger proportional recognition of tones and vowels in subgroup of up-type hearing loss compared with subgroup of non up-type hearing loss. Condusiol~ A poor performance might be a major clinical feature identified AN from SNHL in mandarin tone recognition. There are significant differences between AN patients with up-type hearing loss and patients with non up-type hearing loss in performance of monosyllable recognition and improper pattern proportion of tones and vowels. A psyehophysical testing may be a key potential in diagnosis of AN in further clinical application.