儿童阻塞性睡眠呼吸暂停低通气综合征的听功能评价

Assessment of Auditory Function in Children with Obstructive Sleep Apnea-Hypopnea Syndrome

目的探讨阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-Hypopnea Syndrome;OSAHS)儿童的听功能状态。方法选择OSAHS患儿65例(130耳),根据睡眠呼吸紊乱指数(AHI)分为2组:OSAHS轻度组(10次/h>AHI≥5次/h)和OSAHS中重度组(AHI≥10次/h),作为实验组。并选择正常儿童20例(40耳)作为对照组。均行纯音测听、声导抗检查及纤维鼻咽喉镜检查,并对声导抗测试中鼓室导抗图为"A"型耳,进行听觉脑干诱发电位(ABR)和瞬态诱发耳声发射(TEOAE)检查。与对照组比较,进行统计学分析。结果 OSAHS患儿59例(118耳)正常儿童对照组20例(40耳)进入统计分析;①、125～8 000 Hz各频率气导听阈,OSAHS轻度组与对照组比较无统计学意义(P>0.05),中重度OSAHS组与对照组比较均有增高,差异有统计学意义(P<0.05)。②、OSAHS轻度组鼓室压图异常率51.52%(34/66),OSAHS中重度组鼓室压图异常率62.75%(31/52),组间比较无统计学差异(P>0.05),与对照组比较均有统计学差异(P<0.05);③、鼓室导抗图为"A"型的轻度及中重度OSAHS患儿的TEOAE通过率,与对照组比较差异均有统计学意义(均P<0.01)。④、鼓室导抗图为"A"型的轻度OSAHS患儿ABR听阈、各波潜伏期和波间期与对照组比较无统计学差异(P>0.05);鼓室导抗图为"A"型的中重度OSAHS患儿波Ⅰ、Ⅴ潜伏期及波Ⅰ-Ⅲ、Ⅰ-Ⅴ波间期比对照组延长,Ⅴ波反应阈亦较对照组提高,差异有统计学意义(P<0.05)。⑤、鼓室压曲线异常分别与语言频率平均听阈、腺样体肥大程度、AHI、最低血氧饱和度相关;⑥、对鼓室压图为"A"型的53耳及对照组40耳进行Logistic回归分析:腺样体肥大及AHI是OSAHS患儿耳蜗及听觉神经通路损害的危险因素。结论儿童OSAHS易出现中耳功能异常导致的传导性听力损失,同时中重度OSAHS患者还可能出现缺氧导致的耳蜗及听觉脑干的损害。

Objective To study the hearing characteristics in children with obstructive sleep apnea-hypopnea syn- drome （OSAHS）. Methods Randomly selected 65 children with OSAHS who had undergone polysomnography were divided into a mild OSAHS group [10~apnea hypopnea index （AHI） ~〉5] and a moderate and severe OSAHS group [AHI~〉 10]. The control group was 20 healthy children. Pure tone audiometry and tympanometry were used to measure the auditory function and fiberonasopharyngoseopy was taken to evaluate the size of adenoids. ABR and TEOAEs were recorded in 53 ears with type ＂A＂ tympanogram in children with OSAHS and in the 40 ears of the healthy children. The data were compared between the two OSAHS groups and the control group using the SPSS 11.5 software. Results 1） The difference in pure tone thresh- old across 125 to 8000 Hz between the mild OSAHS group and the control group was not statistically significant （P^0.05）, although it was significant when compared between the moderate and severe OSAHS group and the control group （P 〈0.05）. 2） Type ＂B＂ or ＂C＂ tympanogram was seen in 34 of the 66 ears （51.52%） in the mild OSAHS group and in 31 of the 52 ears （62.75%） in the moderate and severe OSAHS group （P 〉0.05）. However, there was a significant difference when the two OSAHS groups were compared to the control group （P 〈0.05）. 3） In OSAHS patients with type ＂A＂ tympanogram, the preva- lence of TEOAE was only 30.19%, significantly different from the control group. 4） For those with type ＂A＂ tympanogram, ABRs were not signidicantly different between the mild OSAHS group and the control group （P 〉0.05）, although the laten- cies of waves ｜ and V were longer in patients with the moderate and severe OSAHS than those in the control group. The in- terpeak latency intervals of wave I -llI and I - V in the moderate and severe OSAHS patients were also longer than those in the control group （P 〈0.05）, with elevation in wave V threshold compared to the control （P〈0.05）. 5） Abnormal tympanogram was highly correlated to linguistic thresholds, abnormal adenoid sizes, AHI, and the lowest arterial oxygen saturation. 6） The risk factors of brain-stem and cochlear damage in OSAHS patients were the abnormal size of adenoid and AHI . Conclu- sions Conductive hearing loss can be easily identified in children with OSAHS, which is caused by abnormal function in the middle ear. Brain-stem and cochlear damage can occur in children with moderate or severe OSAHS.