自发性耳声发射与耳蜗传出调控的关系探讨

Spontaneous otoacoustic emissions and efferent control of cochlea

目的 探讨自发性耳声发射 (spontaneousotoacousticemissions,SOAE)与内侧橄榄耳蜗传出系统 (medialolivocochlearsystem ,MOCS)对耳蜗调控之间的关系及其临床意义。方法 检测可疑蜗后病变和 (或 )内侧橄榄耳蜗传出系统功能障碍患者及正常中青年人的SOAE、瞬态诱发性耳声发射(transientevokedotoacousticemissions,TEOAE)、畸变产物耳声发射 (distortionproductotoacousticemissions,DPOAE)及后二者的对侧声抑制效应。结果 发现 :①听神经病 6 5例 (130耳 )中 12 6耳、听神经瘤 2例 (2耳 )、听觉过敏 2例 (4耳 )、听力正常耳鸣 2 6例 (48耳 )中共 14 6耳伴有MOCS功能障碍 ;②MOCS功能障碍 14 6耳无论其纯音听阈如何 ,均能引出较强的诱发性耳声发射 (EOAE) ,其中 86 3% (12 6耳 )能引出增强的SOAE ,明显高于健康青年人正常耳的SOAE引出率 34 3% ;③MOCS功能障碍耳SOAE的主要频率范围 0 6 93～ 3 0 5 5kHz明显大于正常耳SOAE的频率范围 1 135～ 2 74 6kHz ,低频端前移有显著统计差异 (P <0 0 1) ;④MOCS功能障碍耳SOAE的平均最高幅值 (- 3 4± 6 4 )dBSPL明显大于正常耳 (- 6 8± 7 8)dBSPL(P <0 0 1) ;⑤正常耳传出抑制的频率范围主要在 0 7～ 3kHz,与MOCS功能障碍耳SOAE的平均频率范围 0

Objective To study the relationship between spontaneous otoacoustic emissions(SOAE) and efferent control of cochlea and their clinical significance Methods SOAE, transient evoked otoacoustic emissions (TEOAE), distortion product otoacoustic emissions (DPOAE) and contralateral white noise (60dB SPL)suppression of TEOAE and DPOAE experiments were conducted in 312 ears of 95 patients with retrocochlear impairment and/or MOCS dysfunction and 64 normal young adults Results MOCS dysfunction was shown in 126 ears of 65 patients (130 ears) with auditory neuropathy, 2 ears of 2 patients with unilateral acoustic neuroma, 4 ears of 2 patients with hyperacusis,14 ears of 26 patients(48 ears) with normal hearing level in unilateral or bilateral tinnitus Stronger EOAE could be recorded in total 146 ears with MOCS dysfunction at any pure tone hearing level SOAE could be recorded in 126 of 146 ears (86 3%) with MOCS dysfunction and 44 of 128 ears (34 3%) with normal hearing SOAE of ears with MOCS dysfunction was mainly at frequencies from 0 693 to 3 055 kHz and SOAE of normal ears was at frequencies from 1 135 to 2 746 kHz Average value of maximum amplitude of SOAE spectrum (-3 4±6 4)dB SPL was significantly greater than that in normal ears (-6 8±7 8)dB SPL ( P <0 01) The major frequency range of SOAE (0 693 3 055 kHz) in MOCS dysfunction ears was essentially consistent with that of efferent suppression in normal ears (0 7 3 kHz) Conclusion The modulation of the cochlear active mechanisms by MOCS mainly presents in the low and mid frequency regions, these frequencies correspond to the frequency range of SOAE Stronger SOAE indicates pathophysiological significance There is a clear clinical relationship between SOAE and the efferent modulation of the cochlea