学龄前腭裂患儿听力学特征分析

Clinical analysis of the hearing characteristics in the preschool children with cleft palate

目的对正常儿和腭裂患儿的听力学检查结果进行分析比对,以探讨腭裂患儿的听力学特点以及年龄因素的影响。方法对60例（120耳）腭裂患儿和76例（152耳）正常儿进行听性脑干反应（auditory brainstem response,ABR）和声导抗检查。结果≤1岁的腭裂患儿比1~2岁和2~6岁患儿的ABR阈值增加（前者S=5.927,后者S=6.020,P〈0.05）。同一年龄段的患儿与正常儿相比,ABR阈值增加（t=8.588、5.436、7.003,P〈0.001）,I、III、V波潜伏期明显延长（〈1岁组t=9.388、4.727、2.398,1~2岁组t=5.386、6.218、5.255,2~7岁组t=7.038、7.282、7.308,P均〈0.05）。腭裂患儿的高频听力损失程度为轻、中度,无重度和极重度听力障碍。3个年龄段腭裂患儿阈值异常率、鼓室图异常率、镫骨肌声反射异常率和分泌性中耳炎患病率差异均无统计学意义（P〉0.05）,而听力损失程度构成比差异有统计学意义（χ2=14.20,P〈0.01）。结论在学龄前婴幼儿腭裂群体中,当鼓室导抗图表现为B型或C型曲线,镫骨肌声反射未引出,同时ABR听阈增加,I、III、V波潜伏期延长,而各波间期无明显延长时,要高度警惕发生分泌性中耳炎,故应在早期行腭裂整复术同时进行鼓室置管术。

OBJECTIVE To evaluate the hearing characteristics of children with cleft palate,by comparing their hearing examinations with that of normal children.METHODS 60 children with cleft palate（120 ears） and 76 normal ones（152 ears） were performed both the brainstem auditory brainstem response（ABR） and acoustic impedance test.RESULTS Significant higher ABR thresholds were observed among the cleft palate children less than 1 year old,compared with that of 1-2 years or 2-6 years old cleft palate patients（S =5.927,S =6.020 respectively,P0.05）.The cleft palate children showed significant higher ABR thresholds（t =8.588,5.436,7.003,P〈0.001） and longer latencies of Ⅰ,Ⅲand Ⅴ peaks compared with normal children of the same ages（t =9.388,4.727,2.398 in 1 year group;t =5.386,6.218,5.255 in 1-2 years group;t =7.038,7.282,7.308 in 2-7 years group;P〈0.05）.There were mild and moderate hearing loss in the high frequence of children with cleft palate,but no severe or extreme hearing loss.A statistic difference（χ 2=14.20,P0.01） was observed in constituent ratio of hearing loss degree.Among three different age groups of the cleft palate children（≤1,1-2 and 2-6 years old）,no statistic differences（P〈0.05） were observed in abnormality rate of threshold,tympanogram,and acoustic stapedius reflex,as well as prevalence of secretory otitis media.CONCLUSIONSecretory otitis media should be considered in the preschool children with cleft palate when the following symptoms occur simultaneously：tympanogram curves are B or C type;acoustic stapedius ref lex disappears;the auditory threshold in the ABR test increases mildly or moderately;the latency prolongation of peak Ⅰ,Ⅲand Ⅴand no interpeak latencies prolongation is observed in the ABR test.So it is recommended that cleft palate patients with secretory otitis media need to be performed cleft palate repair and grommet insertion simultaneously.