小儿感音神经性听力障碍蜗性病变与蜗后病变ASSR的比较研究

Comparison and analysis of ASSR test in sensorineural hearing loss children with cochlear lesion and retrocochlear lesion

目的:本研究对小儿重度感音神经性听力障碍蜗性病变和蜗后病变的多频听觉稳态诱发电位(ASSR)各项参数进行对比研究,探讨蜗后病变ASSR存在的一些特异性现象,帮助临床更准确地诊断蜗后听力损害。方法:选取2008-2012年间我院儿童听力中心诊断为"蜗后听觉神经损害"并同时进行了ASSR测试的95例(179耳)患儿作为蜗后病变组;选取同时期诊断为重度及以上"蜗性听觉神经损害"并同时进行了ASSR测试、且与蜗后病变组相同年龄范围的81例(143耳)患儿作为蜗性病变组;选取本儿童听力中心数据库中正常听力并有ASSR测试记录、且与蜗后病变组相同年龄范围者共26例(50耳)作为正常对照组。分别比较上述3组测试对象间ASSR阈值、引出率及ASSR听力图类型的异同。结果:1ASSR阈值:蜗后病变有波Ⅴ有波Ⅰ分化小组各频点的阈值与蜗性病变小组比较,其500、1 000Hz阈值间差异无统计学意义,2 000、4 000 Hz阈值间有统计学差异;蜗后病变无波Ⅴ无波Ⅰ分化小组各频点的阈值均较蜗性病变对应小组500、1 000、2 000、4 000 Hz 4个频点的阈值均有下降。2ASSR引出率:蜗性病变组无波Ⅴ分化者500、1 000、2 000、4 000 Hz各频点的阈值引出率显著性较蜗后病变各小组相对应频率点的引出率为低。3引出ASSR反应频点数量:蜗后病变组能引出全部4个频点ASSR反应的比例显著高于蜗性病变组。4ASSR听力图类型:蜗后病变组的ASSR听力图上升型曲线的比例分别为26.83%(有波Ⅰ波Ⅴ分化)、40%(有波Ⅰ无波Ⅴ分化)和33.80%(无波Ⅰ波Ⅴ分化),远高于蜗性病变组。结论:1临床上ABR重度以上异常的小儿,当ASSR测试出现上升型听力图时,应考虑可能存在蜗后病变的可能;2ASSR反应阈不能用于判断蜗后病变患儿的听力损失严重程度。

Objective.. To compare the auditory steady-state response （ASSR） test data of severe sensorineural hearing loss children with cochlear lesion and those with retrocochlear lesion and find some specific phenomena of retrocochlear lesion in ASSR, then to improve diagnostic accuracy in clinical practice. Method.. Between 2008 to 2012, 96 children （179 ears） were diagnosed with ＂retrocochlear auditory nerve lesion＂ and recieved ASSR test （＂ retrocochlear lesion＂ group）. Eighty-one （143 ears） the same age children （143 ears） were diagnosed as ＂cochlear auditory nerve lesion＂ and selected them as the ＂cochlear lesion＂ group. Twenty-six （50 ears） normal hearing chil- dren at the same age who had ASSR test records selected from the pediatric hearing center database of our hospital were selected as ＂normal control＂ group. Compare the difference of ASSR threshold, ASSR elicit rate and ASSR audiogram among the three groups. Result： ① ASSR threshold： Compared each frequency threshold in ASSR test with cochlear lesion group, the retroeoehlear lesion group with wave V and wave I had no significant difference in 500 Hz and 1000Hz but had significant difference in 2 000 Hz and 4 000 Hz. As for the retrocochlear lesion group without wave V and wave I, there was a decline in 500 Hz, 1000 Hz, 2 000 Hz and 4 000 Hz compared with cochle- ar lesion group. ②ASSR elicit rate,When compared to retrocochlear lesion group, the cochlear lesion group had a significance lower elicit rate in the four frequency. ③Number of elicit reactions in ASSR test. In the retrocochlear lesion group, the elicit reactions in all the four frequency in ASSR test was significantly higher than ochlear lesion group. ④ASSR audiogram type, The proportion of rising curve audiogram in retrocochlear lesion group was 26.83% （with wave Ⅰ and wave V）.40% （with wave Ⅰ and without wave V） and 33.80% （without wave Ⅰ and wave V ）. Conelution：①Children with a severe hearing loss in ABR test and a rise type audiogram in ASSR test should be most possibly considered as retrocochlear lesion. ②ASSR threshold cannot be used in determinate the severity of hearing loss in children with retrocochlear lesion.