256例腭裂患者临床听力学研究

The Clinical Hearing Results of 256 Patients with Cleft Palate

目的通过对腭裂患者行畸变产物耳声发射(Distortion Product Oto-acoustic Emission,DPOAE)、声导抗测试(Acoustic Immittance Measurement,AIM)、听性脑干反应(Auditory Brainstem Response,ABR)研究,探讨这类患者临床听力学特点,以及性别、年龄、手术等因素对患者听力的影响。方法回顾分析256例腭裂患者(术前243例、术后13例)临床听力学数据。将术前2岁内患者174例按性别分为男、女组,所有术前者243例按年龄分为≤2岁组(A组)、>2岁≤6岁组(B组)、>6岁组(C组),术后≥5年者13例编为D组。DPOAE检查选择1818、2730、3616、5434Hz 4个频点有≥3个频点通过即为该耳通过。AIM以A型图为正常,其它类型均为异常。ABR阈值检查以能重复引出V波的最小刺激强度为ABR阈值,ABR阈值>35 dB nHL即为该耳异常。结果腭裂患者不同性别间DPOAE、AIM、ABR阈值无明显差异(P>0.05),A组DPOAE、AIM、ABR阈值较C组差异显著(P<0.05),A、B组DPOAE、ABR检查差异显著(P<0.05),AIM无明显差异(P>0.05),B、C组DPOAE差异显著(P<0.05),AIM、ABR阈值无明显差异(P>0.05)。C、D组年龄相仿,AIM、ABR检查示差异显著(P<0.05),A、B、C组DPOAE检查较ABR异常率高(P<0.05),差异具有统计学意义。结论腭裂患者不同性别间听力无明显差异,随着年龄的增长,腭裂患者听力呈自愈趋势,腭裂修复术能在一定程度上促进腭裂患者听力的恢复。DPOAE可以作为唇腭裂婴幼者听力检查的手段,但仍需进一步结合AIM及ABR检查,以明确听力损害水平及类型。

Objective To investigate the characteristics of clinical hearing of patients with cleft palate, and to evaluate the effects of sex; age; and surgery on the hearing results.Methods 256 cases of cleft palate ,including 243 cases who had never received cleft-closure operation and 13 cases who had received cleft-closure operation for at least 5 years. To evaluate the effects of sex, we investigated 174 cases（male76, and female 98） who were under 2 years （≤2 y ）, they were divided into 2 groups; to evaluate the effects of age, the 243 cases with no operation history were divided into group A（≤2 y ）; group B （〉2 y ≤6 y）; and group C （〉6 y）; to evaluate the effects of surgery, we compared group C to 13cases who had received cleft-closure operation （group D）, because the ages of these two groups were similar. For DPOAE, at least the pass of/〉3 frequencies at 1818; 2730; 3616; 5434Hz was defined as pass. For AIM, type A was considered to be normal. Part of these cases were also tested by ABR, and the threshold of wave V i〉 35 dB nHL was received to be abnormal.Results 174 Patients （ ~〈2 y, group A）showed no differences in DPOAE, AIM and ABR between sexes （p〉0.05）. Between group A and group C, DPOAE, AIM and ABR showed significant difference （p〈0.05）, Between group A and group B, DPOAE and ABR showed significant difference （p〈0.05）, bat AIM showed no significant difference （p〈0.05）. Between group B and group C, only DPOAE showed significant difference （p〈0.05）, AIM and ABR showed no significant difference （p〉0.05）. Between group C and group D, whose ages were similar, only AIM and ABR showed significant difference（p〈0.05）. In group A,B and C together, the pass rate of DPOAE was higher than the normal rate of ABR （p〈0.05）. Conclusion Sex has no influence on hearing results of patients with clefl palate. In this kind of patients, there is a tendency that the hearing results become better with the increasing of age. Cleft palate surgery is helpful in the recovery of hearing loss. DPOAE is of easy and relatively rapid manipulation, and steady results, it can be a useful method for the hearing test for patients with cleft palate, especially in infants. But to identify the type and extend of hearing impairment, other hearing tests should also be considered.