皮层听觉诱发电位评估耳聋儿童助听器验配效果的意义

The Application of Cortical Auditory Evoked Potentials in the Assessment of Hearing Aid Fitting for Hearing-impaired Children

目的探讨皮层听觉诱发电位（cortical auditory evoked potential,CAEP）在助听器验配效果评估中的应用价值,为临床耳聋儿童听觉言语康复效果评估提供参考。方法 26例语前聋患儿均双耳选配助听器,分别测试患儿助听条件下的CAEP及助听听阈;根据助听后三个刺激声/m/、/g/、/t/在55dB SPL强度下是否全部引出波形将患儿分为A组和B组,全部引出波形的患儿为A组,其余患儿为B组,比较二组的助听听阈。结果 26例患儿CAEP波形引出率为96.15%（25/26）,A组（11例）0.25、0.5、1、2、4kHz助听听阈均值分别为32.73±7.54、27.27±5.18、35.00±5.48、35.91±7.35、35.45±4.72dB HL;B组（15例）,除1例未引出CAEP外,有9例在65dB SPL强度下全部引出CAEP波形,其0.25~4kHz各频率助听听阈均值分别为36.11±7.82、35.00±4.33、38.89±6.51、40.00±7.07、43.33±8.66dB HL;有5例在75dB SPL强度下全部引出CAEP波形,其0.25~4kHz各频率助听听阈均值分别为44.00±12.94、39.00±7.41、49.00±6.52、44.00±6.52、54.00±11.94dB HL,且A组患儿各刺激声对应频段助听听阈均低于B组,差异有统计学意义（P〈0.05）。阈值强度下低频声/m/、中频声/g/、高频声/t/的P1波潜伏期均值分别为130.16±24.85、114.80±25.99、122.88±27.05ms,幅值分别为6.58±4.53、6.41±3.97、5.58±3.56μV,相应频段助听听阈分别为34.30±7.69、40.20±8.48、41.40±8.07dB HL,P1波潜伏期与相应频段助听听阈均无显著相关（P〉0.05）,P1波幅值与相应频段助听听阈呈显著负相关（P〈0.05）。结论 CAEP测试可用于评估儿童助听器选配效果,55dB SPL强度下能够引出CAEP波形可作为评估助听器选配效果良好的指标之一。

Objective To investigate the application of cortical auditory evoked potential（CAEP）in the evaluation of hearing aids fitting,and provide clinical methods and data for the assessment of rehabilitation effects.Methods Twenty six prelingually hearing-impaired children participated in this study.All children were fitted with binaural hearing aids.CAEP was administered at 55,65,and 75 dB SPL for each children fitted with hearing aids.Aided thresholds were measured by using behavioral audiometry.According to the presences of CAEP responses at55 dB SPL for each stimuli of/m/,/g/,and/t/,children were divided into group A and B.Children in group A were all elicited CAEP responses with hearing aids at 55 dB SPL for all three stimuli while the remaining children were in group B.Results The prevalence of CAEP responses was 96.2%.Aided thresholds for the 11 children in group A at 0.25~4kHz tested frequencies were 32.73±7.54,27.27±5.18,35.00±5.48,35.91±7.35,35.45±4.72 dB HL,respectively.Among the 15 children in group B,there were 9children with evoked responses for the three stimuli at 65 dB SPL and aided thresholds for 0.25~4kHz were 36.11±7.82,35.00±4.33,38.89±6.51,40.00±7.07,43.33±8.66 dB HL,respectively.5children could elicite waveformes for the stimuli at 75 dB SPL and aided thresholds for 0.25~4k Hz were 44.00±12.94,39.00±7.41,49.00±6.52,44.00±6.52,54.00±11.94 dB HL.The mean of aided thresholds at each different frequency bands showed significant differences between group A and B（P〈0.05）.The mean latencies of P1 at low,medium,and high frequencies under threshold intensity were 130.16±24.85,114.80±25.99,122.88±27.05 ms.The mean amplitudes were 6.58±4.53,6.41±3.97,5.58±3.56μV.The aided thresholds of corresponding frequencies were 34.30±7.69,40.20±8.48,41.40±8.07 dB HL.P1 latencies showed no significant correlation with aided thresholds（P〈0.05）,but there was a significant correlation between P1 amplitudes and aided thresholds（P〉0.05）.Conclusion CAEP test can be applied to the evaluation of hearing aid fitting.The presense and absense of CAEP responses can be used as an indicator for optimizing hearing aid fitting.