耳蜗死区对感音神经性听力损失患者言语识别能力的影响

The Effects of Cochlear Dead Regions on Speech Recognition Ability in Patients with Sensorineural Hearing Loss

目的探究耳蜗死区在感音神经性听力损失(sensorineural hearing loss,SNHL)患者中的存在情况及其对言语识别能力的影响。方法采用纯音听阈测试筛选出41例(81耳)感音神经性听力损失患者,经均衡噪声阈值测试将患者分为有耳蜗死区组(35耳)和无耳蜗死区组(46耳),分别进行言语识别阈(SRT)和言语识别率(SDS)测试,分析81耳耳蜗死区的分布及其对言语识别能力的影响。结果 41例(81耳)感音神经性听力损失患耳中有35耳(43.21%,35/81)存在耳蜗死区,其中轻度SNHL患耳耳蜗死区检出率为0(0/11),中度SNHL患耳耳蜗死区检出率为24.1%(7/29),重度SNHL患耳耳蜗死区检出率为66.7%(24/36),极重度SNHL患耳耳蜗死区检出率为80.0%(4/5),不同听力损失程度耳耳蜗死区检出率差异有统计学意义(P<0.05);高频耳蜗死区(16耳)明显多于低频耳蜗死区(8耳),但两者的言语识别能力差异无统计学意义(P>0.05);有耳蜗死区患者的言语识别阈及言语识别率分别为61.63±16.76dB HL,86.35%±12.03%,无耳蜗死区的患者分别为75.54±9.56dB HL,64.97%±20.84%,二者间差异有统计学意义(P<0.05)。结论听力损失越重,耳蜗死区检出率越高;高频耳蜗死区较低频常见,且存在耳蜗死区的感音神经性听力损失患者言语识别能力明显低于无耳蜗死区的患者。

Objective To study the distribution of cochlear dead regions in the cochlea with sensorineural hearing loss(SNHL),and to investigate the effects of cochlear dead regions on speech recognition.Methods A total of 41 SNHL patients(81 ears)were divided into the cochlear dead region group(35 ears)and the group without cochlear dead regions(46 ears)by using threshold equalizing noise test(TEN test).Then we used speech recognition threshold(SRT)and speech discrimination score(SDS)tests to study the distribution of cochlear dead regions and to investigate the effects of cochlear dead regions on speech recognition.Results There were 41 cases(81 ears)sensorineural hearing loss patients and 43.21%(35/81)were found to have the cochlear dead regions.The cochlear dead region detection rate for patients with mild SNHL was 0(0/11);in patients with moderate SNHL,the cochlear dead region detection rate was 24.1%(7/29);in patients with severe SNHL the cochlear dead region detection rate was 66.7%(24/36);the cochlear dead regions of profound SNHL patients were 80.0%(4/5)respestively.The existence of the cochlear dead regions was significantly correlated with the degree of hearing loss(P<0.05).The proportion of high frequency cochlear dead regions(16 ears)was much higher than that of the low frequency cochlear dead regions(8 ears).There was no significant reduction of SRT and SDS between high and low cochlear dead regions groups(P>0.05).The SRT and SDS of the patients with cochlear dead regions were 61.63±16.76 dB,86.35%±12.03%.The SRT and SDS of the patient with no cochlear dead regions were 75.54±9.56 dB and64.97%±20.84%.The results showed a significant(P<0.05)reduction of SRT and SDS between the patient with cochlear dead regions and the patient with no cochlear dead regions.Conclusion The greater the degree of hearing loss is,the higher possibility of the existence of cochlear dead regions there is.Cochlear dead regions are common in high frequencies than in low frequencies.The speech recognition ability can be affected.