高危神经母细胞瘤综合治疗患儿远期听力结果调查

The Long Term Hearing Results of the High-risk Neuroblastoma Children with Comprehensive Treatment

目的观察高危神经母细胞瘤(neuroblastoma,NB)儿童经综合治疗后的远期听力发展情况。方法选取我院诊断为高危NB且接受综合治疗的患儿19例(38耳),分别于第一次化疗前(I期)、最后一次化疗后(Ⅱ期)和治疗完成后5年(III期)进行年龄相匹配的规范听力学检查,包括声导抗(226或1000 Hz)、纯音测听、畸变产物耳声发射(DPOAE)和听性脑干反应(ABR)测试,并对结果进行统计分析。结果Ⅱ期和Ⅲ期中均有患者出现不同程度听力下降,且Ⅱ期ABR阈值异常者人数较Ⅲ期纯音听阈异常者少,但DPOAE结果未见明显差异;Ⅲ期时,患者纯音听阈升高的频率与DPOAE异常的频率相对应。结论对于接受过综合治疗的高危NB患儿,早期的ABR结果不能完全反应听力损失情况,建议同时参考DPOAE检查结果,并建立完善的听力随访机制。

Objective To observe the long-term hearing development of children with high-risk NB after comprehensive treatment. Methods 19 children （38 ears） with high-risk NB who were received comprehensive treatment in our hospital, in the first time before chemotherapy （I period）were selected, the last time after chemotherapy （II period） and five years after treatment （III period）,they received standardized audiological examination,including the acoustic immittance（226 or 1000 Hz）,PTA,DPOAE and ABR,age matched. Results Patients with varying degrees of hearing loss in II and III periods, and the number of the patients at period II with ABR threshold abnormal is less than those at period III with pure tone audiometry abnormal, but there was no significant difference between the results of DPOAE, Period III, DPOAE frequency and pure tone audiometry increased the frequency of abnormal matching. Conclusions For children with high-risk NB comprehensive treatment,early ABR results can fully reflect the hearing loss, and also the best reference to the results of DPOAE,and regular hearing follow-up plans should be established.