短纯音耳蜗微音电位评估耳蜗功能的临床应用价值

Clinical values of tone burst evoked cochlear microphonics in evaluating cochlear function

目的通过分别比较听力正常成年人及听力下降(蜗性聋)成年人相应频率的短纯音耳蜗微音电位(CM)及畸变产物耳声发射(DPOAE)的引出情况,探讨短纯音诱发的耳蜗微音电位在成人听力检测中的意义及临床应用价值。方法对听力正常成年人(34例68耳)、轻度听力下降成年人(23例27耳)及中度听力下降成年人(19例22耳)分别进行500 Hz、1000 Hz、2000 Hz短纯音CM及DPOAE检测,通过受试者自身对比,分析比较二者相应频率的检出率。结果听力正常组500 Hz、1000 Hz、2000 Hz短纯音CM的检出率分别为100%(68/68)、100%(68/68)、86.76%(59/68),DPOAE的检出率分别为76.47%(52/68)、100%(68/68)、100%(68/68);听力正常组500 Hz的短纯音CM检出率显著高于DPOAE检出率(P<0.05)。轻度听力下降组(27耳)500 Hz、1000 Hz、2000 Hz短纯音CM的检出率分别为85.19%(23/27)、81.48%(22/27)、37.03%(10/27),相应频率DPOAE的检出率分别为29.63%(8/27)、51.85%(14/27)、44.44%(12/27),此组500 Hz、1000 Hz短纯音CM的检出率均显著高于DPOAE的检出率(P<0.05)。中度听力下降组(22耳)500 Hz、1000 Hz、2000 Hz短纯音CM的检出率分别为77.27%(17/22)、77.27%(17/22)、27.27%(6/22),相应频率DPOAE检出率分别为13.64%(3/22)、40.91%(9/22)、40.91%(9/22),此组500 Hz、1000 Hz短纯音CM的检出率均显著高于DPOAE的检出率(P<0.05)。。结论对于轻度、中度蜗性听力损失患者,CM在500 Hz、1000 Hz的敏感性优于DPOAE,能弥补DPOAE在中低频段敏感性不足、假阳性率高的问题;在临床工作中推荐联合应用CM和DPOAE评估耳蜗功能。

Objective To compare the presence of tone burst evoked CMs and DPOAEs at corresponding frequenciesin adult normal and hearing-impaired ears,and determine the clinical value of tone burst evoked CMs in testinghearing in adults.Methods CMs and DPOAEs evoked by500Hz,1000Hz and2000Hz tone bursts were obtained from68ears in34adults with normal hearing,and from27ears in23adults with mild hearing loss and22ears in19adultswith moderate hearing loss.The rates of presence of CMs and DPOAEs were compared.Results The rate of CM presencein ears with normal hearing was100%at500Hz and1000Hz and86.76%(59/68)at2000Hz,and that of DPOAEpresence was76.47%(52/68)at500Hz and100%at1000Hz and2000Hz.The rate of CM presence at500Hz washigher than that of DPOAE(P<0.05).For ears with mild hearing loss,CMs were present in85.19%(n=23),81.48%(n=22)and37.03%(n=10)of the27ears at500Hz,1000Hz and2000Hz,respectively;while DPOAEs were present in29.63%(n=8),51.85%(n=14)and44.44%(n=12)of the ears,respectively.CMs were present in more ears at all testedfrequencies than DPOAEs for these ears(P<0.05).For ears with moderate hearing loss,CMs were present in77.27%(n=17),77.27%(n=17)and27.27%(n=6)of the22ears at500Hz,1000Hz and2000Hz,and DPOAEs were present in13.64%(n=3),40.91%(n=9)and40.91%(n=9)of the ears at corresponding frequencies,respectively.Again,CMs werepresent in more ears than DPOAEs at all tested frequencies in these ears(P<0.05).Conclusions The results suggesthigher rates of CM detection at middle and low frequencies compared to DPOAEs,which can be used as a supplementto the sometimes difficult to interpret DPOAE evaluation at these frequencies.We recommend combining CMs andDPOAEs in the evaluation of cochlear function.