听神经病患者噪声下言语测听临床应用与分析

Clinical Application of Speech Recognition in Noise Test in Patients with Auditory Neuropathy

目的对比听神经病患者安静与噪声下言语识别率的差异并与正常受试者、感音神经性听力损失组、听神经瘤组进行比较。方法测试在符合国家标准的隔声室内进行,纯音测试及言语测试应用校准后丹麦耳听美Conera听力计Otosuite(版本号4.82)联结计算机输出言语声,受试者佩戴头戴式耳机TDH-39、B71骨导振动器测试纯音。言语识别测试材料采用解放军总医院郗昕编制的《普通话言语测听—单音节识别测试》词表,在安静和噪声环境下,分别测试听神经病患者10例、感音神经性聋患者11例、听神经瘤患者11例和听力正常受试者10例患者在平均听阈、阈上10dB、20dB、30dB处的言语识别率以及信噪比为-0、-5、-10、-15dB的言语识别率得分。结果听神经病患者在噪声下言语识别能力明显低于听神经瘤组、感音神经性听力损失组以及正常听力组(P<0.05);具有相似听力阈值及听力曲线的AN患者,给予安静及不同噪声强度测试,可呈现较差及较好二级分化的SRS曲线;正常组在信噪比为-0、-5、-10、-15dB的环境下,信噪比为10dB时对比自身安静环境言语识别得分无显著性差异(P>0.05),而听神经病组、听神经瘤组和感音神经性听力损失组在-10 SNR处均有显著性差异(P<0.05)。听神经病患者在安静环境下随刺激声强度的升高会出现"回跌"现象。听神经病患者总体水平在安静与噪声环境下纯音听阈与言语识别得分均与无相关性(R2=0.07),其他三组呈现负的弱相关或强相关。结论安静环境下言语识别能力较好的听神经病患者在噪声环境中下降程度更为显著,相对于安静环境言语识别测试更加敏感;采用平均阈上30dB及-10dB信噪比测试,所得言语识别得分可作为临床评价言语功能的敏感指标,且对于听神经病诊断和病变定位及程度分析更具有现实意义,能够更全面评估听神经病患者的言语交流能力。

hoc analysis showed that the mean speech recognition scores in quiet were significantly different from those obtained at signal-to-noise ratio of 0,5 or 10 dB in patients with AN,SNHL and acoustic neuroma.In both quiet and noise,speech recognition screws and pure tone hearing thresholds were negatively correlated in patients with auditory neuropathy,which demonstrated a"fall back"phenomenon at high stimulation intensity in quiet.Conclusion Patients with auditory neuropathy have a significant decline in speech recognition ability in noise,more so in patients with good speech recognition ability in quiet.Speech in noise test may facilitate diagnosis of auditory neuropathy and location of underlying pathology,and provide comprehensive assessment of speech recognition function in auditory neuropathy patients.Objective To report speech perception in noise in patients with auditory neuropathy(AN)in comparison to when in quiet and to normal subjects and subjects with various non-AN hearing disorders.Methods Speech recognition was tested using Chinese language materials in 10 AN patients,11 sensorineural hearing loss(SNHL)patients,11 acoustic neuroma patients and 10 hearing normal(NH)subjects at 4FA,4FA+10 dB,4FA+20 dB and 4FA+30 dB in quiet as well as in noise(signal-to-noise ratio at 5,10 and 15 dB),respectively.Results The speech recognition scores for subjects with AN were significantly poorer than those for subjects with acoustic neuroma,SNHL and NH(P<0.05).Post hoc analysis showed that the mean speech recognition scores in quiet were significantly different from those obtained at signal-to-noise ratio of 0,5 or 10 dB in patients with AN,SNHL and acoustic neuroma.In both quiet and noise,speech recognition screws and pure tone hearing thresholds were negatively correlated in patients with auditory neuropathy,which demonstrated a"fall back"phenomenon at high stimulation intensity in quiet.Conclusion Patients with auditory neuropathy have a significant decline in speech recognition ability in noise,more so in patients with good speech recognition ability in quiet.Speech in noise test may facilitate diagnosis of auditory neuropathy and location of underlying pathology,and provide comprehensive assessment of speech recognition function in auditory neuropathy patients.