短声听性脑干反应结合单频刺激听性稳态反应在感音神经性聋患者听力评估中的应用

The Reliability of Click-evoked Auditory Brainstem Response Combined with Stimulation Auditory Steady-state Response on Sensorineural Deafness

目的探讨短声听性脑干反应(click-evoked auditory brainstem response,c-ABR)结合单频刺激听性稳态反应对感音神经性聋患者听力评估的作用。方法以183例(366耳)感音神经性聋患者为研究对象,其中轻度聋49例(听阈图平坦型23例、非平坦型26例)、中度聋47例(平坦型22例、非平坦型25例)、重度聋45例(平坦型20例、非平坦型25例)、极重度聋42例(平坦型20例、非平坦型22例),分别行纯音听阈、多频刺激听性稳态反应(multiple auditory steady-state response,m-ASSR),以及0.5、1.0 kHz单频刺激听性稳态反应(single-ASSR,s-ASSR)、c-ABR检查;对结果行单因素方差分析及线性相关分析。结果 183例在0.5 kHz处s-ASSR反应阈较m-ASSR反应阈更接近纯音听阈,且差异有统计学意义(P<0.05);平坦型感音神经性聋患者c-ABR(2～4 kHz)和s-ASSR(0.5、1.0 kHz)与纯音听阈之间有更好的相关性,而非平坦型感音神经性聋患者0.5 kHz s-ASSR及1.0、2.0、4.0 kHz m-ASSR与纯音听阈相关性更好。结论听阈图为平坦型感音神经性聋患者采用c-ABR结合s-ASSR评估听力更可靠;非平坦型者则采用s-ASSR结合m-ASSR更可靠。

Objective To investigate the reliability of click-evoked auditory brainstem response(c-ABR) combined with single-frequency auditory steady-state response(s-ASSR) on hearing evaluation in sensorineural deafness patients. Methods A total of 183 patients with sensorineural hearing loss (366 ears),and 49 were mild hearing loss with 23 flat audiograms and 26 non-flat type;47 were moderate with 22 flat and 25 non-flat type;45 were severe loss with 20 flat and 25 non-flat type, and 42 were profound hearing loss with 20 flat and 22 non-flat. These patients were tested for hearing thresholds,m-ASSR, 0.5 , 1.0 kHz s-ASSR,c-ABR. The data were analyzed by SPSS 18.0 for regression analysis and other statistical analysis. Results The s-ASSR response threshold at 0.5 kHz was closer to the pure tone threshold than the m-ASSR threshold. The difference was statistically significant. For the hearing configurations, c-ABRs combined s-ASSRs were better correlated with the pure tone hearing thresholds for the non-flat type while s-ASSRs combined m-ASSRs were better correlated with pure tone hearing threshold. Conclusion c-ABR combined s-ASSR is more reliable to test flat hearing loss, and s-ASSR combined m-ASSR is more reliable to test non-flat type hearing loss.