NBCE-chirp 40Hz ASSR反应阈与纯音听阈的比较研究及在司法鉴定中的应用分析

A Comparative Study of NBCE-chirp 40Hz ASSR Response Threshold and Pure Tone Hearing Threshold and Its Application in Forensic Expertise

目的采用NBCE-chirp刺激声对成年人进行40Hz-ASSR测试,测试结果与其纯音气导听阈进行比较,探讨NBCE-chirpASSR客观听阈测试在司法鉴定中的应用价值。方法研究对象为本实验室2017—2018年度测试者,年龄为(20～78岁),共计100耳,对所有测试者均在500、1 000、2 000、4 000 Hz分别进行纯音听阈及NBCE-chirpASSR测试,根据纯音听阈测试结果将测试者分为正常组、听力障碍组(轻度听力障碍、中度听力障碍、中等重度听力障碍及重度听力障碍),并对各组结果不同频率下的测试结果进行统计分析。结果成年人NBCE-chirp 40Hz ASSR反应阈与纯音气导听阈测试呈显著相关,差值小,测试结果较传统ASSR更接近于纯音听阈,正常组中500、1 000 Hz刺激下两种测试方法的相关性较高,听力障碍组中NBCE-chirp 40 Hz ASSR反应阈普遍低于纯音气导听阈值,差值随听力障碍严重程度呈递减趋势,其中重度及极重度听力障碍组两种方法测试结果的相关性最高。结论 NBCE-chirp 40 Hz ASSR反应阈值能够用于客观评价听阈值,能够反映低频区听力水平,特别是对正常听力者及严重程度较高的听力障碍者,故在司法鉴定听觉功能障碍评定中具有一定的优势。

Objective To explore the application of NBCE-chirp ASSR objective hearing threshold test in forensic expertise. Method For 100 ears of the subjects (aged from 20 to 78) in our laboratory from 2017 to 2018, NBCE-chirp ASSR and pure tone audiometry were performed at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz, respectively. According to the results of pure tone hearing threshold test, the subjects were divided into normal group and hearing impairment group (mild hearing impairment, moderate hearing impairment, moderate and severe hearing impairment). The results of each group at different frequencies were analyzed statistically. Results There was a significant correlation between NBCE-chirp 40 Hz ASSR response threshold and pure tone air conduction threshold test in the subjects. The difference was small, and the test results were closer to pure tone threshold than traditional ASSR. The correlation of the two tests' results under the stimulating frequencies at 500 Hz and 1000 Hz in normal group was higher. The NBCE-chirp 40 Hz ASSR response threshold in hearing impairment group was generally lower than that in pure tone air conduction threshold. The difference value tended to decrease with the severity of hearing impairment. The correlation of the two tests' results in severe and extremely severe groups was the highest. Conclusion NBCE-chirp 40 Hz ASSR response threshold can be used to evaluate the hearing threshold objectively. It can reflect the hearing level in low frequency area, especially for normal hearing people and those with severe hearing impairment. Therefore, it has certain advantages in the evaluation of hearing impairment in forensic expertise.