不同声刺激模式对大前庭水管综合征患者短潜伏期负反应的影响

Effect of Different Sound Stimulation on Acoustically Short Latency Negative Response in LVAS Patients

目的探讨不同声刺激模式对大前庭水管综合征(large vestibular aqueduct syndrom,LAVS)患者短潜伏期负反应(acoustically short latency negative response,ASNR)的影响,建立ASNR引出的最佳声刺激模式。方法选取24例48耳经颞骨CT确诊为LAVS、短声听性脑干反应(click ABR)波V阈值大于或等于90 dB nHL的受试者,分别进行click ABR、500 Hz(tone burst 500 Hz,TB-500 Hz)和1 000 Hz(tone burst 1 000 Hz,TB-1 000 Hz)短纯音听性脑干反应(tone burst ABR)测试,记录三种声刺激模式下ASNR的引出率、阈值、95 dB nHL刺激声强下的ASNR幅值和潜伏期。结果①click、TB-500 Hz、TB-1 000 Hz声刺激下ASNR引出率分别为60.41%(29/48)、68.18%(30/44)、52.38%(22/42),差异无统计学意义(P>0.05),TB-500 Hz ASNR引出率相对较高;②click、TB-500 Hz、TB-1 000 Hz声刺激诱发的ASNR平均阈值分别为90.8±3.48、87.36±4.39、89.23±4.79 dB nHL,TB-500 Hz声刺激下的ASNR阈值较低,差异有统计学意义(P<0.05);③click、TB-500 Hz、TB-1 000 Hz声刺激诱发的ASNR平均潜伏期分别为3.13±0.29、4.32±0.57、4.12±0.21 ms,click声诱发的ASNR潜伏期较短纯音诱发的短,差异有统计学意义(P<0.05);④click、TB-500 Hz、TB-1 000 Hz声刺激诱发的ASNR平均幅值分别为0.29±0.22、0.39±0.31、0.33±0.21μV,TB-500 Hz声刺激下ASNR的幅值明显增高,差异有统计学意义(P<0.05)。结论 LVAS患者短纯音诱发的ASNR潜伏期较click声诱发的明显延长;利用TB-500 Hz声刺激可获得更高的ASNR引出率及振幅,有利于ASNR的正确识别及可疑大前庭水管综合征的早期诊断。

Objective To study the effects of acoustically short latency negative response (ASNR) of large vestibular aqueduct syndrome (LVAS) induced by click, TB-500 Hz and TB-1 000 Hz sound stimulation, and establish the best mode acoustic stimulus to draw forth the ASNR to guide the clinical diagnosis of highly suspected LVAS. Methods ABRS to click,500 Hz tone burst and 1 000 Hz tone burst were recorded from 24 children aged from 0 to 10 years old with LVAS using Charter EP auditory evoked potential system. The thresholds, amplitudes and latencies of ASNR were recorded under the high intensity. Results The induced ASNRs by click, TB-500 Hz and TB-1 000 Hz sound stimulation were 60.41%(29/48), 68.18%(30/44) and 52.38%(22/42), respectively. There was no significant difference among the three kinds of acoustic stimulation conditions( P > 0.05 ).The average thresholds of ASNR induced by click ,TB-500 Hz and TB-1 000 Hz sound stimulation were 90.8 ± 3.48 dB nHL, 87.36 ± 4.39 dB nHL and 89.23 ± 4.79 dB nHL, respectively. There were statistically significant differences in ASNR thresholds between click and TB-500 Hz. The mean latencies of ASNR induced by click,TB-500 Hz and TB-1 000 Hz sound stimulation were 3.13 ± 0.29 ms, 4.32 ± 0.57 ms and 4.12 ± 0.21 ms.ASNR latency induced by click was shorter than tone burst( P < 0.05 ).The mean amplitudes of ASNR induced by click,TB-500 Hz and TB-1 000 Hz acoustic stimulation were 0.29 ± 0.22 μV, 0.39 ± 0.31 μV and, and 0.33 ± 0.21 μV.Those were statistically different. The amplitudes of ASNR were significantly increased under the stimulation of TB-500 Hz. Conclusion The ASNR latency induced by click was shorter than tone bursts. The higher ASNR inducible rates and wave amplitude can be obtained by using the TB-500 Hz acoustic stimulation mode, considered to be beneficial to diagnose highly suspected LVAS.