36例听神经病患儿临床听力学检查结果分析

Analysis of Clinical Audiological Examination Results in 36 Children with Auditory Neuropathy

目的通过分析儿童听神经病的临床听力检查特点,探讨儿童听神经病的临床诊治思路。方法回顾性分析东莞市妇幼保健院耳鼻咽喉头颈外科、东莞市新生儿听力障碍诊治中心2015年9月至2018年8月确诊为听神经病的36例患儿的临床资料,总结分析其病史、听力学特点及耳部影像学特征。结果 36例患儿中,均是双耳发病,其中合并高胆红素血症,需换血治疗的29例(80.6%)、合并新生儿期窒息缺氧的3例(8.3%)、合并癫痫的1例(2.8%)、不明原因的3例(8.3%)。结论新生儿高胆红素血症是导致婴幼儿听神经病的主要因素,对于该类患儿,治疗黄疸的同时及时行DPOAE及AABR联合筛查可早期提示听神经病;ABR、MEA、DPOAE、CM及ASSR的综合评估有利于与其他感音神经性耳聋患儿区分,耳内镜可深度清理外耳道分泌物及了解有无中耳积液,耳内镜检查联合多种听力学检查可提高对听神经病的诊断准确性。

Objective By analyzing the characteristics of clinical audiological examination in children with auditory neuropathy,to explore the clinical diagnosis and treatment of children auditory neuropathy.Methods Retrospective analysis of clinical data of 36 children diagnosed with auditory neuropathy from September 2015 to August 2018 in the Department of Otolaryngology Head and Neck Surgery,Dongguan Maternal and Child Health Hospital,Dongguan Newborn Hearing Impairment Center.The medical history,audiological characteristics and ear imaging features were summarized.Results Among the 36 cases,all of them had binaural diseases,among which 29 cases (80.6%) were combined with hyperbilirubinemia,which needed blood exchange therapy,3 cases (8.3%) were combined with neonatal asphyxia and hypoxia,1 case (2.8%) was combined with epilepsy and 3 cases (8.3%) had unknown causes.Conclusion Neonatal hyperbilirubinemia is the main factor of infant auditory neuropathy.For these children,DPOAE and AABR combined screening in time while treating jaundice can prompt early auditory neuropathy.The comprehensive assessment of ABR,MEA,DPOAE,CM and ASSR is helpful to distinguish them from other children with sensorineural deafness.Otoendoscopy can deeply clean the secretion of external auditory canal and know whether there is middle ear effusion.Otoendoscopy combined with a variety of audiological examinations can improve the accuracy of auditory neuropathy diagnosis.