不同病因致婴幼儿听力障碍的听力学分析

Audiological analysis of hearing disorders in infants caused by different causes

目的:分析不同病因致婴幼儿听力障碍的听力学特点,总结病因及有效鉴别诊断方法。方法:2017年4月-2019年4月收治听力障碍患儿16例,根据病因分为出生时核黄疸组、围产期缺氧缺血组及出生时高胆红素血症组。对不同病因婴幼儿行ASSR检查、VRA检查、ABR检查、声导抗、畸变产物耳声发射及耳蜗微音电位。结果:三组患儿鼓室导抗图均为A型,出生时核黄疸组CM和DPOAE均存在3例;CM存在、DPOAE消失2例;蹬骨肌声反射消失2例,蹬骨肌声反射阈偏高3例;Ⅰ~Ⅲ波间期延长;ASSR反应阈和VRA阈值比较接近,平均相关系数为r=0.91~0.97。围产期缺氧缺血组所有患儿的CM和DPOAE均存在,其中蹬骨肌声反射正常1例,蹬骨肌声反射消失2例,蹬骨肌声反射阈偏高2例;ABR的波Ⅲ与波Ⅴ消失1例,Ⅴ、Ⅰ~Ⅴ延长2例,Ⅴ、Ⅲ~Ⅴ延长2例;各频率的ASSR与VRA平均听阈值呈平坦型,ASSR反应阈明显比VRA听阈值更高,平均相关系数为r=0.42~0.63。出生时高胆红素血症组CM和DPOAE均存在4例,CM存在,DPOAE消失2例;所有蹬骨肌声反射消失;Ⅴ、Ⅰ~Ⅲ延长;ASSR反应阈和VRA阈值平均相关系数为r=0.70~0.85。结论:不同病因导致的婴幼儿听力障碍的听力学特点不同,临床上可以结合听力学检查结果判断病因并采取可靠的干预方案。

Objective:To analyze the audiological characteristics of infants with hearing impairment caused by different causes,summarize the causes and effective differential diagnosis methods.Methods:16 children with hearing impairment were treated from April 2017 to April 2019.According to the etiology,the patients were divided into three groups:the nuclear jaundice at birth group,the perinatal hypoxia ischemia group and the hyperbilirubinemia at birth group.The ASSR,VRA,ABR,acoustic immittance,distortion product otoacoustic emission and cochlear microphonic potential were performed in infants with different etiologies.Results:The tympanic conductance maps of the three groups were all type A.There were 3 cases of CM and DPOAE in the nuclear jaundice at birth group,presence of CM and disappearance of DPOAE in 2 cases.The acoustic reflex disappeared in 2 cases,and the acoustic reflex threshold was higher in 3 cases.The interval betweenⅠ~Ⅲwaves was prolonged.The ASSR response threshold was close to the VRA threshold,and the average correlation coefficient was r=0.91~0.97.In the perinatal hypoxic-ischemic group,CM and DPOAE were found in all the children,including 1 case with normal acoustic reflex,2 cases without acoustic reflex and 2 cases with high acoustic reflex threshold.In ABR,waveⅢand waveⅤdisappeared in 1 case,Ⅴ,Ⅰ~Ⅴprolonged in 2 cases,Ⅴ,Ⅲ~Ⅴprolonged in 2 cases.The average ASSR and VRA listening thresholds at each frequency were flat,and the ASSR response threshold was significantly higher than the VRA listening threshold,the average correlation coefficient was r=0.42~0.63.4 cases of CM and DPOAE were present in the hyperbilirubinemia at birth group,CM was present and of DPOAE disappeared in 2 cases.All acoustic reflexes of the skeletal muscles disappeared,Ⅴ,Ⅰ~Ⅲprolonged.The average correlation coefficient between ASSR threshold and VRA threshold was r=0.70~0.85.Conclusion:The audiological characteristics of infants with hearing impairment caused by different etiologies are different.In clinical practice,we can judge the etiology and take reliable intervention plan based on the results of audiological examination.