不同听力检测方法对早期发现噪声性隐性听力损失的意义

Different Clinical Hearing Testing Methods in Early Detection of Noise-induced Hidden Hearing Loss

目的探讨扩展高频纯音测听、畸变产物耳声发射(DPOAE)及噪声下言语识别能力测试对早期发现噪声性隐性听力损失的意义。方法选取20例常频纯音听阈正常、有噪声接触史的工人(接噪组,年龄20~41岁)与20例无噪声接触史、常频听阈正常的青年人(对照组,年龄19~35岁),分别行扩展高频纯音测听、扩展高频DPOAE及噪声下言语识别能力测试(汉化版噪声下BKB语句测试),记录并比较两组各项测试结果。结果接噪组扩展高频纯音听阈检出率低于对照组,在16 kHz差异有统计学意义(P<0.05),在18、20 kHz差异有显著统计学意义(P<0.01);接噪组8~20 kHz扩展高频纯音听阈平均值高于对照组,在9、18 kHz差异有统计学意义(P<0.05),在14 kHz差异有显著统计学意义(P<0.01);接噪组扩展高频DPOAE的信噪比及幅值均较对照组降低,在10 kHz差异有统计学意义(P<0.05),在8、9 kHz差异均有显著统计学意义(P<0.01);噪声下言语识别能力测试显示接噪组信噪比损失平均值为4.6±2.19 dB,高于对照组(3.00±2.08 dB)(P<0.01)。结论接噪组相较对照组,扩展高频纯音听阈值升高或引不出,扩展高频DPOAE信噪比及幅值降低,噪声下言语识别能力显著下降,以上三种检测方法对早期发现噪声性隐性听力损失有一定的参考价值。

Objective To explore the significance of different clinical audiological tests for early detection of noise-induced hidden hearing loss.Methods A told of 20 noise exposed workers with normal hearing(noise exposed group)and 20 non-noise exposed young people with normal hearing(control group)were selected for this study.Three audiological tests,including extend high frequency audiometric test,distorted product otoacoustic emission(DPOAE)and speech in noise test were conducted to each subject,and all test results were recorded and analyzed.Results The noise receiving group was lower than the control group in the detection rate of extended high-frequency pure tone audiometry,there was a significant difference at 16 kHz(P<0.05),and a statistically significant difference at 18 and 20 kHz(P<0.01).There were significant differences in the average threshold of extended high frequencies at 9 and 18 kHz(P<0.05),and statistically significant differences at 14 kHz(P<0.01),the noise receiving group was higher than the control group.The signal-to-noise ratio(SNR)and amplitude of DPOAE in noise-exposed group were lower than those in the control group,and the SNR was statistically different at 0.5,1 and 10 kHz(P<0.05),and significantly different at 6,7,8 and 9 kHz(P<0.01).The amplitude of 6 and 10 kHz presented statistically differences(P<0.05),and the amplitudes at 0.5,1,7,8 and 9 kHz presented statistically significant differences(P<0.01).The mean SNR loss score of noise-exposed group was lower than that of the control group,and there was statistically significant differences(P<0.01).Conclusion Compared with the control group,the thresholds of extended high-frequency audiogram of noise-exposed group were either elevated or not detected,the SNR and amplitude of DPOAE at high-frequency region were reduced,and the performance of speech in noise was significantly degraded.The above three audiological tests may be measures for early detection of noise-induced hidden hearing loss.