职业性噪声聋患者双耳听力损失不对称性分析

Analysis of asymmetric hearing loss in both ears of patients with occupational noise-induced deafness

目的了解职业性噪声聋患者双耳不对称性听力损失的特征,探讨引起不对称性听力损失的可能原因。方法于2015年5月至2018年5月,收集广东省职业病防治院已诊断为职业性噪声聋的患者423例。以在住院期间相隔3 d以上的连续3次纯音听阈测试(PTA)结果各频率听阈值最小值和多频稳态听觉诱发电位(ASSR)各频率反应阈为依据,以GBZ 49-2014《职业性噪声聋的诊断》标准为基础,计算加权值;采用配对非参数检验的Wilcoxon符号秩检验、Spearman秩相关分析等方法,分析不同性别、年龄、接触噪声工龄、诊断分级患者双耳PTA听阈加权值和ASSR反应阈加权值的差异和关系。结果职业性噪声聋患者男性369人(87.23%),女性54人(12.77%);年龄为(41.8±7.6)岁;工龄为(10.1±6.2)年。职业性噪声聋患者左耳PTA听阈加权值、ASSR反应阈加权值均高于右耳(P<0.001)。男性、年龄≤40岁和41~60岁、工龄3~9年、分级为轻度的患者左耳PTA听阈加权值和ASSR反应阈加权值均高于右耳(P<0.05);特征变量均衡化后,各组左耳PTA听阈加权值和ASSR反应阈加权值亦均高于右耳(P<0.05)。职业性噪声聋患者左右耳PTA听阈加权值与ASSR反应阈加权值均呈正相关(P<0.001)。结论职业性噪声聋患者双耳听力损失存在不对称性,且左耳听力损失高于右耳。

Objective To investigate the characteristics of asymmetric hearing loss in left and right ears of patients with occupational noise-induced deafness and to explore the possible causes of asymmetric hearing loss.Methods A total of 423 cases of occupational noise-induced deafness diagnosed in Guangdong Province Hospital for Occupational Disease Prevention and Treatment from May 2015 to May 2018 were investigated retrospectively.On the basis of three consecutive pure tone audiometry(PTA)with intervals of more than 3 d in hospital,the minimum of hearing threshold of each frequency and the frequency response threshold of auditory steady-state response(ASSR),and based on the GBZ 49-2014"Diagnosis of Occupational Noise-induced Deafness".The statistical analysis of Wilcoxon signed rank test and Spearman correlation analysis were carried out by nonparametric test.The hearing threshold weight of PTA and the response threshold of ASSR were tested and compared from different dimensions according to sex,age,length of service of exposure noise,diagnosis grade and so on.Results There were 369 male(87.23%)and 54 female(12.77%);the age was(41.8±7.6)years;the length of service was(10.1±6.2)years.The weighted values of left ear PTA and ASSR were higher than those of right ear(P<0.001).The weighted values of left ear PTA and ASSR were higher than those of right ear(P<0.05)in men,patients with age≤40 and 41-60 years,3-9 years of service,and patients with mild grade(P<0.05).After the equalization of characteristic variables,the weighted values of left ear PTA and ASSR were also higher than those of right ear(P<0.05).There was a positive correlation between the weighted value of PTA and the weighted value of ASSR(P<0.001).Conclusion There is asymmetry in hearing loss of patients with occupational noise deafness,and hearing loss in the left ear is higher than that in the right ear.