职业噪声暴露人群听力学特征分析

Audiological Characteristics of People Exposed to Occupational Noise

目的探究职业噪声暴露人群的听力学特征,为早期噪声致隐性听力损失提供诊断意义。方法选取37例有噪声暴露史的健听青年(接噪组,年龄28.70±0.76岁)和37例无噪声暴露史的健听男青年(对照组,年龄26.50±0.95岁)的优势耳进行扩展高频(extended high-frequency,EHF)、畸变产物耳声发射(DPOAE)、噪声下言语测听(speech in noise,SIN)、听性脑干反应(ABR)、言语声诱发听性脑干反应(speech evoked auditory brainstem responses,s-ABR),比较对照组和接噪组各项测试结果的差异,并分析测试结果的相关性。结果(1)在EHF测听中,随频率增高,接噪组较对照组检出率降低;接噪组在12.5、14、16、18、20 kHz频率处的平均听阈显著高于对照组(P<0.05)。(2)在DPOAE中,接噪组的信噪比较对照组降低;在4~10 kHz频率上有显著差异(P<0.05)。(3)在SIN测听中,接噪组的信噪比损失较对照组严重,差异有统计学意义(P<0.05)。(4)在clickABR中,接噪组的波Ⅰ幅值较对照组低,波Ⅰ的潜伏期较对照组延长,Ⅰ-Ⅴ的平均峰间间隔较对照组缩短,Ⅴ/Ⅰ波幅比值高于对照组(P<0.05)。(5)在s-ABR测试中,接噪组波A、C、D、O潜伏期较对照组显著延长(P<0.05)。(6)扩展高频阈值分别与DPOAE、s-ABR的C、O波潜伏期具有相关性;DPOAE与SIN信噪比损失存在相关性;ABR与s-ABR对辅音/d/的刺激反应存在相关性。结论EHF、DPOAE、SIN、click-ABR和s-ABR等5种测试对于早期诊断噪声致隐性听力损失可能存在一定临床意义。

Objective To evaluate the clinical significance of possible noise-induced hearing loss by analyzing the audiological characteristics of people exposed to occupational noise.Methods Thirty-seven normal-hearing young adults with a history of noise exposure(noise-exposed group,aged 28.70±0.76 years)and thirty-seven normal-hearing young adults without a history of noise exposure(control group,aged 26.50±0.95 years)were recruited.The following five tests were conducted on each subject’s better ear to obtain audiological data:Extended high-frequency(EHF)audiometry(9-16 kHz),Distortion product otoacoustic emissions(DPOAE),Speech-in-noise(SIN)test,Auditory brainstem response(ABR),and Speech-evoked auditory brainstem reponse(s-ABR).The differences in the test results between the control group and the noise-exposed group were compared.Results 1.In the EHF audiometry,the detection rates of the noise-exposed group were significantly(P<0.05)lower than that of the control group at the frequencies of 12.5-20 kHz.2.In DPOAE,the extended high-frequency signal-to-noise ratio was lower than that in the control group;the differences at 4-10 kHz were statistically significant(P<0.05).3.In the SIN test,the signal-to-noise ratio(SNR)loss in the noise-exposed group was significantly worse than that in the control group(P<0.05).4.In the click-ABR,the amplitude of wave I in the noise-exposed group was lower than that in the control group,the latency of wave I was longer than that in the control group,mean Peak-to-Peak interval for I-V was shorter than that of the control group,and the V/I amplitude ratio of the noised-exposed group was higher than that of the control group,all with statistical significance(P<0.05).5.In the s-ABR,the latencies of A,C,D,and O in the noise-exposed group were significantly longer than these in the control group.6.The extended high-frequency thresholds were correlated with DPOAE,and the latency of s-ABR wave C and O,respectively.DPOAE was correlated with SIN scores.Click-ABR was correlated with s-ABR’s response to the stimulus of consonant/d/.Conclusion The EHF,DPOAE,SIN,click-ABR,and s-ABR tests may have specific clinical significance for the early diagnosis of hidden hearing loss caused by noise.