耳声发射、声导抗、ABR与纯音听阈测试在职业噪声聋诊断中的关联性研究

Correlation of otoacoustic emission,acoustic immittance,ABR and pure tone hearing threshold test in the diagnosis of occupational noise deafness

目的 分析耳声发射、声导抗、听性脑干反应(ABR)测听与纯音听阈测试在职业性噪声聋诊断中的关联性。方法 运用纯音测听、耳声发射、声导抗、ABR为一组测试组合,对66 例(132耳)患者进行检测,分析耳声发射、声导抗、ABR客观电反应阈与纯音测听0.5kHz、1kHz、2kHz、4kHz的主观听阈在职业性噪声聋诊断中的关联性。结果 1、在职业性噪声聋诊断中,纯音听阈值≥40dB与<40dB的情况下畸变产物耳声发射引出率之间对比差异无统计学意义(P>0.05)。2、(排除中耳病变因素)声反射引出率与纯音听阈相应频率阈值≥40dB和<40dB情况下声反射引出率呈现出显著性差异有统计学意义(P <0.05)。3、纯音听阈2KHz、4KHz、2-4KHZ的均值与ABR阈值有正相相关性,以2-4KHz均值相关系数值(0.488)最高。结论 1、职业性噪声聋诊断要求职业危害接触史在3年以上,在此情况下,大多数患者耳蜗损伤已较重,故耳声发射在职业性噪声聋诊断中意义不大。2、声导抗、ABR与纯音听阈测试在职业性噪声聋诊断中具有定性、定量作用,应予以重视。

Objective To analyze the correlation between otoacoustic emission,acoustic immittance,auditory brainstem response (ABR) audiometry and pure tone hearing threshold test in the diagnosis of occupational noise deafness.Methods 66 patients (132 ears) were tested by pure tone audiometry,otoacoustic emission,acoustic immittance and ABR.The correlation between the objective electrical response thresholds of otoacoustic emission,acoustic immittance and ABR and the subjective hearing thresholds of pure tone audiometry at 0.5KHz,1kHz,2KHz and 4kHz in the diagnosis of occupational noise deafness was analyzed.Results 1.In the diagnosis of occupational noise deafness,there was no significant difference in the extraction rate of distortion product otoacoustic emission when the pure tone hearing threshold was ≥ 40dB and < 40dB (P > 0.05).2.(excluding the factors of middle ear lesions) there was a significant difference in acoustic reflex extraction rate when the frequency threshold corresponding to pure tone hearing threshold was ≥ 40dB and < 40dB (P < 0.05).3.The mean values of pure tone hearing thresholds 2KHz,4kHz and 2-4khz were positively correlated with ABR threshold,and the value of 2-4khz mean correlation coefficient (0.488) was the highest.Conclusion 1.The diagnosis of occupational noise deafness requires that the exposure history of occupational hazards is more than 3 years.In this case,most patients have severe cochlear injury,so otoacoustic emission has little significance in the diagnosis of occupational noise deafness.2.2.Acoustic immittance,ABR and pure tone hearing threshold test play a qualitative and quantitative role in the diagnosis of occupational noise deafness.