单侧突发性聋患者对侧耳不同刺激速率听性脑干反应的临床研究

Clinical study on auditory brainstem response to different stimulation rates of the ear in patients with sudden unilateral deafness

目的探讨单侧突发性聋(sudden deafness,SD)患者在不同刺激速率听性脑干反应(auditory brainstem response,ABR)检测下对侧耳内耳听神经通路及供血情况。方法选取2021年9月至2022年1月辽宁中医药大学附属医院耳鼻喉头颈外科收治的单侧SD患者20例(20耳)为病例组,同期选取听力正常人(20人,20耳)为对照组,均进行ABR检测,比较两组不同刺激速率的Ⅰ、Ⅲ、Ⅴ波潜伏期(peak latency,PL)、Ⅰ~V波间期(interpeak latency,IPL)、PL差值(△PL)及IPL差值(△IPL)。结果低刺激速率(11.1次/s)时,病例组Ⅰ、Ⅲ、Ⅴ波的PL以及Ⅰ~Ⅲ、Ⅲ~Ⅴ、Ⅰ~Ⅴ的IPL与对照组比较,差异均无统计学意义(P>0.05);中刺激速率(21.1次/s)时,病例组Ⅰ、Ⅴ波的PL长于对照组[(1.77±0.11)ms比(1.65±0.11)ms,(5.86±0.19)ms比(5.68±0.13)ms],差异均有统计学意义(P<0.05);高刺激速率(55.1次/s)时,Ⅰ、Ⅴ波的PL和Ⅲ~Ⅴ、Ⅰ~Ⅴ的IPL长于对照组[(1.88±0.12)ms比(1.73±0.14)ms,(6.22±0.19)ms比(5.78±0.11)ms,(2.30±0.26)ms比(2.00±0.19)ms,(4.33±0.22)ms比(4.05±0.14)ms],差异均有统计学意义(P<0.05)。病例组高-中刺激速率(55.1~21.11次/s)、高-低刺激速率(55.1~11.1次/s)时的Ⅰ~Ⅴ的△IPL明显长于对照组[(0.25±0.16)ms比(0.02±0.11)ms,(0.57±0.28)ms比(0.17±0.09)ms],差异均有统计学意义(P<0.05)。病例组高、中、低刺激率下Ⅰ~Ⅴ的△IPL总异常率为63.33%(38/60),高于对照组的6.66%(4/60),差异有统计学意义(P<0.05)。结论随着刺激速率增加,ABR中、高速率比低速率刺激能更敏感发现患者听觉脑干通路异常,并提示单侧SD患者对侧耳在听力正常情况下可能存在迷路动脉缺血缺氧症状。与听力正常人相比,突触效能损伤和ABR潜伏期延长对隐形听力损失评估有重要的临床价值。

Objective To explore the auditory nerve pathway and blood supply in the inner ear of patients with unilateral sudden deafness(SD)under different stimulation rates of auditory brainstem response(ABR).Methods A total of20 patients with unilateral SD admitted to the Department of Otolaryngology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from September 2021 to January 2022 were selected as the case group(20 ears),and 20 people with normal hearing(20 ears)were selected as the control group.Both groups were treated with ABR detection.The peak latency(PL)ofⅠ,ⅢandⅤwaves,interpeak latency(IPL)ofⅠ~Ⅴwaves,PL difference(△PL)and IPL difference(△IPL)of the two groups at different stimulation rates were compared.Results At low stimulation rate(11.1 times/s),there was no significant differences in PL ofⅠ,Ⅲ,Ⅴwaves and IPL ofⅠ~Ⅲ,Ⅲ~ⅤandⅠ~Ⅴwaves between the two groups(P>0.05).At the medium stimulation rate(21.1 times/s),the PL of I and V waves in the case group were longer than those in the control group[(1.77±0.1)ms vs.(1.65±0.11)ms,(5.86±0.19)ms vs.(5.68±0.13)ms],and the differences were statistically significant(P<0.05).At high stimulation rate(55.1 times/s),the PL ofⅠ,Ⅴwaves and IPL ofⅢ~ⅤandⅠ~Ⅴwaves in the case group were longer than those in the control group[(1.88±0.12)ms vs.(1.73±0.14)ms,(6.22±0.19)ms vs.(5.78±0.11)ms,(2.30±0.26)ms vs.(2.00±0.19)ms,(4.33±0.22)ms vs.(4.05±0.14)ms],and the differences were statistically significant(P<0.05).At high-medium stimulation rate(55.1~21.1 times/s)and high-low stimulation rate(55.1~11.1 times/s),the △IPL ofⅠ~Ⅴwaves in case group were significantly longer than those in control group[(0.25±0.16)ms vs.(0.02±0.11)ms,(0.57±0.28)ms vs.(0.17±0.09)ms](P<0.05).The total abnormal rate of △IPL in case group at high,medium and low stimulation rates was 63.33%(38/60),which was higher than that in the control group[6.66%(4/60)],and the difference was statistically significant(P<0.05).Conclusions With the increase of stimulation rate,ABR at medium and high rate is more sensitive than that at low rate to detect abnormal auditory brainstem pathway,which suggests that unilateral SD patients may have symptoms of labyrinth artery ischemia and hypoxia in contralateral ear under normal hearing.Compared with people with normal hearing,synaptic efficiency damage and ABR latency prolongation has important clinical value in the assessment of invisible hearing loss.