听神经瘤临床听力学特征分析

Analysis of clinical audiological characteristics of acoustic neuroma

目的分析听神经瘤患者临床听力学特征,为听神经瘤的诊断提供参考依据。方法回顾性分析首都医科大学附属北京天坛医院耳鼻咽喉头颈外科接诊的394例单侧听神经瘤患者临床资料,所有患者均行纯音测听、言语识别率、听性脑干诱发电位和颅脑增强MRI。结果患侧听力正常者54例,轻度听力损失58例,中度63例,中重度45例,重度45例,极重度31例,全聋者98例;高频听力损失最多见。24.7%患者言语识别率和纯音测听下降不成比例。听性脑干诱发电位波形正常者8例,波形缺失者228例和其他波形异常者158例;听性脑干诱发电位诊断听神经瘤的敏感度:内听道内肿瘤85.7%,内听道外98.5%。结论听神经瘤的听力学表型多样,听力正常者不能排除听神经瘤;听力损失程度不能预判肿瘤大小;纯音测听与言语识别率不一致应警惕蜗后病变;听性脑干诱发电位诊断听神经瘤敏感度随肿瘤增大而增加。

OBJECTIVE To analyze the clinical audiological characteristics of patients with acoustic neuroma(AN),and to provide reference for diagnosis of AN.METHODS Clinical datas of 394 patients with unilateral AN admitted to Otorhinolaryngology Head and Neck Surgery department of Beijing Tiantan Hospital affiliated with Capital Medical University were retrospectively analyzed.All patients underwent pure tone audiometry(PTA),speech discrimination score(SDS),auditory brainstem response(ABR)and contrast enhanced MRI.RESULTS There are 54 cases of normal hearing,58 cases of mild hearing loss,63 cases of moderate hearing loss,45 cases of moderate severe hearing loss,45 cases of severe hearing loss,31 cases of extremely severe hearing loss,and 98 cases of total hearing loss.High-frequency hearing loss was the most common.The proportion of SDS and PTA decreased disproportionately was 24.7%.There were 8 cases with normal ABR waveform,228 cases with absent ABR waveform and 158 cases with other abnormal waveforms.The sensitivity of ABR in the diagnosis of AN was 85.7%in the internal auditory canal,98.5%outside the internal auditory canal.CONCLUSION The audiological results of AN are varied.AN cannot be completely excluded from normal hearing.The degree of hearing loss can not predict tumor diameter.Inconsistent SDS and PTA should be vigilant against retrocochlear tumors.The sensitivity of ABR in the diagnosis of AN increase with the size of tumor.