平均听阈正常的听神经瘤患者临床及听力学特征分析

The Clinical and Audiological Characteristics of Auditory Neuroma Patients with Normal Mean Auditory Threshold

目的 分析平均听阈正常(PTA≤25 dB HL)的单侧听神经瘤患者的临床特征及听力学特征,为听神经瘤早期筛查及诊断提供参考。方法 选取平均听阈正常的单侧听神经瘤患者32例(32耳)作为试验组,选取与年龄、性别相匹配的平均听阈正常的耳鸣患者20例(32耳)作为对照组,试验组和对照组均在符合国家标准的隔声室行纯音测听、声导抗、听性脑干反应、畸变产物耳声发射检查,回顾性分析两组临床及听力学特征。结果 单纯耳鸣、耳鸣伴反复发作且可治愈的突发性听力下降为平均听阈正常听神经瘤患者常见的首发症状,占50.00%,多见于30~40岁人群。试验组听性脑干反应异常率为75.00%(24/32),畸变产物耳声反射异常率为78.12%(25/32),患耳的同侧镫骨肌声反射和健耳的交叉声反射异常率分别为28.13%、56.25%,健耳的同侧镫骨肌声反射和患耳的交叉声反射异常率分别为6.25%、62.50%。通过对比分析试验组和对照组听力学特征,两组听性脑干反应的波Ⅲ、波Ⅴ潜伏期、波Ⅰ-波Ⅲ波间期、波Ⅰ-波Ⅴ波间期,患耳的交叉声反射和健耳的交叉声反射(0.5、1、2、4 kHz)、患耳的同侧声反射(2 kHz),均存在统计学差异(P<0.05),两组间畸变产物耳声反射异常率未见统计学差异(P>0.05)。结论 听性脑干反应及镫骨肌声反射检测有助于听神经瘤早期诊断,DPOAE是敏感性高但特异性差的检测指标。对门诊平均听阈正常的单侧耳鸣,或伴有反复发作的、可治愈的突发性听力下降患者,建议联合应用听性脑干反应、镫骨肌声反射、畸变产物耳声发射综合评估,为听神经瘤的早期诊断提供依据。

Objective The clinical and audiological characteristics of unilateral acoustic neuroma patients with normal mean auditory threshold(PTA≤25 dB HL)were analyzed to provide reference for early screening and diagnosis of acoustic neuroma.Methods Thirty-two patients with unilateral acoustic neuroma with normal mean hearing threshold(32 ears)were selected as the experimental group to analyze their clinical and audiological characteristics.A total of 20 patients(32 ears)with normal average hearing threshold matching with age and genders were selected as the control group.Results Tinnitus only,tinnitus accompanied by recurrent and curable sudden hearing loss were the most common initial symptoms in patients with normal auditory threshold auditory neuroma,accounting for 50.00%,most common in people aged 30-40 years old.The abnormal rate of auditory brainstem response was 75.00%(24/32),the abnormal rate of distortion product otoacoustic emission was 78.12%(25/32),the abnormal rates of ipsilomedapedus sound in the affected ear and the abnormal cross acoustic stapedius reflex in the healthy ear were 28.13%and 56.25%,respectively.The abnormal rates of ipsilomedapedial sound in healthy ear and cross acoustic stapedius reflex in affected ear were 6.25%and 62.50%,respectively.The audiological characteristics of the experimental and the control groups were compared and analyzed.For the WaveⅢlatency,WaveⅤlatency,WaveⅠ-Ⅲinterphase and WaveⅠ-Ⅴinterphase of auditory brainstem response in the two groups,the cross acoustic stapedius reflex of the affected ear and the healthy ear(0.5,1,2,4 kHz),and the ipsilateral acoustic stapedius reflex of the affected ear(2 kHz),there was a statistical difference between the two groups(P<0.05),and no statistical difference was found in the abnormal rate of distortion product otoacoustic emission between the two groups(P>0.05).Conclusion Auditory brainstem response and acoustic stapedius reflex detection are helpful for the early diagnosis of acoustic neuroma,while distortion product otoacoustic emission is a highly sensitive but poorly specific detection index.For patients with unilateral tinnitus with normal mean hearing threshold in outpatient clinics,or with recurrent and curable sudden hearing loss,it is recommended to use auditory brainstem response,acoustic stapedius reflex,distortion product otoacoustic emission comprehensive assessment to provide basis for early diagnosis of acoustic neuroma.