皮层听觉诱发电位在听力障碍法医学鉴定中的应用

Application of Cortical Auditory Evoked Potential in Forensic Evaluation of Hearing Impairment

目的 分析残余噪声水平(residual noise level,RNL)对听性脑干反应(auditory brainstem response,ABR)有效识别率的影响,ABR与40 Hz听觉事件相关电位(40Hz audiotory event related potential,40HzAERP)和皮层听觉诱发电位(cortical auditory evoked potential,CAEP)反应阈相关性,探讨CAEP应用于听力障碍法医学鉴定的意义。方法 对26例52耳听力障碍法医学鉴定人群进行听觉神经电生理测试,测量并分析左右两耳所有ABR曲线中的RNL最大值,分析CAEP结果,分析ABR与40HzAERP、CAEP反应阈相关性。结果 ABR曲线有效识别率92.31%,CAEP均可有效识别为引出或未引出反应。1、2 kHz短纯音刺激CAEP反应幅值均高于ABR;ABR与1、2 kHz短纯音刺激的40HzAERP反应阈无相关,差异无统计学意义(P>0.05);ABR与1、2 kHz短纯音刺激的CAEP反应阈无相关,差异无统计学意义(P>0.05);1、2 kHz短纯音刺激40HzAERP与CAEP反应阈无相关,差异无统计学意义(P>0.05)。结论 CAEP不易受到RNL异常增高因素的影响,可获得较为可靠的测试结果,且具有频率特异性,反应阈值与其他客观听力测试结果之间具有稳定的相关性,可作为因RNL异常增高导致ABR无法测试人群进行听力障碍法医学鉴定的方法之一。

Objective By analyzing the effect of residual noise levels(RNL) on the rate of auditory brainstem response(ABR) recognition and comparing the correlation between ABRs and 40 Hz auditory event related potentials(40Hz AERPs) and cortical auditory evoked potential(CAEP) thresholds,to report the value of CAEP in forensic evaluation of hearing impairment.Methods Auditory electrophysiological tests were completed in 26 patients with hearing impairment(52 ears),and the maximal RNL in ABRs in both ears were measured and analyzed,as well as the correlation between ABRs and 40 Hz AERPs and CAEP thresholds.Results The effective recognition rate of ABR curve is92.31%,CAEP can effectively identify whether the reaction is induced or not.1.The amplitude of CAEP response to 2kHz short pure tone stimulation is higher than that of ABR.ABR and 1,2,the 40Hz AERP response threshold of kHz short pure tone stimulation was not correlated,and the difference was not statisticallysignificant(P>0.05);ABR and CAEP inverse of 1 and 2 kHz short pure tone stimulation,there was no correlation between the threshold and the difference was not tatist ically significant(P>0.05);There is no correlation between the response threshold of 40Hz AERP and CAEP stimulated by 1,2 kHz short pure tone,and the difference is not statistically significant meaning(P>0.05).Conclusion CAEPs are not easily affected by abnormal increase of RNL,and can yield consistent and reliable results with frequency specificity,with thresholds consistently correlated with other objective auditory measurements.CAEPs can be used as an alternative methods for forensic evaluation of hearing impairment in populations where ABR thresholds are unreliable due to abnormal increase of RNL.