高频听力减退耳鸣患者的畸变产物耳声发射特征

Distortion product otoacoustic emissions in tinnitus patients with high-frequency hearing loss

目的分析噪声性高频听力减退青年男性耳鸣患者的纯音听阈和畸变产物耳声发射(DPOAE)检测结果,探讨DPOAE和纯音听阈测试在耳鸣患者诊断中的应用价值。方法选择2023年5月至2024年2月在东部战区总医院耳鼻咽喉头颈外科门诊经纯音听阈测试(pure tone audiometry,PTA)诊断为双侧高频听力减退的27例(54耳)青年耳鸣患者作为耳鸣组。另选取同期青年男性志愿者22例(44耳)作为对照组。两组均用CAPELLA耳声发射仪进行常规频率(0.5~8.0 kHz)畸变产物耳声发射测试、MADSEN听力计行0.5~8.0 kHz的纯音听阈测试,并对其纯音听阈和DPOAE结果进行分析比较。结果纯音听阈在除0.5 kHz外的各频率点,耳鸣组明显差于对照组(P<0.05),其中高频4.0 kHz和8.0 kHz两频率处差异最为明显(P<0.001)。两组间的DPOAE结果比较,仅在高频4.0 kHz和8.0 kHz两个频率处,耳鸣组明显差于对照组(P<0.001)。结论纯音听阈和畸变产物耳声发射对于噪声性耳聋的诊断具有重要临床价值,其中感知高频声音的耳蜗外毛细胞更易受损,且该损伤不可逆。

Objective The aim of this study was to analyze the pure tone audiometry(PTA)and distortion product otoacoustic emission(DPOAE)test results of young male patients with noise induced high-frequency hearing loss,and to explore the value of DPOAE and PTA in the diagnosis of tinnitus patients.Methods 27 young male tinnitus patients(54 ears)with bilateral high-fre‐quency hearing loss in pure tone hearing threshold were selected as the tinnitus study group.22 young male volunteers(44 ears)with normal pure tone hearing threshold and no tinnitus symptoms were selected as the normal control group.Both groups underwent conven‐tional frequency(0.5-8.0 kHz)DPOAE testing using CAPELLA otoacoustic emission instrument,and pure tone hearing threshold testing using MADSEN audiometer.The pure tone hearing threshold and DPOAE results of both groups were analyzed and compared.Results The pure tone hearing threshold of tinnitus group was significantly lower than that of the control group at all frequency points except 0.5 kHz(P<0.05),with the most significant differences observed at frequencies 4.0 and 8.0 kHz(P<0.001).The DPOAE results between the two groups were compared.The tinnitus group was significantly worse than the control group(P<0.001)only at the high-frequency points of 4.0 and 8.0 kHz.Conclusion PTA and DPOAE have important clinical value in the diagnosis of noise-induced hearing loss.The outer hair cells of cochlear that perceive high-frequency sound are more susceptible to damage.The damages are irrevers‐ible in noise-induced hearing loss patients.