应用畸变产物耳声发射和扩展高频测听对顺铂耳毒性的临床研究

Clinical study on ototoxicity of cisplatin by distortion product otoacoustic emissions and high frequency audiometry

目的 应用0.5～16 kHz畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)和扩展高频测听对顺铂耳毒性进行临床研究。方法 对24例应用顺铂进行初次化疗的妇科肿瘤病人于化疗前后分别进行0.5～16 kHz DPOAE、常频纯音测听及扩展高频测听检查,比较DPOAE和常频纯音测听、扩展高频测听的结果。结果 顺铂化疗后扩展高频区纯音听阈升高,DPOAE在3 kHz、4 kHz处及扩展高频区下降明显。结论 常频DPOAE较常频纯音测听更敏感,和扩展高频测听检查一样均可用于顺铂耳毒性的监测。扩展高频DPOAE可能比常频DPOAE更敏感。DPOAE与纯音听阈可能并非一一对应关系。病人对顺铂的易感性可能随着年龄的增加逐渐减低。

Objective To investigate the ototoxicity of cisplatin on distortion product otoacoustic emissions (DPOAE) and high frequency audiometry. Methods DPOAE, conventional pure tone audiometry and expanded high frequency audiometry were examined in 24 gynecologic cancer patients of first time cisplatin administration before and after the chemotherapy. DPOAE amplitudes, conventional pure tone hearing thresholds and expanded high frequency hearing thresholds were compared. Results After the cisplatin administration, the pure tone hearing thresholds at expanded high frequency area declined. DPOAE amplitudes at frequency from 3 to 4 kHz and expanded high frequency area declined too. The obvious change occurred in age group of 19 to 29. Conclusion DPOAE is a potential implement to early detect the ototoxicity of cisplatin. It is likely that the origination of DPOAE does not limit to the outer hair cells in corresponding cochlear areas. The originated area and mechanism of DPOAE should be focused on in further studies. The susceptibility to cisplatin may decline with the increase of patients' age.