本文關(guān)鍵詞： 純音測(cè)聽(tīng) 聽(tīng)力監(jiān)測(cè) 低頻波動(dòng)性 感音神經(jīng)性聽(tīng)力損失 低壓艙　出處：《中國(guó)人民解放軍醫(yī)學(xué)院》2015年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景和目的：聽(tīng)力損失是威脅人類(lèi)健康的最常見(jiàn)疾病之一,是世界性的公共衛(wèi)生問(wèn)題。2006年全國(guó)第二次殘疾人口調(diào)查顯示,聽(tīng)力言語(yǔ)殘疾超過(guò)2780萬(wàn),占?xì)埣踩丝倲?shù)的33%,高居各類(lèi)殘疾首位。低頻波動(dòng)性感音神經(jīng)性聽(tīng)力損失表現(xiàn)為低頻聽(tīng)力下降,伴耳悶、耳鳴、眩暈、站立不穩(wěn)等,是一種內(nèi)耳性疾病,患者常有聽(tīng)力反復(fù)波動(dòng)主訴,而現(xiàn)有的臨床檢測(cè)手段只能通過(guò)患者的主觀感受描述和純音測(cè)聽(tīng)結(jié)果提供該病的診斷信息,受制于專(zhuān)業(yè)的測(cè)聽(tīng)隔聲室和測(cè)聽(tīng)設(shè)備。開(kāi)發(fā)一種便攜式聽(tīng)力自我檢測(cè)系統(tǒng),有利于實(shí)時(shí)監(jiān)測(cè)聽(tīng)力損失變化,及時(shí)準(zhǔn)確臨床預(yù)警,以助于科學(xué)臨床診斷和診治。本文研究一在于開(kāi)發(fā)和評(píng)估一種新型聽(tīng)力自我檢測(cè)系統(tǒng),用以聽(tīng)力損失患者聽(tīng)力自我監(jiān)測(cè)。應(yīng)用低壓艙治療多種疾病由來(lái)已久,特別是文獻(xiàn)報(bào)道應(yīng)用低壓艙治療梅尼埃病可能有效,說(shuō)明壓力變化可能對(duì)于內(nèi)耳性疾病產(chǎn)生作用。臨床發(fā)現(xiàn)一些隨訪時(shí)間較長(zhǎng)的低頻波動(dòng)性感音神經(jīng)性聽(tīng)力損失患者最后發(fā)展為梅尼埃病,因此推測(cè)低頻波動(dòng)性感音神經(jīng)性聽(tīng)力損失可能是非典型梅尼埃病的早期階段�，F(xiàn)在普遍認(rèn)為二者具有共同的內(nèi)淋巴積水的病理基礎(chǔ),據(jù)此,低壓艙治療梅尼埃病的成功經(jīng)驗(yàn)為內(nèi)耳性疾病的內(nèi)科治療提供了重要的參考和思路。本文研究二在于初步建立低壓艙規(guī)范治療方案,并研究低頻感音神經(jīng)性聽(tīng)力損失患者應(yīng)用低壓艙治療的臨床效果。方法：研究一：由筆記本電腦、聲卡、耳機(jī)以及自制音頻轉(zhuǎn)換器組成，，使用Microsoft Office Visio軟件編程,建立起便攜式聽(tīng)力自我檢測(cè)系統(tǒng)。系統(tǒng)建立后,先后進(jìn)行小樣本預(yù)實(shí)驗(yàn)和3次評(píng)估實(shí)驗(yàn)。實(shí)驗(yàn)1為37名(74耳)聽(tīng)力正常人,實(shí)驗(yàn)2為40名(80耳)感音神經(jīng)性聽(tīng)力損失患者,實(shí)驗(yàn)3為13名(26耳)聽(tīng)力正常人和37名(74耳)感音神經(jīng)性聽(tīng)力損失患者,分別進(jìn)行1次測(cè)聽(tīng)室內(nèi)的純音測(cè)聽(tīng)和2次聽(tīng)力自我檢測(cè)系統(tǒng)的測(cè)試,以測(cè)聽(tīng)室內(nèi)的純音測(cè)聽(tīng)結(jié)果為“金標(biāo)準(zhǔn)”,對(duì)比250Hz-8000Hz純音測(cè)聽(tīng)與系統(tǒng)自測(cè)的聽(tīng)閾,分析聽(tīng)力自我檢測(cè)系統(tǒng)的準(zhǔn)確性和可靠性。研究二：記錄飛機(jī)起降機(jī)艙內(nèi)壓力變化參數(shù)。采用低壓艙模擬飛機(jī)起降對(duì)7名正常志愿者影響。應(yīng)用4個(gè)不同低壓艙方案治療低頻波動(dòng)性聽(tīng)力損失志愿者,制定最佳低壓艙治療方案。對(duì)20例低頻波動(dòng)感音神經(jīng)性聽(tīng)力損失患者應(yīng)用最佳低壓艙治療方案進(jìn)行治療,對(duì)比分析治療前后患者純音測(cè)聽(tīng)結(jié)果及耳悶堵、耳鳴、顱鳴主觀癥狀程度變化。結(jié)果：研究一：建立便攜式聽(tīng)力自我檢測(cè)系統(tǒng)。實(shí)驗(yàn)1配對(duì)t檢驗(yàn)顯示,雙耳250Hz、 500Hz、8000Hz處自測(cè)與純音測(cè)聽(tīng)結(jié)果偏差無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),雙耳1000Hz、 2000Hz、4000Hz處自測(cè)與純音測(cè)聽(tīng)結(jié)果有偏差(P0.05)。實(shí)驗(yàn)2配對(duì)t檢驗(yàn)顯示，雙耳250Hz、500Hz、8000Hz、右耳1000Hz處自測(cè)與純音測(cè)聽(tīng)結(jié)果偏差無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),左耳1000Hz、雙耳2000Hz、4000Hz處自測(cè)與純音測(cè)聽(tīng)結(jié)果有偏差(P0.05)。實(shí)驗(yàn)3在雙耳250Hz-8000Hz各頻率處2次自測(cè)與純音測(cè)聽(tīng)結(jié)果之間,One-way ANOVA顯示無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),Post-Hoc兩兩比較顯示無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),相關(guān)分析結(jié)果顯示二者具有較高相關(guān)性(R0.6,P0.001),100耳中系統(tǒng)靈敏度為97.6%,特異度為98.3%,感音神經(jīng)性聽(tīng)力損失74耳中系統(tǒng)靈敏度為97.6%,特異度為97%,一致性檢驗(yàn)Kappa=0.848 (P0.001)。研究二：起飛約20分鐘機(jī)艙壓力減壓到約80kPa,下降約30分鐘恢復(fù)到正常大氣壓水平。正常志愿者5例無(wú)耳部不適,2例增壓期出現(xiàn)耳痛,自行緩解。研究制定的最佳低壓艙治療方案是：以3m/s的速度從正常大氣壓降至78.6kPa,相當(dāng)于2.2km海拔氣壓水平,穩(wěn)壓5min,然后以1m/s的速度增壓至89.6kPa,相當(dāng)于1.1km海拔氣壓水平,接著再以3m/s速度減壓至78.6kPa,穩(wěn)壓5min,繼續(xù)以1m/s速度增壓至89.6kPa,接著還以3m/s速度減壓至78.6kPa,穩(wěn)壓5min后,以1m/s的速度恢復(fù)至正常大氣壓�；颊咴�95.1kPa以下,即相當(dāng)于550m海拔以上氣壓水平鼻吸管持續(xù)吸氧2.5L/min。治療每日1次,一療程5次。輕度聽(tīng)力損失需1個(gè)療程,中度聽(tīng)力損失一般需2個(gè)療程,療程間隔2d。20例患者全身狀態(tài)良好,無(wú)不良反應(yīng)。聽(tīng)力損失痊愈7例,顯效4例,有效1例,無(wú)效8例,總有效率為60%。輕度和中度聽(tīng)力損失兩組患者聽(tīng)力療效之間的差別有統(tǒng)計(jì)學(xué)意義(P0.05)。耳悶堵感痊愈17例,顯效0例,有效2例,無(wú)效1例,總有效率為95%。耳鳴痊愈7例,顯效0例,有效5例,無(wú)效8例,總有效率為60%。顱鳴共2例,無(wú)效。隨訪4-6個(gè)月,1例治療有效患者因上呼吸道感染復(fù)發(fā)耳悶堵感,重復(fù)低壓艙治療效果有效。結(jié)論：便攜式聽(tīng)力自我檢測(cè)系統(tǒng)自測(cè)結(jié)果與純音測(cè)聽(tīng)各頻率線(xiàn)性相關(guān),二者具有較好的診斷一致性。應(yīng)用低壓艙治療低頻波動(dòng)性感音神經(jīng)性聽(tīng)力損失具有較好療效,尤其是可顯著改善患者的耳悶堵感,因其屬于無(wú)創(chuàng)性治療方法,所以更具有重要的臨床應(yīng)用價(jià)值。
[Abstract]:Background and objective: hearing loss is one of the most common diseases threatening human health, is to show the.2006 public health problem in the world in the second national survey of disabled population, more than 27 million 800 thousand hearing disability, disabled persons accounted for 33% of the total, the highest in all kinds of disabilities. Low frequency sensorineural hearing loss showed low-frequency hearing loss. With aural fullness, tinnitus, vertigo, standing instability, is a kind of inner ear disease, patients often complained of hearing repeated fluctuations, but only clinical existing detection methods through the subjective experience of patients with pure tone audiometry describe and provide diagnostic information of the disease, subject to professional audiometry and sound insulation room test listen to the equipment. Self detection system to develop a portable listening, is conducive to real-time monitoring the changes of hearing loss, timely and accurate early warning, in order to help the clinical diagnosis and treatment of this study is a science. The development and evaluation of self detection system for a new hearing, for patients with hearing loss hearing. Self monitoring application Hypobaric Treatment of many diseases especially long-standing, reported application of hypobaric chamber may be an effective treatment of Meynier's disease, which shows that the pressure changes may have a role in inner ear disease. The clinical findings of some longer follow-up time low frequency sensorineural nerve hearing loss patients developed Meynier's disease, suggesting that low frequency sensorineural hearing loss may be atypical in early stage of Meynier's disease. It is generally believed that the pathological basis, the two have common endolymphatic hydrops which provides an important reference and thinking of medical treatment experience for the treatment of Meynier's disease in hypobaric chamber inner ear disease. This study is to establish two hypobaric standard treatment, and study of low frequency sensorineural The clinical effect of patients with sensorineural hearing loss. Methods: Hypobaric Treatment: a study by the notebook computer, sound card, headset and homemade audio converter, using Microsoft Office Visio software, establish self detection system for portable listening. After the establishment of the system, has small sample pre experiment and 3 assessment experiments. Experiment 1 37 (74 ears) with normal hearing, experiment 2, 40 (80 ears) with sensorineural hearing loss patients, Experiment 3 was 13 (26 ears) with normal hearing people and 37 patients (74 ears) with sensorineural hearing loss patients were 1 times of pure tone audiometry room audiometry and 2 listening self detection system to measure indoor test, listen to the pure tone audiometry as a "gold standard", compared with the 250Hz-8000Hz system and the self testing of pure tone audiometry threshold, analysis of listening self detection system. The accuracy and reliability of the research: two records Aircraft cabin pressure change parameters. Using low pressure chamber simulation of the effects of aircraft movements in 7 normal volunteers. The application of 4 different hypobaric regimen in the treatment of low frequency fluctuation of hearing loss to volunteers, develop the best treatment options. Hypobaric Treatment of 20 patients with low frequency sensorineural hearing loss in patients with the best hypobaric treatment. Comparative analysis of patients before and after treatment with the results of pure tone audiometry and ear stuffy, tinnitus, cranial tinnitus changes in subjective symptoms. Results: the establishment of self detection system for portable listening. Experiment 1 paired t test showed that 250Hz, 500Hz, 8000Hz ears, self testing and the results of pure tone audiometry deviation was not statistically significant (P0.05), ears 1000Hz, 2000Hz, 4000Hz self testing and pure tone test deviation to the results (P0.05). Experiment 2 paired t test showed that 250Hz, 500Hz, 8000Hz, ears, ear 1000Hz self testing with pure tone audiometry. If the deviation was not statistically significant (P0.05), 1000Hz, left ear dichotic 2000Hz, 4000Hz self testing and pure tone test bias to the results (P0.05). In Experiment 3 250Hz-8000Hz between the ears at each frequency 2 times of self testing and the results of pure tone audiometry, One-way ANOVA showed no significant difference (P0.05), Post-Hoc 22 showed no statistical comparison the difference (P0.05), correlation analysis showed that the two have high correlation (R0.6, P0.001). The sensitivity of the system in 100 ears of 97.6%, a specificity of 98.3%, sensitivity of sensorineural hearing loss in 74 ears was 97.6%, the specificity was 97%, the consistency test of Kappa=0.848 (P0.001). Study two: take off about 20 minutes into the vacuum cabin pressure is about 80kPa, decreased by about 30 minutes to return to normal atmospheric pressure. The level of normal volunteers and 5 patients without ear discomfort, 2 cases of pressurization period earache, relieved. The study made the best treatment in hypobaric chamber is: 3 The speed of m/s from normal atmospheric pressure to 78.6kPa, equivalent to 2.2km above sea level pressure level, the regulator 5min, then with 1m/s speed boost to 89.6kPa, equivalent to 1.1km above sea level pressure level, then at the speed of 3m/s decompression to 78.6kPa, 1m/s speed regulator 5min, continue to boost to 89.6kPa, and then at the speed of 3m/s decompression to 78.6kPa 5min, voltage regulator, recovery at a speed of 1m/s to normal atmospheric pressure. The patients in the following 95.1kPa, which is equivalent to 550m above pressure level Straw nasal oxygen 2.5L/min. treatment 1 times a day, a course of 5 times. Mild hearing loss take 1 courses, moderate hearing loss usually takes 2 course of treatment, treatment interval of 2d.20 cases with the body in good condition, no adverse reactions. Hearing loss, 7 cases were cured, 4 cases were cured, 1 cases effective, 8 cases ineffective, the total effective rate was 60%. between mild and moderate hearing loss in two groups of patients with hearing results had statistic difference Meaning (P0.05). The ear stuffy feeling 17 cases were cured, 0 cases markedly effective, 2 cases effective, 1 cases ineffective, the total effective rate was 95%. tinnitus 7 cases were cured, 0 cases markedly effective, 5 cases effective, 8 cases ineffective, the total effective rate was 60%., a total of 2 cases of skull, 4-6 months of follow-up is invalid. In 1 cases, effective treatment for patients with ear stuffy sense of recurrent upper respiratory tract infection, repeated Hypobaric Treatment. Conclusion: portable self hearing detection system self testing results and pure tone audiometry each frequency linear correlation, the two have good consistency diagnosis. The application of Hypobaric Treatment failure has good curative effect low frequency sensorineural nerve hearing loss, especially can significantly improve the patient's ear stuffy feeling, because it is noninvasive treatment method, so it has important value in clinical application.

【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R764.43

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