本文選題：聽性穩(wěn)態(tài)反應 + 參數　； 參考：《復旦大學》2010年碩士論文

【摘要】：目的 通過對正常及感音神經性聽力障礙嬰幼兒不同調制方法的聽性穩(wěn)態(tài)反應(auditory steady-state responses, ASSR)檢測結果的比較,找到最接近嬰幼兒行為聽閾的ASSR調制方法,以便為聽力障礙嬰幼兒提供更為可靠的聽力學評估,有效地指導診斷和治療。 方法 受試者為2009年1月至8月在上海市兒童聽力障礙診治中心進行聽力檢測的聽力正常嬰幼兒75名和感音神經性聽力障礙嬰幼兒60名,月齡為6-36月。 所有正常嬰幼兒均接受視覺強化測聽(visual reinforcement audiometry, VRA)和一種參數設置下的ASSR檢測。將ASSR設定三種參數設置方法：調制Ⅰ為單純調幅調制(amplitude modulation, AM),調幅深度100%；調制Ⅱ為調幅深度100%、調頻(frequency modulation, FM)深度10%；調制Ⅲ為調幅深度100%、調頻深度15%。受試嬰幼兒按隨機雙盲對照原則進行上述三種調制方法之一的ASSR檢測,從而分為Ⅰ(15名,25耳)、Ⅱ(30名,52耳)、Ⅲ(30名,50耳)組。兩兩比較三組ASSR和VRA閾值之差,明確最接近行為聽閾的參數設置方法。 感音神經性聽力障礙嬰幼兒均接受聽性腦干反應(auditory brainstem response,ABR)、調制Ⅱ及調制Ⅲ的ASSR檢測,以ABR閾值為標準分為輕度(12名,20耳)、中～中重度(18名,30耳)、重度～極重度(30名,56耳)聽力障礙三組。分別比較每組嬰幼兒調制Ⅱ及調制Ⅲ的ASSR I閡值,明確適合不同程度聽力障礙嬰幼兒ASSR檢測的參數設置方法。 結果 1.三組正常聽力嬰幼兒VRA聽閾無差異,具有可比性。三種不同調制方法的ASSR與VRA閾值均有差異,但混合調制ASSR (調制Ⅱ和Ⅲ)與VRA差異較單純調幅調制(調制Ⅰ)為小。 2.通過方差分析比較三組ASSR閾值,得到三組ASSR 250、500、1000、2000、4000Hz載頻的閾值均有統(tǒng)計學差異(F=10.56、16.26、18.99、11.64、9.41,P0.05)。 3.將三組ASSR與VRA閾值分別通過Spearman等級相關分析,得到組I ASSR250-4000Hz載頻閾值與相應的VRA閾值相關系數r分別為0.53、0.62、0.59、0.70、0.59,組Ⅱ分別為0.76、0.65、0.65、0.62、0.69,組Ⅲ分別為0.85、0.78、0.75、0.72、0.70；所有rr.005(v)(P0.05),均與行為聽閾顯著相關,組Ⅲ各相關系數更大。 4.對三組正常聽力嬰幼兒兩兩比較ASSR和VRA閾值之差,可見調制Ⅰ的ASSR各載頻閾值與VRA之差均明顯高于調制Ⅱ及調制Ⅲ與VRA的差值,差異有統(tǒng)計學意義(P0.05)。調制Ⅱ和Ⅲ所得閾值在250、500、1000 Hz載波頻率差異明顯(P0.05),2000、4000Hz差異不明顯(P=0.215,0.058)。 5.比較不同程度感音神經性聽力障礙嬰幼兒調制Ⅱ及調制Ⅲ的ASSR閾值,可見輕度及中～中重度聽力障礙組250、500、1000Hz ASSR閾值受調頻深度影響明顯(P=0.000,差異有統(tǒng)計學意義),2000及4000Hz閾值受調頻深度影響不明顯(P=0.056、0.090、0.297、0.339,差異無統(tǒng)計學意義),但調頻深度為15%(調制Ⅲ)的ASSR各載頻閾值均低于調頻深度為10%(調制Ⅱ)的ASSR閾值。 6.重～極重度聽力障礙嬰幼兒250-4000HzASSR閾值均不受調頻深度改變的影響(P=0.422、0.501、0.749、0.888、0.496,差異無統(tǒng)計學意義) 結論 1.在正常聽力嬰幼兒中,ASSR混合調制所得聽閾低于單純調幅調制的聽閾,適當增加混合調制中的調頻深度所得聽閾有下降,以低頻(250、500、1000Hz)影響更明顯,更適合嬰幼兒ASSR檢測。 2.對輕度及中～中重度聽力障礙嬰幼兒來說,可以采用增加混合調制中調頻深度的調制方法行ASSR檢測,以降低ASSR閾值,更接近行為聽閡。 3.重～極重度聽力障礙嬰幼兒各載頻ASSR閡值均不受一定程度調頻深度改變的影響,可以采用系統(tǒng)默認調制方法以節(jié)約檢測時間。
[Abstract]:objective
By comparing the results of auditory steady-state response (auditory steady-state responses, ASSR) of different modulation methods for infants with normal and sensorineural hearing impairment, we find the ASSR modulation method closest to the infant behavior hearing threshold so as to provide more reliable audiological assessment for hearing impaired infants and to guide the diagnosis effectively. And treatment.
Method
From January 2009 to August, 75 hearing normal infants and 60 children with sensorineural hearing impairment were tested for hearing impairment center in Shanghai from January 2009 to August, and the month was 6-36 months.
All normal infants receive visual intensive audiometry (visual reinforcement audiometry, VRA) and a ASSR test under a parameter setting. ASSR set three parameter setting methods: modulation I is pure amplitude modulation (amplitude modulation, AM), amplitude modulation depth 100%; modulation II is amplitude modulation depth 100%, frequency modulation (frequency modulation, F) M) depth 10%; modulation III was 100% of amplitude modulation depth, and FM depth 15%. was tested by ASSR for one of the three modulation methods according to random double blind control principle, which was divided into 1 (15, 25 ears), II (30, 52 ears), III (30, 50 ears). 22 compared to the difference between the three group and VRA threshold, the parameters closest to the behavioral hearing threshold were defined. Set the method.
Children with sensorineural hearing impairment received auditory brainstem response (auditory brainstem response, ABR), modulation II and modulation III ASSR detection. The ABR threshold was divided into mild (12, 20 ears), medium to moderate to severe (18, 30 ears), severe severe severe (30, 56 ears) hearing impairment in three groups of infants in each group. Modulate the ASSR I threshold of III, and define the parameter setting method suitable for ASSR detection of infants with different degree of hearing impairment.
Result
1. the three groups of normal hearing children have no difference in VRA hearing threshold. The ASSR and VRA thresholds of three different modulation methods are different, but the difference of mixed modulation ASSR (modulation II and III) and VRA is smaller than that of pure amplitude modulation (modulation I).
2. compared the three groups of ASSR threshold by analysis of variance analysis, the threshold of three groups of ASSR 250500100020004000Hz carrier frequency was statistically different (F=10.56,16.26,18.99,11.64,9.41, P0.05).
3. the three groups of ASSR and VRA thresholds were analyzed by Spearman level correlation, and the group I ASSR250-4000Hz carrier frequency threshold and the corresponding VRA threshold correlation coefficient r were 0.53,0.62,0.59,0.70,0.59, group II was 0.76,0.65,0.65,0.62,0.69 and group III was 0.85,0.78,0.75,0.72,0.70 respectively, and all rr.005 (V) were all with behavioral hearing threshold. The correlation coefficient of group III is greater.
4. to three groups of normal hearing children 22 comparison of the difference of ASSR and VRA threshold, it can be seen that the difference of ASSR carrier frequency threshold and VRA of modulation I is significantly higher than modulation II and modulation III and VRA, the difference is statistically significant (P0.05). Modulation II and III threshold in 2505001000 Hz carrier frequency difference is obvious (P0.05), 20004000Hz difference is not It is obvious (P=0.215,0.058).
5. comparing the ASSR threshold of modulation II and modulation III in infants with different degree of sensorineural hearing impairment, the 2505001000Hz ASSR threshold in the mild and medium to moderate severe hearing impairment group was significantly affected by the frequency of frequency modulation (P=0.000, the difference was statistically significant), and the 2000 and 4000Hz threshold were not significantly affected by the frequency of frequency modulation (P=0.056,0.090,0.297,0.339, The difference is not statistically significant. However, the carrier frequency thresholds of ASSR with modulation depth of 15% (modulation III) are lower than those of ASSR with modulation depth of 10% (modulation II).
The 250-4000HzASSR threshold of 6. severe severe hearing impaired infants was not affected by the change of FM depth (P=0.422,0.501,0.749,0.888,0.496, the difference was not statistically significant).
conclusion
1. in normal hearing children, the hearing threshold of ASSR mixed modulation is lower than that of simple amplitude modulation, and the hearing threshold of the mixed modulation is decreased, the influence of low frequency (2505001000Hz) is more obvious, and it is more suitable for infant ASSR detection.
2. for infants with moderate to moderate to moderate to moderate to severe hearing loss, ASSR detection can be used to increase the modulation depth of mixed modulation in order to reduce the ASSR threshold and closer to the behavioral hearing gap.
The carrier frequency ASSR threshold of 3. severe hearing impaired infants is not affected by a certain degree of frequency modulation, and the system default modulation method can be used to save detection time.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R764.04

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本文編號：2015820