本文選題：感音神經(jīng)性耳聾 + 低頻��； 參考：《天津醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的 分析急性低頻感音神經(jīng)性聾(acute low-frequency sensorineural hearing loss, ALHL)的純音聽閾、聲導(dǎo)抗測試、聽性腦干反應(yīng)(ABR)、畸變產(chǎn)物耳聲發(fā)射(DPOAE)和耳蝸電圖(ECochG)的特征,探討ALHL的臨床表現(xiàn)及聽力學(xué)特征,病因和發(fā)病機制及診斷方法,以期避免誤診,提高診斷率。 方法 選取2007年9月～2009年6月天津市第一中心醫(yī)院耳鼻咽喉頭頸外科門診確診為ALHL,且測試資料保存完整者46例(47耳),選取正常聽力志愿者20例(40耳)為正常對照組,另選取Meniere病組8例(9耳)；聽神經(jīng)病(auditory neuropathy,AN)組7例(14耳)；感音神經(jīng)性耳聾組18例,其中突發(fā)性聾6例(6耳),噪聲性聾2例(4耳),藥物中毒性聾2例(4耳),不明原因感音神經(jīng)性聾8例(16耳),作為疾病對照組。對患者詳細(xì)詢問病史,進(jìn)行仔細(xì)的耳科常規(guī)檢查,常規(guī)行純音聽閾、聲導(dǎo)抗、ABR、DPOAE、ECochG及CT和／或MRI檢查,綜合分析各項檢查結(jié)果,總結(jié)ALHL的聽力學(xué)特征。所得數(shù)據(jù)采用SPSS for Windows Ver16.0軟件進(jìn)行統(tǒng)計學(xué)分析。 結(jié)果 1.臨床表現(xiàn)：本組46例(47耳)ALHL患者均為無明顯誘因急性發(fā)病的低頻感音神經(jīng)性聽力損失,男16例(34.78%),女30例(65.22%)；發(fā)病年齡16-59歲,平均(39.13±11.01)歲；單側(cè)占97.83%(45／46),雙側(cè)占2.17%(1／46)。39耳(82.98%,39／47)伴低調(diào)耳鳴、耳部堵悶或脹滿感。 2.聽力學(xué)結(jié)果 2.1純音聽閾(pure tone threshold, PTT):本組ALHL 46例(47耳)PTT圖呈以低頻聽閾升高為特征的上坡型圖。0.125-1 kHz平均聽閾為(35.00±8.30)dBHL,2～8kHz平均聽閾為(13.62±3.53)dBHL。ALHL患耳與健耳之間、患耳與正常對照組之間在0.125 kHz、0.25 kHz、0.5 kHz及1 kHz處平均聽閾差異有顯著統(tǒng)計學(xué)意義(P0.01),在2kHz、4 kHz和8 kHz處平均聽閾差異無統(tǒng)計學(xué)意義(P0.05)。 2.2聲導(dǎo)抗：ALHL患耳鼓室壓圖均呈A型曲線,鼓室壓和聲順值均在正常范圍。在0.5kHz,鐙骨肌聲反射(acoustic stapedius reflex, AR)引出率為74.47%, Metz重振試驗陽性率為65.96%。在1 kHz時,AR引出率為82.98%,Metz重振試驗陽性率為14.89%。 2.3聽性腦干反應(yīng)(auditory brainstem response, ABR):ALHL組46例,均雙耳受檢,均可引出正常ABR波形,各波潛伏期及波間期均在正常范圍。 2.4畸變產(chǎn)物耳聲發(fā)射(distortion product otoacoustic emission, DPOAE):本組ALHL46例(47耳)DPOAE在0.553～1.105kHz的引出率為19.15%,在2.211～8.837kHz的引出率為90.23%。ALHL患耳(47耳)與正常對照組20例(40耳)的DP-gram幅值在0.553kHz、0.783kHz、1.105kHz和2.211kHz處差異有顯著統(tǒng)計學(xué)意義(P0.01),在4.416kHz、6.250kHz和8.837kHz處差異無統(tǒng)計學(xué)意義(P0.05)。 2.5耳蝸電圖(Electrocochleogram, ECochG):46例ALHL患者,-SP幅值分別為：患耳(0.50±0.41)μV,健耳(0.28±0.19)μV,其差異有統(tǒng)計學(xué)意義(P0.01);-SP/AP比值分別為：患耳0.40±0.17,健耳0.23±0.23,其差異有統(tǒng)計學(xué)意義(P0.01)�；级�(47耳)中-SP幅值和-SP/AP比值增大耳數(shù)分別24耳(51.06%,24／47)和30耳(63.83%,30／47)�；级�(47耳)與正常對照組(40耳)的-SP幅值和-SP/AP比值差異有顯著統(tǒng)計學(xué)意義(P0.01)。 結(jié)論 1. ALHL急性發(fā)病,以單側(cè)發(fā)病為主,常伴低調(diào)耳鳴、耳部堵悶及脹滿感。多發(fā)病于中青年,女性多見。 2. ALHL鼓室壓圖均呈A型曲線,鼓室壓和聲順值均在正常范圍,AR大多可引出,表明中耳功能正常,ABR正常說明聽覺神經(jīng)傳導(dǎo)徑路正常。 3. ALHL患者PTT以低頻聽閾升高為特征,表明其病變僅局限于耳蝸頂周低頻區(qū),Metz重振試驗陽性表明病變在耳蝸,0.553～1.105kHz DP-gram幅值降低,客觀地顯示出ALHL伴有耳蝸頂周處輕微的外毛細(xì)胞(outer hair cell, OHC)受損,近2／3的患者-SP幅值和-SP/AP比值大于正常人,表明耳蝸膜迷路積水。故ALHL是一種病變局限于耳蝸頂周的,以膜迷路積水為特征,具有一定臨床特征的耳蝸疾病。 4. ALHL的診斷應(yīng)該以低頻(0.125～1 kHz) PTT平均閾值≥26 dB HL為依據(jù),以提高ALHL的診斷率,避免漏診。
[Abstract]:Purpose



The characteristics of pure tone threshold , acoustic immittance test , auditory brainstem response ( ABR ) , distortion product otoacoustic emission ( DPOAE ) , and cochlear electrogram ( EHCG ) in acute low - frequency sensorineural hearing loss ( ALHL ) were analyzed .



method



From September 2007 to June 2009 , the first central hospital in Tianjin was diagnosed as ALHL , and 46 cases ( 47 ears ) were kept intact , 20 cases ( 40 ears ) of normal hearing volunteers were selected as normal controls , and 8 cases ( 9 ears ) were selected .
The auditory neuropathy ( AN ) group was 7 cases ( 14 ears ) .
18 cases of sensorineural deafness group , 6 cases of sudden deafness ( 6 ears ) , 2 cases of sensorineural deafness ( 4 ears ) , 2 cases of sensorineural deafness ( 4 ears ) , 8 cases of unknown reason sensorineural deafness ( 16 ears ) , were used as the disease control group .



Results



1 . Clinical manifestations : 46 cases ( 47 ears ) of ALHL patients had low frequency sensorineural hearing loss , male 16 cases ( 34.78 % ) and female 30 cases ( 65.22 % ) .
The age of onset ranged from 16 to 59 years ( 39.13 鹵 11.01 ) years .
The unilateral accounted for 97.83 % ( 45 / 46 ) , the double side accounts for 2 . 17 % ( 1 / 46 ) . 39 ( 82.98 % , 39 / 47 ) with low - tone tinnitus , and the ears were blocked or inflated .



2 . Listen to the mechanical results



The mean threshold of hearing threshold was ( 35.00 鹵 8.30 ) dBHL , ( 13.62 鹵 3.53 ) dBHL and ( 13.62 鹵 3.53 ) dBHL . The mean threshold difference between the affected ear and the normal control group was 0 . 125 kHz , 0.25 kHz , 0.5 kHz and 1 kHz ( P0.01 ) . There was no statistical significance at 2 kHz , 4 kHz and 8 kHz ( P0.05 ) .



The positive rate of acoustic stapedius reflex ( AR ) was 74.47 % and the positive rate of Metz was 65.96 % . At 1 kHz , the positive rate of AR was 82.98 % , and the positive rate of Metz was 14.89 % .



2 . Auditory brainstem response ( ABR ) : 46 cases of ALHL group , both ears were subject to normal ABR , and the latency and interval of each wave were in the normal range .



2.4 Distortion product otoacoustic emission ( DPOAE ) : The lead - out rate of ALHL 46 cases ( 47 ears ) was 19.15 % at 0.553 锝，

本文編號：2073909