诱发电位,听觉%诱发电位,听觉,脑干%判别分析%听力
誘髮電位,聽覺%誘髮電位,聽覺,腦榦%判彆分析%聽力
유발전위,은각%유발전위,은각,뇌간%판별분석%은력
背景:多频稳态诱发电位测试是近年来应用于临床的客观听力检查方法.与以往的听性脑干诱发电位检查比较,多频稳态诱发电位测试具有频率特异性.目的:了解多频稳态诱发电位测试在客观听力评价中的准确性.设计:病例-对照观察.单位:中山大学附属第一医院耳鼻咽喉科.对象:听力正常组为在校大学学生21人42耳,无任何耳科疾病症状,无噪声暴露史及前庭系统疾病,耳镜检查正常.感音神经性聋患者均为在中山大学附属第一医院耳鼻咽喉科门诊和住院部求治的病例,均行磁共振检查排除中枢性病变;疾病种类主要为:突发性耳聋6例耳、老年性耳聋8例耳,其他不明原因的感音神经性耳聋20例耳,按纯音测听结果均为平坦型或渐降型听力图,按听力损害程度分3组,轻度聋组13例耳、中度聋组9例耳和中重度聋组12例耳.方法:①在隔音室内采用纯音测听检查,测试方法按0.125～8 000 Hz各倍频程的纯音测听,听力正常者的听阈级符合GB-7583-87期望值分布标准.感音神经性聋病例的纯音测听气导听力阈值取0.5,1,2和4 kHz 4个频率的均值.②在声电磁屏蔽室内进行多频稳态诱发电位检查,采用双耳同一刺激强度、相同4个载频音0.5,1,2和4 kHz共8个点同步刺激模式.③在声电磁屏蔽室内进行听性脑干诱发电位检查,采用刺激声为疏波短声,使用插入式耳机,阈值结果判定按取可辨别出Ⅴ波的最小刺激声强度.④以纯音测听结果和听性脑干诱发电位检查结果为参照对比,将不同听力水平组的多频稳态诱发电位测试结果进行方差分析、Bayers准则下分类资料的多类判别分析和q检验.主要观察指标:纯音测听阈值、频稳态诱发电位测试阈值和听性脑干诱发电位检查阈值,Bayers准则下多类判别分析的正确率.结果:正常听力组42例耳及轻度聋组13例耳、中度聋组9例耳和中重度聋组12例耳均测出各项指标,全部进入结果分析.①听性脑干反应值与实际听力水平相符合,与多频稳态诱发电位1.0～2.0 kHz的阈值最为接近;不同频率的多频稳态诱发电位的引出率随着听力损害的加重而逐渐降低,听力正常或轻度聋者多频稳态诱发电位的引出率均为100%,而中度、中重度聋组的引出率有所下降(0.5 kHz时,分别为77.8%和92.8%;4 kHz时,分别为88.9%和85.7%).不同频率时,中重度聋组的多频稳态诱发电位阈值显著高于听力正常组,差异有显著性意义(P＜0.05);0.5 kHz及4 kHz时中重度聋组的多频稳态诱发电位阈值显著高于轻度聋组,差异有显著性意义(P＜0.05);2 kHz时轻度聋组的多频稳态诱发电位阈值显著高于听力正常组,差异均有显著性意义(P＜0.05);4 kHz时中度聋组的多频稳态诱发电位阈值显著高于听力正常组和轻度聋组,差异均有显著性意义.②由多频稳态诱发电位检查结果和实际纯音测听的组别经交互聚类判别纯音测听结果所犯的判断错误,听力正常组的判别符合正确率为100%;轻度聋组12例中仅有1例错判,正确率为92%;中度聋组9例中1例错判,正确率为89%,中重度聋组判别正确率为83%.结论:由多频稳态诱发电位测试结果可推测以纯音测听结果为标准的客观听力状况所犯的判别错误,多频稳态诱发电位测试在客观听力评价中对轻度聋以上的有较好的准确率,在实际应用中有较好应用前景.
揹景:多頻穩態誘髮電位測試是近年來應用于臨床的客觀聽力檢查方法.與以往的聽性腦榦誘髮電位檢查比較,多頻穩態誘髮電位測試具有頻率特異性.目的:瞭解多頻穩態誘髮電位測試在客觀聽力評價中的準確性.設計:病例-對照觀察.單位:中山大學附屬第一醫院耳鼻嚥喉科.對象:聽力正常組為在校大學學生21人42耳,無任何耳科疾病癥狀,無譟聲暴露史及前庭繫統疾病,耳鏡檢查正常.感音神經性聾患者均為在中山大學附屬第一醫院耳鼻嚥喉科門診和住院部求治的病例,均行磁共振檢查排除中樞性病變;疾病種類主要為:突髮性耳聾6例耳、老年性耳聾8例耳,其他不明原因的感音神經性耳聾20例耳,按純音測聽結果均為平坦型或漸降型聽力圖,按聽力損害程度分3組,輕度聾組13例耳、中度聾組9例耳和中重度聾組12例耳.方法:①在隔音室內採用純音測聽檢查,測試方法按0.125～8 000 Hz各倍頻程的純音測聽,聽力正常者的聽閾級符閤GB-7583-87期望值分佈標準.感音神經性聾病例的純音測聽氣導聽力閾值取0.5,1,2和4 kHz 4箇頻率的均值.②在聲電磁屏蔽室內進行多頻穩態誘髮電位檢查,採用雙耳同一刺激彊度、相同4箇載頻音0.5,1,2和4 kHz共8箇點同步刺激模式.③在聲電磁屏蔽室內進行聽性腦榦誘髮電位檢查,採用刺激聲為疏波短聲,使用插入式耳機,閾值結果判定按取可辨彆齣Ⅴ波的最小刺激聲彊度.④以純音測聽結果和聽性腦榦誘髮電位檢查結果為參照對比,將不同聽力水平組的多頻穩態誘髮電位測試結果進行方差分析、Bayers準則下分類資料的多類判彆分析和q檢驗.主要觀察指標:純音測聽閾值、頻穩態誘髮電位測試閾值和聽性腦榦誘髮電位檢查閾值,Bayers準則下多類判彆分析的正確率.結果:正常聽力組42例耳及輕度聾組13例耳、中度聾組9例耳和中重度聾組12例耳均測齣各項指標,全部進入結果分析.①聽性腦榦反應值與實際聽力水平相符閤,與多頻穩態誘髮電位1.0～2.0 kHz的閾值最為接近;不同頻率的多頻穩態誘髮電位的引齣率隨著聽力損害的加重而逐漸降低,聽力正常或輕度聾者多頻穩態誘髮電位的引齣率均為100%,而中度、中重度聾組的引齣率有所下降(0.5 kHz時,分彆為77.8%和92.8%;4 kHz時,分彆為88.9%和85.7%).不同頻率時,中重度聾組的多頻穩態誘髮電位閾值顯著高于聽力正常組,差異有顯著性意義(P＜0.05);0.5 kHz及4 kHz時中重度聾組的多頻穩態誘髮電位閾值顯著高于輕度聾組,差異有顯著性意義(P＜0.05);2 kHz時輕度聾組的多頻穩態誘髮電位閾值顯著高于聽力正常組,差異均有顯著性意義(P＜0.05);4 kHz時中度聾組的多頻穩態誘髮電位閾值顯著高于聽力正常組和輕度聾組,差異均有顯著性意義.②由多頻穩態誘髮電位檢查結果和實際純音測聽的組彆經交互聚類判彆純音測聽結果所犯的判斷錯誤,聽力正常組的判彆符閤正確率為100%;輕度聾組12例中僅有1例錯判,正確率為92%;中度聾組9例中1例錯判,正確率為89%,中重度聾組判彆正確率為83%.結論:由多頻穩態誘髮電位測試結果可推測以純音測聽結果為標準的客觀聽力狀況所犯的判彆錯誤,多頻穩態誘髮電位測試在客觀聽力評價中對輕度聾以上的有較好的準確率,在實際應用中有較好應用前景.
배경:다빈은태유발전위측시시근년래응용우림상적객관은력검사방법.여이왕적은성뇌간유발전위검사비교,다빈은태유발전위측시구유빈솔특이성.목적:료해다빈은태유발전위측시재객관은력평개중적준학성.설계:병례-대조관찰.단위:중산대학부속제일의원이비인후과.대상:은력정상조위재교대학학생21인42이,무임하이과질병증상,무조성폭로사급전정계통질병,이경검사정상.감음신경성롱환자균위재중산대학부속제일의원이비인후과문진화주원부구치적병례,균행자공진검사배제중추성병변;질병충류주요위:돌발성이롱6례이、노년성이롱8례이,기타불명원인적감음신경성이롱20례이,안순음측은결과균위평탄형혹점강형은력도,안은력손해정도분3조,경도롱조13례이、중도롱조9례이화중중도롱조12례이.방법:①재격음실내채용순음측은검사,측시방법안0.125～8 000 Hz각배빈정적순음측은,은력정상자적은역급부합GB-7583-87기망치분포표준.감음신경성롱병례적순음측은기도은력역치취0.5,1,2화4 kHz 4개빈솔적균치.②재성전자병폐실내진행다빈은태유발전위검사,채용쌍이동일자격강도、상동4개재빈음0.5,1,2화4 kHz공8개점동보자격모식.③재성전자병폐실내진행은성뇌간유발전위검사,채용자격성위소파단성,사용삽입식이궤,역치결과판정안취가변별출Ⅴ파적최소자격성강도.④이순음측은결과화은성뇌간유발전위검사결과위삼조대비,장불동은력수평조적다빈은태유발전위측시결과진행방차분석、Bayers준칙하분류자료적다류판별분석화q검험.주요관찰지표:순음측은역치、빈은태유발전위측시역치화은성뇌간유발전위검사역치,Bayers준칙하다류판별분석적정학솔.결과:정상은력조42례이급경도롱조13례이、중도롱조9례이화중중도롱조12례이균측출각항지표,전부진입결과분석.①은성뇌간반응치여실제은력수평상부합,여다빈은태유발전위1.0～2.0 kHz적역치최위접근;불동빈솔적다빈은태유발전위적인출솔수착은력손해적가중이축점강저,은력정상혹경도롱자다빈은태유발전위적인출솔균위100%,이중도、중중도롱조적인출솔유소하강(0.5 kHz시,분별위77.8%화92.8%;4 kHz시,분별위88.9%화85.7%).불동빈솔시,중중도롱조적다빈은태유발전위역치현저고우은력정상조,차이유현저성의의(P＜0.05);0.5 kHz급4 kHz시중중도롱조적다빈은태유발전위역치현저고우경도롱조,차이유현저성의의(P＜0.05);2 kHz시경도롱조적다빈은태유발전위역치현저고우은력정상조,차이균유현저성의의(P＜0.05);4 kHz시중도롱조적다빈은태유발전위역치현저고우은력정상조화경도롱조,차이균유현저성의의.②유다빈은태유발전위검사결과화실제순음측은적조별경교호취류판별순음측은결과소범적판단착오,은력정상조적판별부합정학솔위100%;경도롱조12례중부유1례착판,정학솔위92%;중도롱조9례중1례착판,정학솔위89%,중중도롱조판별정학솔위83%.결론:유다빈은태유발전위측시결과가추측이순음측은결과위표준적객관은력상황소범적판별착오,다빈은태유발전위측시재객관은력평개중대경도롱이상적유교호적준학솔,재실제응용중유교호응용전경.
BACKGROUND: Auditory steady-state responses (ASSR) is an objective method of hearing examination in clinic in recent years. ASSR has the frequency specificity as compared with previous auditory brainstem responses (ABR).OBJECTIVE: To investigate the accuracy of ASSR in objective hearing assessment.DESIGN: A case-control observation.SETTING: Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: The subjects in the normal hearing group were the 21 undergraduates (42 ears) were enrolled, they all had not any symptoms of ear disease, without history of noise exposure and disease of vestibule system, and they were normal in otoscopy. The outpatients and inpatients with neurosensory deafness were selected from the Department of Otorhinolaryngology, the First Affiliated Hospital of Sun Yat-sen University. All the children cases worn hearing aids, and had the speech ability, and cooperated in the examination. The main types included 6 ears of sudden deafness,8 ears of presbycusis, and 20 ears of neurosensory deafness due to other unknown causes. Central lesions were excluded by MR examination, and all the patients agreed with the enrollment. The results of pure-tone audiometry were all flat or descending audiogram. According to the severity of hearing damage, the patients were divided into mild deafness group (13ears), moderate deafness group (9 ears) and moderate-to-severe deafness group (12 ears).METHODS: ① The pure-tone audiometry was performed at the frequencies of 0.125-8 000 Hz in a sound insulation room. The auditory threshold grades of the subjects with normal hearing all accorded with the standards of GB-7583-87 expected value distribution. The average value of air-conduction auditory thresholds of pure-tone audiometry at the frequencies of 0.5, 1, 2 and 4 kHz was calculated. ② ASSR measurement was performed with the synchronous stimulation pattern in a sound and electromagnetic shielding room, including 8 points for both ears of the same stimulation intensity and the carrier frequency tones of 0.5, 1, 2 and 4 kHz respectively.③ ABR examination was performed by click sounds with sparse waves in a sound and electromagnetic shielding room, and insert earphones were used.The threshold results were judged according to the minimal stimulation sound intensity of the distinguishable Ⅴ wave. ③ The results of pure-tone audiometry were compared with those of ABR examination, and the results of ASSR measurement in different hearing groups were processed with analysis of variance, multi-classification discrimination based Bayes standard and q test.MAIN OUTCOME MEASURES: The thresholds of pure-tone audiometry, ASSR measurement and ABR examination, and the correct rate analyzed by the multi-classification discrimination based Bayes standard were mainly observed.RESULTS: The indexes of the 42 ears in the normal hearing group, 13, 9 and 12 ears in the mild, moderate and moderate-to-severe deafness groups were all involved in the analysis of results. ① The ABR values were accorded with the actual hearing levels, and the closest to the ASSR thresholds at 1-2 kHz; ASSR reflected induction rates at different frequencies were gradually decreased with the aggravation of hearing damage, and that at each frequency varied with the changes of hearing level, the induction rates of ASSR responses were all 100% for the subjects with normal hearing and patients with mild deafness, but those for the patients with moderate and moderate-to-severe deafness were decreased (0.5 kHz: 77.8%,92.8%; 4 kHz: 88.9%, 85.7%). At different frequencies, the ASSR thresholds in the moderate-to-severe deafness group were significantly higher than those in the normal hearing group (P ＜ 0.05). The ASSR thresholds at 0.5 and 4 kHz in the moderate-to-severe deafness group were significantly higher than those in the mild deafness group (P ＜ 0.05). The ASSR threshold at 2 kHz in the mild deafness group was significantly higher than that in the normal hearing group (P ＜ 0.05). The ASSR thresholds at 4 kHz in the everedeafness group were significantly higher than those in the normal hearing group and mild deafness group. ② The incorrect discriminations of actual pure-tone audiometry were analyzed with the interactive clustering discriminant analysis of ASSR measurement and actual pure-tone audiometry, and the results showed that the correct rate of discrimination was 100% in the normal hearing group; Only 1 of the 12 cases in the mild deafness group was incorrectly judged, and the correct rate was 92%; Only 1 of the 19 cases in the moderate deafness group was incorrectly judged, and the correct rate was 89%; the correct rate in the moderateto-severe deafness group was 83%.CONCLUSION: The results of ASSR measurement can detect the incorrect discrimination of objective hearing condition by taking the results of pure-tone audiometry as the standards. ASSR has an acceptable accuracy for deafness higher than mild level in estimating objective hearing, and it has a better prospect of application in practice.
