【摘要】 目的:应用客观听力检测技术分析新生儿核黄疸后听觉通路损伤的临床听力学特点,评价感音神经性耳聋患儿的蜗性及蜗后病变特征。方法:选择1999-06/2003-12就诊的2岁以下新生儿核黄疸后伴听觉通路损伤患者32例(62耳)为核黄疸组;以大脑半球病变为主的疾病,如新生儿缺血缺氧性脑病恢复期、精神和运动发育迟缓等其它中枢性病变伴听觉通路损伤患儿34例(68耳)为中枢性病变组;并选取同年龄段听力正常小儿30例(54耳)为健康对照组。同时进行脑干听觉诱发电位、畸变产物耳声发射和镫骨肌声反射检测,对比不同组别间脑干听觉诱发电位波V阈值及畸变产物耳声发射各自的特点,同一组间不同脑干听觉诱发电位波V阈值耳畸变产物耳声发射的变化特征。各组间畸变产物耳声发射幅值的差异显著性选用方差分析,11个频点引出率等计数资料的差异显著性选用卡方检验。结果:各组患儿治疗过程中无脱落,均纳入结果分析。核黄疸组脑干诱发电位波V阈值>80nHLdB占81%,-80nHLdB占3%,-60nHLdB占16%;中枢性病变组分别为46%、28%、26%,分布比例较为均衡。核黄疸组脑干诱发电位波V阈值在-60nHLdB和>80nHLdB的F5频点后畸变产物耳声发射幅值差异无显著性(P>0.05),但低于中枢性病变组(P<0.05);核黄疸组和中枢性病变组听阈值在-60nHLdB的F5频点后畸变产物耳声发射检出率差异无显著性(χ2=0.72,P>0.05)。中枢性病变组听阈值在-60nHLdB和-80nHLdB听阈值F5频点后的畸变产物耳声发射幅值与对照组差异无显著性(P>0.05);-60nHLdB,-80nHLdB,>80nHLdB听阈值F5频点后的畸变产物耳声发射检出率与健康对照组相比差异无显著性(χ2=5.76,P>0.05)。结论:新生儿核黄疸后听觉通路损伤患者可联合应用客观听力检测进行评估,脑干听觉诱发电位检测和畸变产物耳声发射检测应成为临床上测试听力的两项基本无创客观手段。更多还原

【Abstract】 AIM To analyze the clinical audiological characteristics of sensorineural hearing loss SHL after kernicterus of newborn with objective hearing detection technique and evaluate pathological characteristics both cochlea and retrocochlear deafness in newborn with SHL. METHODS From June 1999 to December 2003 32 patients 62 ears with SHL caused by kernicterus aged less than 2 years old were selected as kernicterus group 34 cases 68 ears of SHL with central lesion including convalescent of hypoxic-ischemic encephalopathy hypoevolutism of psychomotor etc. as central lesion group. Thirty normal children 54 ears who had the same age period and normal hearing were selected as healthy control group. Meanwhile the different brainstem auditory evoked potential BAEP distortion product otoacoustic emissions DPOAE and stapedial acoustic reflex were detected.The threshold of wave V of BAEP and each feature of DPOAE in different group were compared. The threshold of wave V of BAEP and the changes characteristics of DPOAE in the same group were compared. The significant differences of DPOAE in every group were performed with analysis of variance. The significant differences of mean enumeration data of detected percentage at eleven points were assessed with chi-square. RESULTS All the children patients were involved in the result analysis without drop in the process of treatment. In kernicterus group the threshold wave V of BAEP beyond 80 nHLdB accounted for 81% between 80 nHLdB and 60 nHLdB accounted for 3% and below 60 nHLdB accounted for 16% and in CNS lesions group they accounted for 46% 28% and 26% respectively with equal distribution proportion. In the kernicterus group the wave value of DPOAE after F5 point had no remarkable difference P > 0.05 when the threshold wave V of BAEP below 60 nHLdB and beyond 80 nHLdB but which were lower than that in the central lesions group P < 0.05. Between two groups the detected percentage of DPOAE after F5 point had no remarkable difference χ2=0.72 P > 0.05 when the threshold wave V of BAEP below 60 nHLdB. Contrasted to the control group the wave value of DPOAE after F5 point had no remarkable difference P > 0.05 when the threshold wave V of BAEP between 60 and 80 nHLdB in central lesion group and the wave value of DPOAE ofter F5 point had no remarkable difference χ2=5.76 P > 0.05 in all the thresholds wave V compared with that in the healthy aontrol group. CONCLUSION Sensorineural hearing loss SHL caused by kernicterus can be evaluated combining with objective audiological detection in newborns. The BAEP and DPOAE are basic non-injury objective methods to check auditory capacity in clinic.更多还原