【摘要】 目的探讨分析鼓室图正常、气导短声听性脑干反应(click auditory brainstem response,click-ABR)阈值≤30d B nHL的婴幼儿畸变产物耳声发射(DPOAE)以及气导500 Hz短纯音听性脑干反应(tone burst-ABR,TB-ABR)的检测结果,为婴幼儿听力损失的早期诊断和评估提供参考。方法选取2018年1月～2020年12月在我科就诊的中耳功能正常且clickABR阈值≤30dBnHL的婴幼儿170例共计272耳作为研究对象,对其临床资料进行整理分析。根据click-ABR阈值分为5组,A组:click-ABR阈值≤10dBnHL;B组:click-ABR阈值为15dBnHL;C组:click-ABR阈值为20dBnHL;D组:clickABR阈值为25dBnHL;E组:click-ABR阈值为30dBnHL。根据DPOAE的测试结果分为4～5个频率点通过组、6点通过组与少于4个频率点未通过组,将6点通过组设为对照组,比较4～5个频率点通过组、未通过组与对照组TB-500HzABR的反应阈是否存在差异。结果随着click-ABR阈值增大,DPOAE通过率降低,卡方检验显示总体上5组DPOAE的通过率存在显著差异(χ~2=72.56,P=0.000)。采用Boferroni校正法进行组间多重比较,A、B、C3组间显著差异,D、E两组间无显著差异,A、B、C3组与D、E组间存在显著差异(P<0.05)。A、B两组中4～5个频率点通过组的TB-500HzABR阈值与对照组无显著差异(P>0.05),其余各组TB-500HzABR阈值与对照组存在显著差异(P<0.05)。结论当click-ABR阈值≥25dBnHL时,DPOAE通过率明显降低。对于中耳功能正常且click-ABR阈值≤30dBnHL的婴幼儿,clcik-ABR≤15dBnHL但DPOAE未通过以及无论DPOAE是否通过、click-ABR阈值≥20 dB nHL时均需要加做TB-500 Hz ABR评估低频听力。更多还原

【Abstract】 Objective To analyze Distortion Product Otoacoustic Emissions(DPOAE) and Tone Burst 500 Hz ABR in Infants with normal tympanograms and click ABR thresholds ≤ 30 dB nHL in order to provide reference for early diagnosis and evaluation in infants with hearing loss. Methods The auditory data in infants with normal tympanogram and click-ABR threshold of ≤30 dB nHL who visited our department from January 2018 to December 2020 were selected in this study, with a total of 170 cases(272 ears) being analyzed. According to click ABR thresholds of these infants, they were divided into five groups, namely, group A: ≤10 dB nHL, group B: 15 dB nHL, group C: 20 dB nHL, group D: 25 dB nHL and group E: 30 dB nHL. According to DPOAE results, they were divided into 4-5 frequency points pass group, full frequency pass group and refer group. The full frequency pass group was set as the control group, and TB-500 Hz thresholds in 4-5 frequency points pass group, refer group were compared with the control group. Results Along with the increase of click ABR threshold, the DPOAE pass rate was decreased. There was a significant difference in the pass rate of DPOAE among the five groups(χ~2 = 72.56, P=0.000). There were no significant differences among group A, B and C, and also between group D and E. The differences of TB-500 Hz threshold between the control group and the group A and B with 4-5 frequency points pass were not statistically significant(P>0.05), while the differences between the remaining groups and the control group were statistically significant(P<0.05). Conclusion When click ABR threshold was worse than or equal to 25 dB nHL, the DPOAE pass rate decreased significantly. For infants with normal tympanogram and click ABR threshold ≤30 dB nHL, if click ABR ≤15 dB nHL but DPOAE failed, and whether DPOAE passed or not and click ABR threshold ≥20 dB nHL, TB-500 Hz ABR should be added to evaluate low-frequency hearing.更多还原