【作者】 别旭；

【导师】 吕宏光；

【作者基本信息】 大连医科大学 ， 耳鼻咽喉科学， 2003， 硕士

【摘要】 目的：发作性旋转性眩晕伴耳鸣，耳聋是梅尼埃病的典型表现，其最显著的病理特征为内淋巴积水。但对于没有听力下降的可疑梅尼埃病患者，其内淋巴积水早期对耳蜗功能的影响，已不能被常规的纯音测听所反映，本试验用耳声发射甘油试验来观察甘油的脱水作用对内淋巴积水早期耳蜗功能的影响。 方法：对可疑梅尼埃病者单侧或双侧患耳(共40耳)及正常对照组(共34耳)，分别进行常规的耳科检查、声阻抗检查及纯音测听，并于服用甘油1小时前后分别进行耳声发射测试，包括畸变产物耳声发射(DPOAE)、瞬态诱发性耳声发射(TEOAE)及自发性耳声发射(SOAE)。 结果：除2例可疑耳出现Hennerbert征阳性外，余受试耳常规的耳科检查、纯音测听及声阻抗检查均未见异常。正常34耳均引出正常耳声发射，甘油试验前后DPOAE各频率点幅值和TEOAE各频率相关性及信噪比无明显变化(p＞0.05)，男女间及左右耳间无差别(p＞0.05)。可疑40耳均于自觉眩晕发作时行耳声发射检测，甘油试验后均自觉症状改善，其中2耳Hennerbert征由阳性转为阴性，DPOAE各频率变化以0.5KHz幅值及信噪比变化最为显著(p＜0.05)，TEOAE各频率相关性及信噪比变化以1.0KHz最明显(p＜0.05)。与正常耳比较可疑耳DPOAE 0.5kHz幅值变化(5.27±8.64 dB，正常耳-1.15+4.18 dB)和信噪比变化(3.85+6.27dB，正常耳-0.79±2.80dB)，1.0kHz信噪比变化(2.43+4.38dB，正常耳-0.47+3.97dB)明显提高(p＜0.05)。TEOAE以1.0kHz的相关性变化(17.10±23.65％，正常耳2.21±15.94％)和信噪比变化(2.12±2.85dB，正常耳-0.36±3.23dB)，2.0kHz的相关性变化(6.53±26.83％，正常耳-0.65+14.72％)最明显(p＜0.05)。研究还发现DPOAE幅值及信噪比变化，TEOAE相关性与信噪比的变化有一定的线性增长趋势。SOAE检测可疑40耳有18耳出现在623Hz处，其中有11耳于甘油试验后消失。 结论：耳声发射甘油试验在早期内淋巴积水患耳检测中以DPOAE 0.5KHz幅值和TEOAE 1.0kHz相关性及信噪比的变化最为明显；并可依此检查为临床中无听力下降的可疑梅尼埃病者的早期诊断，提供一定的客观依据；在耳声发射甘油试验中还要重视信噪比的变化。更多还原

【Abstract】 Objective: Meniere’s disease is characterized by recurrent, spontaneous episodic vertigo with tinnitus and hearing loss; Its pathologic feature is the endolymphtic hydrops. But for the patients of the probable Meniere’s disease without hearing loss, the routine pure tone audiometry (PTA) can not show the change of the cochlear function with the early endolymphatic hydrops. Otoacoustic emission(OAE) is a more sensitive method, which can describe the cochlear function with or even without hearing loss. The motive of this investigation is to use OAE combined with the glycerol test to find this change.Method: We chosed single or double ears (40 ears) of the patients of the probable Meniere’s disease as the doubtful group and the control group consisted of 17 normal volunteers (34 ears). Following external and middle ear assessments and PTA, OAE were recorded before and 1 hour after oral administration of the glycerol. OAE measurements included distortion product Otoacoustic emission (DPOAE), transiently evoked Otoacoustic emission (TEOAE) and spontaneous Otoacoustic emission(SOAE).Result: Except 2 doubtful ears had positive Hennerbert signs, the other tested ears were normal in external and middle ear assessments and PTA. 34 normal ears elicited normal OAE, the glycerol test had no effect on every frequency of both the level, S/N ratio of DPOAE and the correlation, S/N ratio of TEOAE (p>0.05) . There were no differences of gender and left or right ear either (p>0.05) . 40 doubtful ears were all detected when the patients themselves felt vertigo, after the glycerol test the symptom were relieved with the different degree and 2 ears with positive Hennerbert signs turned to negative. During the glycerol test, the level and S/N ratio of DPOAE at 0.5KHz, the correlation and S/N ratio of TEOAE at 1.0KHz had significant changes among all of the frequencies (p>0.05) . To compare with the control group, the doubtful group showed significant changes in the level and S/N ratio of DPOAE at 0.5KHz (level: the doubtfulgroup 5.27±8.64 dB, the control group -1.15±4.18 dB; S/N ratio: the doubtful group 3.85±6.27 dB, the control group-0.79±2.80 dB), in the S/N ratio at 1.0 KHz(the doubtful group 2.43±4.38 dB, the control group -0.47±3.97 dB) (p>0.05); So did in the correlation and S/N ratio of TEOAE at 1.0KHz (correlation: the doubtfdl group 17.10±23.65 %, the control group 2.21±15.94 %; S/N ratio: the doubtful group 2.12±2.85 dB, the control group -0.36±3.23 dB), in the correlation at 2.0KHz (the doubtful group 6.53±26.83%, the control group -0.65±14.72 %) (p>0.05). We also found there were a certain positive linear trend between the level and S/N ratio of DPOAE, the correlation and S/N ratio of TEOAE. SOAE were detected in 18 ears of the 40 doubtful ears at 623Hz, among them after glycerol test SOAE disappeared in 11 ears. Conclusion: The present results suggest that for the ears with probable Meniere’s disease, which may be in the early phase of the endolymphatic hydrops, the most significant changes are showed in the level of DPOAE at 0.5KHz, in the correlation and S/N ratio of TEOAE at 1.0KHz during the glycerol test; According to this, we can use OAE glycerol test to offer an objective basis for an early diagnosis to the patients of the probable Meniere’s disease; When using this detection, the changes of S/N ratio should be paid more attention to.更多还原