【作者】 李丹；

【导师】 孔维佳；

【作者基本信息】 华中科技大学 ， 耳鼻咽喉科学， 2009， 博士

【摘要】 第一部分Bays判别分析和直线回归方程在气导多频稳态诱发电位测试听力评估中的应用目的：(1)研究气导多频稳态诱发电位(AC-ASSR)测试在客观听力评价中的准确性。(2)基于Bayes多类判别函数确定听力损失的分类，再利用直线回归方程进行AC-ASSR对纯音气导听阈的预测。方法：正常人(60耳)及轻度、中度、中重度、重度、极重度感音神经性聋患者(40耳、34耳、28耳、24耳、14耳)分别进行纯音测听和AC-ASSR测试。分析不同频率，不同听力组AC-ASSR阈值，建立Bays判别函数模型。分析不同频率，不同听力组AC-ASSR阈值和纯音气导听阈的关系，建立纯音气导听阈(Y)对AC-ASSR阈值(X)的回归方程模型。结果：AC-ASSR与纯音气导听阈的相关系数r介于0．7到0．94。由AC-ASSR测定结果推测客观听力状况，自身检证法的判别符合率91．5％，交互验证法的判别符合率90．5％。结论：AC-ASSR在客观听力评价中有较好的准确性；在实际AC-ASSR阈值预测纯音气导听阈时，可以基于Bayes多类判别函数确定听力损失的分类，再利用直线回归关系进行AC-ASSR对纯音气导听阈的预测。以获得较准确的纯音气导听阈的预测。第二部分正常青年人和轻度感音神经性聋者骨导多频稳态诱发电位测试目的：研究BC-ASSR测试在正常青年人和轻度感音神经性聋患者的临床应用价值。方法：正常青年人(30例，60耳)和轻度感音神经性聋患者(20例，20耳)进行BC-ASSR测试。BC-ASSR测试载波频率为500Hz-4000Hz，调制频率为77Hz-101Hz，调幅／调频调制，交替性刺激极性。比较BC-ASSR阈值和纯音骨导听阈以及BC-ASSR阈值和AC-ASSR阈值的关系。结果：正常青年人BC-ASSR阈值在500，1000，2000，4000Hz分别为68．08±5．83，59．92±6．86，57．08±8．60，61．83±8．63 dB SPL；比纯音骨导听阈分别高：16．25±4．94，11．58±5．48，15．67±6．74，15．75±5．86dB。BC-ASSR阈值和BC-PTA听阈pearson相关系数在500，1000，2000，4000Hz分别为0．67，0．61，0．62，0．71。轻度感音神经性聋患者得到的结果与正常人相似。结论：本研究显示BC-ASSR测听技术可以较好的评估正常青年人和轻度感音神经性聋患者的骨导听阈。第三部分骨导多频稳态诱发电位测试的赝反应目的：分析骨导多频稳态诱发电位测试(BC-ASSR)赝反应的特点及产生的原因，探讨可能减少赝反应的方法及临床应用价值。方法：对80例经过一系列传统的检查方法证实为极重度感音神经性聋的患儿，给予BC-ASSR的声刺激，强度为50-100 dB SPL。该组患儿听不到骨导刺激声，如果出现反应就是赝反应。结果：在较高的声刺激强度，假阳性率明显增加。由于该组患儿证实为极重度感音神经性听力损失，我们可以推断BC-ASSR反应不是来源于听觉系统。结论：在较高的声刺激强度时BC-ASSR测试出现赝反应。BC-ASSR测试临床应用时，500，1000，2000Hz最好分别限定为80，90，90dB SPL。更多还原

【Abstract】 Part 1 Application of Bayes discriminatory analysis and linear regressionequation predicting behavioral thresholds using AC-ASSR testObjective :(1)To study the accuracy of air condition multiple auditorysteady-state responses(AC-ASSR) for estimating behavior hearingthresholds. (2)To build a mechanism model for the classification of hearingloss by Bayes discriminatory analysis and predict behavioral thresholds bylinear regression equation.Methods:Normal adults and patients of different degree sensorineuralhearing loss were tested by AC-ASSR and AC-PTA respectively. A mechanismmodel was built for the classification of hearing loss by Bayes discriminatoryanalysis by different frequency and different hearing group ASSR thresholdanalysis. Linear regression equation was built by thresholds of AC-ASSR andAC-PTA of different frequencies, different hearing group.Result: The BC-ASSR thresholds and BC-PTA thresholds with Pearsoncorrelation coefficients were between 0.7 and 0.94. The accurate rate ofdiagnostic model was 91.5% of original grouped cases classified and 90.5%of cross validated grouped cases classified.Conclusion: AC-ASSR was proven to be a valid technique for estimation ofan objective audiogram. Bayes discriminatory analysis could be useful inclassification of hearing loss. Linear regression equation could be usefulin predicting behavioral thresholds. Part 2 Multiple auditory steady-state response thresholds tobone-conduction stimuli in young adults with normal hearing and adults withmild sensorineural hearing lossObjective: To investigate the clinical usefulness of multiple auditorysteady-state response thresholds to bone-conduction stimuli in young adultswith normal hearing and adults with mild sensorineural hearing loss.Methods: ASSR thresholds to bone conduction stimuli(carrierfrequencies:500Hz to 400Hz;77 Hz to 101Hz modulation rates;ampltitude/frequency modulated; alternate polarity stimulus)were tested in 30 normalhearing young adults and 20 mild sensorineural hearing loss. The responsethresholds were compared with pure tone audiometry for bone conduction stimulithresholds.Result: In normal young adults the thresholds for BC-ASSR at500, 1000,2000,4000Hz were 68.08±5.83, 59.92±6.86, 57.08±8.60, 61.83±8.63dB SPL, respectively and 16.25±4.94, 11.58±5.48, 15.67±6.74, 15.75±5.86dBHL above pure tone thresholds for bone conduction stimuli. The BC-ASSRthresholds and BC-PTA thresholds with Pearson correlation coefficients were0.67,0.61,0.62,0.71 at 500, 1000,2000,4000Hz respectively. The similar resultswere observed in the audlts with mild sensorineural hearing loss.Conclusion: The study shows that multiple auditory steady state responsesto bone bone-conduction technique is useful method in estimating of hearingthreshold of young adults with normal hearing and adults with mildsensorineural hearing loss. Part 3 Bone conduction multiple auditory steady-stateresponse:investigations into Artifact responsesObjective:To investigate the characteristic and clinical application ofartifact of bone conduction multiple auditory steady state response.Methods: 80 deaf-mute children examined by a series of traditionalcomprehensive test battery proved to be severe-to-profound sensorineuralhearing losses(SNHL). This group children could not heard the BC-ASSRs stimuliwith the intensity varied from 50 to 100dB SPL and if only the response appearedduring the test, that is a spurious response.Result: The false positive rate significantly increased at high-intensityBC ASSR stimuli. Because all subjects were bilateral severe-to-profoundSNHL, it was reasonable to conclude that the BC-ASSRs were not generated bythe auditory system.Conclusions: An artifact may be present in the recording of BC-ASSR at highlevels. Upper limits of BC-ASSR may be determined 80,90,90dB SPL at500,1000,2000Hz respectively.更多还原