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聽神經(jīng)病患者的臨床聽力學(xué)特征分析
【摘要】 目的 總結(jié)52例聽神經(jīng)病(AN)患者的臨床表現(xiàn)特點(diǎn)和聽力學(xué)特征，分析聽力學(xué)檢測在AN診斷中的意義并探討其病損部位。方法 回顧性分析52例AN患者的臨床表現(xiàn)、純音聽力、聲導(dǎo)抗、言語識別率、聽性腦干反應(yīng)(AP)、畸變產(chǎn)物耳聲發(fā)射(DPOAE)及對側(cè)白噪聲抑制試驗(yàn)的結(jié)果。結(jié)果 本組52例AV患者純音聽閾測試結(jié)果均為骨、氣導(dǎo)一致性下降的感音神經(jīng)性聾。兩耳間的差異無統(tǒng)計(jì)學(xué)意義（P＞0.05)，言語識別率明顯差于純音聽力；鼓室導(dǎo)抗圖為“A”型，鐙骨肌聲反射未引出，AP不能引出或嚴(yán)重異常；52例(104耳)DPOAE全部正常引出 ；對側(cè)聲抑制減弱或消失。影像學(xué)檢查(HRCT或MRI)無異常發(fā)現(xiàn)。結(jié)論 AN的臨床表現(xiàn)和系統(tǒng)的聽力學(xué)檢查對認(rèn)識和明確診斷有重要意義。AN的病損部位可能在耳蝸神經(jīng)傳入通路和耳蝸傳出周圍通路。
【關(guān)鍵詞】 聽神經(jīng)病；聽力學(xué)檢測；感音神經(jīng)性聽力損失；病損部位
Analysis for the clinical audiological characteristics in patients with auditory neuropathy ZHANG Xiqin,ZHU Qingwen,DUAN Naichao,et al. Department of Otolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000,China
【Abstract】Objective To summarize the features of clinical manifestation and audiological characteristics in patients with auditory neuropathy (AN) in order to analyze the significance of audiometry detection in the diagnosis of AN,and to investigate its lesion site. Methods The audiological data of 52 AN patients were retrospective reviewed.The patients’clinical findings, pure tone threshold and the examination results by acoustic impedance audiometry,speech audiometry, auditory Painstem response (AP), distortion product otoacoustic emission (DPOAE) and contralateral suppression were analyzed. Results In all the patients, the ratio of genders was 1:1.70(male:female). The patients’range was between 5 and 31 years,and averaged age was (16±7) years. All the patients complained of bilateral gradual hearing loss. The patients could not discriminate speech correctly, especially in noisy environment. Among 52 patients 28 patients(50.85％) complained of last or discontinuous tinnitus. 4 patients developed evidence for a peripheral neuropathy. Most patients’audiograms showed a low frequency loss(93.3%，97/104). The patients’speech hearing was worse obviously than the pure tone hearing. AP was absent or abnormal severely,but DPOAE in all the patients were normally recorded. Acoustic stapedius reflex was absent and the contralateral suppression effect of DPOAE was disappeared. Tympanogram curve was “A”curve, and ipsilateral and contralateral acoustic stapedius reflexes were absent or present at some frequency,however,the acoustic reflex threshold was increased. Conclusion The clinical manifestation and systematic audiometry detection play an important role in the diagnosis of AN. The main lesion sites may be located in the afferent pathway of cochlear nerve and efferent pathway of cochlea
【Key words】auditory neuropathy； audiometry detection； sensorineural hearing loss； site of lesion
