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目的听性稳态诱发反应(auditory steadystat eresponse,ASSR)新技术与视觉强化测听(visionrein for cementaudiometry,VRA)阈值的相关性分析研究,探讨听神经病症侯群及其鉴别诊断。方法10例(20耳)对照组,年龄6～12个月,测得ASSR和VRA的正常阈值。16例(26耳)异常听力组患儿(年龄在3～6个月),根据其所患疾病分为3个亚组:Ⅰ组为早孕感染组5例(8耳),Ⅱ组为窒息缺氧组5例(10耳),Ⅲ组为高胆红素血症组6例(8耳),检测畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)潜伏期、肌反射值与ASSR和VRA及其相关性结果对照。结果Ⅰ组中2例次(2耳次)为单纯疱疹病毒感染。5例次(8耳次)DPOAE消失,4例次(6耳次)ABR波Ⅰ潜伏期延长、ⅠⅤ波间潜伏期缩短,3例次(6耳次)500Hz和1000Hz的镫骨肌反射正常,2例次(2耳次)镫骨肌反射阈偏高,初步推测单纯耳蜗性病变,排除听神经病可能,测得ASSR平均估计阈值与VRA平均阈值具有很好的相关性(r=0.95～0.98)。Ⅱ组中4例次(8耳次)畸变产物耳声发射消失,其中1例次(2耳次)ABR波Ⅰ、波Ⅲ、波Ⅴ消失和肌反射消失,3例次(5耳次)ABR波Ⅰ消失和波Ⅲ及波Ⅴ潜伏期延长,以及肌反射消失。2例次(3耳次)ⅠⅢ波间潜伏期延长,肌反射也消失。推测可能为听神经病症侯群(耳蜗至脑干下听觉传导通路受损)伴有耳蜗功能障碍,测得ASSR平均估计阈值与VRA平均阈值具有较好的相关性(r=0.72～0.84)。Ⅲ组中6例次(8耳次)DPOAE存在,4例次(5耳次)ABR波Ⅰ、Ⅲ、Ⅴ和肌反射消失,2例次(3耳次)ⅠⅤ波间潜伏期延长,镫骨肌反射阈正常偏高,初步分析推测为听神经病症侯群病损在脑干以上,测得ASSR平均估计阈值与VRA平均阈值具有很弱的相关性(r=0.43～0.64),ASSR阈值和VRA阈值不一致,进一步说明这组的病损应该在脑干或皮层。3个亚组的每个频率(0.25、0.5、1、2、4kHz)平均ASSR和VRA阈值差值比较,差异都具有统计学意义(F检验,P<0.05、P<0.01、P<0.01、P<0.05、P<0.05)。结论通过ASSR阈值和VRA阈值相关性技术研究或许可提供诊断及鉴别诊断在各种频率听力障碍婴儿的听神经病症侯群(病变高位)、听神经病症侯群伴有耳蜗功能障碍(病变低位)以及单纯耳蜗性病(非听神经病)。
Objective To investigate the relationship between auditory steady-state response (ASSR) and visionrein for cementaudiometry (VRA) threshold, and to investigate the auditory neuropathies and their differential diagnosis. Methods Ten cases (20 ears) of control group, aged 6 to 12 months, were measured ASSR and VRA normal threshold. Sixteen (26 ears) abnormal hearing children (aged 3-6 months) were divided into 3 subgroups according to the diseases they suffered: group Ⅰ was 5 cases (8 ears) in the group of early pregnancy infection, and group Ⅱ was asphyxia (10 ears) in hypoxia group and 6 cases (8 ears) in hyperbilirubinemia group in group Ⅲ.The detection of distortion product otoacoustic emissions (DPOAE), auditory brainstem response (ABR) latency and muscle reflex Contrast with ASSR and VRA and their correlations. Results In group Ⅰ, 2 cases (2 ears) were herpes simplex virus infection. 5 cases (8 ears) DPOAE disappeared, 4 cases (6 ears) ABR wave Ⅰ latency was prolonged, IⅤ wave latency was shortened, 3 times (6 ears) 500Hz and 1000Hz stapedius muscle reflex, 2 (2 ears), the reflex threshold of the stapedius muscle was high. The preliminary estimation of pure cochlear lesions and the possible exclusion of auditory neuropathy had a good correlation between the mean estimated ASSR and the mean VRA threshold (r = 0.95-0.98) . In group Ⅱ, 4 cases (8 ears) distorted otoacoustic emissions disappeared, and 1 case (2 ears) ABR wave Ⅰ, wave Ⅲ, wave Ⅴ disappeared and muscle reflex disappeared, 3 cases (5 ears) Disappearance of ABR wave Ⅰ and wave Ⅲ and wave Ⅴ latency, and disappearance of muscle reflex. 2 cases (3 ears) Ⅰ Ⅲ wave latency was prolonged, muscle reflex disappeared. It is speculated that there may be a correlation between the average estimated ASSR threshold and the mean VRA threshold (r = 0.72-0.84) for the auditory neurosis patient group (cochlear to auditory nerve conduction pathway impaired in the brainstem) with cochlear dysfunction. In group Ⅲ, there were 6 cases of DPOAE (8 ears), 4 cases (5 ears) of ABR disappeared Ⅰ, Ⅲ, Ⅴ and muscle reflex, 2 cases (3 ears) Muscular reflex threshold was normal and high. The preliminary analysis presumed that the auditory neuropathies had lesions above the brainstem, and the mean estimated ASSR had a weak correlation with the mean VRA threshold (r = 0.43-0.64). The ASSR threshold and VRA Inconsistent thresholds further suggest that lesions in this group should be in the brain stem or cortex. The average ASSR and VRA threshold differences at each frequency (0.25,0.5,1,2,4 kHz) in the three subgroups were statistically significant (F test, P <0.05, P <0.01, P <0.01, P <0.05, P <0.05). Conclusions ASSR threshold and VRA threshold correlation techniques may provide diagnostic and differential diagnosis of auditory neuropathies (hyperopia) in infants with hearing loss, auditory neuropathies with cochlear dysfunction (lesions) and simple Cochlear disease (non-auditory neuropathy).