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目的探讨轻度闭合性头颅外伤造成听力损害的特点,为法医临床学鉴定提供理论依据。方法选取51例轻度闭合性头颅外伤后听力损害的患者,经详细询问病史、耳科及神经系统全面检查、颞骨或头颅CT扫描,对纯音测听(pure tone audiometry,PTA)、声导抗(acoustic immittance,AT)、听性脑干反应(auditory brainstem response,ABR)及40Hz听觉相关电位(40Hz auditory event related potential,40Hz AERP)检查进行分析研究。结果轻度闭合性头颅外伤后听力损害多为感音神经性耳聋,听力损失程度多≤60dB,少数患者听力损失较重或为混合性聋,部分患者可伴耳鸣、眩晕、恶心或短暂呕吐等症状;伤后不同就诊时间的各项听力检查与正常对照组比较均有明显差异(P<0.05),听力损失在高频区明显;ABR各波潜伏期、波间期与正常对照组比较,Ⅰ～Ⅲ波间期差异不显著(P>0.05),各波潜伏期、Ⅲ～Ⅴ波间期、Ⅰ～Ⅴ波间期均有显著差异(P<0.05)。结论轻度闭合性头颅外伤可以造成一定程度的高频听力损害和脑干功能受损,部分患者伴有前庭功能障碍,结合临床表现及辅助检查,考虑迷路震荡在损伤机制中起着重要作用。
Objective To investigate the characteristics of hearing loss caused by mild closed craniocerebral injury and provide theoretical basis for forensic clinical identification. Methods Totally 51 patients with mild hearing loss after closed head injury were enrolled in this study. After detailed examination of history, otology and neurological examination, temporal bone or cranial CT scan, the effects of pure tone audiometry (PTA) (AT), auditory brainstem response (ABR) and 40 Hz auditory event related potential (40 Hz AERP). Results Most of hearing loss after mild traumatic craniocerebral injury was sensorineural deafness, the degree of hearing loss was more than 60dB, a few patients had severe hearing loss or mixed hearing loss, and some patients had tinnitus, dizziness, nausea or transient vomiting. There was significant difference (P <0.05) between the hearing tests at different time points after injury and those in the normal control group. The hearing loss was significant in the high frequency region. Compared with the normal control group, (P> 0.05). There were significant differences in latency, III ~ Ⅴ wave interval, Ⅰ ~ Ⅴ wave interval among all wave groups (P <0.05). Conclusions Mild craniocerebral trauma can cause some high frequency hearing loss and impaired brainstem function. Some patients have vestibular dysfunction. Combined with clinical manifestations and laboratory examinations, it is considered that labyrinthine shock plays an important role in the injury mechanism.