CE—Chirp聲誘發(fā)的聽(tīng)性腦干反應(yīng)對(duì)嬰幼兒聽(tīng)力損失診斷的價(jià)值及臨床運(yùn)用分析

王遠(yuǎn)明+李楚凌++羅香林++羅仁忠++王小亞++徐亞雄+++譚淑娟++尹寶珠

[摘要] 目的 探討CE-Chirp聲誘發(fā)的聽(tīng)性腦干反應(yīng)（ABR）對(duì)嬰幼兒可疑聽(tīng)力損失診斷的價(jià)值及臨床運(yùn)用分析。 方法 選取2014年2月～2015年5月于東莞市婦幼保健院聽(tīng)力門診就診的可疑聽(tīng)力異常嬰幼兒67例（143耳）進(jìn)行統(tǒng)計(jì)分析，同時(shí)采用短聲（click）刺激聲、CE-Chirp聲進(jìn)行ABR檢測(cè)，分別記錄患兒的V波反應(yīng)閾值。 結(jié)果 兩種刺激聲ABR檢測(cè)不同程度耳聾陽(yáng)性率比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）；兩種刺激聲ABR檢測(cè)不同程度耳聾V波反應(yīng)閾值比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 CE-Chirp聲誘發(fā)的ABR檢測(cè)在嬰幼兒可疑聽(tīng)力診斷中可用于聽(tīng)力損失評(píng)估，但在實(shí)際應(yīng)用的過(guò)程中，應(yīng)將檢測(cè)方法規(guī)范化，對(duì)于有聽(tīng)力損失的患兒進(jìn)行聽(tīng)閾評(píng)估時(shí)需結(jié)合其他檢測(cè)方法。

[關(guān)鍵詞] 聽(tīng)性腦干反應(yīng)；chirp刺激聲；短聲；閾值；嬰幼兒；聽(tīng)力診斷

[中圖分類號(hào)] R764.04 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2017）11（c）-0111-04

Diagnostic value of CE-Chirp ABR in infants with suspected hearing loss and clinical application analysis

WANG Yuanming LI Chuling LUO Xianglin LUO Renzhong WANG Xiaoya XU Yaxiong TAN Shujuan YIN Baozhu

Department of Otolaryngology and Head Surgery， Dongguan Maternity and Child Health Hospital Dongguan Women and Children Hospital， Guangdong Province， Dongguan 523003， China

[Abstract] Objective To explore the diagnostic value and clinical application of CE-Chirp ABR in infants with suspected hearing loss. Methods From February 2014 to May 2015， 67 infants（143 ears）with suspected hearing loss in Dongguan Women and Children Hospital were analyzed in this study. Click （short sound stimulation） sound and CE-Chirp evoked auditory brainstem response （ABR） were performed in two groups of participants respectively and thresholds of wave V were recorded and analyzed. Results There were no significant difference in the positive rate of different degrees hearing loss or thresholds of wave V between Click sound and CE-Chirp sound （P > 0.05）. Conclusion CE-Chirp ABR can be used for the evaluation of hearing loss and its value is equal to that of click ABR. However， a careful analysis and standardization of detection method and combination with other methods should be noted in practical application.

[Key words] Auditory brainstem response chirp； Click acoustic stimulation； Short sound； Hearing threshold； Infant； Diagnosis of hearing

聽(tīng)性腦干反應(yīng)（auditory brainstem response，ABR）在臨床中應(yīng)用廣泛，特別是在兒童客觀聽(tīng)力評(píng)估、病變定位診斷中具有重要的應(yīng)用價(jià)值。傳統(tǒng)的ABR刺激聲類型主要有短聲（click）、短音（tone pip）以及純短音（tone burst），其中click-ABR應(yīng)用較為廣泛。由于click-ABR的能量主要集中在2～4 kHz，測(cè)試結(jié)果可有效反映2～4 kHz的高頻聽(tīng)力[1]。臨床實(shí)踐也表明，ABR的閾值與2～4 kHz純音聽(tīng)閾很接近。但由于耳蝸的生理解剖特點(diǎn)，聲音在耳蝸傳導(dǎo)中會(huì)存在行波延遲，因此該方法存在一定的局限性[2]。click-ABR與其他頻率相關(guān)性差，不能滿足臨床早期精準(zhǔn)干預(yù)的需要。近年來(lái)隨著聽(tīng)力診斷研究深入，CE-Chirp聲誘發(fā)的ABR檢測(cè)得到應(yīng)用[3]。CE-Chirp刺激聲信號(hào)相位特征表現(xiàn)為：按照次序發(fā)出低頻聲、中頻聲、高頻聲，克服了耳蝸的特殊解剖結(jié)構(gòu)造成的行波延遲，促使波形振幅明顯增加，V波辨認(rèn)率提高，縮短檢測(cè)時(shí)間。本研究……