Application of auditory brainstem response to different types of hearing loss in infants
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摘要: 目的 分析不同中耳功能状态及不同听力水平时听性脑干反应(ABR)各波潜伏期、波间期的变化特征，探讨ABR检测方法用于婴幼儿听力评估的价值。方法 研究对象为2020年5月-2021年4月就诊于首都医科大学附属北京儿童医院耳鼻咽喉头颈外科儿童听力诊疗中心的670例儿童，根据听力检测结果分为正常组(A组)632耳、耳功能正常听力异常组(B组)157耳和中耳功能异常组(C组)551耳。B组进一步分为轻度听力损失亚组(49耳)、中度听力损失亚组(47耳)和重-极重度听力损失亚组(61耳); C组进一步分为听力正常亚组(307耳)、轻度听力损失亚组(110耳)、中度听力损失亚组(107耳)和重-极重度听力损失亚组(27耳)。分析B、C两组各亚组与A组、以及各亚组间ABR Ⅰ、Ⅲ、Ⅴ波潜伏期、Ⅰ~Ⅲ、Ⅰ~Ⅴ波间期的差异。结果 刺激强度为80 dB nHL时，B组各亚组与A组ABR潜伏期和波间期比较，B组轻度和中度听力损失亚组与A组的差异均无统计学意义(P>0.05)，两亚组间比较亦无显著性差异(P>0.05)。重-极重度听力损失亚组中，部分耳ABR Ⅰ、Ⅲ、Ⅴ波均无法引出，仅4耳引出Ⅲ、Ⅴ波，7耳引出Ⅴ波。该11耳Ⅲ、Ⅴ波潜伏期的平均值分别为(5.20±0.44) ms和(6.80±0.75) ms，较轻度和中度听力损失亚组延长。与A组比较，C组中听力正常亚组仅Ⅰ波潜伏期显著延长，其余亚组Ⅰ、Ⅲ、Ⅴ波潜伏期均明显延长(P < 0.01)。就Ⅰ~Ⅲ、Ⅰ~Ⅴ波间期而言，C组中听力正常亚组和轻度听力损失亚组与A组相比差异无统计学意义; 中度听力损失亚组和重-极重度听力损失亚组较A组明显缩短(P < 0.01)。C组各亚组间比较，不同程度听力损失亚组与听力正常亚组比较Ⅰ、Ⅲ、Ⅴ波潜伏期明显延长(P < 0.01)。中度听力损失亚组较轻度听力损失亚组Ⅰ波潜伏期明显延长(P < 0.01)。重-极重度听力损失亚组各波潜伏期均明显长于轻度听力损失亚组和中度听力损失亚组(P < 0.01)。各亚组波间期比较，轻度听力损失亚组与听力正常亚组无差异(P>0.05)。中度听力损失亚组和重-极重度听力损失亚组较听力正常亚组和轻度听力损失亚组明显缩短，且差异有统计学意义(P < 0.01)，两组间比较亦有显著差异(P < 0.01)。结论 感音神经性听力损失中，轻、中度听力损失对ABR各波潜伏期及波间期无明显影响。重-极重度听力损失各波潜伏期无法正常引出或只引出Ⅲ、Ⅴ波，且明显延长。中耳功能异常时，ABRⅠ波潜伏期显著延长。中耳功能异常伴听力异常时，各波潜伏期均有明显延长。听力损失达到一定程度时，波间期显著缩短。因此，对于轻中度听力损失，ABRⅠ波潜伏期是否延长对于听力损失的定性诊断具有一定价值，Ⅰ波潜伏期明显延长对判断婴儿中耳功能障碍有临床意义。Abstract: Objective The aim of this study is to analyze the variation characteristics of ABR wave latency and wave interval in different functional states of middle ear and different hearing levels, and to explore the value of ABR detection method in hearing assessment of infants.Methods A total of 670 children were enrolled in the Pediatric Hearing Diagnosis and Treatment Center of the Department of Otolaryngology head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from May 2020 to April 2021. According to the hearing test results, they were divided into group A normal group(632 ears). Group B consisted of normal middle ear function and abnormal hearing(157 ears), further divided into mild hearing loss subgroup(49 ears), moderate hearing loss subgroup(47 ears) and severe to very severe hearing loss subgroup(61 ears). Group C was a group with abnormal middle ear function(551 ears), which was further divided into normal hearing subgroup(307 ears), mild hearing loss subgroup(110 ears), moderate hearing loss subgroup(107 ears) and severe to very severe hearing loss subgroup(27 ears). The differences of Ⅰ, Ⅲ, Ⅴ Wave Latency, Ⅰ—Ⅲ, Ⅰ—Ⅴ wave interval between subgroups B and C and Group A, and between subgroups B and C were analyzed.Results When the stimulus intensity was 80 dB nHL, there was no significant difference in ABR latency and wave interval between group B and group A, and there was no significant difference between group B and group A(P>0.05), nor between the two groups(P>0.05). In the subgroup of severe to very severe hearing loss, some ABRⅠ, Ⅲ and Ⅴwaves could not be elicited, only Ⅲ and Ⅴ waves were elicited from 4 ears and Ⅴ waves were elicited from 7 ears. The mean latency of 11 ear Ⅲ and Ⅴ waves was (5.20±0.44) ms and (6.80±0.75) ms, respectively, which was longer than that of mild and moderate hearing loss subgroups. Compared with group A, the latency of normal hearing subgroup in group C was significantly prolonged only for wave Ⅰ, and the latency of wave I, Ⅲ and Ⅴin other subgroups was significantly prolonged(P < 0.01). In terms of Ⅰ—Ⅲ and Ⅰ—Ⅴ wave intervals, there was no significant difference between group C and group A in normal hearing subgroup and mild loss subgroup. The subgroup of moderate hearing loss and the subgroup of severe to very severe hearing loss were significantly shorter than the group A(P < 0.01). Compared with the normal group, the latency of Ⅰ, Ⅲ and Ⅴ waves in group C were significantly longer(P < 0.01). The latency of wave Ⅰ, in the moderate hearing loss group was significantly longer than that in the mild hearing loss group(P < 0.001). The latency of each wave in severe to very severe hearing loss subgroup was significantly longer than that in mild and moderate hearing loss subgroup(P < 0.001). There was no difference between mild hearing loss subgroup and normal hearing subgroup(P>0.05). The subgroup of moderate hearing loss and severe to very severe hearing loss were significantly shorter than the subgroup of normal hearing and the subgroup of mild hearing loss, and there was a significant difference between the two groups(P < 0.01).Conclusion In sensorineural hearing loss, mild and moderate hearing loss had no significant effect on the latency and interwave period of ABR. The latency of each wave in severe to very severe hearing loss cannot be elicited normally or only Ⅲ and Ⅴ waves can be elicited, and it is significantly prolonged. The latency of ABR Ⅰwave was significantly prolonged when middle ear function was abnormal. The latency of each wave was significantly prolonged when middle ear function was abnormal and hearing was abnormal. When hearing loss reaches a certain degree, the interwave period is shortened significantly. Therefore, for mild to moderate hearing loss, the prolonged latency of ABRⅠ wave is of certain value for the qualitative diagnosis of hearing loss, and the prolonged latency of ABR Ⅰwave is of significance for judging middle ear dysfunction in infants.
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Key words:
- hearing loss /
- infants /
- auditory brainstem response /
- middle ear
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表 1 3组耳数、年龄、性别情况
组别 耳数 年龄/月 性别(男女比例) A组 632 5.17±2.4 1.2∶1 B组 轻度听力损失 49 5.35±1.9 1.0∶1 中度听力损失 47 5.08±2.2 1.3∶1 重-极重度听力损失 61 4.89±4.1 1∶1.1 C组 听力正常 307 5.81±3.1 1.0∶1 轻度听力损失 110 5.30±2.6 1.1∶1 中度听力损失 107 5.03±2.1 1.0∶1 重-极重度听力损失 27 3.98±3.1 1.0∶1 合计 1340 5.22±2.5 1.1∶1 
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表 2 中耳功能正常不同听力水平婴幼儿ABR潜伏期及波间期比较
组别 耳数(%) 潜伏期/ms 波间期/ms Ⅰ波 Ⅲ波 Ⅴ波 Ⅰ~Ⅲ Ⅰ~Ⅴ A组 632(80.1) 1.32±0.13 3.91±0.22 6.04±0.29 2.59±0.21 4.73±0.29 B组 轻度听力损失 49(6.2) 1.33±0.38 3.90±0.38 6.01±0.42 2.57±0.26 4.68±0.39 中度听力损失 47(6.0) 1.36±0.54 3.96±0.54 6.10±0.59 2.60±0.25 4.74±0.33 P值 0.429 0.433 0.374 0.774 0.509
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表 3 中耳功能异常各亚组与A组Ⅰ、Ⅲ、Ⅴ波潜伏期的比较
组别 耳数(%) 潜伏期/ms Ⅰ波 Ⅲ波 Ⅴ波 A组 632(53.4) 1.32±0.13 3.91±0.22 6.04±0.29 C组 听力正常 307(26.0) 1.35±0.161) 3.92±0.24 6.07±0.33 轻度听力损失 110(9.3) 1.70±0.381) 4.31±0.382) 6.42±0.423) 中度听力损失 107(9.0) 1.91±0.541) 4.37±0.542) 6.44±0.593) 重-极重度听力损失 27(2.3) 2.27±0.621) 4.66±0.642) 6.84±0.683) 与A组Ⅰ波比较，1)P < 0.01;与A组Ⅲ波比较，2)P < 0.01;与A组Ⅴ波比较，3)P < 0.01。
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表 4 中耳功能异常各亚组与A组Ⅰ~Ⅲ、Ⅰ~Ⅴ波间期的比较
组别 耳数 波间期/ms Ⅰ~Ⅲ Ⅰ~Ⅴ A组 632 2.59±0.21 4.73±0.29 C组 听力正常 307 2.57±0.20 4.72±0.32 轻度听力损失 110 2.61±0.25 4.72±0.33 中度听力损失 107 2.46±0.261) 4.53±0.392) 重-极重度听力损失 27 2.39±0.281) 4.57±0.392) 与A组Ⅰ~Ⅲ波间期比较，1)P < 0.01;与A组Ⅰ~Ⅴ波间期比较，2)P < 0.01。
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表 5 中耳功能异常组不同听力水平婴幼儿ABR潜伏期及波间期比较
组别 耳数 潜伏期 波间期 Ⅰ波 Ⅲ波 Ⅴ波 Ⅰ~Ⅲ Ⅰ~Ⅴ A组 632(54) 1.32±0.13 3.91±0.22 6.04±0.29 2.59±0.21 4.73±0.29 C组 听力正常 307 1.35±0.16 3.92±0.24 6.07±0.33 2.57±0.20 4.72±0.32 轻度听力损失 110 1.70±0.381) 4.31±0.381) 6.42±0.421) 2.61±0.25 4.72±0.33 中度听力损失 107 1.91±0.541)2) 4.37±0.541) 6.44±0.591) 2.46±0.261)2) 4.53±0.391)2) 重-极重度听力损失 27 2.27±0.621)2)3) 4.66±0.641)2)3) 6.84±0.681)2)3) 2.39±0.281)2) 4.57±0.391)2) P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 注：P为单因素方差分析的P值。与听力正常亚组比较，1)P < 0.05;与轻度听力损失亚组比较，2)P < 0.05;与中度听力损失亚组比较，3)P < 0.01。
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