Electrophysiological study of the cochlea in patients with unilateral acute tinnitus
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摘要: 目的 分析单侧急性耳鸣患者纯音测听(PTA)、扩展高频测听(EHFA)、畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)、耳蜗电图(ECochG)的客观检测结果，探讨其对隐性听力损失的临床应用价值。方法 对33例以单侧急性耳鸣为主诉的患者进行PTA、DPOAE、ABR、ECochG检测，对DPOAE各频率检出率及反应幅值、ABR各波潜伏期及波间期、ECochG中-SP/AP的结果进行分析。结果 ① 双耳PTA在0.25~8 kHz各频率阈值结果均在正常范围内(P>0.05)，患耳在9~16 kHz各频率听阈均高于健耳(P < 0.001)；②DPOAE在3、4、6、8 kHz 4个高频频率检出率和反应幅值双耳差异有统计学意义(P < 0.05)；③ABRⅠ波患耳潜伏期为(1.55±0.17) ms，健耳潜伏期为(1.50±0.14) ms，患耳潜伏期较健耳延长(P < 0.05)；④ECochG中-SP振幅耳间差异无统计学意义(P>0.05)，AP振幅及-SP/AP振幅比耳间差异有统计学意义(P < 0.05)。结论 EHFA、DPOAE、ABR、ECochG检测对于耳鸣患者的耳蜗功能评价具有临床意义。Abstract: Objective To analyze the objective test results of the pure-tone audiogram (PTA), extended high-frequency audiometry (EHFA), distortion product otoacoustic emission (DPOAE), auditory brainstem response(ABR), and electrocochleogram (ECochG) in patients with unilateral acute tinnitus, summarize their characteristics and explore their clinical application value in hidden hearing loss.Methods PTA, DPOAE, ABR, and ECochG tests were performed in 33 patients with unilateral acute tinnitus as the chief complaint. The detection rate and response amplitude of each DPOAE frequency, incubation period, and interval of ABR waves and -SP/AP in ECochG were analyzed.Results ① The thresholds of PTA at 0.25-8 kHz in both ears were in the normal range (P>0.05), and the thresholds of PTA at 9-16 kHz in affected ears were higher than those in healthy ears (P < 0.001); ②There was statistical significance in the detection rate and response amplitude of DPOAE at 3, 4, 6, 8 kHz between ears (P < 0.05); ③The incubation period of ABR Ⅰ wave in affected ears was (1.55±0.17) ms, that in the healthy ear was (1.50±0.14) ms, among them, the incubation period of ABR Ⅰ wave in the affected ear was longer than that in the healthy ear, and the difference was statistically significant (P < 0.05); ④In ECochG, there was no significant difference in -SP amplitude between ears (P>0.05), but there was a significant difference in AP amplitude and -SP/AP amplitude between ears (P < 0.05).Conclusion EHFA, DPOAE, ABR, and ECochG have clinical significance in evaluating cochlear function in tinnitus patients.
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表 1 耳鸣患者常频PTA结果
dB HL，X±S 侧别 0.25 kHz 0.5 kHz 1 kHz 2 kHz 4 kHz 8 kHz 患耳 13.76±5.69 12.16±4.99 11.61±4.99 13.64±5.99 15.52±6.14 18.81±6.10 健耳 12.52±5.77 11.32±5.51 11.22±5.54 12.64±5.85 15.08±6.62 17.88±6.41 t值 0.855 1.115 0.263 0.663 0.275 0.568 P值 0.399 0.273 0.795 0.512 0.785 0.561 
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表 2 耳鸣患者EHFA结果
dB HL，X±S 侧别 9 kHz 10 kHz 11.2 kHz 12.5 kHz 14 kHz 16 kHz 患耳 35.29±6.77 50.85±6.48 55.92±6.60 57.10±6.68 75.39±7.18 66.18±8.75 健耳 18.04±6.09 18.10±6.07 25.83±5.83 31.73±6.28 40.58±6.99 35.85±7.99 t值 10.366 20.687 19.252 14.968 20.100 15.291 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
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表 3 耳鸣患者DPOAE不同频率检出率
% 侧别 0.5 kHz 0.75 kHz 1 kHz 1.5 kHz 2 kHz 3 kHz 4 kHz 6 kHz 8 kHz 患耳 42.40 66.70 75.80 97.00 87.90 84.80 72.70 66.70 42.42 健耳 57.60 84.80 87.90 97.00 93.90 100.00 97.00 93.90 87.88 χ2 1.515 2.970 1.630 0.000 0.733 5.410 7.543 7.759 13.235 P值 0.218 0.085 0.202 1.000 0.392 0.020 0.006 0.005 < 0.001
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表 4 耳鸣患者DPOAE不同频率反应幅值(信噪比)
dB SPL，X±S 侧别 0.5 kHz 0.75 kHz 1 kHz 1.5 kHz 2 kHz 3 kHz 4 kHz 6 kHz 8 kHz 患耳 3.23±5.94 6.74±6.50 9.03±7.47 13.98±5.32 14.65±6.67 14.13±7.34 11.21±9.08 10.46±8.72 8.14±5.83 健耳 4.85±6.33 8.74±2.91 11.59±4.57 15.01±5.45 16.44±5.73 17.26±4.23 15.27±7.89 14.96±7.70 14.03±8.08 t值 -1.118 -1.673 -1.838 -0.996 -1.685 -2.468 -2.775 -3.012 -3.546 P值 0.272 0.104 0.075 0.327 0.102 0.019 0.009 0.005 < 0.001
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表 5 耳鸣患者ABR潜伏期及波间期参数值
ms，X±S 侧别 Ⅰ Ⅲ Ⅴ Ⅰ~Ⅲ Ⅲ~Ⅴ Ⅰ~Ⅴ 患耳 1.55±0.17 3.71±0.20 5.58±0.27 2.17±0.15 1.87±0.17 4.04±0.23 健耳 1.50±0.14 3.68±0.23 5.55±0.28 2.18±0.16 1.86±0.19 4.05±0.21 t值 2.126 1.286 1.638 -0.671 0.364 -0.346 P值 0.041 0.208 0.111 0.507 0.718 0.732
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表 6 耳鸣患者ECochG的-SP、AP振幅及-SP/AP振幅比
X±S 侧别 -SP振幅 AP振幅 -SP/AP 患耳 0.04±0.04 0.16±0.06 0.23±0.17 健耳 0.03±0.03 0.23±0.10 0.14±0.15 t值 0.971 -3.607 2.070 P值 0.338 0.001 0.046
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