Application of narrow-band CE-Chirp NB ASSR in hearing threshold assessment of hearing-impaired children
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摘要: 目的 探讨窄带CE-Chirp声听觉稳态反应(NB CE-Chirp ASSR)测试在听障儿童听阈评估中的应用价值。 方法 回顾性研究2023年1月至2023年12月在上海市儿童医院确诊的感音神经性听力损失患儿44例(88耳)的听力检测结果，其中听力损失轻度组19耳，中度组26耳，重度组20耳，极重度组23耳。分析不同听力损失组听性脑干反应(ABR)阈值、纯音测听(PTA)阈值与NB CE-Chirp ASSR反应阈之间的相关性。 结果 不同程度的听力损失组其ABR与NB CE-Chirp ASSR(2 000~4 000 Hz)反应阈差值为0.50~4.08 dB；每组NB CE-Chirp ASSR与ABR反应阈之间均有显著相关性(P＜0.001)，且轻度、重度及极重度组的相关系数均>0.8，呈极强相关。各组PTA与NB CE-Chirp ASSR平均阈值差值为1.88~3.91 dB；相关系数均>0.8，呈极强相关。每组在500、1 000、2 000、4 000 Hz处PTA与NB CE-Chirp ASSR反应阈差值为0.25~3.84 dB；随频率升高，PTA与NB CE-Chirp ASSR反应阈二者间的相关系数呈上升趋势，系数最高的频率为4 000 Hz，r均>0.9，其次为2 000 Hz，500 Hz处相对较低；在极重度组中各频率系数均大于0.7，呈极强相关。 结论 NB CE-Chirp ASSR具备良好的频率特异性，能可靠地评估听障儿童的听觉阈值。Abstract: Objective To investigate the application value of NB CE-Chirp ASSR in the assessment of hearing threshold in children with hearing impairment. Methods The hearing test results of 44 children with sensorineural hearing loss(88 ears) diagnosed in Shanghai Children's Hospital from January 2023 to December 2023 were retrospectively studied, including 19 ears in mild hearing loss group, 26 ears in moderate group, 20 ears in severe group and 23 ears in extremely severe group. Correlations between auditory brainstem response(ABR) thresholds, pure tone audiometry(PTA) thresholds and NB CE-Chirp ASSR response thresholds in different hearing loss groups were analyzed. Results The threshold difference between ABR and NB CE-Chirp ASSR(2 000-4 000 Hz) was between 0.50-4.08 dB in different degrees of hearing loss group. There was a significant correlation between NB CE-Chirp ASSR and ABR response threshold in each group(P < 0.001), and the correlation coefficients of mild, severe and extremely severe groups were all greater than 0.8, showing a strong correlation. The average threshold difference between PTA and NB CE-Chirp ASSR in each group was between 1.88-3.91 dB. The correlation coefficients were all greater than 0.8, showing a strong correlation. The difference between PTA and NB CE-Chirp ASSR response threshold at 500, 1 000, 2 000 and 4 000 Hz in each groupwas between 0.25-3.84 dB. With the increase of frequency, the correlation coefficient between PTA and NB CE-Chirp ASSR response threshold showed an upward trend. The frequency with the highest coefficient was 4 000 Hz, and the r values were all greater than 0.9, followed by 2 000 Hz, and the correlation coefficient was relatively low at 500 Hz. In the extremely severe group, each frequency coefficient was greater than 0.7, showing a strong correlation. Conclusion NB CE-Chirp ASSR has good frequency specificity and can reliably assess hearing thresholds in hearing-impaired children.
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表 1 不同听力损失组ABR与NB CE-Chirp ASSR(2 000~4 000 Hz)相关系数比较
X±S 听力损失程度 耳数 ABR NB CE-Chirp ASSR 差值 r P 轻度 19 34.21±10.04 30.13±13.50 4.08±7.51 0.836 ＜0.001 中度 26 50.38±8.93 51.15±14.23 -0.77±10.55 0.673 ＜0.001 重度 20 66.50±17.09 66.00±14.94 0.50±9.68 0.826 ＜0.001 极重度 23 93.48±9.35 92.39±7.99 1.08±5.48 0.811 ＜0.001 
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表 2 不同听力损失组PTA与NB CE-Chirp ASSR(500~4 000Hz)相关系数比较
X±S 听力损失程度 耳数 PTA NB CE-Chirp ASSR 差值 r P 轻度 19 32.63±14.94 30.13±13.50 2.50±4.56 0.954 ＜0.001 中度 26 54.61±13.03 51.15±14.23 3.46±8.15 0.825 ＜0.001 重度 20 67.87±10.20 66.00±14.94 1.88±8.11 0.858 ＜0.001 极重度 23 96.30±8.18 92.39±7.99 3.91±5.05 0.806 ＜0.001
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表 3 44例(88耳)听力损失患儿PTA与NB CE-Chirp ASSR各频率相关性比较
X±S 频率 PTA NB CE-Chirp ASSR 差值 r P 500 58.63±26.84 60.22±26.19 -1.59±13.19 0.877 ＜0.001 1 000 60.45±27.50 62.72±26.36 -2.27±13.28 0.879 ＜0.001 2 000 63.69±25.84 61.64±26.35 2.04±9，63 0.932 ＜0.001 4 000 63.63±25.97 61.25±27.32 2.38±8.70 0.948 ＜0.001
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表 4 轻度听力损失组(19耳)患儿PTA与NB CE-Chirp ASSR各频率相关性比较
X±S 频率 PTA NB CE-Chirp ASSR 差值 r P 500 27.63±8.39 31.57±9.43 -3.94±9.06 0.480 0.034 1 000 26.84±9.16 30.26±9.04 -3.42±4.73 0.865 ＜0.001 2 000 30.78±12.83 28.95±11.00 1.84±6.71 0.882 ＜0.001 4 000 34.47±18.33 31.31±17.86 3.15±6.50 0.936 ＜0.001
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表 5 中度听力损失组(26耳)患儿PTA与NB CE-Chirp ASSR各频率相关性比较
X±S 频率 PTA NB CE-Chirp ASSR 差值 r P 500 44.23±15.27 46.73±18.22 -2.50±14.91 0.616 0.001 1 000 45.76±12.62 47.69±12.58 -1.90±12.25 0.528 0.006 2 000 54.04±10.77 50.96±13.63 3.07±10.00 0.687 ＜0.001 4 000 55.19±17.17 51.35±17.35 3.84±7.39 0.908 ＜0.001
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表 6 重度听力损失组(20耳)患儿PTA与NB CE-Chirp ASSR各频率相关性比较
X±S 频率 PTA NB CE-Chirp ASSR 差值 r P 500 67.50±9.10 68.50±9.88 -1.00±8.97 0.556 0.010 1 000 70.50±7.41 70.75±10.24 -0.25±9.10 0.516 0.020 2 000 68.00±9.78 66.75±11.84 1.25±8.41 0.713 ＜0.001 4 000 66.50±12.98 65.25±18.95 1.25±9.16 0.902 ＜0.001
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表 7 极重度听力损失组(23耳)患儿PTA与NB CE-Chirp ASSR各频率相关性比较
X±S 频率 PTA NB CE-Chirp ASSR 差值 r P 500 91.52±11.12 89.56±8.90 1.95±7.03 0.770 ＜0.001 1 000 95.86±8.61 92.82±6.87 3.04±5.38 0.781 ＜0.001 2 000 97.39±7.66 95.21±10.71 2.17±5.18 0.893 ＜0.001 4 000 94.78±10.60 92.17±10.95 2.60±3.95 0.933 ＜0.001
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