耳鸣声学特征与扩展高频听阈的关系

目的 探讨纯音听阈正常的耳鸣患者耳鸣音调与扩展高频听阈的关系。 方法 对156例纯音听阈正常的耳鸣患者进行耳鸣生理声学检测,以纯音听阈正常的无耳鸣患者为对照组,对两组均进行扩展高频听阈检测。按年龄(25~35岁、36~45岁、46~55岁、≥55岁)分组,比较各组扩展高频听阈的平均值。将耳鸣组患者按耳鸣音调进行分类:低频组(125 Hz、250 Hz、500 Hz)、中频组(1.5 kHz、3 kHz)、高频组(4 kHz、6 kHz、8 kHz、≥9 kHz),一共9组,将各扩展高频平均听阈值(9 kHz、10 kHz、11.2 kHz、12.5 kHz、14 kHz、16 kHz)与对照组患者分别比对分析。 结果 耳鸣组和无耳鸣组之间比较,扩展高频各频率平均阈值差异无统计学意义(P>0.05),但各年龄组之间对比,年龄、是否耳鸣对扩展高频平均听阈都有显著影响。耳鸣音调1.5 kHz耳鸣组中9 kHz、耳鸣音调3 kHz耳鸣组中11.2 kHz、耳鸣音调4 kHz耳鸣组中10 kHz、耳鸣音调6 kHz耳鸣组中10 kHz和11.2 kHz、耳鸣音调8 kHz耳鸣组中10 kHz和11.2 kHz、耳鸣音调≥9 kHz耳鸣组中10 kHz、11.2 kHz和12.5 kHz平均阈值与对照组比较差异有统计学意义。 结论 扩展高频听阈下降与是否耳鸣、年龄有关。10 kHz、11.2 kHz平均听阈值下降与中、高频耳鸣有关联,特别是对高频耳鸣的患者很敏感,可以作为早期评估高频耳鸣患者早期耳蜗功能的敏感指标。     

200例主观性耳鸣患者听力损失临床分析

目的:对耳鸣患者的听力损失进行分析,为进一步探讨耳鸣的发病原因、检查方法提供临床依据。方法:对以主观性耳鸣为主诉的200例患者进行耳科专科检查、声导抗检测、常频纯音听阈测听和高频扩展听阈测听检查。结果:200例耳鸣患者中,单侧耳鸣123例(61.5%),双侧耳鸣77例(38.5%);46例(23.0%)听力正常。单侧耳鸣中,患侧与对侧听阈比较0.125～8kHz差异有统计学意义(P<0.05),10kHz及其以上频率差异无统计学意义(P>0.05)。常频听力正常组与听力异常组比较各频率阈值差异均具有统计学意义(均P<0.05),听力异常组扩展高频检出率低于听力正常组。结论:耳鸣可以存在听力正常的人群中,扩展高频测听能否为耳鸣患者提供早期听力损失的依据,尚需对更多的临床资料进一步研究。     

煤矿井下噪声暴露工人扩展高频测听

目的 探讨扩展高频纯音听阈在听力监测及早期发现噪声性听力损害中的价值.方法 对73名(142耳)耳科正常者(对照组)和78名(154耳)煤矿井下噪声暴露工人(实验组,其中常频纯音听阈正常组45名90耳,常频纯音听阈异常组33名64耳),行常频纯音测听、扩展高频纯音(0.5～16kHz)测听,将两组结果进行比较.结果实验组纯音听阈在4.0、6.0 kHz及扩展高频区与对照组比较明显升高,扩展高频未检出率逐渐增加,差异有显著意义(P＜0.05);常频纯音听阈正常的实验组与对照组比较,其扩展高频听阈升高,未检出率在14 kHz开始升高,差异有显著意义(P＜0.05);常频听阈异常的实验组与对照组比较,扩展高频听阈升高,未检出率在11.2 kHz开始增加,差异均有显著意义(P＜0.01).结论 扩展高频测听可用于噪声性聋的早期诊断和听力监测.     

随身听装置对青年人听力的影响

目的　探讨使用随身听装置对青年人听力的影响及其早期监测手段。方法　对 30名 (6 0耳 )耳科正常青年人 (对照组 )及 12 0名 (2 4 0耳 )“随身听”使用者 (观察组 )进行常频听阈测试 (0 .5～ 8kHz)和扩展高频听阈测试 (10～ 2 0kHz) ,并对其结果进行统计分析。结果　观察组的扩展高频纯音听阈和常频纯音听阈与对照组相比明显升高 (P <0 .0 5 ) ,且随着随身听使用时间的延长 (P <0 .0 5 ) ,有更多的频率点的听阈高于对照组 ;观察组的扩展高频听阈检出率明显低于对照组 ;观察组中常频听阈正常者和常频听阈异常者其扩展高频听阈均高于对照组 (P <0 .0 5 )。结论　“随身听”的使用可以对正常青年人的听力造成危害 ,扩展高频听阈测试可望成为对噪声造成的早期听力损害的一种敏感监测方法。     

不同听力检测方法对早期发现噪声性隐性听力损失的意义

目的探讨扩展高频纯音测听、畸变产物耳声发射(DPOAE)及噪声下言语识别能力测试对早期发现噪声性隐性听力损失的意义。方法选取20例常频纯音听阈正常、有噪声接触史的工人(接噪组,年龄20~41岁)与20例无噪声接触史、常频听阈正常的青年人(对照组,年龄19~35岁),分别行扩展高频纯音测听、扩展高频DPOAE及噪声下言语识别能力测试(汉化版噪声下BKB语句测试),记录并比较两组各项测试结果。结果接噪组扩展高频纯音听阈检出率低于对照组,在16 kHz差异有统计学意义(P<0.05),在18、20 kHz差异有显著统计学意义(P<0.01);接噪组8~20 kHz扩展高频纯音听阈平均值高于对照组,在9、18 kHz差异有统计学意义(P<0.05),在14 kHz差异有显著统计学意义(P<0.01);接噪组扩展高频DPOAE的信噪比及幅值均较对照组降低,在10 kHz差异有统计学意义(P<0.05),在8、9 kHz差异均有显著统计学意义(P<0.01);噪声下言语识别能力测试显示接噪组信噪比损失平均值为4.6±2.19 dB,高于对照组(3.00±2.08 dB)(P<0.01)。结论接噪组相较对照组,扩展高频纯音听阈值升高或引不出,扩展高频DPOAE信噪比及幅值降低,噪声下言语识别能力显著下降,以上三种检测方法对早期发现噪声性隐性听力损失有一定的参考价值。     

正常人扩展高频测听结果报告

目的研究正常人扩展高频听敏度,观察扩展高频听力随年龄增加的细微变化.方法用意大利Amplaid-460型听力计,频率范围8～18kHz.测试正常人128人、256耳,17～50岁,男92人,女36人,其中17～29岁90人,30～50岁38人,125Hz～8kHz纯音各频率听阈≤20dBHL,声导抗测听正常.以5岁为一年龄段分5组进行分析.结果1.正常年轻人(17～29岁)高频听阈总的趋势是随频率提高,听阈逐渐增加,出现率逐渐下降,在14kHz以上频率更为显著;2.正常人17～19岁、20～24岁、25～29岁、30～34岁、35岁以上各年龄组间12、14、16、18kHz听阈相比差异有显著性(P＜0.05),随年龄增加听阈逐渐提高,高频听阈出现率逐渐下降,随频率增加各年龄组差距逐渐明显,14kHz以上频率最为明显.结论人耳的老化是一个逐渐的过程,随年龄增加听阈提高.频率越高受影响越明显.扩展高频纯音测听结果可反映耳蜗亚临床病理状态,有利于早期发现听觉感受器病变,可用于临床监测耳毒性听力损失和早期诊断梅尼埃病等.     

儿童与成人慢性化脓性中耳炎听力学分析

目的　探讨儿童组与成人组不同类型慢性化脓性中耳炎 (CSOM)听力损失有何异同。方法　对 70例(85耳 )儿童和 99例 (14 1耳 )成人进行纯音测听检查 ,两组患耳进行比较。结果　两组三个类型CSOM患者纯音测听气导听阈均升高。单纯型CSOM在 1～ 8kHz范围内 ,两组气导检查结果呈现听力损失一致 (P >0 .0 5 )。骨疡型和胆脂瘤型CSOM ,除骨疡型 8kHz外 ,两组患耳各频率听力损失也相同 (P >0 .0 5 )。儿童组单纯型CSOM骨导检查结果基本正常 ,而骨疡型和胆脂瘤型CSOM ,成人组在中高频听力损失比儿童重。结论　虽然儿童CSOM病程短 ,呈现气导检查中频、高频听力损失与成人一样重的趋势 ,但无内耳损害或损害较轻。     

多频听性稳态反应评估听力正常青年人纯音听阈的探讨

目的　探讨多频听性稳态反应(multipleauditorysteadystateresponse ,MASSR)评估听力正常青年人纯音听阈的可靠性。方法　对2 8名( 5 6耳)听力正常青年人进行MASSR及纯音听阈检查,记录0 .5、1、2、4kHz反应阈及行为听阈,比较二者间的相关性。结果　MASSR反应阈左右耳间无显著性差异;各频率间MASSR反应阈比较,0 .5kHz较其他各频率有显著性差异(P <0 .0 0 1) ,1、2、4kHz三个频率间均无显著性差异(P >0 .0 5 )。MASSR反应阈与纯音听阈在0 .5、1、2、4kHz相关系数分别为0 .71、0 .83、0 .86、0 .87。结论　MASSR反应阈与纯音听阈间有较好的相关性,MASSR可用于评估纯音听阈     

高频测听在语频听力正常的耳鸣患者中的应用及其意义

目的 观察语频听力正常的耳鸣患者的高频测听结果并探讨其临床意义。方法 应用8－20kHz的纯音听力计对语频听力正常（≤25dB HL）的耳鸣组患者35例（60耳）和相同年龄段的正常对照组人群30例（60耳）进行高频测听。结果 耳鸣组患者的高频听阈检测结果显示，随频率增高，听阈逐渐提高，听阈检出率逐渐下降。相同频率耳鸣组患者与对照组人群移的差异有显著性意义（P＜0.05），14－20kHz范围内两组听阈检出率差异也有显著性意义（P＜0.01）。结论 耳鸣组患者高频听阈明显高于正常对照组，在14kHz以上听阈检出低于正常对照组。高频测听能够在早期为耳鸣患者提供听力受损的直接参考依据，患者的高频听务损失，可能在最初的耳鸣发生中起一定的作用。     

外伤性鼓膜穿孔患者常频与扩展高频测听结果分析

目的探讨外伤性鼓膜穿孔对扩展高频听力的影响。方法对55例（55耳）外伤性鼓膜穿孔患者在鼓膜愈合前后行常频纯音测听及扩展高频测听,骨导频率范围0.25～4kHz,气导频率范围0.125～16kHz,并与30例（60耳）健康对照组比较。结果在常频段,外伤性鼓膜穿孔患者鼓膜穿孔时所有频率气、骨导阈值均高于对照组,差异有统计学意义（P〈0.05）,鼓膜愈合后气、骨导阈值与对照组比较差异无统计学意义（P〉0.05）,骨、气导差距明显减小。在扩展高频段,鼓膜愈合前后所有频率气导阈值均高于对照组,差异有统计学意义（P〈0.05）,且穿孔愈合后有随着频率增高气导改善逐渐减少的趋势。结论外伤性鼓膜穿孔患者鼓膜愈合后常频段纯音气、骨导听阈恢复较好,但扩展高频区恢复较慢,甚至不可逆。     

Tinnitus with normal hearing sensitivity: extended high-frequency audiometry and auditory-nerve brain-stem-evoked responses

Extended high-frequency (HF) audiometry and auditory-nerve brain-stem-evoked responses (ABR) were carried out on two groups of subjects with normal hearing sensitivity. The experimental group comprised 17 subjects with tinnitus, while the control group consisted of age- and sex-matched subjects, not suffering from tinnitus. The aim of the study was to determine whether extended HF audiometry or ABR might reveal significant differences between these two groups of subjects with normal hearing sensitivity. In addition, the characteristics of tinnitus in subjects with normal audiograms were discussed. The results of extended HF audiometry showed no significant differences between the subjects with and without tinnitus. The ABR parameters considered were also within normal limits bilaterally. Based on the methods employed in this study, tinnitus in normal listeners does not appear to reflect appreciable damage in the cochlea or in the brain-stem auditory pathways. The authors present some suggestions for future research.     

82例耳鸣患者半倍频程频率纯音测听的特征及意义

目的 :观察常规倍频程纯音测听听阈无异常的耳鸣患者的半倍频程频率测试结果并探讨其特征及临床意义。方法 :应用纯音听力计对 82例 (14 0耳 )倍频程纯音测听听阈无异常的耳鸣组患者和 30例 (6 0耳 )正常对照组进行半倍频程频率测试。结果 :耳鸣组 14 0耳中 ,发现 37.14 %存在听力下降 ;主要为高频下降 ;大多为轻度下降 ;下降的频率与耳鸣频率有高度一致性 ;耳鸣的强度 (dBSL)与听力下降与否无关。结论 :半倍频程频率测试方法可为倍频程纯音测听听阈无异常的耳鸣患者早期听力损害的检出提供直接参考依据 ,对临床早期发现其潜在的耳蜗病变有积极意义     

Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

Objective

A few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125 Hz to 8000 Hz (≤20 dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.

2171例耳鸣患者的临床特征分析

目的 探讨耳鸣患者的临床特征,为耳鸣诊治提供参考.方法 收集2014年1月至2015年12月就诊于中山大学孙逸仙纪念医院耳鼻喉科门诊以耳鸣为第一主诉的2 171例(2 736耳)耳鸣患者的临床资料,以耳鸣残疾量表(tinnitus handicap inventory,THI)及视觉模拟评分(visual analogue scale,VAS)评估耳鸣的严重程度,并分析耳鸣的发病年龄、耳鸣侧别、听力状况及可能病因等基本特征.结果 2 171例耳鸣患者平均年龄为44.08±15.37岁,其中41~50岁为分布最集中的年龄段(491例,22.60%),其次为31~40岁(445例,20.50%)1~60岁(438例,20.20%);主观性耳鸣2 120例(97.65%),客观性耳鸣51例(2.35%);单侧耳鸣(1 606例,73.98%)多于双侧耳鸣(539例,24.83%), 颅鸣最少(26例,1.19%);2 736侧耳鸣耳8 000 Hz的平均听阈为69.26±27.70 dB HL,高于1 606侧非耳鸣耳(54.16±30.98 dB HL);THI分级以2、3级为主(55.78%,1 211/2 171),VAS分级以轻、中度耳鸣为主(83.83%,1 820/2 171);音调匹配以高频多见(4~8 kHz,1 199例,55.23%);位于前三位的可能病因为不明原因591例(27.22%)、突发性聋549例(25.29%)及中耳疾病270例(12.44%).结论 本组耳鸣患者中以主观性耳鸣为主,中青年者居多,单侧耳鸣多于双侧耳鸣,耳鸣与听力关系密切;引起耳鸣的病因多而复杂,部分患者不明原因或与耳疾有关,习服治疗是值得推广的治疗方法.     

Hearing Abilities at Ultra-High Frequency in Patients with Tinnitus

Objectives

To compare tinnitus patients who have normal hearing between 250 Hz and 8 kHz with normal controls with regard to the ability of each group to hear extended high-frequency pure tone thresholds.

Methods

We enrolled 18 tinnitus patients, each of whom had a threshold of HL <25 dB and threshold differences of <10 dB between ears at frequencies of 250 and 500 Hz and 1, 2, 4, and 8 kHz. We also enrolled age- and gender-matched normal volunteers (10 ears), for each patient. Extended high frequency pure tone audiometry was performed, and the mean hearing thresholds at 10, 12, 14, and 16 kHz of each tinnitus ear were compared with those of the 10 age- and sex-matched normal ears.

Results

Of the 18 patients with tinnitus, 12 had significantly increased hearing thresholds at more than one of the four high frequencies, compared with the normal group. When we assessed results according to frequency, we found that 8 patients had decreased hearing ability at 10 kHz, 10 at 12 kHz, 8 at 14 kHz, and 4 at 16 kHz.

Conclusion

Some patients with tinnitus who have normal hearing below 8 kHz have decreased hearing ability at extended high-frequencies. Thus, the proportion of patients with tinnitus who have normal hearing over the entire audible range is smaller than in previous reports.     

Relation of distortion product otoacoustic emission with tinnitus

OBJECTIVE: To investigate cochlear outer hair cell function based on distortion product otoacoustic emission (DPOAE) in patients with tinnitus. STUDY DESIGN: This is a case control study. SUBJECTS AND METHODS: The subjects are patients who attended the Otorhinolaryngology Clinic in Hospital Universiti Kebangsaan Malaysia over a period of 19 months from April 2005 until October 2006. All patients underwent a full ENT assessment and had tympanometry, pure tone audiometry, and DPOAE tests. The UKM Research and Ethics Committee reviewed and approved the study proposal prior to commencement of this study. RESULTS: The study population included 49 patients. They consisted of 16 patients (32 ears) with tinnitus and reduced hearing, 13 patients (26 ears) with tinnitus and normal hearing, 7 patients (13 ears) without tinnitus with reduced hearing, and 13 patients (26 ears) without tinnitus with normal hearing. Statistical analysis showed significant differences (P = .00) of mean DPOAE levels between the four groups of patients. CONCLUSION: Our results suggest that reduced outer hair cell activity, as detected by reduced DPOAE levels, may manifest as tinnitus even before there is a shift on hearing threshold. We also postulate that further reduction of cochlear outer hair cell activity, as shown by further reduced DPOAE levels, may actually terminate the source of tinnitus.     

Pneumatic external counterpulsation (PECP): a new treatment option in therapy refractory inner ear disorders?

BACKGROUND: The established therapeutic principle for sudden deafness and tinnitus is based on the stimulation of the inner ear perfusion by infusion therapy using vaso-active or hemodilutive agents. Concerning a mechanically induced increase of the inner ear's blood supply, the new technique of Pneumatic External Counterpulsation (PECP) was performed. This technique had already been used successfully in patients suffering from coronary heart disease. Due to an ECG-guided pneumatic compression of the lower extremities during diastole an increase of arterial perfusion of the extracranial supplying brain vessels can be obtained by PECP-treatment. PATIENTS AND METHODS: PECP was used in 33 patients (22 males, 11 females) between 19 and 76 years of age suffering from persisting acute hearing disorders and/or tinnitus after adequate infusion therapy. 3 patients revealed mild complications during PECP-treatment (e.g. thoracic pain) which seemed to be related to the therapeutic regime and disappeared completely after cessation of PECP. 30 patients underwent PECP-treatment on 5 following days for 1 hour. This standardized hourly treatment regime was extended to 10 days in 12 patients. Therapeutic effects were determined by color-coded duplexsonography and pure tone audiometry eventually masking the audiogram. RESULTS: During treatment an increase of 19% flow volume in the internal carotid arteries and of 11% in the vertebral arteries was evaluated using color-coded duplexsonography. In 47% of cases (n = 14) decrease of tinnitus intensity and/or tinnitus appearance with an average of 16 dB was perceived after the end of the treatment series. Hearing threshold increased in 28% of cases (n = 7) with an average threshold shift of 19 dB after PECP-treatment. All patients were examined by pure tone audiometry during the follow-up after 4, 8 and 12 weeks as well as after 6 and 12 months. In all cases the audiometric benefit lasted throughout the follow-up 1 year, after treatment. CONCLUSIONS: The determination of a positive correlation between vascular flow increase in the extracranial brain-supplying vessels during PECP-treatment and the encouraging therapeutic results obtained by audiometry seem to make this new and promising therapeutic option effective, practicable and easy to handle. These preliminary results of the PECP technique should be validated in further studies featuring larger numbers of patients suffering from therapy-resistant inner ear disorders.     

Depression,Anxiety and Stress Scale in patients with tinnitus and hearing loss

The study was proposed to evaluate co-morbid depression, anxiety and stress associated with tinnitus patients. The study was done on 196 subjects: 100 patients suffering from subjective tinnitus associated with hearing loss (tinnitus group), 45 patients suffering from hearing loss only (hearing loss group) and 50 healthy subjects not suffering from tinnitus or hearing loss (control group); the age ranges from 20 to 60 years old. The studied sample was subjected to full ear, nose and throat examinations and audiological evaluation. Depression, Anxiety and Stress Scale (DASS) was developed by Levibond H and Levibond F to assess three self-report scales designed to measure the negative emotional status of depression, anxiety and stress. All patients and control group were evaluated by DASS. (1) Depression: males were affected more than females. All patients over 60 years were affected by depression. The duration of tinnitus seems correlating with the severity of depression. Only 2 patients (4.3 %) of the hearing loss group suffer from depression. (2) Anxiety: 90 % of males suffer from anxiety as compared to 83.3 % females. The age group 20–29 years old suffers more than other age groups. Only 4 patients (8.7 %) of hearing loss group suffer from anxiety. (3) Stress: females seem to be affected by the stress (76.7 %) more than males (67.5). Patients in age group 30–39 suffer the most from the disease. There is a direct correlation between duration of tinnitus and severity of stress. No one of the hearing loss group suffers from stress. In conclusion, depression, anxiety and stress should be taken into consideration in the treatment of patients suffering from tinnitus.     

Long-term hearing outcomes after recurrent acute otitis media during early childhood

Objective: To survey long-term hearing outcomes and middle ear pathology in a 30-year follow-up in individuals with onset of recurrent acute otitis media (rAOM) before three years of age.

Methods: 28 adults, aged 30.1–31.8 years, who originally – at the age of 12–32 months – participated in a study on rAOM between 1979 and 1983, were re-examined regarding self-reported ear problems, current tympanic membrane changes and audiology. Thirteen subjects had suffered from rAOM during early childhood and 15 subjects served as a control group.

Results: Recurrent acute otitis media subjects reported hearing problems comparable to those of the controls. Pure tone audiometry, at 125–8000?Hz, did not differ between groups. The rAOM group had a trend for impaired high-frequency (9000–14,000?Hz) threshold levels (9000–14,000?Hz); implying that their cochlear function seemed to have deteriorated.

Conclusions: Adults, who suffered from recurrent acute otitis media as infants, did not show any clinically significant hearing loss for pure tone audiometry when compared to controls, but there was a trend for impaired results regarding extended high frequency audiometry (9–14?kHz). Children suffering from rAOM will be at low risk of developing hearing loss and severe middle ear disease.     

听神经病听力学分析

目的 探讨听神经病的听觉电生理特点。方法 总结了10例听神经病患者的病史、纯音测听、镫骨肌反射、听性脑干反应（auditory brainstem response,ABR)、耳蜗电图、畸变产物耳声发射（distortion product otoacoustic emission,DPOAE)及对侧白噪声抑制试验、中潜伏期反应和慢皮层反应。5例患者作了颅脑CT或磁共振成像（magnetic resonance imaging,MRI)。结果 患者男女兼有，平均年龄为20．3岁，10余岁的青少年占多数。9例主诉双耳听力下降，1例双耳鸣。纯音测听示19耳为轻度至中度的低频下降型感音神经性听力损失，听力损失最严重的频率为0．5kHz或（和）0．25kHz；1耳听力正常。19耳镫骨肌反射消失，1耳纯音测听为上升型曲线者反射阈提高。ABR不能引出或仅出现波V和（和）波1。全部病例均可记录到DPOAE，但不能被对侧噪声抑制。耳蜗电图示大部分病例动作电位（action potential,AP)消失或振幅很小，负总和电位（negative summating potential,-SP)振幅绝对平均值为0．595μV，慢皮层反应皆正常，6例测中潜伏期反应5例正常。CT或MRI无异常发现。结论 听神经病早期纯音测听可正常，但其镫骨肌反射和ABR消失或阈值升高，其确切病变部位尚不明了，可能位于脑干平面以下的听觉系统。