耳蜗死区对感音神经性听力损失患者言语识别能力的影响

目的 探究耳蜗死区在感音神经性听力损失(sensorineural hearing loss,SNHL)患者中的存在情况及其对言语识别能力的影响.方法 采用纯音听阈测试筛选出41例(81耳)感音神经性听力损失患者,经均衡噪声阈值测试将患者分为有耳蜗死区组(35耳)和无耳蜗死区组(46耳),分别进行言语识别阈(SRT)和言语识别率(SDS)测试,分析81耳耳蜗死区的分布及其对言语识别能力的影响.结果 41例(81耳)感音神经性听力损失患耳中有35耳(43.21％,35/81)存在耳蜗死区,其中轻度SNHL患耳耳蜗死区检出率为0(0/11),中度SNHL患耳耳蜗死区检出率为24.1％(7/29),重度SNHL患耳耳蜗死区检出率为66.7％(24/36),极重度SNHL患耳耳蜗死区检出率为80.0％(4/5),不同听力损失程度耳耳蜗死区检出率差异有统计学意义(P＜0.05);高频耳蜗死区(16耳)明显多于低频耳蜗死区(8耳),但两者的言语识别能力差异无统计学意义(P＞0.05);有耳蜗死区患者的言语识别阈及言语识别率分别为61.63±16.76 dB HL,86.35％±12.03％,无耳蜗死区的患者分别为75.54±9.56 dBHL,64.97％±20.84％,二者间差异有统计学意义(P＜0.05).结论 听力损失越重,耳蜗死区检出率越高;高频耳蜗死区较低频常见,且存在耳蜗死区的感音神经性听力损失患者言语识别能力明显低于无耳蜗死区的患者.     

单侧极重度感音神经性听力损失患者试戴BAHA结果分析

目的:了解单侧极重度感音神经性听力损失患者佩戴骨导助听器BAHA的获益情况。方法:对16例单侧极重度感音神经性听力损失患者进行BAHA的纯音助听听力测试,双耳在裸耳状态下声场安静环境中的言语识别阈测试和MHINT测试,比较未助听与助听后的结果。结果:BAHA对患耳侧来的声源有较好的阈值补偿作用,但对于在安静和噪声中的言语识别阈无明显提升作用。结论:根据该研究和患者的感受,反馈BAHA对于单侧极重度听力损失的获益不大。患者选配前需要进行相关测试了解获益情况,再决定是否植入或佩戴BAHA。尚需要进一步了解单侧极重度感音神经性听力损失患者长期佩戴BAHA后的获益情况。     

急性低频感音神经性听力损失临床分析

目的探讨急性低频感音神经性听力损失(acute low-frequency sensorineural hearing loss,ALHL)的发病特点、听力学特征及治疗方法。方法回顾性分析47例ALHL患者的临床症状、体征、听力学检查及随访结果。结果 47例ALHL患者平均发病年龄为36.91±10.18岁,女性24例(51.06%),男性23例(48.94%)。单耳发病43例(91.49%,43/47),31例(65.96%)患者伴耳鸣,10例(21.28%)伴耳闷。全部患者纯音听阈均表现为低频听力下降,鼓室导抗图均为A型,ABR均正常。经脱水剂或利尿剂及类固醇激素等治疗后总有效率为85.11%(40/47),1例自愈。随访4～25个月,37例无复发(90.24%,37/41),4例复发(9.76%,4/41)。结论 ALHL一般单耳发病,中青年居多,伴随症状以耳鸣最为常见,其次是耳闷;听力学检测主要提示耳蜗受累;脱水剂或利尿剂及类固醇激素疗效显著;该病有复发的可能,应加强随访。     

感音神经性听力损失治疗的研究进展

感音神经性听力损失（sensorineural hearing loss,SNHL）是听力障碍的常见临床类型,其主要是由于耳蜗螺旋器毛细胞以及听神经以上通路受损,导致声音的感受、神经传导及皮质功能障碍,引发的听力减退和（或）听力丧失,占所有听力障碍的90%以上,严重影响人们的日常工作及生活。由于SNHL在临床中最为常见,发病率高,病因、发病机制及病理改变等复杂多样,治疗手段不尽相同,总体疗效不一,选择正确的治疗方法对于听力改善或恢复具有重要意义。本文就国内外SNHL的治疗进展进行归纳总结,为SNHL的临床规范诊治提供参考。     

儿童突发性感音神经性听力损失的诊治体会

对18例20耳8～14岁突发性感音神经性听力损失患儿的临床资料进行了总结和分析,结果表明儿童突发性感音神经性听力损失发病与首诊之间病程较长,部分患儿有上感、流行性腮腺炎病史,可能和听力损失发生有关.儿童突发性感音神经性听力损失治疗效果类似于成人患者,而全聋者疗效差.东菱克栓酶同样适于治疗儿童突发性感音神经性听力损失且疗效和安全性较好,无明显的出血倾向和其它并发症.     

感音神经性听力损失的MRI特征

感音神经性听力损失(SNHL)是耳科常见疾病,主要表现为听力损失伴或不伴耳鸣、眩晕、耳闷等症状,SNHL病因复杂多样,目前尚未有一个确切的病因。近年来磁共振影像技术(MRI)得到了较好的发展和运用,内听道MRI在显示软组织方面更具优势,可用来研究SNHL患者的内耳疾病,如研究小脑前下动脉来进一步阐述内耳微循环,轧造影显示梅尼埃病患者膜迷路积水,以及功能MRI对脑区活动的研究等等。本文主要以内听道MRI影像学特征来探讨SNHL的潜在病因,为耳科医生诊疗SNHL提供新思路。     

低频感音神经性听力损失的病因分析

目的分析低频感音神经性听力损失的病因,以避免漏诊和误诊。方法对56例低频感音神经性听力损失患者详细了解其病史,进行仔细的耳科常规检查及纯音听阈（PTT）、声导抗、听性脑干反应（ABR）、畸变产物耳声发射（DPOAE）、耳蜗电图（ECochG）及CT和/或MRI检查,综合分析各项结果。结果在56例患者中病因不明的急性低频感音神经性听力损失38例,梅尼埃病9例,听神经病6例,听神经瘤1例,多发性硬化1例,小脑半球旁蛛网膜囊肿1例。结论低频听阈升高的上坡型感音神经性听力损失可见于多种疾病。对低频感音神经性听力损失应采用多项组合的听力学检测方法进行检查和综合分析,必要时辅以CT和/或MRI检查可以及时、有效地作出可靠的诊断和鉴别诊断。     

急性低频下降型感音神经性听力损失

低频下降型感音神经性聋通常出现在Meniere病的早期阶段,但也可能由其它许多疾病引起,例如突发性聋、听觉神经病（auditory neuropathy)、前地水管扩大、听神经瘤、噪声性聋、持久的外淋巴造的内淋巴积水等。1982年Abe报道了39例突发性的低频下降型感音神经性聋,急性发病,不伴眩晕,所报道的全部病例听力完全恢复,没有波动和复发,所以最初认为这是一种低频下降型的突发性聋,但是后来的临床观察发现一些患者确实可以出现听力波动和复发,偶尔也出现眩晕。经过临床逐步总结和研究,这类病症被认为是一种独立的疾病,现在被称为急性低频感音神经性耳聋（acute low-tone sensorineural hearing loss,ALHL)。     

复发性低频感音神经性听力损失临床特点Meta分析

目的基于Meta分析,评价复发性低频感音神经性听力损失发病率等临床特点,分析与相关疾病的关系,为临床诊疗提供参考。方法全面系统地检索了Cochrane Library、PubMed、中国生物医学文献数据库、中文生物医学期刊文献数据库、中国知网(CNKI)、万方、维普、中国医学学术会议论文数据库(CMAC),收集关于复发性低频感音神经性听力损失的所有文献,检索时间为各数据库建库至2017年12月,采用Cochrane提供的观察性质量评价工具对纳入的文献进行质量评估,使用Stata15进行统计分析纳入的文献。结果符合纳入标准的文献共计15篇,发表时间为2002年至2016年,病例总数共计54364例,复发性低频感音神经性听力损失患者共计2736例,对纳入研究的15篇文献进行分析,合并后效应值为0.010,即低频感音神经性听力损失复发率为1.0%,分析文献得出最终确诊梅尼埃病暴露率1.6%(44/2736);听神经肿瘤暴露率0.07%(2/2736)。结论复发性低频感音神经性听力损失发病率低,极少部分患者发展成梅尼埃病,且与部分内耳病在短期内不易鉴别,其病理生理过程需要继续探索。     

既往存在感音神经性听力损失突发性聋患者临床特征与疗效分析

目的探讨既往存在感音神经性听力损失突发性聋患者临床特征与疗效。方法对61例(63耳)既往存在感音神经性听力损失突发性聋患者的临床资料进行系统性分析,包括临床表现、疗效评估等,与同期收入院的既往不存在感音神经性听力损失突发性聋患者资料对比,分析发病和影响疗效的高危因素,总结该病发生、发展及预后的特点。结果既往存在和不存在感音神经性听力损失突聋患者的性别、现患耳侧别、病程差异无统计学意义(P值均>0.05),发病年龄差异具有统计学意义(P<0.05)。既往存在和不存在感音神经性听力损失突聋患者的听力曲线类型、听力损失程度差异无统计学意义(P值均>0.05),既往存在感音神经性听力损失突聋患者总有效率低于既往不存在感音神经性听力损失突聋患者总有效率,差异有显著统计学意义(χ²=6.915,P=0.009),既往存在感音神经性听力损失突聋患者痊愈率低于既往不存在感音神经性听力损失突聋患者痊愈率,差异无统计学意义(χ²=0.221,P=0.638)。结论既往存在感音神经性听力损失突聋患者病因复杂,疗效较差,应加大研究制定个性化的诊疗方案。     

Speech perception in noise with BICROS hearing aids.

The speech perception in noise abilities of 14 asymmetrically hearing-impaired subjects who had been fitted with Bilateral Contralateral routing of Signal (BICROS) hearing aids was evaluated. Speech tests were administered with subjects wearing both conventional monaural amplification and their own BICROS aids. Test procedures involved the use of sentence lists from the Speech Perception in Noise (SPIN) test and the Synthetic Sentence Identification (SSI) test, presented in a background of recorded four-talker babble. The performance of the subjects was found to be significantly better with the BICROS aids than with monaural amplification alone.     

Speech recognition performance of patients with sensorineural hearing loss under unaided and aided conditions using linear and compression hearing AIDS

OBJECTIVES: This study compared speech recognition performance on the Northwestern University Auditory Test No. 6 (NU-6) and the Connected Speech Test (CST) for three hearing aid circuits (peak clipping [PC], compression limiting [CL], and wide dynamic range compression [WDRC]) in adults with symmetrical sensorineural hearing loss. The study also questioned whether or not hearing aid benefit for the three circuits was dependent upon the speech level and the signal-to-babble ratio (S/B) and upon the degree and slope of hearing loss. DESIGN: Unaided speech recognition performance for NU-6 and CST materials presented from a loudspeaker at 0 degrees was measured during Visit 1, and both unaided and aided performance was measured at 3-mo intervals during Visits 2 to 4. The NU-6 was presented in quiet at a conversational speech level of 62 dB SPL. The CST was presented in 10 listening conditions-three S/B (-3, 0, and 3 dB) at each of three speech levels (soft speech at 52 dB SPL, conversational speech at 62 dB SPL, and loud speech at 74 dB SPL) and in quiet at 74 dB SPL. Uncorrelated multi-talker babble was presented from two loudspeakers at 45 degrees on each side of the main speaker. Hearing aid benefit was examined for 360 subjects divided into four groups of hearing loss, pure tone average <40 dB HL and slope <10 dB/octave or >10 dB/octave and hearing loss >40 dB HL for the two slope categories. RESULTS: Hearing aid benefit (aided minus unaided performance) measured on the NU-6 in quiet exceeded 31 rau for all three circuits. Although small statistical advantages were found for the WDRC, the differences were approximately 2% and are not considered clinically relevant. Unaided CST performance showed a complex relationship between presentation level and signal-to-babble ratio that was further confounded by the degree of hearing loss. For the two mild hearing loss groups and for each of the three nominal signal-to-babble ratios, CST performance decreased by 20 rau for the -3 dB S/B to 6 rau for the 3 dB S/B as speech level increased from 52 to 74 dB SPL. In contrast, unaided performance increased by 32 to 13 rau with signal level for all signal-to-babble ratios for the two >40 dB hearing loss groups. Overall, aided CST performance exceeded unaided performance for all 10 conditions. As expected, hearing aid benefit was greatest (27 rau) for soft speech and smallest for loud speech (6 rau). Differences among the hearing aid circuits were small with only one significant difference; the WDRC at 62/0 was poorer by 3 rau than the other two circuits. When the CST data were analyzed as a function of hearing loss, five pair-wise comparisons were significant. In contrast to the unaided performance, aided performance for all hearing loss groups decreased as presentation level increased, even though the signal-to-babble ratio was constant. CONCLUSIONS: All three hearing aids circuits provided benefit over the unaided condition in both quiet and noise. The greatest benefit was measured for soft speech in the more severe hearing loss groups. Although only small differences were measured among the three hearing aid circuits, significant differences favored the PC and CL circuits over the WDRC in the mild hearing loss groups and favored the WDRC over the PC in the more severe, sloping hearing loss group. An interesting interaction between speech level, signal-to-babble ratio, degree of hearing loss, and amplification was found. For a constant signal-to-babble ratio, recognition performance decreased as speech level increased from 52 to 74 dB SPL. The effect was most marked in the milder hearing loss groups and in the aided conditions, and occurred at even the lowest speech levels.     

Progression of sensorineural hearing impairment in aided and unaided ears

The possibility of "adult onset auditory deprivation" has been proposed as a condition of extensive deterioration of speech discrimination in unaided ears. Pure tone thresholds and speech discrimination were studied in a follow-up examination on 500 patients using hearing aids unilaterally. The follow-up time ranged from 5 to 24 years. In average the same amount of deterioration was obtained in both ears. Deterioration in pure tone thresholds increased after the age of 80 years and speech discrimination after 65 years respectively. The results obtained gave no support to the concept of adult onset auditory deprivation in unaided ears.     

Speech perception in adolescents with pre-lingual hearing impairment with cochlear implants

Profound hearing loss is a disability that affects personality and when it involves teenagers before language acquisition, these bio-psychosocial conflicts can be exacerbated, requiring careful evaluation and choice of them for cochlear implant.AimTo evaluate speech perception by adolescents with profound hearing loss, users of cochlear Implants.Study DesignProspective.Materials and MethodsTwenty-five individuals with severe or profound pre-lingual hearing loss who underwent cochlear implantation during adolescence, between 10 to 17 years and 11 months, who went through speech perception tests before the implant and 2 years after device activation. For comparison and analysis we used the results from tests of four choice, recognition of vowels and recognition of sentences in a closed setting and the open environment.ResultsThe average percentage of correct answers in the four choice test before the implant was 46.9% and after 24 months of device use, this value went up to 86.1% in the vowels recognition test, the average difference was 45.13% to 83.13% and the sentences recognition test together in closed and open settings was 19.3% to 60.6% and 1.08% to 20.47% respectively.ConclusionAll patients, although with mixed results, achieved statistical improvement in all speech tests that were employed.     

Pitch vulnerability in sensorineural hearing impairment

Listeners with cochlear impairment were studied in an ABX pitch-matching paradigm. These listeners showed excellent ability to adjust one sinusoid (X) to match the frequency of another (B), except when a leading tone (A) was present. Pitch shifts induced by the leading tone exaggerate the pitch contrast between tones A and B, even in normal-hearing listeners, but the effect in sensorineural listeners is several times larger and indicates a severe vulnerability of pitch. The degree of pitch distortion does not appear to bear any simple relationship to the degree of hearing loss, or to stimulus amplitudes. The effect is obtained at 'comfortable' listening levels. Vulnerability of pitch, rather than a failure in discriminative capacity, may underlie some of the qualitative perceptual difficulties found in sensorineural hearing impairment.     

Simulation of sensorineural hearing impairment

A hearing loss simulation system (HELOS) was designed and constructed to simulate various aspects of sensorineural hearing impairment. The theoretical bases for HELOS were several threshold and suprathreshold auditory phenomena typically exhibited by people with sensorineural hearing losses. In addition to providing differential attenuation of acoustic signals across the frequency range, HELOS simulated loudness recruitment, loudness discomfort thresholds, reduced dynamic range, and reduced frequency selectivity. Three basic audiometric configurations were chosen to investigate the effects of the aforementioned components of a sensorineural hearing impairment on the auditory perception of speech. They were: (1) a sloping high-frequency hearing loss; (2) a flat, severe hearing loss; (3) a severe/profound hearing loss. The battery of tests administered to a group of normal-hearing adults consisted of pure-tone audiometry and PB-word recognition tests, as well as vowel and consonant identification tests. For comparable audiometric configurations, the results from the speech-perception tests were in good agreement with the published results of similar tests administered to persons with sensorineural hearing losses.     

Tone perception in Cantonese-speaking children with hearing aids

OBJECTIVES: In this study we investigated the benefit of using hearing aids for Cantonese tone perception among children with various degrees of hearing impairment. METHODS: Forty-eight children with moderate to profound hearing loss were investigated. They were required to perform a lexical tone perception test with recorded test stimuli presented at 65 dB in soundproof booths. To allow for comparison, the subjects performed the test under 2 conditions: with their hearing aids turned off (unaided condition) and with them turned on (aided condition). RESULTS: The mean tone perception scores for the aided condition were higher than those for the unaided condition across all of the subject groups. Paired sample t-tests showed statistically significant improvement in tone perception in the moderate and severe hearing loss groups (p = .02 and p = .03, respectively). The result obtained from the moderately severe hearing loss group was marginally significant (p = .058). The improvement in tone perception in the profound hearing loss group was insignificant (p = .55). CONCLUSIONS: The use of a hearing aid is beneficial for Cantonese tone perception in children who have moderate to severe hearing impairment. When a hearing loss is greater than 90 dB, ie, in children who are classified as having profound hearing loss, a hearing aid is not effective in aiding Cantonese tone perception.