听力正常儿童的听觉发育

本重点介绍听力正常儿童的听觉发育和获得性经验性在发育中的作用以及听觉感受和听觉语言感受的概念。     

卡铂对灰鼠中枢听觉系统的影响

目的 卡铂选择性破坏灰鼠的内毛细胞和Ⅰ型传入神经末梢已被人们所证实,但是,卡铂是否损害耳蜗核、下丘和听觉皮层还不清楚,本文旨在观察卡铂对灰鼠听觉中枢的毒性作用。方法采用恒低温冷冻连续脑组织切片,以中枢听觉系统神经元的密度来评价卡铂对灰鼠中枢听觉系统的影响。结果发现注射卡铂3和4周后,耳蜗背侧核和腹侧核神经元明显的减少,与正常动物比较有显著性差异。而下丘和听觉皮层神经元的变化与正常灰鼠比较无明显差异。结论 说明注射卡铂3和4周后对耳蜗核有明显的毒性作用,可引起耳蜗核神经元明显的减少,但是,对灰鼠下丘和听皮层未见明显的毒性作用。     

深圳市0-7岁儿童听觉言语障碍流行病学研究

目的 了解深圳市0-7岁儿童听力、言语障碍流行现状,探索流行因素。方法 依据《中国残疾人实用评定标准》对户籍在深圳市的全部77,727名儿童采用三阶段筛查程序进行调查,采用病例对照研究进行流行因素分析。结果 听力障碍现患率为1.11‰,言语障碍现患率为1.88‰,假阴性为1.55‰,以此推算的官语障碍实际现患率为3.43‰,随年龄增大,听力、言语障碍现患率增高,可疑致病因素中以低出生体重、出生异常及婴幼儿期曾患病的影响最大。结论 深圳市听力障碍现患率低于1987年全国抽样调查相同年龄段水平,言语障碍现患率高于1987年全国调查水平,其原因有待进一步研究。     

听障儿童听觉能力评估方法

听障儿童的听觉能力是在听力补偿或听力重建后,随着儿童实际年龄和听觉经验的增长,通过康复训练而逐渐习得的.通过对听障儿童进行听觉能力评估,可以了解儿童的听觉功能状况,从而为优化助听设备、确定听觉康复起点、监控听觉康复进程、提高听觉康复质量提供保障.     

不同听觉补偿方式下听障儿童的听觉言语康复效果比较

目的比较选配助听器与人工耳蜗植入术后听障儿童的听觉言语康复效果,探讨不同听觉补偿方式对其听觉言语康复效果的影响。方法选取32例6~43月龄选配助听器或人工耳蜗植入后的重度及极重度感音神经性语前聋患儿为研究对象,其中助听器组18名,人工耳蜗组14名,两组的听力损失程度无统计学差异,均在干预1年内进行相同的听觉言语康复训练,使用声场测听测试助听听阈;使用婴幼儿有意义听觉整合量表评估干预前及干预后3、6、9、12个月时的听觉能力;采用《听障儿童听觉言语能力评估》测试两组康复训练前后的言语能力。结果两组患儿助听听阈均优于助听前,但人工耳蜗组各频率助听听阈显著优于助听器组(P<0.05);两组听觉能力得分均随听觉补偿时间的延长而提高(P<0.05);助听器组在干预后9个月的听觉能力得分明显高于干预前、干预3个月及干预6个月(P<0.05);人工耳蜗组在术后6个月的听觉能力得分高于术前及术后3个月(P<0.05);人工耳蜗组在干预后6、9、12个月的听觉能力得分均高于助听器组(P<0.05);两组助听后康复级别及言语年龄均高于助听前,人工耳蜗组康复级别及言语年龄均高于助听器组(P<0.05)。结论对于极重度以上感音神经性聋婴幼儿,人工耳蜗植入者听觉言语康复效果优于助听器选配者。     

儿童复发性呼吸道乳头状瘤

儿童复发性呼吸道乳头状瘤病(juvenile onset recurrent respiratory papillomatosis,JORRP)年发病率为3．6／10万～4．3／10万,由于其易复发,常需多次手术,目前临床尚无特效的治疗方法。为探讨更为有效的治疗方法,现将我科1999年1月-2002年7月收治的37例JORRP患儿的临床资料报道如下。     

儿童皮肤钙化上皮瘤2例

例1,女,5岁。肿物位于右耳前,病史6个月,无红肿疼痛,肿物渐进性长大。例2,女,8岁。肿物位于左侧耳垂前下方,病史2个月。体检:局部可触及一直径约1.5cm的类圆形肿物,质硬,与皮肤有粘连,粘连中心部位可见针尖样凹陷,基底部活动度可,无触压痛,界限清楚。例1术前诊断为面部皮肤肿物,皮脂腺囊肿?畸胎瘤?从美观角度出发拟沿耳屏前皮肤皱褶向前翻皮瓣行肿物切除,     

听神经瘤的听力保护

影像学的进步,使症状轻微的听神经瘤(acoustic neuroma,AN)可以早期发现,其治疗已进入功能保全时代。AN术后的听力保护或丧失是多因素的,依赖于内听动脉、内耳结构和蜗神经的完整及功能正常。复习文献,听力保护率在6％～80％,主要原因是病例选择和听力评价标准不同。     

肾功能障碍对听觉的影响

报告对慢性肾炎的正常期、氮质血症期及尿毒症期分别进行纯音与语言测听检查,结果表明肾功能障碍可引起听觉减退。     

儿童人工耳蜗植入后的听觉言语康复

植入人工耳蜗为听力障碍儿童感知声音、重建听力奠定了良好基础，但是要使儿童在人工耳蜗植入后获得听觉言语康复必须经过长期的听觉培建，语言学习和语音异常矫治。     

Evaluation of hearing in children with solid tumors treated by chemotherapy

Ototoxicity of cisplatin is documented in during the last years. In material of 13 children with solid tumors (neuroblastoma, nephroblastoma, rhabdomyoscarcoma) treated with cisplatin, ototoxicity was observed in 2 cases. There were presented audiological findings. The role of otoacoustic emission measurements in monitoring of cisplatin--induced ototoxicity was underlined.     

Novel-word learning in children with normal hearing and hearing loss

OBJECTIVE: The goal of this study was to assess performance on a novel-word learning task by normal-hearing and hearing-impaired children for words varying in form (noun versus verb), stimulus level (50 versus 60 dB SPL), and number of repetitions (4 versus 6). It was hypothesized that novel-word learning would be significantly poorer in the subjects with hearing loss, would increase with both level and repetition, and would be better for nouns than verbs. DESIGN: Twenty normal-hearing and 11 hearing-impaired children (6 to 9 yr old) participated in this study. Each child viewed a 4-minute animated slide show containing 8 novel words. The effects of hearing status, word form, repetition, and stimulus level were examined systematically. The influence of audibility, word recognition, chronological age, and lexical development also were evaluated. After hearing the story twice, children were asked to identify each word from a set of four pictures. RESULTS: Overall performance was 60% for the normal-hearing children and 41% for the children with hearing loss. Significant predictors of performance were PPVT raw scores, hearing status, stimulus level, and repetitions. The variables age, audibility, word recognition scores, and word form were not significant predictors. CONCLUSIONS: Results suggest that a child's ability to learn new words can be predicted from vocabulary size, stimulus level, number of exposures, and hearing status. Further, the sensitivity to presentation level observed in this novel-word learning task suggests that this type of paradigm may be an effective tool for studying various forms of hearing aid signal processing algorithms.     

儿童及青少年中耳炎听力损失相关因素分析

目的总结儿童及青少年慢性化脓性中耳炎的听力学特点,为儿童及青少年慢性化脓性中耳炎的临床早期诊断及手术制定方案提供思路。方法对121例(134耳)儿童及青少年患者进行纯音测听检查,并对病变类型、鼓膜穿孔的位置,病变范围及听骨链损伤的程度进行总结和比较。结果本组患者的气导平均听阈(Air conduction-Puretone average,AC-PTA)为45.6±16.3dBHL(简写为dB)。其中中耳胆脂瘤、化脓性中耳炎、鼓室硬化症对听力的影响无显著性差异。穿孔位于松弛部或紧张部对AC-PTA的影响没有显著性差异(P=0.25);病变范围同时累积上鼓室及中后鼓室的,其PTA明显高于上鼓室单独受累的病例(P=0.027)。胆脂瘤患者中,AC-PTA>41.9dB及ABG>30.7dB对于听骨链中断有着一定的诊断价值(P<0.001)。结论在儿童及青少年慢性化脓性中耳炎的患者中,病变类型、病变范围及听骨链中断是影响听力的重要因素。     

Sensorineural hearing loss in children

Sensorineural hearing loss in children, either congenital or acquired, has an incidence of 2-4 per million. Molecular diagnosis of early childhood deafness became available for some types of syndromal and non-syndromal forms and will offer different treatment modalities in the future. Severe to profound sensorineural hearing loss can be effectively treated with cochlear implants. There is evidence of cerebral auditory plasticity under electrical stimulation of the auditory nerve with better performance in early implanted children. Other predicting factors are related to the type of schooling, family support and residual hearing. In the long-term, prelingually deafened children will develop considerable speech perception and production. Children with marginal benefit from hearing aid amplification show significant improvements in speech perception following implantation. Implantation is also possible in cases of cochlear malformation. However, special attention has to be given to the facial nerve, a possible CSF leak and electrode misplacement. Apart from hearing improvement cochlear implants have a positive impact on the family situation, schooling and personal well-being.     

Functional hearing loss in children

This report reviewed 39 school-age children diagnosed as having a functional hearing loss utilizing auditory brainstem response (ABR) audiometry during the past 5 years at the Department of Otolaryngology, Kyushu University Hospital in Japan. Twenty-seven cases were females and 12 were males. Seven cases had a hearing loss unilaterally and 32 bilaterally. Although pure-tone audiometry revealed a variety of audiogram shapes, two-thirds of the cases had a flat or saucer-shaped audiogram with a mild to moderately severe hearing loss. ABR audiometry for the frequencies of 1, 2 and 4 kHz indicated a normal hearing threshold in 65 ears of 35 patients, and mild threshold elevations of at least one frequency in the remaining 6 ears of 4 patients. Three illustrative cases were demonstrated, and a discussion was held regarding the features in audiometric tests, and environmental factors surrounding the children with this condition. We emphasized that the physiological hearing measurement such as ABR audiometry should be performed when any discrepancy was noted between the patient's history and results of pure-tone audiometry, because of not infrequent occurrence of functional hearing loss.     

Unilateral hearing loss in children

Recent reports suggest that early onset, severe unilateral sensorineural hearing loss (USNHL) in children may be associated with significant deficits in auditory and psycholinguistic skills and school performance. This report reviews a consecutive series of 324 children and adolescents (202 males, 122 females) with documented USNHL evaluated at the Boys Town National Research Hospital. The left ear was affected in 168 (52%) and the right ear in 156 (48%). Based on speech frequency threshold averages (i.e., 500, 1000, and 2000 Hz), the losses were classified by severity as follows: borderline, 43 (13%); mild, 51 (16%); moderate, 40 (12%); severe, 19 (6%); profound, 31 (10%), and anacusic, 50 (15%). The remaining 90 children (28%) had high frequency losses (i.e, above 2000 Hz). The mean and median age of diagnosis were 8.78 years and 7.75 years. Temporal bone imaging studies, auditory brainstem responses (ABRs), and vestibular evaluations were performed on selected cases. Etiology was uncertain in 34.8% of cases, while hereditary factors (12.6%), head trauma (10.8%), and perinatal risk factors (10.7%) were the most commonly identified etiologies. Thirty-one percent of the children had scholastic or behavioral problems in school. A concerted effort aimed at early identification and intervention in cases of USNHL is warranted.     

Functional hearing loss in children

The cases of children diagnosed with pseudohypacusis in the Department of Pediatric Otolaryngology were presented. Probable mechanism of its pathogenesis was described. The main stress was put on its correct diagnosis particularly in children with co-existing organic changes. Diagnosis of pseudohypacusis in children is not problematic provided that the occurence of this disease is taken into consideration during diagnostic procedures.     

Effect of bimodal hearing in Korean children with profound hearing loss

Conclusion. Bimodal hearing with combined acoustic stimulation and electric stimulation could enhance speech performance in deaf patients by residual hearing even though the amount of residual hearing is not enough to be used for communication by amplification. Objectives. The cochlear implant (CI) is a well-known therapeutic option for patients with profound hearing loss. However, deaf patients with a CI still have trouble in localization of sounds and understanding speech in a noisy environment. The aim of this study was to evaluate the benefits of bimodal hearing with a CI in one ear and a hearing aid in the contralateral ear in Korean children with profound hearing loss. Subjects and methods. Fourteen deaf children with residual hearing participated in this study. There were eight male and six female patients, with an age range of 4.6–13.8 years at the time of testing. The test was conducted between 3 months and 4.2 years after cochlear implantation. Speech performance was examined in a noisy environment using Korean word lists. A speech sound and the noise were presented to the child from the front loudspeaker. Results. The results showed that speech performance in a noisy environment was significantly better with bimodal hearing than with a CI alone.