儿童孤独症患者脑干听觉诱发电位改变的初步观察

目的：通过观察儿童孤独症患者患者脑干听觉诱发电位的改变,探讨听觉诱发电位检测在听觉障碍儿童孤独症诊断中的临床意义。方法：按DSM－IV诊断标准确诊的15例孤独症患儿的14例正常对照组,同期接受听觉诱发反应检测,比较两组间波Ⅰ-Ⅴ各波峰潜伏期,波峰潜伏期差和波幅的差异。结果：孤独症患儿左侧波Ⅴ、右侧波Ⅱ峰间潜伏期和右侧Ⅰ－Ⅲ、Ⅰ－Ⅴ峰间潜伏期差较对照组显著延长（P＜0．05－0．005）,孤独症组右侧波Ⅲ振幅较对照组增高（P＜0．05）,其他各指标两组间无显著性差异,结论：孤独症患儿脑干听觉诱发电位的突出改变是潜伏期有延长的趋势,对就诊于耳鼻咽喉科的听阈正常而有听觉障碍,言语交往能力着,脑干听觉诱发电位检查潜伏期延长的儿童,应警惕孤独症或其他神经精神发育障碍。     

脑干听觉诱发电位用以检测腭裂患儿听力的评价

目的:评价腭裂患儿脑干听觉诱发电位(BAEP)的异常情况及听力障碍程度、性质.方法:应用脑干听觉诱发电位检测32例腭裂患儿的听觉阈值,各波潜伏期及阈值异常率,潜伏期延长的异常率.结果:腭裂患儿听觉阈值及各波潜伏期较正常儿显著提高和延长(P＜0.01),阈值异常率为68.75%,腭裂患儿普遍存在程度不同的听力障碍,半数以上为中、重度听力障碍.潜伏期延长的异常率为65.6%.患侧耳数Ⅰ、Ⅲ、Ⅴ波延长分别为30耳、18耳、32耳.腭裂患儿Ⅰ～Ⅴ波峰间期较正常儿童明显延长,表明存在一定程度的中枢传导通路功能障碍.不同类型及不同年龄腭裂患儿之间BAEP反应阈及异常率比较差异无显著性(P＞0.05).结论:68.75%腭裂患儿存在听力障碍且大部分是传导性听力丧失,BAEP作为筛选适于低龄儿童听力的工具,具有重要的临床意义.     

言语听觉脑干诱发电位的临床应用

1 盲语听觉脑干诱发电位的由来 脑干在言语感知中发挥着重要作用,人们对人类言语感知能力的认识,不能仅仅关注高位听皮层的价值,还要探讨低位中枢的作用. 在听觉系统中,由声信号转化而成的、快速变化着的神经冲动,在脑干水平进行编码.     

听觉稳态诱发电位正常阈值的研究

随着听觉稳态诱发电位（ASSR）在临床上越来越多的应用,临床工作者急需了解其对于临床听力学的价值。每一个临床听力学实验室应该建立本实验室的正常值数据库以指导临床应用。本试验的目的即通过测试听力正常的青年男女的ASSR,建立自己的正常值范围,分析ASSR0．5～4．0kHZ分布的相位以及噪声相位有无统计学规律。     

脑干听觉诱发电位波幅声强函数曲线研究

目的研究脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)波幅与声强之间的函数关系,指导临床应用.方法对50例健康、无耳疾成人进行双耳BAEP测试,选用55、75、95、100、105、110、115、 120、125dB疏密交替波短声给声刺激.结果求出了BAEP波幅与声强之间的函数关系曲线及与其相应的回归方程,表明(1)波Ⅰ、波Ⅲ、波Ⅴ波幅均随声强增大而增大; (2)波Ⅲ、波Ⅴ曲线陡度在90dB以前较大、90dB以后较平缓;波Ⅰ陡度远大于前者,几乎呈直线上升; (3)波Ⅲ与波Ⅴ近于平行; (4)Ⅴ/Ⅰ直线下降,与波Ⅰ几乎成反变关系;Ⅴ/Ⅲ近乎平坦直线;(5)90dB前,V/I大于1,随声强降低,V/I 迅速增大,远大于1;90dB后,V/I接近于1,且较稳定.结论在临床评价Ⅴ/Ⅰ比值结果时,若在＜100dB范围内给声刺激则易出现假阴性结果,在100～120dB声强范围内选取给声强度是适当的.     

听觉脑干诱发电位波形变化在听神经瘤诊断中的意义

目的探讨听神经瘤病人听觉脑干诱发电位(ABR)波形改变的意义。方法对手术证实为听神经瘤的23例病人ABR的潜伏期、波形进行回顾性分析。结果在23例病人中,11例潜伏期延长,Ⅰ~Ⅴ波间期耳间差(IPL)大于0.4 ms;2例潜伏期延长,但Ⅰ~Ⅴ波间期耳间差小于0.4 ms;2例V波缺失;8例无波形反应。全部患侧波形均异常、重复性差,2例出现对侧波形异常。结论ABR波形变化在听神经瘤诊断中有重大意义;波形异常、重复性差可作为判断ABR异常的辅助指标。     

脑干听觉诱发电位对颈性眩晕的诊断价值

目的 研究脑干听觉诱发电位对椎基动脉供血不足引起的颈性眩晕的诊断价值。方法 对５０例颈性眩晕的患者和４０例健康人进行脑干听觉诱发电位检查,测量Ｉ、Ⅲ、Ⅴ各波潜伏期,Ｉ－Ⅲ、Ⅲ－Ⅴ和Ｉ－Ⅴ波峰间潜伏期,Ⅲ－Ⅴ和Ｉ－Ⅲ波比值,采用ｔ检验对二组检查结果进行比较并分析疾病组的异常表现。结果 疾病组Ｖ波潜伏期,Ⅲ－Ⅴ和Ｉ－Ⅴ波峰间潜伏期明显增大,Ⅲ－Ⅴ／Ⅰ－Ⅲ比值大于１。结论 本组资料提示颈性眩晕者可以产生     

脑干听觉诱发电位对脑外伤后持续植物状态评价的意义

目的：通过脑干听觉诱发电位（brainstem auditory evoked potential, BAEP）评估颅脑外伤后持续植物状态（persistent vegetative state, PVS）患者的脑干功能。方法：对25例（50耳）PVS患者行BAEP检测,并与对照组行单因素方差分析。结果：PVS患者的BAEP异常率为80%。其改变复杂多样,主要表现为Ⅰ V各波的异常或分化不良,甚至波形缺如;Ⅰ、Ⅲ、Ⅴ波潜伏期（peak latency, PL）延长,I V波间潜伏期（Interpeak latency, IPL）延长,双侧V波潜伏期的耳间差（inter aural latency difference, ILD）增大;Ⅲ V与Ⅰ Ⅲ波IPL之比大于1。结论：PVS患者的BAEP结果呈多样性改变,反映了患者植物状态下存在不同程度的脑干损害,为其诊疗及预后判断提供了可靠的依据。     

脑干听觉诱发电位对高危新生儿听力检查的意义：附116耳…

对５８例（１１６耳）高胆红素血症及缺血缺氧脑病新生儿进行脑干听觉诱发电位（ＢＡＥＰ）检查。结果显示，两组高危新生儿的听觉系统均有损害。反应阈较正常儿增高，以周围性损害为主，合并脑室扩张之高危患儿损害最重，与一般高危儿相比，差异非常显著（Ｐ〈０．０５）；患儿血中胆红素高，听力损失就较重，Ｐ〈０．０１，１年后对ＢＡＥＰ异常的２０耳进行追踪复查，反应阈全部恢复正常。提示对缺血缺氧脑病和高胆红素血症的新生     

脑性瘫痪患儿听性脑干反应及多频稳态听性反应分析

目的：通过听性脑干诱发反应（ABR）及听性稳态反应（ASSR）分析，探讨脑性瘫痪（脑瘫）患儿的听力障碍及脑干听通道功能变化。方法：采用美国GSIAudera听性脑干反应及听性稳态诱发电位测试仪，测试脑瘫患儿52例104耳。对照组为同龄健康儿童19例38耳。结果：脑瘫组患儿的ABR各波潜伏期及峰间潜伏期均较对照组明显延长；脑瘫组ASSR结果以轻度低频听力损失为著，并且各频率听力损失的平均值非常接近。结论：ABR和ASSR同时应用，为脑瘫患儿听力损失进行定性定量诊断提供了客观的测试方法。     

婴幼儿缺铁性贫血治疗前后脑干听性反应的变化

对 50例 (94耳 )缺铁性贫血 (IDA)患儿治疗前后脑干听性反应 (ABR)的结果进行分析 ,认为 IDA可造成听传导路的周围性损害 ,主要表现为 ABR波形分化不良 ,反应阈值提高 , 、 、 波绝对潜伏期 (PL )延长 ,少数患儿的 - 峰间期 (IPL)达临界值 ,而 - IPL无异常 ,经补铁治疗后 ,ABR各参数恢复正常 ,说明这种改变是可逆的。提示 ,对小儿 IDA应早期发现 ,早期治疗。     

骨导听性脑干反应影响因素的研究

目的 :观察不同位置放置骨振荡器 ,不同的刺激速率等对骨导听性脑干反应的影响。方法 :对 2 0例听力正常青年人以不同的骨振荡器放置位置、不同的刺激速率行骨导ABR测试 ,并与气导ABR进行对比。结果 :2 0例受试者在较高强度刺激下 (4 0dBnHL以上 )均可记录到清晰、稳定的骨导ABR各波 ,且气、骨导ABR反应阈相似 ,均在其主观阈上 5～ 10dB ;前额和乳突放置骨振荡器相比较 ,其ABR波Ⅴ潜伏期差异有显著性 ;气导和乳突骨导ABR波V潜伏期差异不显著 ;骨导短声刺激速率从 2 0次 /s增到 5 2次 /s时 ,ABR波Ⅴ潜伏期明显延长。结论 :骨导ABR测试受骨振荡器的位置、刺激速率等的影响 ;但其仍不失为一可行而有效的听力检测手段 ,对婴幼儿听力筛选、耳蜗残余功能的判定及各种听力损失的鉴别诊断有着重要作用。     

The effect of notch filtering on the waveform of the newborn auditory brainstem response

Abstract

Objective: To identify whether the use of a notch filter significantly affects the morphology or characteristics of the newborn auditory brainstem response (ABR) waveform and so inform future guidance for clinical practice. Design: Waveforms with and without the application of a notch filter were recorded from babies undergoing routine ABR tests at 4000, 1000 and 500 Hz. Any change in response morphology was judged subjectively. Response latency, amplitude, and measurements of response quality and residual noise were noted. An ABR simulator was also used to assess the effect of notch filtering in conditions of low and high mains interference. Results: The use of a notch filter changed waveform morphology for 500 Hz stimuli only in 15% of tests in newborns. Residual noise was lower when 4000 Hz stimuli were used. Response latency, amplitude, and quality were unaffected regardless of stimulus frequency. Tests with the ABR stimulator suggest that these findings can be extended to conditions of high level mains interference. Conclusions: A notch filter should be avoided when testing at 500 Hz, but at higher frequencies appears to carry no penalty.     

正常气骨导听性脑干反应及其应用

［摘要］目的：研究骨导听性脑干反应(ABR)的波形特点及正常的气、骨导ABR Ⅴ波潜伏期-强度曲线及相应的反应阈值,为临床气导ABR（AC ABR）和骨导ABR(BC ABR)的联合应用提供参考依据。方法：利用Nicolet spirit型诱发电位仪、EAR 3A插入式耳机和Radioear B 71骨振动器对一组听力正常年轻人（男32耳、女24耳）进行短声气骨导ABR测试,并观察对侧给予白噪声掩蔽对BC ABR阈值及潜伏期的影响。结果：气骨导ABR相应强度下波形相似波Ⅴ潜伏期－强度曲线表明,随着刺激强度逐渐减低,潜伏期逐渐延长。骨导Click的潜伏期要比气导Click潜伏期延长的程度大,BC ABR反应阈比气导ABR高。对侧70?dBSPL以下强度宽带噪声的使用对BC ABR阈值及阈上10?dB强度下波Ⅴ潜伏期均无显著影响（P＞0.05）。结论：(1) BC ABR波形特点与相应刺激强度的AC ABR极为相似。BC ABR与AC ABR潜伏期-强度函数曲线可望联合用于传导障碍及其程度的评估;(2) 骨导行为的听阈水平超过40?dBHL时,BC ABR难以引出,对其结果的解释应持慎重态度;(3) 骨导ABR测试时常规加对侧噪声掩蔽,但掩蔽声强度不应超过60?dB。     

听力筛查异常婴儿听性脑干反应测试随访

目的:对本地区听力筛查异常婴儿ABR测试结果进行分析并总结其特点。方法:对140例新生儿听力筛查异常者在3个月龄左右时进行第1次ABR测试,第1次ABR诊断异常者于6个月龄左右进行第2次ABR测试,并进行统计分析。结果:140例婴儿经第1次ABR诊断,65例正常(46.43%);75例有单耳或双耳听力障碍(53.57%),其中单耳17.14%,双耳36.43%,以轻度听力障碍为最多,占27.14%,极重度听力障碍亦不少见,占14.29%;男、女听力障碍的发病率差异无统计学意义(P>0.05),高危儿与非高危儿发生听力障碍例数经比较差异无统计学意义(P>0.05),重度以上听力损失例数高危儿与非高危儿比较差异有统计学意义(P<0.05)。第2次ABR复诊38例,正常8例,总正常率52.14%(73/140);16例轻度听力障碍中10例转为正常或好转、6例无变化或加重,3例中度听力障碍中1例好转、2例无变化,9例重度听力障碍中3例好转、3例无变化、3例加重,10例极重度听力障碍中9例无变化或加重,1例脑瘫儿极重度听力障碍转归为正常;非高危儿听力好转情况显著高于高危儿(P<0.05)。结论:应全面开展新生儿听力筛查,重点关注高危儿听力损失;重度以下听力障碍具有可变性,对脑瘫等特殊儿童听力情况评估应慎重;应尽快建立健全的追踪、随访和管理体系。     

Aging and the auditory brainstem response in mice with severe or minimal presbycusis

Threshold, latency, and amplitude of the auditory brainstem response (ABR) were obtained with filtered noise pips in young and aging C57BL/6J mice (to 16-months), which undergo severe progressive age-related sensorineural hearing loss (presbycusis) and CBA/J mice (to 19-months), which show only mild loss late in life. Aging per se (CBA mice) is not associated with significant changes in ABR parameters. Presbycusis, in aging C57 mice, is associated with increased thresholds; there is a trend toward increased latencies, but only when threshold elevations are substantial. Amplitudes of early waves, but not late waves, decrease greatly in aging C57 mice. In young C57 mice, amplitudes of early ABR waves vary monotonically with intensity, while amplitudes of later waves (IV and V) have a relatively flat, or even nonmonotonic, relationship to intensity; in older C57 mice, all waves have monotonie intensity functions. ABR parameters are not affected by gender in either strain. The mouse models can help to clarify some inconsistencies in the human literature on aging and the ABR.     

Auditory steady-state response and auditory brainstem response thresholds in children

The inclusion of the auditory steady-state response (ASSR) into test-batteries for objective audiometry has allowed for clinical comparisons with the most widely used procedure, the auditory brainstem response (ABR). The current study describes ASSR and ABR thresholds for a group of infants and young children with various types and degrees of hearing loss. A sample of 48 subjects (23 female) with a mean age of 2.8 ± 1.9 years SD were assessed with a comprehensive test-battery and classified according to type and degree of hearing loss. Thresholds were determined with a broadband click-evoked ABR and single frequency ASSR evoked with continuous tones (0.25–4 kHz) amplitude modulated (67–95 Hz). Mean difference scores (±SD) between the ABR and high frequency ASSR thresholds were 9.8 (±11), 3.6 (±12) and 10.5 (±12) dB at 1, 2 and 4 kHz, respectively. An ASSR mean threshold for 2–4 and 1–4 kHz compared to the ABR threshold revealed an average difference of 7 (±9) and 7.9 (±8) dB, respectively. The overall correlation between the ABR and ASSR thresholds was highest for the mean ASSR thresholds of 2–4 and 1–4 kHz (r = 0.92 for both conditions). Correlations between the ABR and individual ASSR frequencies were slightly less (0.82–0.86). The average of the 2–4 kHz ASSR thresholds correlated best with the click-evoked ABR for all categories of hearing loss except for the sensorineural hearing loss category for which the 1–4 kHz ASSR average was better correlated to ABR thresholds. Findings demonstrate the reliability of verifying high frequency ASSR thresholds with a click-evoked ABR as an important cross-check in infants for whom behavioural audiometry may not be possible.     

听性脑干反应与畸变产物耳声发射检测在听神经病诊断中的表现和意义

目的分析听神经病患者的听性脑干反应与畸变产物耳声发射特征,探讨该类听力学检测方法在听神经病诊断中的意义。方法回顾性研究本科确诊为听神经病的患者37例,比较分析其听性脑干反应与畸变产物耳声发射检测结果,探索其诊断意义。结果本组患者中,3例5耳（双耳病变2例,单耳病变1例）可引出V波,阈值70～90dB SPL,其余患耳ABR各波均未引出（刺激声强〉100dB SPL）。无论纯音听阈损失程度轻重如何,所有患者的DPOAE均全部引出。在各个频率点上,DPOAE的DP—gram幅值左、右耳间的差异均无统计学意义（P〉0．10）。结论听神经病的主要病变部位可能位于听神经传入通路,或伴有脑干内侧橄榄耳蜗系统的传出神经通路病变。