扩展高频畸变产物耳声发射在纯音听阈正常的耳鸣患者中的临床应用

Clinical application of extended high frequency distortion product otoacoustic emission in idiopathic tinnitus patients with normal pure-tone average

摘要:

目的 分析纯音听阈正常的耳鸣患者扩展高频畸变产物耳声发射(EHF DPOAE)的特点，探讨在常规纯音检测结果正常情况下，EHF DPOAE发现早期隐匿性听力损失的临床意义。方法 选取常规纯音听阈正常的耳鸣患者68例(104耳)为实验组，对照组为纯音听阈正常无耳鸣症状的志愿者40例(40耳)。两组均用Neuro-Audio耳声发射仪进行常规频率(1~6 kHz)畸变产物耳声发射(DPOAE)测试 、EHF DPOAE(8~12 kHz)测试。结果 对照组常规频率DPOAE的平均检出率为97.2%，EHF DPOAE的检出率为88.7%；实验组常规频率DPOAE的检出率为72.2%，EHF DPOAE的检出率为51.2%。实验组EHF DPOAE引出率明显低于对照组EHF DPOAE引出率(P<0.001)；实验组EHF DPOAE中振幅值明显低于对照组EHF DPOAE的振幅值(P<0.001)；实验组EHF DPOAE的平均信噪比值明显低于对照组EHF DPOAE的平均信噪比值(P<0.001)。结论 在常规纯音听力检测正常的特发性耳鸣患者中，EHF DPOAE的引出率明显低于常规频率DPOAE的引出率，且EHF DPOAE的每个频率振幅值有明显下降，提示EHF DPOAE相对于常规频率DPOAE对“听力正常”耳鸣患者的隐匿性听力损失有较高的敏感性，能早期反映其耳蜗外毛细胞功能状态。

关键词:耳鸣;扩展高频畸变产物耳声发射;听力检测;听力

Abstract:

Objective To investigate the characteristics of extended high frequency distortion product otoacoustic emission (EHF DPOAE) in idiopathic tinnitus patients with normal pure-tone average (PTA), and investigate the clinical values for finding early hidden hearing loss with EHF DPOAE in these patients. Methods In this study, 68 tinnitus patients (104 ears) with normal PTA (experimental group) and 40 normal PTA volunteers (40 ears) without tinnitus (control group) were enrolled. All subjects were tested with distortion product otoacoustic emission (DPOAE) of routine frequencies ranged from 1 to 6 kHz and EHF DPOAE of 8 to 12 kHz by using Neuro-Audio otoacoustic emission analyzer. Results The detectable rates of the routine DPOAE and EHF DPOAE for the control group were 97.2% and 88.7%, while those for the experimental group were 72.2% and 51.2%. The detectable rate of EHF DPOAE for the experimental group was significantly lower than that of the control group (P<0.001). The average DP amplitudes of the experimental group were significantly lower than those of the control group (P<0.001). The average SNRs of the experimental group were also significantly lower than those of the control group (P<0.001). Conclusion The detectable rate of EHF DPOAE is significantly lower than that of the routine DPOAE in tinnitus subjects with normal PTA and the DP amplitude of EHF DPOAE at each frequency decreases significantly, which indicates that the EHF DPOAE has higher sensitivity in diagnosing the hidden hearing loss for the idiopathic tinnitus patient with "normal hearing" than the routine DPOAE, and can reflect the early functional status of cochlear outer hair cell.

Key words:Tinnitus;Extended high frequency distortion product otoacoustic emission;Hearing test;Hearing