短声听性脑干反应与多频稳态反应联合评估非综合征型腭裂并发分泌性中耳炎患儿听力的临床研究

Clinical study on combined assessment of hearing in children with non-syndromic cleft palate and concurrent secretory otitis media using c-ABR and ASSR

摘要:

目的 探讨将短声听性脑干反应(c-ABR)与多频稳态反应(ASSR)联合应用于评估非综合征型腭裂(NSCP)并发分泌性中耳炎患儿听力状况的临床价值。方法 回顾性分析2017年1月—2023年12月确诊的36月龄以下无法配合行为测听NSCP传导性听力损失严重程度，根据c-ABR检测中V波阈值判断严重程度，同时结合ASSR判断此类患儿听力损失频率分布，采用Spearman系数评估c-ABR与ASSR的相关性，并依据年龄、性别、腭裂程度进行分组比较。结果 本研究筛选了588例NSCP，最终纳入330例(660耳)，其中男103例(206耳)，女227例(454耳)。根据c-ABR将听力损失严重程度分为正常(118耳)、轻(442耳)、中(100耳)。以ASSR的结果补充低频听力，其中0.5 kHz的未引出率较高。整体上c-ABR与ASSR阈值相关性为2 kHz相关性最高(r=0.359)，按性别、年龄、腭裂程度分层后，其中婴儿期r=0.350，幼儿期r=0.433；男r=0.255，女r=0.386；腭裂Ⅱ度r=0.331，Ⅲ度r=0.747以上相关性均具有统计学意义(P<0.01)。结论 c-ABR与ASSR是NSCP听力学评估的重要工具，有助于NSCP传导性听力损失的早期诊断与干预，当腭裂程度为III度c-ABR和ASSR结果高度相关，且需重视0.5 kHz的听力补充检查；在临床检测中需互相补充，二者联合应用更有利于准确评估NSCP听力损失程度。

Abstract:

Objective To explore the clinical value of combining click auditory brainstem responses (c-ABR) and auditory steady-state response (ASSR) in evaluating the hearing status of children with non-syndromic cleft palate (NSCP) complicated with secretory otitis media. Methods A retrospective analysis was conducted on patients under 36 months of age who were diagnosed between January 2017 and December 2023 and were unable to cooperate with behavioral audiometry. The severity of conductive hearing loss was determined based on the V-wave threshold in c-ABR, while ASSR was used to assess the frequency-specific distribution of hearing loss. The correlation between c-ABR and ASSR was evaluated using Spearman’s coefficient, with group comparisons based on age, gender, and severity of cleft palate. Results A total of 588 cases of NSCP were screened, and 330 patients (660 ears) were ultimately included, among them 103 were male (206 ears) and 227 were female (454 ears). Based on c-ABR, hearing loss severity was classified as normal (118 ears), mild (442 ears), and moderate (100 ears). ASSR supplemented low-frequency hearing assessment, with a higher non-elicitation rate at 0.5 kHz. Overall, the highest correlation between ABR and ASSR thresholds was observed at 2 kHz (r=0.359). After stratification by gender, age, and degree of cleft palate, analysis revealed correlations of r=0.350 in infants and r=0.433 in young children; r=0.255 in males and r=0.386 in females; and r=0.331 in grade II cleft palate and r=0.747 in grade III. All correlations were statistically significant (P<0.01). Conclusions c-ABR and ASSR are essential tools for audiological evaluation in NSCP patients, facilitating early diagnosis and intervention for conductive hearing loss. When the degree of cleft palate is III, the results of c-ABR and ASSR are highly correlated, and it is necessary to pay attention to the supplementary hearing test at 0.5 kHz. In clinical detection, they should complement each other, and their combined application is more conducive to accurately assessing the degree of hearing loss in NSCP.