摘要
目的探讨听性脑干反应（auditory brainstem response，ABR）测试在1岁6个月～6岁的儿童分泌性中耳炎诊治中的应用价值。方法①在首诊时采用ABR测试97例179耳1岁6个月～6岁的分泌性中耳炎患儿，根据反应阈提高的程度分为3组：轻度组为20～30dB nHL，中度组为40～60dB nHL；重度组为70～90dB nHL。以同一年龄段的正常小儿为对照组，分析4组ABR波潜伏期和波间期的特点。②选择轻，中度组病例各10例（20耳）、重度组5例（10耳），行鼓膜穿刺或鼓膜切开术，分析中耳积液量和性状与ABR波潜伏期的关系。③随诊治疗中，每周检测ABR一次，以监测疗效，并以对照组ABR潜伏期和反应阈为指标判断预后。结果①轻、中、重度3组随着ABR反应阈的提高，Ⅰ、Ⅲ、Ⅴ波潜伏期延长增多，而波间期无明显变化。②轻、中度组随着中耳积液的增多变稠，ABR的Ⅰ、Ⅲ、Ⅴ波潜伏期延长增多。重度组中耳积液与中度组无明显差异，而Ⅰ、Ⅲ、Ⅴ波潜伏期延长却明显增加。③轻、中、重度3组预后不同。结论在分泌性中耳炎的诊治中，声导抗测试虽能为中耳病变提供重要依据，但辅以ABR测试，不仅能提供更多的中耳信息，还能反映内耳功能和高频听觉状态，作为该病诊断以及判断疗效和预后的依据。
Objective To analyze the role of auditory brainstem response （ABR） in the diagnosis and treatment of secretory otitis media （SOM） in children （1.5-6 years old）. Methods 97 children（179 ears）of 1.5-6 years old with secretory otitis media received ABR test during the initial diagnosis and were later divided into three groups based on the response thresholds： the mild group （20-30 dB nHL）, the moderate group （40-60 dB nHL） and the severe group （70-90 dB nHL）. Children of the same age were taken as the control group, and the characteristics of latencies and wave intervals of ABR from the four groups were analyzed. 10 mild cases （20 ears）, 10 moderate cases （20 ears） and 5 severe cases （10 ears） were randomly selected for tympanocentesis or myringotomy. The relationship between middle ear effusion and the latency of ABR was analyzed. During the follow-up, ABR test was administered once a week to monitor the prognosis of the patients in comparison with the control group. Results With increasing ABR thresholds, the latencies of Waves Ⅰ,Ⅲ and Ⅴ from the three experimental groups were prolonged but no significant changes were noted in wave intervals. For the mild and moderate groups, the latencies of Wave Ⅰ,Ⅲ and Ⅴ were prolonged as the middle ear effusion was increasing and becoming thicker. For the severe group, the latencies of Waves Ⅰ,Ⅲ and Ⅴ were clearly prolonged, although there was no significant difference in the middle ear effusion from that of the moderate group. The mild, the moderate and the severe group showed different results of prognosis. Conclusion Acoustic immittance measurement can provide important evidence to detect any pathologic changes in the middle ear in the diagnosis and treatment of SOM. As supported by ABR test, the assessment protocol can provide more information on the middle ear as well as the functions of the inner ear. The high-frequency auditory state can be obtained through the diagnosis, treatment and prognosis of SOM.
出处
《中国听力语言康复科学杂志》
2009年第1期26-30,共5页
Chinese Scientific Journal of Hearing and Speech Rehabilitation
