幼兒無線聽性腦幹反應閾值與行為閾值之比較

Comparison of Wireless Auditory Brainstem Response Thresholds and Behavioral Thresholds in Young Children

蔡螢芷(Ying-Chih Tsai) ； 周寶宣(Pao-Hsuan Chou) ； 范君揚(Jun-Yang Fan) ； 楊義良(Edward Y-L Yang)

《The Changhua Journal of Medicine》 14卷4期 (2016/12) Pp. 187-204

https://doi.org/10.6501/CJM.1404.005

摘要

本研究目的為評估正常聽力及感音神經性聽力損失幼兒無線聽性腦幹反應與行為閾值之相關性。本研究以500、1,000、2,000及4,000Hz窄頻噪音為刺激音，測試幼兒之制約遊戲聽力(conditioned play audiometry, CPA)閾值，並與click、500及2,000Hztoneburst為刺激音之無線聽性腦幹反應閾值，並比較兩者之差異。參與本研究之個案共19位，年齡範圍2.5至6.5歲，每位個案均完成鼓室圖、變頻耳聲傳射(distortion product otoacoustic emission, DPOAE)、制約遊戲聽力檢查及無線聽性腦幹反應檢查。研究結果顯示，聽常幼兒其click ABR與2,000及4,000 Hz行為閾值之比較，相關係數為0.72；聽常幼兒之500與2,000 Hz tone burst ABR與行為閾值之平均差異，均在± 20 dB以內，相關係數為-0.08及0.32。聽損幼兒其clickABR與2,000及4,000Hz行為閾值之比較，相關係數為0.91；聽損幼兒在500 Hz的tone burst ABR與行為聽閾值之平均差異在20 dB以內，相關係數為0.95，其2,000 Hz tone burst ABR與行為閾值之平均差異在10 dB以內，相關係數為0.93。此外，本研究顯示高頻聽損幼兒以刺激音click及2,000 Hz tone burst ABR皆低估其聽閾值，建議未來臨床用途上，針對6歲以下嬰幼兒個案執行特定頻率聽性腦幹反應，在考量有效率及測試時間下，需快速鑑定出個案之聽損類型與程度時，宜選擇500 Hz及4,000 Hz為刺激音可能較佳。由於本研究個案皆為自然睡眠或安靜配合測試無線聽性腦幹反應，需要較長的檢查時間，研究結果顯示不論聽常組或聽損組測試時間皆需70分鐘左右。無線聽性腦幹反應可在未使用鎮靜劑之下執行，需時較長，但可降低醫療風險，適用於其他特殊疾病或鎮靜劑禁忌症之個案，如腦性麻痺、癲癇。整體而言，無線聽性腦幹反應與行為閾值之間具有良好相關性；無線聽性腦幹反應能有效評估聽力正常或聽力損失之幼兒聽力閾值。

關鍵字

行為聽力檢查 ； 幼兒 ； 無線聽性腦幹反應

並列摘要

Background: The purpose of this study was to compare wireless auditory brainstem response (ABR) and behavioral thresholds in children with normal hearing and those with sensorineural hearing loss. Hearing thresholds were obtained by conditioned play audiometry (CPA) to 500, 1,000, 2,000 and 4,000 Hz narrow band noise. These thresholds were compared with the wireless ABR thresholds to click, 500 and 2,000 Hz tone bursts. Methods: Nineteen subjects aged from 2.5 to 6.5 years participated in this study. All subjects were tested with tympanometry, distortion product otoacoustic emission (DPOAE) wireless ABR to click, 500 and 2000 Hz tone bursts, and CPA to 500, 1,000, 2,000 and 4,000 Hz narrow band noise. Results: The results indicated that the correlation coefficient of click ABR with behavioral thresholds to 2,000 and 4,000 Hz narrow band noise was 0.72. The differences between wireless ABR thresholds to 500 and 2,000 Hz tone bursts and behavioral thresholds to 500 and 2,000 Hz narrow band noise were within ± 20 dB in the normal hearing group, with correlation coefficients of -0.08 and 0.32, respectively. The correlation coefficient of click ABR with behavioral thresholds to 2,000 and 4,000 Hz narrow band noise was 0.91. The differences between the 500 Hz tone burst ABR threshold and behavioral thresholds were lower than 20 dB in the hearing loss group, with a correlation coefficient of 0.95. The study showed that the click and 2000 Hz tone burst ABR underestimated the hearing threshold of children with high-frequency hearing loss. In consideration of the efficiency of the test for identification of the type and degree of hearing loss, it is suggested that the auditory brainstem responses to 500 and 4,000 Hz tone bursts be used. All participants were sleeping naturally or resting under quiet conditions during wireless ABR testing. The test duration for each subject was typically around 70 minutes. The advantage of testing infants and children without sedation is the elimination of risks associated with sedation, particularly in cases such as patients with cerebral palsy and epilepsy. Conclusion: The wireless ABR thresholds and behavioral thresholds exhibited high correlation. It is suggested that wireless ABR may be used as a reliable tool for estimation of auditory sensitivity in children.

並列關鍵字

behavioral ； audiometry ； children ； wireless auditory ； brainstem response