- 期刊
腦幹聽性反應檢查用於神經耳科學診斷的效度
The Validity of Auditory Brainstem Response in Neurotological Diagnosis
摘要
背景：對於神經耳科學診斷，腦幹聽性反應檢查是有效而普遍使用的檢查方法之一，就節省醫療資源的觀點，評估對所有主訴聽力損失、耳鳴或眩暈而懷疑顱內病變的病人均先用腦幹聽性反應檢查偵測顱內病變的效度和成本效益。 方法：對象為主訴聽力損失、耳鳴或眩暈而接受純音聽力檢查和氣導腦幹聽性反應檢查的1285名病人，男性630名，女性655名，分為漸進性不對稱感覺神經性聽力損失763名、突發性耳聾166名、低頻聽力損失42名和對稱感覺神經性聽力損失或聽力正常者314名等4組；其中174名接受磁振影像檢查。計算各組之腦幹聽性反應檢查偵測耳蝸後病變的效度，並評估腦幹聽性反應檢查用於神經耳科學診斷的成本效益。 結果：腦幹聽性反應異常而懷疑有顱內病變的有12%(158/1285)，無腦幹聽性反應的有7%(88/1285)。磁振影像檢查確定耳蝸後病變的有39%(68/174)。各組病例用腦幹聽性反應檢查偵測顱內病變之偽陽性率／偽陰性率分別為：漸進性聽力損失者46%/0%、突發性耳聾者25%/9%、對稱性聽力者57%/17%。總括全部病例的話，偽陽性率為45%，偽陰性率為9%。若全部病人均先檢查腦幹聽性反應，有異常和無反應者才做磁振影像檢查的話，則診斷1個顱內病變所花的費用約為全部病人均直接做磁振影像檢查的1/4。 結論：腦幹聽性反應檢查是神經耳科學診斷上可靠且靈敏度高的檢查，對所有主訴聽力損失、耳鳴或眩暈而懷疑顱內病變的病人均先用腦幹聽性反應檢查篩檢是合乎成本效益的。
並列摘要
Background: The auditory brainstem response (ABR) test is a useful screening method for retrocochlear diseases. The advent of magnetic resonance imaging (MRI) has significantly increased the ability to detect small retrocochlear lesions. We evaluated the validity of ABR as a screening test for intracranial lesions in patients with asymmetric sensorineural hearing loss, tinnitus or vertigo. Method: A total of 1285 cases received ABR testing. They were devided into 4 groups: progressive hearing loss, sudden hearing loss, low-tone hearing loss and symmetric hearing. MRI was available in 174 cases. Result: Positive ABR finding was noted in 12% and non-conclusive ABR was noted in 8% of all cases. Sixty-eight cases (39%) revealed intracranial lesions in MRI. The false-positive rate and false-negative rate for progressive hearing loss group, sudden hearing loss group and symmetric hearing group were 46%/0%, 25%/9% and 57%/17%, respectively. The false-positive rate(45%) and false-negative rate(9%) for total cases were still acceptable. In stead of MRI study for all cases, it costs only 1/4 expense to diagnose an intracranial lesion if ABR screening test is performed before MRI study which is done only for those with positive ABR finding. Conclusion: We suggest to continue to use ABR as a screening test for suspicious intracranial lesions in patients with asymmetric sensorineural hearing loss, tinnitus or vertigo.
延伸閱讀
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