- ASSR ASSR 28 (56 ) ASSR 500Hz 1000Hz 2000Hz 4000Hz ASSR ASSR ASSR ASSR ASSR ASSR 500Hz 1000Hz 2000Hz 4000Hz 29 8dBHL 29 8dBHL 28 9dBHL 30 10dBHL P>0

Transcription

1 安徽医科大学硕士学位论文正常青年人多频稳态听觉诱发电位阈值的测试姓名 : 江文博申请学位级别 : 硕士专业 : 耳鼻咽喉科学指导教师 : 许为青 ; 孙敬武

2 - ASSR ASSR 28 (56 ) ASSR 500Hz 1000Hz 2000Hz 4000Hz ASSR ASSR ASSR ASSR ASSR ASSR 500Hz 1000Hz 2000Hz 4000Hz 29 8dBHL 29 8dBHL 28 9dBHL 30 10dBHL P>0.05, ASSR 13dB-15dB, ASSR (P>0.05), PTA PTA 8dB, 6 9 ASSR (P>0.05) ASSR 15dB ASSR ICS Chartr EP 6 ASSR ASSR 2

3 Test on Auditory Steady-state Responses of Normal-hearing Adults Otolaryngology - head and neck department The affiliated Anhui provincial hospital of Anhui medical university Abstract Objective: To discuss the method of forecasting the normal-hearing adult s audio state through the thresholds of auditory steady-state response(assr) and the creditability of shorten the testing time of ASSR. Methods: The pure tone audiometry and ASSR to multiple simultaneous stimuli were tested in a sample of 28 normal-hearing adults(56 ears). The thresholds of pure tone and ASSR, and the searching time when ASSR thresholds appear in 500Hz,1000Hz,2000Hz,4000Hz were recored. Speculating the pure tone average(pta) based the mean of ASSR thresholds. Analyzing the relationship between ASSR thresholds and pure tone thresholds and find weather the max researching time may influence the ASSR thresholds. Results: The ASSR thresholds at 500,1000,2000,4000 Hz were 29 8 dbhl 29 8 dbhl 28 9 dbhl and dbhl The test showed no significant difference between frequencies (P>0.05). ASSR thresholds were about 13dB-15dB higher than pure tone thresholds in four frequencies. There was no significant correlation between ASSR thresholds and pure tone thresholds. The predictive value of PTA was about 8 dbhl higher than substantive PTA. The max researching time in all frequencies showed no significant difference to the ASSR thresholds between 6min and 9min(χ2= , P>0.05). Conclusion: The ASSR thresholds was no more than 15 dbhl higher than pure tone thresholds in normal-hearing adult. It was not suitable to predict the pure tone thresholds in normal-hearing adult through their ASSR thresholds. For ICS Chartr EP system, if we 3

4 set the max research time for 6min, the ASSR thresholds detection rate won t change and the testing time could be shorten. Key word auditory steady-state response pure tone thresholds recording parameters 4

5 Abbreviation ASSR auditory steady-state response AMFR amplitude modulation following response CF carrier frequenc MF modulation frequenc AM amplitude modulation frequency FM frequency modulation PTA pure tone audiometry 1

6 -

7 500Hz 1000Hz 2000Hz 4000Hz (auditory steady-state response,assr) ASSR amplitude modulation following response,amfr ASSR 40Hz ASSR carrier frequency,cf, modulation frequency.mf, amplitude modulation frequency AM frequency modulation, FM CF MF MF [1] MF ASSR ASSR 5

8 ABR, ( ), [2] ABR [3] ASSR 120 db nhl ABR 100 db nhl 100 db Rance 108 ABR ASSR Hz 1/ 4 ASSR, [4] ASSR ABR ASSR EEG, EEG,, ASSR 70 Hz, [5] Aoyagi [6], ASSR, ASSR ASSR :, ;, [7] ASSR, [8,9] ASSR ASSR [9-11 ], db, ASSR, ASSR, ASSR 20 db ;, 10 db ;, 5 db [9], 6

9 ( ), ASSR, ASSR [9,13 ], :, ; [10], 500 Hz ;, 4000 Hz 100 Hz 2. 5 %, 500 Hz 100 Hz 20 %, ;, [12] ASSR 1.5 [14] ASSR ASSR 20dB [15] ASSR A 125Hz~4kHz 20 db HL 7

10 2.2 1 Madsen OB 922 MADSEN Fig. 1 2 TDH-39 MADSEN 3 Impedance Audiometer AZ26 Fig. 2 4 ICS Chartr EP ICS Fig. 1 Madsen OB 922 8

11 Fig. 2 Impedance Audiometer AZ Madsen OB 922 ( ) 0.125~8kHz <30 db(a) GB dB 9

12 5dB dB 5dB Hz 8000Hz [16] Impedance Audiometer AZ hz ±4mm 10

13 % Nuprep 5K 2K TDH-39 ASSR ASSR 500Hz 1000Hz 2000Hz 4000Hz 44Hz 51Hz 53Hz 41Hz Hz 57 Hz 43 Hz 60 db HL 0 db HL 95% 9 50K 10Hz 105Hz 8 30 db HL, 10 db HL 10 db HL ASSR ASSR 9 ASSR 11

14 db HL 500Hz % 1000Hz 2 7.1% 2000Hz % 4000Hz 2 7.1% 3.1 Fig. 3 Fig. 4 Fig.3 12

15 db HL 500Hz % 1000Hz 2 7.1% 2000Hz % 4000Hz 2 7.1% 3.1 Fig. 3 Fig. 4 Fig.3 12

16 Fig ASSR : ASSR (n=56) Hz ASSR ASSR p>0.05, ASSR ASSR p>0.05 ASSR 13

17 3.3 ASSR PTA PTA Joonh [9] PTA =1.05 ASSR -7.6 ASSR 500Hz 1kHz 2kHz 4kHz ASSR 500Hz 1kHz 2kHz 4kHz ASSR ASSR PTA PTA ASSR PTA PTA ASSR PTA PTA PTA (db HL) (db HL) (db HL) PTA (db HL) ASSR PTA p ASSR 9 ASSR 6 ASSR ASSR (n=56) 500 Hz 1000 Hz 2000 Hz 4000 Hz 6min >6min p

18 ASSR Kuwada 55Hz ASSR Hz ASSR [17] ASSR John, Hz,, Hz Hz, ABR [18] Picton ASSR 40Hz ASSR 80Hz [19] ASSR ASSR ASSR, ASSR [20] ASSR ASSR ASSR 95, 1 ASSR ASSR [14 21] (neural synchronization) 15

19 ASSR ASSR 4 ASSR 2 ASSR Rance (1995 ) < 35 db HL ASSR 17dB(250 Hz) 35dB(4000 Hz) Lins ASSR 10 15dB [9] Perez-Abalo [15] db ASSR Joong Ho Ahn ASSR PTA ASSR PTA =1.05 ASSR -7.6 [22] ASSR PTA PTA 8dB Joong Ho Ahn ( ) [2] ASSR ASSR 3 ASSR ( ) 2 3 [23] 16

20 ASSR ASSR 6 9 ASSR 6 4. ASSR ( ),, 15 %, 67 % 73 % 76 %,, 1/ 2,, 17 %, 82 % 82 % 84 %,,, [24] 5. 17

21 6. ASSR ASSR EEG, EEG,, ASSR 70 Hz, [10] Aoyagi, ASSR, ASSR [6],, 40Hz [ Hz, 60Hz, 25] ASSR 15dB ASSR 5.2 ICS Chartr EP 6 ASSR ASSR 6. ASSR, 18

22 , 6, ; ASSR, ; ASSR, ;, ASSR ;, ASSR, ASSR,, ASSR, khz, ASSR [4] [1]. [M] [2]. [J].,2005,13 (1): [3] Dureux - Smith A,Picton TW, Bernard P, et al. Prognostic validity of brainstem electric-response audiometry (BERA) in infants of a neonatal intensive care unit (NICU) [J]. Audiology.1991,30 :249. [4] Rance G, Dowell RC, Rickards F W, et al. Steady-stste evoked potential and behavioral hearing thresholds in a group of children with absent click-evokked auditory brain stem response [J].Ear Hear.1998,19 :48. [5] [J]..2007, 15(1): [6] Aoyagi M, Kiren T, Kim Y, et al. Optimal modulation frequency for amplitude-modulation following response in young children during sleep [J]. Hear Res. 1993,65:

23 [7] Picton TW, Durieux - Smith A, Champagne SC, et al. Objective evaluation of aided thresholds using auditory steady-state responses [J]. Am Acad Audiol.1998,9 : [8] Aoyagi M, Suzuki Y, Yokota M, et al. Reliability of 80Hz amplitude-modulation-following response detected by phase coherence [J]. Audiol Neurootol.1999,4 : [9] Lins O G, Picton T W, Boucher B L,et al. Frequency specific audiometry using steady-state responses [J]. EarHear.1996,17 : [10] Cohen LT, Rickards FW, Clark GM. A comparison of steady state evoked potentials to modulated tones in awaked and sleeping humans [J]. Acoustic Soc Am.1991, 90 (2) 467. [11] Rance G, Rickards F W, Cohen L T,et al. The auto-mated prediction of hearing thresholds in sleeping subjects using auditory steady-state evoked potentials [J]. EarHear.1995,16 : [12] Aoyagi M, Yoshinori K, Suzuki Y, et al. Optimal modulation frequency for amplitude-modulation following response in young children during sleep [J]. Hear Res.1993,65 :253. [13],,,. [J]..2004,11 (5) : [14] Herdmau AT Stapells DR Thresholds determined using the monotic and dichotic multiple auditory steady-state response technique in normal-hearing subjects[j] Scand Audiol [15] Perez-Abalo MC Savio G Torres A. et a1 Steady state responses to multiple amplitude-modulated tones an optimaized method to test frequency-specific thresholds in hearing-impaired children and norreal-hearing subjects[j] Ear Hear : [16]. GB/T ISO8253-2: [17] Kuwada S,Bat re R,Maher VL. Scalp potentials of normoland hearing impaired 20

24 subjects in response to sinusoidally amplitude-modulated tones [J]. Hear Res.1986,21 (2) : [18] John M S, Picton TW. Human auditory steady-state responses to amplitude-modulated tones : phase and latency measurements [J]. Hear Res 2000, 141 : [19] Ross B, Picton TW, Pantev C. Temporal integrationin the human auditory cortex as represented by the development of the steady-state magnetic field [J]. Hear Res.2002,165 : [20] Giraud A L Lorenzi C,Ashburner J.et al.representation of the temporal envelope of sounds in the humanbrain [J]. Neurophysiol. 2000,84 : [21] John MS Dimtrijevie A van Roon P, et a1 Multiple auditory steady-state responses to AM and FM stimuli[j] Audiol Neurootol l2-19. [22] Ahn, H. Lee, Y. Kim, T. Yoon, et al.comparing pure-tone audiometry and auditory steady state response for the measurement of hearing loss Otolaryngology Head and Neck Surgery[J] , [23] John MS Purcell DW Dimtrijevie A et a1 Advantages and caveats when recording steady-state responses multiple simultaneous stimuli[j] JAm Acad Audiol [24] John MS,Dimit rijevic A,Van Roon P,et al. Multiple auditory steady-state responses to AM and FM stimuli [J]. Audiologyand Neural2Otology,2001,6 (1) : [25] Levi EC, Folsom RC, Dobie RA.Amplitude-modulation following response (AM FR ) : Effects of modulat ion rate,carrier frequency, age and state [J]. Hear Res,.1993,68:

25 ,13(12):

26 23

27 - (multi-frequency steady-state evoked potential,mfssep) (auditory steady-state response,assr), ABR ASSR 1. ASSR 1.1ASSR ASSR ASSR amplitude modulation following response,amfr ASSR 40Hz 500Hz 1000Hz 2000Hz 4000Hz ASSR carrier frequency,cf, modulation frequency.mf, amplitude modulation frequency AM 24

28 modulation, FM CF MF MF [1] MF ASSR 2. ASSR ASSR ASSR, ASSR [2] ASSR Kuwada 55Hz ASSR Hz ASSR [3] ASSR John, Hz, Hz , ABR [4] Picton ASSR 40Hz ASSR 80Hz 5 ASSR 3. ASSR ASSR 30dB(A), khz, kHz 100K, 25

29 , 95% 5K 3K (response confidence) 95 6, ( ) db HL, 10 db HL 10 db HL

30 4.1 ABR ASSR 4.2 ASSR ABR, ( ), [7] ABR [8] 4.3 ASSR ABR 4.4 ASSR 120HL ABR 100 db nhl 100 db nhl Rance 108 ABR ASSR, Hz 1/ 4 ASSR, 27

31 [9] ASSR ASSR Savio < ,,, db db, db, db [10] Gary, 1, 10 db [11] 5.2 ASSR ASSR EEG, EEG,, MSSR 70 Hz, [12] Aoyagi, ASSR, ASSR [13],, 40Hz [14-16] 80Hz, 60Hz, 6. ASSR ASSR 28

32 MSSR :, ;, [17] 6.1 ASSR ASSR [18-19] [20-21] ASSR db [17,22-25] Aoyagi ASSR db [22], 5 13 db Lins [23] Picton [17] [25] ASSR, [26] ASSR 20dB 500Hz ASSR Luts [27] ASSR ASSR, OAE OAE >40-45 db HL,, ASSR OAE, ASSR 1995 Rance Audera x ASSR y 1995 Audera ASSR 55dB HL 29

33 1 Rance Hz y=1.295x y=1.182x y=1.045x y=1.193x Joong Ho Ahn ASSR PTA =1.05 ASSR Hz 1kHz 2kHz 4kHz ASSR 500Hz 1kHz 2kHz 4kHz ASSR [23] ASSR 6.2 ASSR ASSR,ASSR, [9] ( ) [24], ( ) ( ) ( ) ASSR /, (intensity -discrimination) (frequency - discrimination) (temporal resolution of the auditory system), [30] 30

34 ASSR 31

35 [1]. [M] [2] Giraud A L Lorenzi C,Ashburner J.et al.representation of the temporal envelope of sounds in the humanbrain [J]. Neurophysiol. 2000,84 : [3] Kuwada S,Bat re R,Maher VL. Scalp potentials of normoland hearing impaired subjects in response to sinusoidally amplitude-modulated tones [J]. Hear Res.1986,21 (2) : [4] John M S, Picton TW. Human auditory steady-state responses to amplitude-modulated tones : phase and latency measurements [J]. Hear Res.2000, 141 : [5] Ross B, Picton TW, Pantev C. Temporal integrationin the human auditory cortex as represented by the development of the steady-state magnetic field [J]. Hear Res.2002,165 : [6] [J]..2007, 15(1): [7]. [J].,2005,13 (1): [8] Dureux - Smith A,Picton TW, Bernard P, et al. Prognostic validity of brainstem electric-response audiometry (BERA) in infants of a neonatal intensive care unit (NICU) [J]. Audiology.1991,30 :249. [9] Rance G, Dowell RC, Rickards F W, et al. Steady-stste evoked potential and behavioral hearing thresholds in a group of children with absent click-evokked auditory brain stem response [J].Ear Hear.1998,19 :48. [10] Savio G,Cardenas J, Perez-Abalo M.et al. The low and high frequency auditory steady-state responses mature at different rates [J]. Audiology and Neuro- otology.2001,6 (3) : [11] Gary Rance, Dani Tomlin. Maturantion of auditory steady-state responses in normal 32

36 babies [J]. Ear and Hearing.2006,27 (1) : [12] Cohen LT, Rickards FW, Clark GM. A comparison of steady state evoked potentials to modulated tones in awaked and sleeping humans [J]. Acoustic Soc Am.1991, 90 (2) 467. [13] Aoyagi M, Yoshinori K, Suzuki Y, et al. Optimal modulation frequency for amplitude-modulation following response in young children during sleep [J]. Hear Res.1993,65 :253. [14] Levi EC, Folsom RC, Dobie RA.Amplitude-modulation following response (AM FR ) : Effects of modulat ion rate,carrier frequency, age and state [J]. Hear Res,. 1993,68: [15] Cohen L T, Rikards FW, Clark GM. A comparison of steady state evoked potentials to modulated tones in awake and sleeping humans [J]. A scout Soc Am. 1991, 90: [16] Aoyagi M, Kiren T, Kim Y, et al. Optimal modulation frequency for amplitude-modulation following response in young children during sleep [J]. Hear Res. 1993,65: [17] Picton TW, Durieux - Smith A, Champagne SC, et al. Objective evaluation of aided thresholds using auditory steady-state responses [J]. Am Acad Audiol. 1998,9 : [18] Ahn JH, Lee HS, Kim YJ, et al. Comparing pure-tone audiometry and auditory steady state response for the measurement of hearing loss [J]. Otolaryngol Head Neck Surg 2007;136(6): [19]. [J] (20) [20] Stroebel D, Swanepoel de W, Groenewald E. Aided auditory steady-state responses in infants [J]. Int J Audiol 2007;46(6): [21] Rance G, Tomlin D, Rickards FW. Comparison of auditory steady-state responses and tone-burst auditory brainstem responses in normal babies [J]. Ear Hear 33

37 2006;27(6): [22] Aoyagi M, Suzuki Y, Yokota M, et al. Reliability of 80Hz amplitude- modulation-following response detected by phase coherence [J]. Audiol Neurootol.1999,4 : [23] Lins O G, Picton T W, Boucher B L,et al. Frequency specific audiometry using steady-state responses [J]. EarHear.1996,17 : [24] Rance G, Rickards F W, Cohen L T,et al. The auto-mated prediction of hearing thresholds in sleeping subjects using auditory steady-state evoked potentials [J]. EarHear.1995,16 : [25],,,. [J]..2004,11 (5) : [26]. [J]..2007,4: [27] Luts H,Desloovere C,Kumar A, et al. Objective assessment of frequency-specific hearing thresholds in babies[j]. Int J Pediatr Otorhinolaryngol 2004;68(7): [28] Joong Ho Ahn, MD, Hyo-Sook Lee, MA, Young-Jin Kim, MD,et al. Comparing pure-tone audiometry and auditory steady state response for the measurement of hearing loss [J]. Otolaryngology Head and Neck Surgery.(2007) 136, [29] Williams, Wilkins. Comprehensive dictionary of audiology [J]. Baltimore.Stach B A [30] Dimitrijevis A, John MS, Room PV, et al. Human Auditory steady- state responses to tones independently modulated in both frequency and amplitude[j]. Ear Hear.2001,22 :