Threshold Equalizing Noise Test Reveals Suprathreshold Loss of Hearing Function, Even in the "Normal" Audiogram Range.
Threshold Equalizing Noise Test Reveals Suprathreshold Loss of Hearing Function, Even in the "Normal" Audiogram Range.
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阈值均衡噪声测试显示超过阈值的听力功能损失，即使在“正常”听力图范围内。
DOI：
10.1097/aud.0000000000001175
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发表时间：
2022-07-01
期刊：
影响因子：
3.7
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中科院分区：
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阈值均衡噪声（TEN（HL））是临床上施用的检测耳蜗“死区”（即，内毛细胞[IHC]连通性丧失的区域），使用基于色调检测任务中掩蔽阈值的升高程度的“通过/失败”标准。对于感音神经性听力损失，通常观察到掩蔽阈值的一些升高，但通常不足以创建“失败”诊断。本文报告的实验调查了通过和失败之间的灰色区域是否包含与年龄或累积高水平噪声暴露（>100 dBA声压级）等因素相关的信息，可能表明耳蜗结构受损，而不是更常见的外毛细胞。招募了112名参与者（71名女性），他们接受了感音神经性听力损失的听力筛查，分为正常或轻度。他们的年龄范围为32至74岁。他们在四个频率，0.75，1，3和4 kHz，和两个感觉水平，12和24分贝以上的纯音绝对阈值在每个频率的TEN测试。测试频率选择为明显远离或位于2至6 kHz区域内，在该区域内，噪声引起的听力损失首先在听力图中作为缺口在临床上观察到。累积噪声暴露通过噪声暴露结构化访谈（NESI）进行评估。NESI的元素还允许参与者根据音乐经验进行分层。在所有频率和测试水平中，TEN阈值升高与绝对阈值之间观察到强正相关。即使排除噪音暴露和音乐体验，这些相关性也几乎没有变化。甚至在“正常”听力范围内（绝对阈值≤15 dB HL）也观察到相关性。使用临床测试，即使在临床“正常”听力范围内也可观察到感音神经性听力缺陷。TEN测试的结果介于“通过”和“未通过”之间，主要由与IHC无关的过程决定。因此，应仅考虑其原始设计功能的IHC相关功能的TEN检测，以生成通过或未通过的二元判定。
The threshold equalizing noise (TEN(HL)) is a clinically administered test to detect cochlear “dead regions” (i.e., regions of loss of inner hair cell [IHC] connectivity), using a “pass/fail” criterion based on the degree of elevation of a masked threshold in a tone-detection task. With sensorineural hearing loss, some elevation of the masked threshold is commonly observed but usually insufficient to create a “fail” diagnosis. The experiment reported here investigated whether the gray area between pass and fail contained information that correlated with factors such as age or cumulative high-level noise exposure (>100 dBA sound pressure levels), possibly indicative of damage to cochlear structures other than the more commonly implicated outer hair cells. One hundred and twelve participants (71 female) who underwent audiometric screening for a sensorineural hearing loss, classified as either normal or mild, were recruited. Their age range was 32 to 74 years. They were administered the TEN test at four frequencies, 0.75, 1, 3, and 4 kHz, and at two sensation levels, 12 and 24 dB above their pure-tone absolute threshold at each frequency. The test frequencies were chosen to lie either distinctly away from, or within, the 2 to 6 kHz region where noise-induced hearing loss is first clinically observed as a notch in the audiogram. Cumulative noise exposure was assessed by the Noise Exposure Structured Interview (NESI). Elements of the NESI also permitted participant stratification by music experience. Across all frequencies and testing levels, a strong positive correlation was observed between elevation of TEN threshold and absolute threshold. These correlations were little-changed even after noise exposure and music experience were factored out. The correlations were observed even within the range of “normal” hearing (absolute thresholds ≤15 dB HL). Using a clinical test, sensorineural hearing deficits were observable even within the range of clinically “normal” hearing. Results from the TEN test residing between “pass” and “fail” are dominated by processes not related to IHCs. The TEN test for IHC-related function should therefore only be considered for its originally designed function, to generate a binary decision, either pass or fail.