Auditory neuropathy/dyssynchrony - Its diagnosis and management
Auditory neuropathy/dyssynchrony - Its diagnosis and management
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DOI：
10.1016/s0031-3955(03)00031-2
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发表时间：
2003-04-01
影响因子：
2.6
通讯作者：
Hood, LJ
中科院分区：
文献类型：
--
作者：
Berlin, CI;Morlet, T;Hood, LJ
耳声发射、中耳肌肉反射和听觉脑干反应（ABR）通常被视为“客观且可靠的听力筛查工具”。他们不是。虽然具有正常潜伏期强度功能的正常 ABR 通常伴随着正常的周围听力，但 ABR 缺失或严重异常并不总是与耳聋相关。相比之下，30 dB 或以上的听力损失通常预示着不存在耳声发射，但在一些行为听力图表明完全耳聋的患者中可以看到正常的发射。在至少 10% 有语言和听力问题的儿童中可能会出现这种情况，ABR 和中耳肌肉反射可能会缺失，而发射结果却正常。这种组合严重影响了管理指南，因此应该成为每个新患者筛查程序的一部分。本文回顾了使这些测试有用且可能具有误导性的基本听觉生理学，并建议初级保健医生和其他专业人员考虑采取的步骤，以弥补每个程序的漏洞。
Otoacoustic emissions, middle ear muscle reflexes, and auditory brain stem response (ABR) often are presented as "objective and infallible hearing screening tools." They are not. Although a normal ABR with a normal latency-intensity function usually accompanies normal peripheral hearing, an absent or grossly abnormal ABR is not always associated with deafness. In contrast, a hearing loss of 30 dB or more usually predicts absent otoacoustic emissions, but normal emissions can be seen in some patients whose behavioral audiograms imply total deafness. Under circumstances that may occur in at least 10% of children with language and hearing problems, ABR and middle ear muscle reflexes can be absent while emission results are normal. This combination seriously affects management guidelines and, therefore, should be part of the screening procedure for every new patient. This article reviews the underlying auditory physiology that makes these tests useful and potentially misleading, and recommends steps to be considered by primary care physicians and other professionals to compensate for the vulnerabilities of each of the procedures.