Toward a Differential Diagnosis of Hidden Hearing Loss in Humans.
Toward a Differential Diagnosis of Hidden Hearing Loss in Humans.
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DOI：
10.1371/journal.pone.0162726
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Maison SF
中科院分区：
文献类型：
--
作者：
Liberman MC;Epstein MJ;Cleveland SS;Wang H;Maison SF
最近的研究表明，毛细胞并不是内耳中最脆弱的元素;相反，毛细胞和耳蜗神经末梢之间的突触在老化或噪音暴露的耳朵中首先退化。这种原发性神经退化不影响听力阈值，但可能导致在困难的听力环境中理解语音的问题，并且可能在耳鸣和/或听觉过敏的产生中很重要。为了寻找人类耳蜗突触病的迹象，我们招募了大学生，并根据自我报告的噪音暴露和听力保护的使用情况将他们分为低风险和高风险组。通过耳声发射和点击诱发的耳蜗电描记术评估耳蜗功能;通过行为测听和有或无噪声或时间压缩和混响的单词识别评估听力。两组在标准测听频率下的阈值均正常，然而，高风险组在高频（10-16 kHz）下显示出显著的阈值升高，与噪声损伤的早期阶段一致。耳蜗电描记术显示由毛细胞（总和电位; SP）与耳蜗神经元（动作电位; AP）产生的波形峰之间的比率（即SP/AP比率）的显著差异，与选择性神经损失一致。高风险组在噪音或时间压缩和混响中的单词识别性能也显着较差，并报告对声音的反应与听觉过敏一致。这些结果表明，SP/AP比可能是有用的诊断“隐藏的听力损失”，并建议由动物模型，噪声引起的耳蜗神经突触的损失导致听力缺陷的困难听的情况下，尽管存在正常阈值在标准测听频率。
Recent work suggests that hair cells are not the most vulnerable elements in the inner ear; rather, it is the synapses between hair cells and cochlear nerve terminals that degenerate first in the aging or noise-exposed ear. This primary neural degeneration does not affect hearing thresholds, but likely contributes to problems understanding speech in difficult listening environments, and may be important in the generation of tinnitus and/or hyperacusis. To look for signs of cochlear synaptopathy in humans, we recruited college students and divided them into low-risk and high-risk groups based on self-report of noise exposure and use of hearing protection. Cochlear function was assessed by otoacoustic emissions and click-evoked electrocochleography; hearing was assessed by behavioral audiometry and word recognition with or without noise or time compression and reverberation. Both groups had normal thresholds at standard audiometric frequencies, however, the high-risk group showed significant threshold elevation at high frequencies (10–16 kHz), consistent with early stages of noise damage. Electrocochleography showed a significant difference in the ratio between the waveform peaks generated by hair cells (Summating Potential; SP) vs. cochlear neurons (Action Potential; AP), i.e. the SP/AP ratio, consistent with selective neural loss. The high-risk group also showed significantly poorer performance on word recognition in noise or with time compression and reverberation, and reported heightened reactions to sound consistent with hyperacusis. These results suggest that the SP/AP ratio may be useful in the diagnosis of “hidden hearing loss” and that, as suggested by animal models, the noise-induced loss of cochlear nerve synapses leads to deficits in hearing abilities in difficult listening situations, despite the presence of normal thresholds at standard audiometric frequencies.
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