刺激声间隔觉察阈测试在听神经病患者诊断中的临床应用

摘要

目的：建立刺激声间隔觉察测试（Random Gap Detection Test, RGDT）方法并对健听青年人、感音性聋患者及听神经病患者的听觉间隔觉察阈（Gaps-in-Noise, GIN）进行比较和分析。方法本文主要通过在噪声下改变间隔时间的长短来检测受试者听觉系统的时间整合能力。噪声间隔的改变采用的是一种自适应的调节方式，即连续两次选择正确则增加测试难度，缩短间隔时间；若一次选择错误则降低测试难度，延长间隔时间。本文选取健听组60耳，感音性耳聋组25耳，听神经病组20耳，分别进行GIN测试。结果健听组中，女性的GIN阈值为2.95±0.86ms，男性的GIN阈值为3.10±1.15ms，男女性别无显著性差异（P=0.683>0.05, F=0.138）；双耳的测试结果为3.02±1.00ms，左耳的测试结果为3.63±1.39ms，右耳的测试结果为3.38±1.25ms，不同耳别之间没有显著性差异（P=0.162＞0.05, F=1.857）。用one-way ANOVA对听神经病组、感音性聋组及健听组进行统计学分析发现三组有显著性差异（P=0.000＜0.05），其中听神经病组GIN阈值为29.59±19.27ms，与健听组3.34±1.24ms相比明显延长(P=0.000＜0.05)，感音性聋组5.34±2.78ms与健听组有显著性差异（P=0.005＜0.05），听神经病组与感音性聋组相比也有显著性差异（P=0.000＜0.05）。结论RG-DT是一种测试听觉中枢系统时间分辨率的一项有效方法，可行性高，尤其对于听神经病患者的临床应用价值较高。RGDT可以为进一步鉴别诊断听神经病和感音性聋提供一定参考依据。间隔觉察阈值测试可作为一项辅助工具补充并验证言语测听的测试结果。%Objective To establish a method of Random Gap Detection Test (RGDT) and to compare the Gaps-in-Noise (GIN) threshold and perceived auditory threshold of interval among normal hearing young people, patients with sensorineural hearing loss and patients with auditory neuropathy (AN) patients. Methods The interval between testing sound signals was ma-nipulated to test auditory temporal integration capability against a background noise. An adaptive approach was used, i.e., diffi-culties increased upon two consecutive correct answers and decreased (increasing interval) upon a wrong answer. The GIN test was applied to 60 normal hearing ears, 25 ears with sensorineural hearing loss and 20 ears with auditory neuropathy. One-way ANOVA was used for comparison among the normal hearing, sensorineural hearing loss and auditory neuropathy groups. Re-sults The GIN threshold of the auditory neuropathy group (29.59 ± 19.27 ms) was longer than the normal hearing (3.34 ± 1.24 ms) and sensorineural hearing loss (5.34±2.78 ms) groups. Within the normal hearing group, the GIN thresholds of the females (2.95 ± 0.86 ms) and males (3.10 ± 1.15 ms) showed no significant gender difference (P=0.683>0.05, F=0.138). The binaural GIN threshold was 3.02 ± 1.00 ms. The left ear GIN threshold (3.63 ± 1.39 ms) was not significantly different from that of the right ear (3.38±1.25 ms) (P=0.162>0.05, F=1.857). Conclusions RGDT test is a useful clinical tool in assessment of auditory temporal resolution. It is highly feasible and has profound values in clinical application, especially for patients with AN, facili-tating differential diagnosis. It can also be used as a complementary tool to verify the result of speech audiometry.