使用扩展听力学检查组合对军事人员爆震诱导的隐匿性听力损失进行早期检测。

文献信息

中文摘要

背景/目的： 军事人员经常暴露于爆炸波引起的高风险声创伤。虽然鼓膜穿孔（TMP）等宏观损伤容易识别，但隐匿性听力损失（HHL）等亚临床微观损伤通常无法通过标准听力计检查发现。本研究调查了一次意外弹药库爆炸对听力的影响，重点关注扩展高频（EHF）听力计检查和客观电生理测量在检测爆震诱导的早期损伤中的诊断价值。方法：本回顾性病例系列纳入了8名参与弹药库120毫米榴弹炮炮弹爆炸的军事人员。受试者被分为直接爆炸暴露组（n = 2）和间接冲击组（n = 6）。听力学评估包括耳镜检查、标准纯音听力计检查（0.25-8 kHz）、EHF听力计检查（9-14 kHz）、听性脑干反应（ABR）和畸变产物耳声发射（DPOAE）。结果与参考组和对照组进行比较。两名直接创伤患者接受了I型鼓室成形术以修复TMP。结果：直接暴露人员遭受了近全TMP和显著的混合性听力损失。相比之下，六名间接受影响人员表现出“临床正常”的标准听力图；然而，与对照组相比，他们在9、10、12.5和14 kHz处的EHF阈值显著升高（p < 0.05）。爆炸组在1、1.5和10 kHz处的DPOAE振幅显著降低，表明外毛细胞功能障碍。ABR显示波I潜伏期延长具有统计学显著性（p = 0.014），但波I振幅降低在组间无显著性；这些发现提示可能存在耳蜗突触病，与HHL一致，但不具有诊断性。结论：爆炸暴露可能产生显性和亚临床听觉损伤。即使在常规听力图正常的个体中，我们的初步发现表明，EHF听力计检查和耳声发射测试在识别与HHL一致的早期耳蜗功能障碍方面显示出前景。虽然需要在更大队列中进一步验证以确定明确的诊断效用，但这些产生假设的观察结果突出了高级听力学评估在检测和监测军事人员爆震相关听觉损伤中的潜在价值。

英文摘要

Background/Objectives: Military personnel are frequently exposed to high-risk acoustic trauma from blast waves. While macroscopic injuries like tympanic membrane perforation (TMP) are easily identified, subclinical microscopic damage, such as hidden hearing loss (HHL), often goes undetected by standard audiometry. This study investigates the auditory impacts of an accidental ammunition depot explosion, focusing on the diagnostic value of extended high-frequency (EHF) audiometry and objective electrophysiological measures in detecting early-stage blast-induced damage. Methods: This retrospective case series included eight military personnel involved in a 120 mm howitzer shell explosion at an ammunition depot. Subjects were categorized into direct blast exposure (n = 2) and indirect impact (n = 6). Audiological evaluations included otoscopy, standard pure-tone audiometry (0.25-8 kHz), EHF audiometry (9-14 kHz), auditory brainstem response (ABR), and distortion product otoacoustic emissions (DPOAEs). Results were compared to reference and control groups. Two patients with direct trauma underwent type I tympanoplasty to repair TMP. Results: Directly exposed personnel sustained near-total TMPs and significant mixed hearing loss. In contrast, the six indirectly impacted personnel exhibited "clinically normal" standard audiograms; however, their EHF thresholds at 9, 10, 12.5, and 14 kHz were significantly elevated compared to controls (p < 0.05). DPOAE amplitudes at 1, 1.5, and 10 kHz were significantly reduced in the blast group, indicating outer hair cell dysfunction. ABR showed a prolonged wave I latency with statistical significance (p = 0.014), but a decreased wave I amplitude was nonsignificant between groups; these findings are suggestive of possible cochlear synaptopathy, consistent with, but not diagnostic of, HHL. Conclusions: Blast exposure may produce both overt and subclinical auditory injury. Even in individuals with normal conventional audiograms, our preliminary findings suggest that EHF audiometry and otoacoustic emission testing show promise in identifying early cochlear dysfunction consistent with HHL. While further validation in larger cohorts is required to establish definitive diagnostic utility, these hypothesis-generating observations highlight the potential value of advanced audiologic assessments for the detection and monitoring of blast-related auditory injury in military personnel.