临床听力图正常的耳鸣患者的多域听觉差异：考虑扩展高频听力

文献信息

中文摘要

目的： 耳鸣可发生于临床听力图正常的个体，提示基于常规阈值的测量可能无法捕捉细微的听觉系统差异。本研究旨在采用多域、探索性多变量框架，表征耳鸣患者的外周和皮层下听觉功能。
方法： 20名临床常规听力图（0.125-8 kHz）正常的耳鸣患者和25名年龄匹配的对照者接受了多域听觉评估，包括听性脑干反应（ABR）、耳声发射、内侧橄榄耳蜗抑制、中耳肌反射、时间精细结构和扩展高频（EHF）听力测试。组间差异采用探索性未校正分析评估，随后进行EHF校正的协方差分析和探索性主成分分析（PCA）。
结果： 初步探索性比较显示，耳鸣组EHF阈值升高、ABR波I振幅降低、耳蜗输出和传出反射测量存在差异，且时间处理表现较差。然而，在校正EHF阈值后，这些差异不再显著，提示总体模式主要与基底耳蜗变异性有关。PCA识别出三个成分，解释72%的累积方差，分别反映传入听觉贡献和基底耳蜗输出、传出反射调节以及耳蜗-时间耦合。
结论： 临床常规听力图正常的耳鸣患者在多个听觉域表现出细微差异，而非单一孤立缺陷。其中若干差异在校正EHF后减弱，表明在解读该人群的听觉发现时应考虑EHF听力。这些发现支持将EHF评估纳入耳鸣患者的听力学评估。

英文摘要

OBJECTIVE: Tinnitus can occur in individuals with clinically normal audiograms, suggesting that conventional threshold-based measures may not capture subtle auditory-system differences. This study aimed to characterize peripheral and subcortical auditory function in tinnitus using a multidomain, exploratory multivariate framework.
METHOD: Twenty individuals with tinnitus and clinically normal conventional audiograms (0.125-8 kHz) and 25 age-matched controls underwent a multidomain auditory assessment, including auditory brainstem response (ABR), otoacoustic emission, medial olivocochlear suppression, middle ear muscle reflex, temporal fine structure, and extended high-frequency (EHF) audiometry. Group differences were evaluated using exploratory unadjusted analyses, followed by EHF-adjusted analysis of covariance and exploratory principal component analysis (PCA).
RESULTS: Initial exploratory comparisons showed that the tinnitus group had elevated EHF thresholds, reduced ABR Wave I amplitude, differences in cochlear-output and efferent reflex measures, and poorer temporal-processing performance. However, these differences were no longer significant after adjustment for EHF thresholds, suggesting that the overall pattern was largely related to basal cochlear variability. PCA identified three components explaining 72% of cumulative variance, reflecting afferent auditory contribution and basal cochlear output, efferent reflex regulation, and cochlear-temporal coupling.
CONCLUSIONS: Individuals with tinnitus and clinically normal conventional audiograms exhibited subtle differences across multiple auditory domains rather than a single isolated deficit. Several of these differences were attenuated after adjustment for EHF, indicating that EHF hearing should be considered when interpreting auditory findings in this population. These findings support the inclusion of EHF assessment as part of the audiological evaluation of individuals with tinnitus.