听觉稳态反应与畸变产物耳声发射在职业性噪声性听力损失中与纯音测听的一致性和诊断价值评估
Consistency and Diagnostic Value Assessment of Auditory Steady-State Response and Distortion Product Otoacoustic Emissions Compared with Pure-Tone Audiometry in Occupational Noise-Induced Hearing Loss.
文献信息
| PMID | 42976022 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 日期未报告 |
| 作者 | Kai Yan |
| 作者单位 | Occupational Health Check-up Centre, Shilong Hospital, National Centre for Occupational Safety and Health, National Health Commission, Beijing, China. |
| 期刊 | Noise & health |
| SCI 分区 | Q3 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 本研究旨在探讨听觉稳态反应（ASSR）和耳声发射（OAE）与纯音测听（PTA）在职业性噪声性聋诊断中的一致性及应用价值。
方法： 回顾性分析182名职业性噪声暴露者的临床资料。经筛选后，55例患者组成听力损失组，另匹配55名无噪声暴露的对照者。所有参与者均接受PTA、ASSR（500-6000 Hz）和OAE（500-6000 Hz）检查。采用Kappa分析和受试者工作特征（ROC）曲线评估一致性和诊断性能。
结果： 听力损失组在所有频率的PTA阈值和ASSR反应阈值均显著高于对照组，而OAE振幅（500-6000 Hz）显著降低（P < 0.05）。ASSR的诊断敏感性和特异性均为92.70%，与PTA具有极好的一致性（Kappa = 0.85）。OAE的诊断敏感性为74.50%，特异性为80.00%，与PTA具有中等一致性（Kappa = 0.54）。ASSR的ROC曲线下面积（AUC = 0.950，95%置信区间[CI]：0.914-0.987）显著高于OAE（AUC = 0.891，95% CI：0.820-0.962）。在对年龄、性别、吸烟、饮酒和噪声暴露时长进行多变量调整后，ASSR异常（比值比[OR] = 28.64，95% CI：10.35-79.12，P < 0.001）和OAE异常（OR = 6.73，95% CI：2.81-16.10，P < 0.001）仍是职业性噪声性聋的独立影响因素。
结论： 在500-6000 Hz范围内，ASSR与PTA具有高度一致性，可作为可靠的客观验证工具。OAE为早期耳蜗功能提供了补充性信息。两者的联合应用值得进一步前瞻性验证。
英文摘要
OBJECTIVE: This study aimed to explore the consistency and application value of auditory steady-state response (ASSR) and otoacoustic emissions (OAE) with pure-tone audiometry (PTA) in the diagnosis of occupational noise-induced deafness.
METHODS: Clinical data from 182 individuals with occupational noise exposure were retrospectively reviewed. After screening, 55 patients comprised the hearing loss group, whereas 55 controls without noise exposure were matched. All participants underwent PTA, ASSR (500-6000 Hz) and OAE (500-6000 Hz). Consistency and diagnostic performance were assessed using Kappa analysis and receiver operating characteristic (ROC) curves.
RESULTS: PTA thresholds and ASSR response thresholds at all frequencies were significantly higher in the hearing loss group than in the control group, whereas OAE amplitudes (500-6000 Hz) were significantly lower ( P < 0.05). ASSR demonstrated a diagnostic sensitivity and specificity of 92.70%, with excellent agreement with PTA (Kappa = 0.85). OAE showed a diagnostic sensitivity of 74.50% and specificity of 80.00%, with moderate agreement with PTA (Kappa = 0.54). The area under the ROC curve for ASSR (area under the curve [AUC] = 0.950, 95% confidence interval [CI]: 0.914-0.987) was significantly higher than that for OAE (AUC = 0.891, 95% CI: 0.820-0.962). After multivariable adjustment for age, sex, smoking, alcohol consumption and duration of noise exposure, ASSR abnormality (odds ratio [OR] = 28.64, 95% CI: 10.35-79.12, P < 0.001) and OAE abnormality (OR = 6.73, 95% CI: 2.81-16.10, P < 0.001) remained independent influencing factors for occupational noise-induced deafness.
CONCLUSION: Within the 500-6000 Hz range, ASSR demonstrates strong concordance with PTA and serves as a reliable objective verification tool. OAE provides complementary insights into early cochlear function. Their combined use warrants further prospective validation.