耳聋与听力图分析

耳聋与听力图分析Hearinglossdisease&audiogramanalysis耳的症状学Earsemeiology耳痛otalgia耳漏Otorrhea耳痒earitch耳鸣tinnitus耳聋hearingloss眩晕vertigo面瘫faceparalysis耳后肿胀tumefaction耳聋的分类按耳聋病发的时间分类antenatalpre-birthhearinglossinheritance1.先天性耳聋：出生以前的耳聋2.后天性耳聋：出生以后的耳聋postnatalafterbirthhearingloss耳聋的分类按病发的部位分类Hearinglossclassaccordingtoinflammationpart.1.蜗前聋：传导性耳聋，外耳、中耳病变。Pre-cochleahearingloss:conductivehearingloss,externalearandmiddleearhaveinflammation.2.蜗性聋：感应性耳聋，耳蜗本身病变。Cochleahearingloss:sensorineuralhearingloss,thecochleahastheinflammation.3.蜗后聋：神经性耳聋，大脑听中枢病变。CentralHearingloss:sensorineuralhearingloss,nervecenteristhemorbidpart.耳聋的分类Conductivehearingloss传音性（传导性、蜗前聋）SensorineuralHearingloss感音神经性（蜗性、蜗后聋）Mixedhearingloss混合性CentrumHearingloss中枢性（蜗后聋）传导性耳聋Conductivehearingloss正常听力图Thenormalaudiogram频率Frequencyonthex-axis声强Intensityonthey-axisFrequencyrange:125-8000HzIntensityrange:-10-120dB(airconduction)ExampleofConductivehearingloss传导性耳聋Conductivehearingloss1.骨导正常Boneconditionisnormal.2.气导下降Aircondition3.气骨导差10dBA-Bgapismorethan10dB.传导性耳聋的听损程度传导性耳聋的听损程度1.鼓膜穿孔。ABG30dB左右2.鼓膜穿孔伴听骨链中断。ABG40dB左右3.鼓膜和听骨完全缺如。4.鼓膜完整伴听骨链中断。ABG60dB5.鼓膜完整+听骨链中断+卵圆窗封闭。6.外耳道堵塞。传导性耳聋的常见病变耳部畸形Earmalformations耵聍栓塞Impactedearwax外耳湿疹Acuteotitismedia外耳道炎Inflammationoftheearcanal外耳道塌陷Dentoftheearcanal耳道扩大Expandoftheearcanal异物eyewinker鼓膜穿孔Perforatedeardrum流脓Purulence穿孔后愈合ScaroverafterPerforated肿瘤或胆脂瘤Exostosesandosteomas鼓膜疤痕Eardrumscar鼓膜硬化Eardrumsclerosis常见的中耳疾病化脓性中耳炎Suppurativeotitismedia分泌性中耳炎Secretoryotitismedia耳硬化症Otosclerosis听骨链固定Fixationoftheossicularchain听骨链中断Interruptionoftheossicularchain鼓室硬化tympanasclerosis感音神经性耳聋Sensorineuralloss响度改变Alteredloudness–Poorersensitivitytosoftandintermediatesounds–Sometimesincreasedsensibilitytoloudsounds失真Distortion(missingfrequencies)言语分辨率下降Poordiscrimination(especiallyinnoisecondition)耳鸣Tinnitus伴随症状AssociatedproblemsFrequencyresolvingabilityStach,1998pp.96Sensorineuralhearingloss1.气骨导都下降。Airconductivedecline2.气导早期以高频下降为主，晚期低频也下降。Highfrequencydeclineatfirsttime,thenbothdecline.3.气骨导差10dBThereisnoadistanceshowbetweentheboneconditionandaircondition.感音神经性聋病因老年性耳聋噪声性耳聋突发性耳聋迷路炎Labyrinthitis颞骨骨折temporalbonefracture非器质性聋–心因性聋或功能性聋–伪聋RetrocochlearlossHereditaryhearinglossNoiseinducedhearinglossCongenital(germanmeasles)MénièresdiseaseAgerelatedhearinglossHereditary+ageTreatmentofsensorineurallossesHearinginstruments混合性耳聋MixedhearinglossExampleofmixedloss混合性耳聋Mixedhearingloss1.骨导下降Boneconditiondeclines.2.气导下降Aircondition3.气骨导差10dBA-Bgapismorethan10dB耳聋分类时间-congenital&acquired性质-organic&functional/psychogenic部位-conductive,sensorineural&mixedcochlear,retrocochlear¢ral病因耳聋病因中耳疾病及耳硬化症先天性聋中毒性聋感染性聋老年性聋爆震性聋及噪声性声损伤内耳免疫及自身免疫性内耳病全身及其它器官系统的慢性疾病引起的耳聋特发性突聋外淋巴瘘蜗后性聋诈聋和精神性聋中耳疾病急性/慢性化脓性中耳炎耳硬化症原因不明原发于骨迷路局灶性病变镫骨性-环韧带镫骨活动受限/固定CHL耳蜗性-耳蜗/内听道SNHL双侧20-40y缓慢进行性加重听力图：早期气导上升型－平坦型Carhart切迹（2kHz15dB)声导抗：AsCT：骨迷路、两窗区/内耳道骨壁上界限分明的局灶性硬化改变先天性聋遗传性遗传方式病变部位发病时间非遗传性⒈产前期母体的感染、中毒⒉分娩期窒息、外伤中毒性聋氨基甙类抗生素链霉素、卡那霉素、庆大霉素、新霉素某些抗肿瘤药顺铂、卡铂、氮芥袢利尿剂速尿、利尿酸水杨酸制剂阿司匹林（停药后一般可迅速消失）奎宁局部麻醉药的卡因、利多卡因（轻度，各个频率，可恢复）重金属铅、镉、汞、砷（不可逆蜗后性聋、伴前庭损害）吸入性有害气体氨基苯、CO、CS2、SO2（内耳、中枢）其它万古霉素、多粘菌素B中成药牛黄清心丸（雄黄为砷剂）感染性聋腮腺炎-儿童单侧SNHL高频不可逆麻疹-双耳不对称性SNHL高频不可逆带状疱疹-单侧前庭SNHL可逆细菌性脑膜炎-10-20%早期双耳重度波动梅毒-3-38%早期/晚期双侧突发前庭重度老年性聋原因：听觉系统衰老症状：不明原因双侧缓慢进行性加重SNHL-高频为主言语识别能力明显下降声创伤爆震性/急性-中耳内耳噪声性声创伤-世界性七大公害之首强度时间频谱（高频低频，窄带宽带）影响听阈频率损伤部位（外毛-内毛细胞，蜗底-蜗顶）4000Hz切迹自身免疫性内耳病（AIED）自身免疫性损害累及耳蜗&/前庭临床特点中年女性双侧不对称或单侧快速进行性/波动性蜗性或蜗后性HL伴其它自身免疫性疾病病程较长（数周）诊断缺乏敏感可靠的试验诊断方法治疗高剂量类固醇药物和免疫抑制剂少数经恰当治疗可获较好疗效的内耳病之一外淋巴瘘原因：外淋巴和中耳腔之间的骨质破损膜性组织/韧带破裂致使外淋巴和中耳腔交通诊断：有使中耳或颅内压突然升高的病史单耳突发性SNHL伴前庭症状治疗后眩晕不减轻&SNHL逐渐加重特发性突聋突然发生原因不明数分钟、数小时单耳高频SNHL50％伴眩晕7-10d内治疗效果较好1/31/31/3全身性疾病甲状腺功能减退症肾脏疾病糖尿病高血压和高血脂症血液性疾病助听器选配对象/适应症有残余听力药物或手术治疗无效，病情稳定传导性聋耳硬化症特发性突聋前庭导水管扩大综合症骨导助听器选配适应症外耳道闭锁、狭窄、长期流脓等不适宜用耳塞者1k和2kHzABGHL40dB验配助听器的步骤1.询问病史Toaskexperienceinthepast:听力不好有多长时间了？做过哪些检查和治疗？是否戴过助听器,效果怎样?howlongyouhavehearingloss?Didyouseeadoctor?didyouwearahearingaids?howaboutyourfeeling?2.检查耳部Tolookoverear:耳廓外型是否正常？外耳道是否通畅？是否有分泌物？如果有是干性还是湿性,鼓膜是否完整？有无鼓膜内陷、中耳积液、穿孔、炎性息肉等。auricleshape?externalearcanal?eardrum?middleear？Cerumen?验配助听器的步骤3.检查听力并对照检查结果作出分析。Toanalysishearingtest’sresult.4.选择功率和听力曲线匹配的助听器进行调试。Tochoosethesuitablehearingaids.5.使用电脑软件、声场或Aurical的长期会话图谱测试效果。Toevaluateresultbyusingthecomputersoftware,soundfield,Aurical.6.询问需要的档次,说服并达成协议。ToasksomedetailandpersuadehimtopurchasehearingaidsTHANKYOU!