耳聋相关疾病与听力图分析讲诉PPT课件.ppt

耳耳聋相关疾病与听力相关疾病与听力图分析分析Hearing loss disease&audiogram analysis耳的症状学耳的症状学 Ear semeiologyEar semeiology耳痛耳痛otalgiaotalgia耳漏耳漏OtorrheaOtorrhea耳痒耳痒ear itchear itch耳耳鸣tinnitustinnitus耳耳聋hearing hearing lossloss眩眩晕vertigovertigo面面瘫 face paralysisface paralysis耳后耳后肿胀 tumefactiontumefaction 耳耳聋的分的分类 按耳按耳聋病病发的的时间分分类 antenatal pre-birth hearing loss antenatal pre-birth hearing loss inheritanceinheritance1.1.先天性耳先天性耳聋：出生以前的耳：出生以前的耳聋 2.2.后天性耳后天性耳聋：出生以后的耳：出生以后的耳聋 postnatal after birth hearing losspostnatal after birth hearing loss耳耳聋的分的分类 按病按病发的部位分的部位分类Hearing loss class according to inflammation part.1.1.蜗前前聋：传导性耳性耳聋，外耳、中耳病，外耳、中耳病变。Pre-cochlea hearing loss:conductive hearing Pre-cochlea hearing loss:conductive hearing loss,loss,external ear and middle ear have external ear and middle ear have inflammation.inflammation.2.2.蜗性性聋：感：感应性耳性耳聋，耳，耳蜗本身病本身病变。Cochlea hearing loss:sensorineural hearing Cochlea hearing loss:sensorineural hearing loss,the loss,the cochlea has the inflammation.cochlea has the inflammation.3.3.蜗后后聋：神：神经性耳性耳聋，大，大脑听中枢病听中枢病变。Central Hearing loss:sensorineural hearing Central Hearing loss:sensorineural hearing loss,loss,nerve center is the morbid part.nerve center is the morbid part.耳耳聋的分的分类 Conductive hearing lossConductive hearing loss传音性（音性（传导性、性、蜗前前聋）Sensorineural Hearing lossSensorineural Hearing loss感音神感音神经性（性（蜗性、性、蜗后后聋）Mixed hearing lossMixed hearing loss混合性混合性Centrum Hearing Centrum Hearing lossloss中枢性（中枢性（蜗后后聋）传导性耳性耳聋 Conductive hearing Conductive hearing lossloss正常听力正常听力图 The normal audiogramThe normal audiogram频率率 Frequency on the x-Frequency on the x-axisaxis声声强 Intensity on the y-Intensity on the y-axisaxisFrequency range:Frequency range:125-8000 Hz125-8000 HzIntensity range:Intensity range:-10-120 dB-10-120 dB(air conduction)(air conduction)Example of Conductive hearing lossExample of Conductive hearing loss 传导性耳性耳聋 Conductive hearing lossConductive hearing loss1.1.骨骨导正常正常Bone condition is normal.Bone condition is normal.2.2.气气导下降下降Air conditionAir condition3.3.气骨气骨导差差 10 dB 10 dBA-B gap is more than 10A-B gap is more than 10dB.dB.传导性耳性耳聋的听的听损程度程度传导性耳性耳聋的听的听损程度程度1.1.鼓膜穿孔。鼓膜穿孔。ABG 30dBABG 30dB左右左右2.2.鼓膜穿孔伴听骨鼓膜穿孔伴听骨链中断。中断。ABG40dBABG40dB左右左右3.3.鼓膜和听骨完全缺如。鼓膜和听骨完全缺如。4.4.鼓膜完整伴听骨鼓膜完整伴听骨链中断。中断。ABG60dBABG60dB5.5.鼓膜完整鼓膜完整+听骨听骨链中断中断+卵卵圆窗封窗封闭。6.6.外耳道堵塞。外耳道堵塞。传导性耳性耳聋的常的常见病病变耳部畸形耳部畸形Ear Ear malformations 耵耵聍栓塞栓塞Impacted earwax外耳湿疹外耳湿疹Acute otitis media外耳道炎外耳道炎Inflammation of the ear canal外耳道塌陷外耳道塌陷Dent of the ear canal耳道耳道扩大大Expand of the ear canal异物异物eyewinker鼓膜穿孔鼓膜穿孔Perforated eardrum流流脓Purulence穿孔后愈合穿孔后愈合Scar over after Perforated肿瘤或胆脂瘤瘤或胆脂瘤Exostoses and osteomas鼓膜疤痕鼓膜疤痕Eardrum scar鼓膜硬化鼓膜硬化Eardrum sclerosis常常见的中耳疾病的中耳疾病 化化脓性中耳炎性中耳炎Suppurative otitis media 分泌性中耳炎分泌性中耳炎Secretory otitis media 耳硬化症耳硬化症Otosclerosis 听骨听骨链固定固定Fixation of the ossicular chain 听骨听骨链中断中断Interruption of the ossicular chain 鼓室硬化鼓室硬化tympana sclerosis感音神感音神经性耳性耳聋 Sensorineural Sensorineural lossloss响度改响度改变 Altered loudness Altered loudnessPoorer sensitivity to soft and intermediate soundsSome times increased sensibility to loud sounds失真失真 Distortion(missing frequencies)Distortion(missing frequencies)言言语分辨率下降分辨率下降 Poor discrimination(especially in noise Poor discrimination(especially in noise condition)condition)耳耳鸣 TinnitusTinnitus伴随症状伴随症状Associated problemsAssociated problemsFrequency resolving abilityFrequency resolving abilityStach,1998 pp.96Sensorineural hearing Sensorineural hearing lossloss1.1.气骨气骨导都下降。都下降。Air conductive declineAir conductive decline2.2.气气导早期以高早期以高频下降下降为主，主，晚期低晚期低频也下降。也下降。High frequency decline at first time,then both decline.3.3.气骨气骨导差差 10 dB 10 dB 10 dBA-B gap is more than 10dBA-B gap is more than 10dB耳耳聋分分类时间-congenital&acquired-congenital&acquired性性质-organic&functional/psychogenic-organic&functional/psychogenic 部位部位-conductive,-conductive,sensorineuralsensorineural&mixed&mixed cochlear,retrocochlear&cochlear,retrocochlear&centralcentral病因病因耳耳聋病因病因中耳疾病及耳硬化症中耳疾病及耳硬化症先天性先天性聋中毒性中毒性聋感染性感染性聋老年性老年性聋爆震性爆震性聋及噪声性声及噪声性声损伤内耳免疫及自身免疫性内耳病内耳免疫及自身免疫性内耳病全身及其它器官系全身及其它器官系统的慢性疾病引起的耳的慢性疾病引起的耳聋特特发性突性突聋外淋巴瘘外淋巴瘘蜗后性后性聋诈聋和精神性和精神性聋中耳疾病中耳疾病急性急性/慢性化慢性化脓性中耳炎性中耳炎耳硬化症耳硬化症原因不明原因不明 原原发于骨迷路于骨迷路 局灶性病局灶性病变镫骨性骨性-环韧带 镫骨活骨活动受限受限/固定固定 CHLCHL耳耳蜗性性-耳耳蜗/内听道内听道 SNHLSNHL双双侧 20-40y 20-40y 缓慢慢进行性加重行性加重 听力听力图：早期气：早期气导上升型平坦型上升型平坦型CarhartCarhart切迹（切迹（2kHz 15dB)2kHz 15dB)声声导抗：抗：AsAsCTCT：骨迷路、两窗区：骨迷路、两窗区/内耳道骨壁上界限分明的局灶性硬化改内耳道骨壁上界限分明的局灶性硬化改变先天性先天性聋遗传性性 遗传方式方式 病病变部位部位 发病病时间非非遗传性性 产前期母体的感染、中毒前期母体的感染、中毒 分娩期窒息、外分娩期窒息、外伤中毒性中毒性聋氨基氨基甙类抗生素抗生素 链霉素、卡那霉素、霉素、卡那霉素、庆大霉素、新霉素大霉素、新霉素某些抗某些抗肿瘤瘤药 顺铂、卡、卡铂、氮芥、氮芥袢利尿袢利尿剂 速尿、利尿酸速尿、利尿酸水水杨酸制酸制剂 阿司匹林（停阿司匹林（停药后一般可迅速消失）后一般可迅速消失）奎宁奎宁 局部麻醉局部麻醉药 的卡因、利多卡因（的卡因、利多卡因（轻度，各个度，各个频率，可恢复）率，可恢复）重金属重金属 铅、镉、汞、砷（不可逆、汞、砷（不可逆蜗后性后性聋、伴前庭、伴前庭损害）害）吸入性有害气体吸入性有害气体 氨基苯、氨基苯、COCO、CSCS2 2、SOSO2 2（内耳、中枢）（内耳、中枢）其它其它 万古霉素、多粘菌素万古霉素、多粘菌素B B中成中成药 牛黄清心丸（雄黄牛黄清心丸（雄黄为砷砷剂）感染性感染性聋腮腺炎腮腺炎-儿童儿童 单侧 SNHL SNHL 高高频 不可逆不可逆麻疹麻疹-双耳双耳 不不对称性称性 SNHL SNHL 高高频 不可逆不可逆带状疱疹状疱疹-单侧 前庭前庭 SNHL SNHL 可逆可逆细菌性菌性脑膜炎膜炎-10-20%10-20%早期早期 双耳双耳 重度重度 波波动梅毒梅毒-3-38%3-38%早期早期/晚期晚期 双双侧 突突发 前庭前庭 重度重度老年性老年性聋原因：听原因：听觉系系统衰老衰老症状：不明原因症状：不明原因 双双侧 缓慢慢进行性加重行性加重SNHL-SNHL-高高频为主主 言言语识别能力明能力明显下降下降声声创伤爆震性爆震性/急性急性-中耳中耳 内耳内耳噪声性声噪声性声创伤-世界性七大公害之首世界性七大公害之首强度度 时间 频谱（高（高频 低低频，窄，窄带 宽带）影响听）影响听阈频率率 损伤部位（外毛部位（外毛-内毛内毛细胞，胞，蜗底底-蜗顶）4000Hz4000Hz切迹切迹自身免疫性内耳病（自身免疫性内耳病（AIEDAIED）自身免疫性自身免疫性损害累及耳害累及耳蜗&/&/前庭前庭临床特点床特点 中年女性中年女性 双双侧不不对称或称或单侧快速快速进行性行性/波波动性性 蜗性或性或蜗后性后性HL HL 伴其它自身免疫性疾病伴其它自身免疫性疾病 病程病程较长（数周）数周）诊断断 缺乏敏感可靠的缺乏敏感可靠的试验诊断方法断方法治治疗 高高剂量量类固醇固醇药物和免疫抑制物和免疫抑制剂 少数少数经恰当治恰当治疗可可获较好好疗效的内耳病之一效的内耳病之一外淋巴瘘外淋巴瘘原因：原因：外淋巴和中耳腔之外淋巴和中耳腔之间的骨的骨质破破损膜性膜性组织/韧带破裂破裂致使外淋巴和中耳腔交通致使外淋巴和中耳腔交通诊断：断：有使中耳或有使中耳或颅内内压突然升高的病史突然升高的病史单耳耳 突突发性性SNHL SNHL 伴前庭症状伴前庭症状治治疗后眩后眩晕不减不减轻&SNHL&SNHL逐逐渐加重加重特特发性突性突聋突然突然发生生 原因不明原因不明 数分数分钟、数小、数小时 单耳耳 高高频SNHL 50SNHL 50伴眩伴眩晕7-10d7-10d内治内治疗效果效果较好好1/3 1/3 1/31/3 1/3 1/3全身性疾病全身性疾病甲状腺功能减退症甲状腺功能减退症肾脏疾病疾病糖尿病糖尿病高血高血压和高血脂症和高血脂症血液性疾病血液性疾病助听器助听器选配配对象象/适适应症症有残余听力有残余听力药物或手物或手术治治疗无效，病情无效，病情稳定定 传导性性聋耳硬化症耳硬化症特特发性突性突聋前庭前庭导水管水管扩大大综合症合症骨骨导助听器助听器选配适配适应症症外耳道外耳道闭锁、狭窄、狭窄、长期流期流脓等不适宜用耳塞等不适宜用耳塞者者1k1k和和2kHz ABG HL 40dB2kHz ABG HL 40dB验配助听器的步配助听器的步骤1.1.询问病史病史To ask experience in the past:To ask experience in the past:听力不好有多听力不好有多长时间了？做了？做过哪些哪些检查和治和治疗？是否？是否戴戴过助听器助听器,效果怎效果怎样?how long you have hearing loss?Did you see a how long you have hearing loss?Did you see a doctor?did you wear a hearing aids?how about your doctor?did you wear a hearing aids?how about your feeling?feeling?2.2.检查耳部耳部To look over ear:To look over ear:耳廓外型是否正常？外耳道是否通耳廓外型是否正常？外耳道是否通畅？是否有分泌是否有分泌物？如果有是干性物？如果有是干性还是湿性是湿性,鼓膜是否完整？有无鼓膜内鼓膜是否完整？有无鼓膜内陷、中耳陷、中耳积液、穿孔、炎性息肉等液、穿孔、炎性息肉等 。auricle shape?external ear canal?ear auricle shape?external ear canal?ear drum?middle ear drum?middle ear？Cerumen?Cerumen?验配助听器的步配助听器的步骤3.3.检查听力并听力并对照照检查结果作出分析。果作出分析。To analysis hearing tests result.To analysis hearing tests result.4.4.选择功率和听力曲功率和听力曲线匹配的助听器匹配的助听器进行行调试。To choose the suitable hearing aids.To choose the suitable hearing aids.5.5.使用使用电脑软件、声件、声场或或AuricalAurical的的长期会期会话图谱测试效果。效果。To evaluate result by using the computer software To evaluate result by using the computer software,sound field,Aurical.,sound field,Aurical.6.6.询问需要的档次需要的档次,说服并达成服并达成协议。To ask some detail and persuade him to purchase To ask some detail and persuade him to purchase hearing aidshearing aidsTHANK YOU!THANK YOU!人有了知人有了知识，就会具，就会具备各种分析能力，各种分析能力，明辨是非的能力。明辨是非的能力。所以我所以我们要勤要勤恳读书，广泛，广泛阅读，古人古人说“书中自有黄金屋。中自有黄金屋。”通通过阅读科技科技书籍，我籍，我们能丰富知能丰富知识，培养培养逻辑思思维能力；能力；通通过阅读文学作品，我文学作品，我们能提高文学能提高文学鉴赏水平，水平，培养文学情趣；培养文学情趣；通通过阅读报刊，我刊，我们能增能增长见识，扩大自己的知大自己的知识面。面。有有许多多书籍籍还能培养我能培养我们的道德情操，的道德情操，给我我们巨大的精神力量，巨大的精神力量，鼓舞我鼓舞我们前前进。50.51.THANK YOUSUCCESS2024/1/282024/1/28周日周日5252.