耳聋相关疾病与听力图分析模版课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,耳聋相关疾病与听力图分析,Hearing loss disease & audiogram analysis,耳的症状学,Ear semeiology,耳痛otalgia,耳漏Otorrhea,耳痒ear itch,耳鸣tinnitus,耳聋hearing loss,眩晕vertigo,面瘫,face paralysis,耳后肿胀,tumefaction,耳聋的分类,按耳聋病发的时间分类,antenatal pre- birth hearing loss inheritance,1.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,postnatal after birth hearing loss,遗传,遗传,非遗传,非遗传,耳聋的分类,按病发的部位分类,Hearing loss class according to inflammation part.,1.蜗前聋：传导性耳聋，外耳、中耳病变。,Pre-cochlea hearing loss: conductive hearing loss,external ear and middle ear have inflammation.,2.蜗性聋：感应性耳聋，耳蜗本身病变。,Cochlea hearing loss: sensorineural hearing loss,the,cochlea has the inflammation.,3.蜗后聋：神经性耳聋，大脑听中枢病变。,Central Hearing loss: sensorineural hearing loss,nerve center is the morbid part.,感音神经性耳聋,传导性耳聋,耳聋的分类,Conductive hearing loss,传音性（传导性、蜗前聋）,Sensorineural Hearing loss,感音神经性（蜗性、蜗后聋）,Mixed hearing loss,混合性,Centrum Hearing loss,中枢性（蜗后聋）,传导性耳聋 Conductive hearing loss,正常听力图 The normal audiogram,频率,Frequency on the x-axis,声强,Intensity on the y-axis,Frequency range:,125 - 8000 Hz,Intensity range:,-10 - 120 dB,(air conduction),Example of Conductive hearing loss,传导性耳聋,Conductive hearing loss,1.骨导正常,Bone condition is normal.,2.气导下降,Air condition,3.气骨导差 10 dB,A-B gap is more than 10,dB.,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。 ABG 30dB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。 ABG60dB,5.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,Ear,malformations,耵聍栓塞,Impacted earwax,外耳湿疹,Acute otitis media,外耳道炎,Inflammation of the ear canal,外耳道塌陷,Dent of the ear canal,耳道扩大,Expand of the ear canal,异物,eyewinker,鼓膜穿孔,Perforated eardrum,流脓,Purulence,穿孔后愈合,Scar over after Perforated,肿瘤或胆脂瘤,Exostoses,and,osteomas,鼓膜疤痕,Eardrum scar,鼓膜硬化,Eardrum sclerosis,常见的中耳疾病,化脓性中耳炎,Suppurative otitis media,分泌性中耳炎,Secretory otitis media,耳硬化症,Otosclerosis,听骨链固定,Fixation of the ossicular chain,听骨链中断,Interruption of the ossicular chain,鼓室硬化,tympana sclerosis,感音神经性耳聋 Sensorineural loss,响度改变,Altered loudness,Poorer sensitivity to soft and intermediate sounds,Some times increased sensibility to loud sounds,失真,Distortion (missing frequencies),言语分辨率下降,Poor discrimination (especially in noise condition),耳鸣,Tinnitus,伴随症状,Associated problems,Relationship of loudness and intensity level,Stach, 1998 pp. 97,Frequency resolving ability,Stach, 1998 pp. 96,Sensorineural hearing loss,1.气骨导都下降。,Air conductive decline,2.气导早期以高频下降为主，晚期低频也下降。,High frequency decline at first,time, then both decline.,3.气骨导差 10 dB,A-B gap is more than 10dB,耳 聋 相 关 疾 病,耳聋分类,时间- congenital & acquired,性质- organic & functional/psychogenic,部位- conductive,sensorineural,& mixed,cochlear, retrocochlear & central,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（2kHz 15dB),声导抗：As,CT：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, 产前期母体的感染、中毒, 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、CS,2,、SO,2,（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SNHL 50伴眩晕,7-10d内治疗效果较好,1/3 1/3 1/3,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2kHz ABG HL 40dB,验配助听器的步骤,询问病史,To ask experience in the past:,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,?,how long you have hearing loss? Did you see a doctor?did you wear a hearing aids?how about your feeling?,检查耳部,To look over ear:,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 。,auricle shape?external ear canal?ear drum?middle ear,？,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。,To analysis hearing tests result.,4.选择功率和听力曲线匹配的助听器进行调试。,To choose the suitable hearing aids.,5.使用电脑软件、声场或Aurical的长期会话图谱测试效果。,To evaluate result by using the computer software ,sound field, Aurical.,6. 询问需要的档次,说服并达成协议。,To ask some detail and persuade him to purchase hearing aids,THANK YOU!,