耳聋的分类及区别

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,10/8/2024,耳 聋,Hearing loss,GN Resound Asia Trade promotion&Training Dept.,2,耳聋的定义,耳聋是指听觉系统的传音、感音功能异常所导致的听觉障碍或听力减退。,听觉能力随年龄的增长而逐渐减退的现象称为老年性聋。,3,听力损失的程度,25dB HL,正常,normal,26,40dB HL,轻度,light,41,55dB HL,中度,middle,56,70dB HL,中重度,middle severe,71,90dB HL,重度,severe,90dB HL,极重度,profound,HL:,听力级，以听力零级为标准,耳聋的分级,4,耳聋的分类及病因,按耳聋发病的时间分类（一）,1.,先天性耳聋：,孕期、分娩期及产后最初数日内发生的听力障碍均称为先天性聋。,（,1,）遗传性聋：基因或染色体异常所致的耳聋。,（,2,）非遗传性聋：孕期、临产期、产后因素所致。,2.,后天性耳聋：,后天因素导致的耳聋。,（,1,）感染性聋：各种急、慢性传染病所致。,（,2,）药毒性聋：某些药物或化学制剂所致。,（,3,）创伤性聋：外伤因素。,（,4,）慢性中耳炎,5,耳聋的分类及病因,按耳聋发病的时间分类（二）,1.,产前原因：,（,1,）遗传性因素：基因或染色体异常所致的耳聋，占,50%,。,（,2,）感染性因素：感染风疹、麻疹病毒等某些病原微生物。,（,3,）医源性因素：使用某些药物或接受某些医学检查。,（,4,）全身性因素：患糖尿病、高血压等疾病。,2.,产期原因：,缺氧、产伤、早产、低体重、高胆红素血症,3.,产后原因：,（,1,）遗传性因素：出生后听力正常，到一定年龄才出现听力损失。,（,2,）感染性因素：各种急、慢性传染病所致。,（,3,）药物性因素：,100,多种耳毒性药物。,（,4,）自身免疫缺陷性因素、变态反应性因素、爆震和噪声、外伤、肿瘤等,6,耳聋的分类及病因,按病变的性质分类,1.,器质性聋：,听觉系统有器质上的变化。,（,1,）传导性聋,（,2,）感音神经性聋：蜗性聋、蜗后聋,（,3,）混合性聋,2.,非器质性聋：,纯音听阈测试结果与实际听力损失程度不一致的情况称为非器质性聋。,（,1,）功能性聋：精神性聋、癔病性聋，受刺激引起，属精神或心理因素致聋。,（,2,）伪聋,7,耳聋的分类,按发病的部位分类,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：,感音性耳聋，耳蜗病变。,Cochlea hearing loss:sensorineural hearing loss,the,cochlea has the inflammation.,3.,蜗后聋：,神经性耳聋，听神经或大脑听中枢病变,Central Hearing loss nervous hearing loss,the morbid part of the nerve center.,感音神经性耳聋,传导性耳聋,8,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,Central Hearing loss,中枢性（蜗后聋）,9,Conductive loss,传导性耳聋,发病部位：外耳、中耳,10,-10,0,10,20,30,40,50,60,70,80,90,100,110,120,dB Hearing Threshold Level,125 250 500 1500 3000 6000,1000 2000 4000 8000,R,Unmasked,L,Unmasked,x,O,听力图特点,传导性聋 Conductive loss,O,O,x,O,x,O,x,x,O,O,x,x,Air Bone Gap,R Bone,L Bone,传导性聋(CONDUTION HEARING LOSS),气导异常,（一般不超过,60dB,）,骨导正常,气骨导间距大于等于10dBHL(ABG,10dBHL),见于外耳及中耳疾患,11,传导性耳聋,Conductive hearing loss,特点：,1.,骨导正常,Bone condition is normal.,2.,气导下降，早期以低频下降,为主，晚期高频也下降。,Air condition drop.At first,Low frequency go down mostly.,Then each frequency drop together.,3.,骨气导值之间有一个明显的距离。,The distance show between the,bone condition and air condition.,4.,阈上功能测试：无重振。,5.,声导抗测试：鼓室功能曲线异常。,6.ABR,测试：阈值升高、潜伏期延长。,12,Conductive loss,传导性耳聋,病 因,外耳道疾病,The external ear disease,：,耳部畸形,Congenital malformations,耵聍栓塞,Impacted earwax,外耳道炎,Inflammation of the ear canal,13,Conductive loss,传导性耳聋,病 因,常见的中耳疾病,The middle ear disease,：,急性中耳炎,Acute otitis media,慢性中耳炎,Chronic otitis media,鼓膜穿孔,Perforated eardrum,耳硬化症,Otosclerosis,听骨链中断,Interruption of the ossicular chain,咽鼓管功能异常,Dysfunction of the Eustachian tube,肿瘤或胆脂瘤,Exostoses and osteomas,14,Sensorineural loss,感音神经性耳聋,发病部位：耳蜗、听神经、中枢,15,-10,0,10,20,30,40,50,60,70,80,90,100,110,120,dB Hearing Threshold Level,125 250 500 1500 3000 6000,1000 2000 4000 8000,R Air,L Air,x,O,感音神经性聋,Sensorineural loss,听力图特点,O,x,x,O,O,O,O,O,x,O,x,x,x,x,R Bone,L Bone,感音神经性聋(SENSORY NEURAL HEARING LOSS SNHL),气导异常,骨导异常,气骨导间距小于等于5dBHL(ABG,5dBHL),见于内耳及听中枢疾患,16,Sensorineural hearing loss,感音神经性耳聋,特点：,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.,气导骨导之间无距离,There is no a distance show,between the bone condition and air condition.,4.,阈上功能测试：可能出现重振。,5.,声导抗测试：鼓室功能曲线正常，镫,骨肌反射引不出。,6.ABR,测试：阈值升高或引不出、潜伏期,延长。,17,感音神经性聋,Sensorineural hearing loss,病 因,突发性聋,sudden deaf,中枢性聋,central hearing loss,先天性聋,antenatal pre-birth hearing loss,遗传性,inheritance,非遗传性：母亲妊娠早期，患流感、风疹。,梅尼埃病,M,ni,re disease,听神经瘤,hearing neuroma,18,感音神经性聋,Sensorineural hearing loss,病 因,迷路炎,Labyrinthitis,颞骨骨折,temporal bone fracture,非器质性聋,功能性聋,伪聋,19,先天性耳聋,Heritage,感染性耳聋,Infections,：脑膜炎,噪音性耳聋,Noise exposure:4000Hz,老年性耳聋,Age,药物中毒性耳聋,Drug,感音神经性聋,The sensorineural losses,20,感音神经性聋,Sensorineural hearing loss,药物中毒性耳聋,Drug,氨基甙类抗生素（链霉素、庆大霉素和卡那霉素等）,非氨基甙类抗生素（氯霉素、红霉素等）,水杨酸盐（阿司匹林、解热镇痛片等）,利尿剂（呋塞米、利尿酸等）,抗疟药（奎宁、氯奎等）,抗肿瘤药物（顺铂、氮芥、氨甲嘌呤等）,其它（乙醇、一氧化碳、心得安、胰岛素、乌头碱、铅、,汞、金、砷等,）,21,Mixed hearing loss,混合性耳聋,病变部位：外耳和（或）中耳、内耳,22,-10,0,10,20,30,40,50,60,70,80,90,100,110,120,dB Hearing Threshold Level,125 250 500 1500 3000 6000,1000 2000 4000 8000,R,Unmasked,L,Unmasked,x,O,O,O,x,x,O,x,O,O,x,x,O,x,L Bone,R Bone,混合聋(MIXED HEARING LOSS),气导异常,骨导异常,气骨导间距大于等于10dBHL(ABG,10dBHL),见于外和/或中、内耳共存疾患,混合聋 Mixed hearing loss,听力图特点,23,Mixed hearing loss,混合性耳聋,特点：,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.,气导骨导,有一个明显的距离。,The distance show between the bone condition and air condition.,4.,阈上功能测试：可能出现重振。,5.,声导抗测试：可能异常。,6.ABR,测试：阈值升高、潜伏期延长。,24,耳聋的预防,传导性、神经性、混合性耳聋的预防,遗传性、药物性、感染性、噪音性、爆震性耳聋的预防,小儿耳聋的预防,老年性耳聋的预防,25,如何保护听力,1.,慎用耳毒性药物,比如链霉素、庆大霉素等，儿童尽量不用,2.,防止耳部感染,预防感冒，患中耳炎要尽早治疗,3.,远离噪音,少听随身听,4.,及时发现听力障碍,及早选配助听器，避免听力障碍加重,26,Treatment of hearing impairment,Medication,药物,Opera