Musiek Frank E, Shinn Jennifer, Chermak Gail D, Bamiou Doris-Eva
The University of Arizona, Tucson, AZ.
The University of Kentucky, Lexington, KY.
J Am Acad Audiol. 2017 Jul/Aug;28(7):655-671. doi: 10.3766/jaaa.16061.
The pure-tone audiogram, though fundamental to audiology, presents limitations, especially in the case of central auditory involvement. Advances in auditory neuroscience underscore the considerably larger role of the central auditory nervous system (CANS) in hearing and related disorders. Given the availability of behavioral audiological tests and electrophysiological procedures that can provide better insights as to the function of the various components of the auditory system, this perspective piece reviews the limitations of the pure-tone audiogram and notes some of the advantages of other tests and procedures used in tandem with the pure-tone threshold measurement.
To review and synthesize the literature regarding the utility and limitations of the pure-tone audiogram in determining dysfunction of peripheral sensory and neural systems, as well as the CANS, and to identify other tests and procedures that can supplement pure-tone thresholds and provide enhanced diagnostic insight, especially regarding problems of the central auditory system.
A systematic review and synthesis of the literature.
The authors independently searched and reviewed literature (journal articles, book chapters) pertaining to the limitations of the pure-tone audiogram.
The pure-tone audiogram provides information as to hearing sensitivity across a selected frequency range. Normal or near-normal pure-tone thresholds sometimes are observed despite cochlear damage. There are a surprising number of patients with acoustic neuromas who have essentially normal pure-tone thresholds. In cases of central deafness, depressed pure-tone thresholds may not accurately reflect the status of the peripheral auditory system. Listening difficulties are seen in the presence of normal pure-tone thresholds. Suprathreshold procedures and a variety of other tests can provide information regarding other and often more central functions of the auditory system.
The audiogram is a primary tool for determining type, degree, and configuration of hearing loss; however, it provides the clinician with information regarding only hearing sensitivity, and no information about central auditory processing or the auditory processing of real-world signals (i.e., speech, music). The pure-tone audiogram offers limited insight into functional hearing and should be viewed only as a test of hearing sensitivity. Given the limitations of the pure-tone audiogram, a brief overview is provided of available behavioral tests and electrophysiological procedures that are sensitive to the function and integrity of the central auditory system, which provide better diagnostic and rehabilitative information to the clinician and patient.
纯音听力图虽是听力学的基础,但存在局限性,尤其是在中枢听觉受累的情况下。听觉神经科学的进展凸显了中枢听觉神经系统(CANS)在听力及相关疾病中更为重要的作用。鉴于现有的行为听力学测试和电生理检查方法能够更深入地了解听觉系统各组成部分的功能,本文综述了纯音听力图的局限性,并指出了与纯音阈值测量联合使用的其他测试和检查方法的一些优点。
回顾并综合有关纯音听力图在确定外周感觉和神经系统以及CANS功能障碍方面的实用性和局限性的文献,并确定其他能够补充纯音阈值并提供更深入诊断见解的测试和检查方法,尤其是关于中枢听觉系统问题的方法。
对文献进行系统回顾和综合。
作者独立检索并回顾了与纯音听力图局限性相关的文献(期刊文章、书籍章节)。
纯音听力图提供了所选频率范围内听力敏感度的信息。尽管存在耳蜗损伤,有时仍可观察到正常或接近正常的纯音阈值。相当数量的听神经瘤患者的纯音阈值基本正常。在中枢性耳聋的情况下,降低的纯音阈值可能无法准确反映外周听觉系统的状态。纯音阈值正常时也会出现听力困难。阈上检查程序和其他各种测试可以提供有关听觉系统其他且通常更中枢功能的信息。
听力图是确定听力损失类型、程度和形态的主要工具;然而,它仅为临床医生提供有关听力敏感度的信息,而不提供有关中枢听觉处理或现实世界信号(即语音、音乐)听觉处理的信息。纯音听力图对功能性听力的洞察有限,应仅视为听力敏感度测试。鉴于纯音听力图的局限性,本文简要概述了对中枢听觉系统功能和完整性敏感的现有行为测试和电生理检查方法,这些方法可为临床医生和患者提供更好的诊断和康复信息。