Antonelli A R, Bellotto R, Grandori F
Audiology. 1987;26(4):209-26. doi: 10.3109/00206098709081550.
122 subjects divided into four groups according to the site of lesion (cochlea, eighth nerve, brainstem and temporal lobe) were subjected to an audiometric test battery, including pure-tone sensitivity measures, recruitment testing, tone decay, Békésy audiometry, speech audiometry, stapedius reflex measures and auditory brainstem response (ABR) audiometry. The results were contrasted among the four groups by calculating several measures of test performance, including sensitivity, specificity, efficiency, A' (test performance) and plots on the receiver operating characteristic (ROC) space of pure positives versus false alarms. In the differential diagnosis between eighth nerve and cochlear site, the various measures did not rank the tests in the same order: (a) for efficiency: ABR, Békésy audiometry; (b) for A' (similarly to the analysis into the ROC space): ABR, recruitment, Békésy, stapedius reflex, speech audiometry, tone decay. In distinguishing an eighth nerve from a brainstem site, it is important to consider amount of hearing loss, presence of tinnitus, abnormal tone decay and Békésy audiometry patterns. ABR adds significant diagnostic efficiency only when waves II, III and V are detectable: a prolonged I-II interpeak interval (IPI) and a normal III-V IPI are characteristic of the eighth nerve site. ABR gives good diagnostic support in the intrinsic brainstem lesions by suggesting changes in the generator sites of the component waves. The audiometric diagnosis of temporal lobe lesions involving the auditory cortex still relies upon speech audiometry: tests specifically designed for this purpose by Bocca and Calearo and by Jerger - i.e. the 'sensitized sentences' and the identification of synthetic sentences under ipsi- or contralateral competing message - are commendable for their sensitivity and efficiency in distinguishing brainstem from temporal lobe sites. In brainstem sites, the most affected ear is ipsilateral to the lesion for ABR, but contralateral for speech audiometry.
122名受试者根据病变部位（耳蜗、第八神经、脑干和颞叶）分为四组，接受了一系列听力测试，包括纯音敏感度测量、重振测试、音衰测试、Békésy听力计测试、言语听力测试、镫骨肌反射测量和听觉脑干反应（ABR）听力测试。通过计算几种测试性能指标，包括敏感度、特异度、效率、A'（测试性能）以及在纯阳性与假警报的接收者操作特征（ROC）空间上的绘图，对四组结果进行了对比。在第八神经和耳蜗部位的鉴别诊断中，各种指标对测试的排序并不相同：（a）效率方面：ABR、Békésy听力计测试；（b）A'方面（类似于ROC空间分析）：ABR、重振、Békésy、镫骨肌反射、言语听力测试、音衰测试。在区分第八神经和脑干部位时，重要的是要考虑听力损失程度、耳鸣的存在、异常音衰和Békésy听力计测试模式。只有当能检测到波II、III和V时，ABR才会增加显著的诊断效率：I-II峰间潜伏期（IPI）延长且III-V IPI正常是第八神经部位的特征。ABR通过提示成分波发生器部位的变化，为脑干内部病变提供了良好的诊断支持。涉及听觉皮层的颞叶病变的听力诊断仍然依赖于言语听力测试：由博卡和卡莱罗以及杰格尔专门为此设计的测试——即“致敏句子”以及在同侧或对侧竞争信息下对合成句子的识别——因其在区分脑干和颞叶部位方面的敏感度和效率而值得称赞。在脑干部位，ABR受影响最严重的耳朵与病变同侧，但言语听力测试则相反。
