轻微-轻度听力损失与正常听力学龄期儿童听觉处理能力差异的多维度评估

doi:10.12372/jcp.2025.25e0845

摘要/Abstract

摘要：

目的分析轻微-轻度感音神经性听力损失（SMHL）患儿与正常听力（NH）儿童在多种中枢听觉处理任务上的差异，探索早期识别与干预轻度听力损失儿童听觉功能的必要性及可能性。方法研究采用病例对照设计，选择2023年12月至2024年12月于耳鼻咽喉头颈外科听语中心门诊以及新生儿听力障碍诊治中心就诊的6~9岁儿童作为研究对象。按纯音测听结果将受试者分为SMHL组和NH组，比较两组的时间分辨率（采用噪声间隙测试）、空间分辨率（采用声源定位任务）及言语识别（采用双耳言语识别率测试）。结果共纳入58例学龄期儿童，SMHL组与NH组各29例，每组男女比均为15∶14。SMHL组年龄为（89.7±12.0）个月，NH组年龄为（90.4±10.6）个月。SMHL患儿组在不同噪声条件下的双耳言语识别率显著低于NH儿童组（P均<0.05），SNR越低，任务表现越差。SMHL患儿组最小可听角（P<0.01）以及粉噪声角度识别均方根误差（P<0.01）显著低于NH儿童组。SMHL患儿组的噪声间隙识别门限高于NH组但不显著（P=0.375）。结论 SMHL患儿在噪声环境中言语识别、部分声源定位任务上表现显著不如NH儿童，提示后续有必要开展研究，评估SMHL患儿的上述障碍是否进一步影响他们的认知发展和社会适应，以及干预的适宜性。

关键词: 轻微-轻度听力损失, 听觉处理, 学龄期儿童

Abstract:

Objective To investigate the differences between children with slight-mild hearing loss (SMHL) and children with normal hearing (NH) on a variety of central auditory processing tasks, and to explore the necessity and possibility of early identification and intervention of auditory function in children with mild hearing loss. Methods The study adopted a case-control design and selected children aged 6 to 9 who visited the outpatient department of the Otorhinolaryngology Head and Neck Surgery Hearing and Speech Center and the Neonatal Hearing Impairment Diagnosis and Treatment Center from December 2023 to December 2024 as the research subjects. According to the pure tone audiometry results, the two groups of subjects were divided into the SMHL group and the NH group. The temporal resolution (using the gap-in-noise test), spatial resolution (using the sound source localization task), and speech recognition (using the binaural speech recognition rate test) of the two groups were compared. Results A total of 58 school-age children were included, with 29 children in the SMHL group and 29 children in the NH group. The male-to-female ratio in each group was 15:14. The age of the SMHL group was (89.7±12.0) months, and that of the NH group was (90.4±10.6) months. The binaural speech recognition rate of the SMHL group under different noise conditions was significantly lower than that of the NH group (P<0.05), and the lower the SNR, the worse the task performance. The minimum audible angle (P<0.01) and the root mean square error of pink noise source azimuth identification (P<0.01) in the SMHL group were significantly lower than those in the NH group. The threshold for gap-in-noise (GIN) recognition was higher in the SMHL group than that in the NH group but not significant (P=0.375). Conclusions Children with SMHL demonstrate significantly poorer performance in speech recognition and certain sound source localization tasks in noisy environments compared to NH children, suggesting the need for further research to evaluate whether these deficits may further impact their cognitive development and social adaptation, as well as the appropriateness of interventions.

Key words: slight-mild hearing loss, auditory processing, school-age children

中图分类号:

刁聪, 沈怡雯, 王强, 赵宇, 孟照莉. 轻微-轻度听力损失与正常听力学龄期儿童听觉处理能力差异的多维度评估[J]. 临床儿科杂志, 2025, 43(12): 922-927.

DIAO Cong, SHEN Yiwen, WANG Qiang, ZHAO Yu, MENG Zhaoli. Multidimensional assessment of differences in auditory processing ability between slight-mild hearing loss and normal-hearing school-age children[J]. Journal of Clinical Pediatrics, 2025, 43(12): 922-927.

图/表 3

表1

表2

表3

参考文献 23

[1]	Guzzetta F, Conti G, Mercuri E. Auditory processing in infancy: do early abnormalities predict disorders of language and cognitive development?[J]. Dev Med Child Neurol, 2011, 53(12): 1085-1090. doi: 10.1111/j.1469-8749.2011.04084.x pmid: 21838818
[2]	Sininger YS, Grimes A, Christensen E. Auditory development in early amplified children: factors influencing auditory-based communication outcomes in children with hearing loss[J]. Ear Hear, 2010, 31(2): 166-185.
[3]	Ross DS, Holstrum WJ, Gaffney M, et al. Hearing screening and diagnostic evaluation of children with unilateral and mild bilateral hearing loss[J]. Trends Amplif, 2008, 12(1): 27-34. doi: 10.1177/1084713807306241 pmid: 18270176
[4]	Tharpe AM. Unilateral and mild bilateral hearing loss in children: past and current perspectives[J]. Trends Amplif, 2008, 12(1): 7-15. doi: 10.1177/1084713807304668 pmid: 18270174
[5]	Moore DR, Zobay O, Ferguson MA. Minimal and mild hearing loss in children: association with auditory perception, cognition, and communication problems[J]. Ear Hear, 2020, 41(4): 720-732.
[6]	Walker EA, Sapp C, Dallapiazza M, et al. Language and reading outcomes in fourth-grade children with mild hearing loss compared to age-matched hearing peers[J]. Lang Speech Hear Serv Sch, 2020, 51(1): 17-28. doi: 10.1044/2019_LSHSS-OCHL-19-0015 pmid: 31913806
[7]	Clark JG. Uses and abuses of hearing loss classification[J]. ASHA, 1981, 23(7): 493-500. pmid: 7052898
[8]	Crandell CC. Speech recognition in noise by children with minimal degrees of sensorineural hearing loss[J]. Ear Hear, 1993, 14(3): 210-216. doi: 10.1097/00003446-199306000-00008
[9]	Lewis DE. Speech understanding in complex environments by school-age children with mild bilateral or unilateral hearing loss[J]. Semin Hear, 2023, 44(Suppl 1): S36-S48.
[10]	Lewis D, Schmid K, O’Leary S, et al. Effects of noise on speech recognition and listening effort in children with normal hearing and children with mild bilateral or unilateral hearing loss[J]. J Speech Lang Hear Res, 2016, 59(5): 1218-1232. doi: 10.1044/2016_JSLHR-H-15-0207
[11]	Chen Z, Yuan W. Central plasticity and dysfunction elicited by aural deprivation in the critical period[J]. Front Neural Circuits, 2015, 9: 26.
[12]	Lewis D, Al-Salim S, McDermott T, et al. Impact of room acoustics and visual cues on speech perception and talker localization by children with mild bilateral or unilateral hearing loss[J]. Front Pediatr, 2023, 11: 1252452. doi: 10.3389/fped.2023.1252452
[13]	Lewis DE, Smith NA, Spalding JL, et al. Looking behavior and audiovisual speech understanding in children with normal hearing and children with mild bilateral or unilateral hearing loss[J]. Ear Hear, 2018, 39(4): 783-794.
[14]	Ahrens A, Joshi SN, Epp B. Perceptual weighting of binaural lateralization cues across frequency bands[J]. J Assoc Res Otolaryngol, 2020, 21(6): 485-496. doi: 10.1007/s10162-020-00770-3
[15]	Bonham BH, Lewis ER. Localization by interaural time difference (ITD): effects of interaural frequency mismatch[J]. J Acoust Soc Am, 1999, 106(1): 281-290. pmid: 10420622
[16]	Park TJ. IID sensitivity differs between two principal centers in the interaural intensity difference pathway: the LSO and the IC[J]. J Neurophysiol, 1998, 79(5): 2416-2431. pmid: 9582217
[17]	Folkerts ML, Picou EM, Stecker GC. Spectral weighting functions for localization of complex sound. III. The effect of sensorineural hearing loss[J]. J Acoust Soc Am, 2024, 156(4): 2434-2447. doi: 10.1121/10.0030471 pmid: 39400266
[18]	Ginzburg J, Fornoni L, Aguera PE, et al. Development of auditory cognition in 5- to 10-year-old children: focus on speech-in-babble-noise perception[J]. Child Dev, 2025, 96(1): 407-425. doi: 10.1111/cdev.v96.1
[19]	Osman H, Sullivan JR. Children’s auditory working memory performance in degraded listening conditions[J]. J Speech Lang Hear Res, 2014, 57(4): 1503-1511. doi: 10.1044/2014_JSLHR-H-13-0286
[20]	Litovsky R. Development of the auditory system[J]. Handb Clin Neurol, 2015, 129: 55-72. doi: 10.1016/B978-0-444-62630-1.00003-2 pmid: 25726262
[21]	Baltus A, Herrmann CS. Auditory temporal resolution is linked to resonance frequency of the auditory cortex[J]. Int J Psychophysiol, 2015, 98(1): 1-7. doi: 10.1016/j.ijpsycho.2015.08.003 pmid: 26268810
[22]	Jain S, Vasudevamurthy B, Raghavendra A. Maturation of temporal processing in children: measurements using speech and non-speech stimuli[J]. J Hear Sci, 2015, 5(2): 23-35. doi: 10.17430/893284
[23]	Shiell MM, Champoux F, Zatorre RJ. The right hemisphere planum temporale supports enhanced visual motion detection ability in deaf people: evidence from cortical thickness[J]. Neural Plast, 2016, 2016: 7217630.

项目	SMHL组(n=29)	NH组(n=29)	统计量	P
男性[n(%)]	15(17.24)	15(17.24)	χ²=0.00	1.000
听力情况[M(P₂₅~P₇₅)]/dB HL
右耳平均听阈	27.50(20.63~35.00)	7.50(5.00~10.00)	Z=6.55	<0.001
左耳平均听阈	28.75(20.63~36.25)	6.25(5.00~10.00)	Z=6.55	<0.001
年龄($\bar{x}±s$)/月	89.7±12.0	90.4±10.6	t=0.26	0.799
高危因素[n(%)]	2(3.44)	1(1.72)	－	1.000¹⁾
其他疾病史[n(%)]	1(1.72)	1(1.72)	－	1.000¹⁾
睡眠问题[n(%)]	5(8.62)	4(6.90)	－	1.000¹⁾
母亲学历[n(%)]			χ²=0.27	0.605
大专及以下	9(15.52)	7(12.07)
本科及以上	20(34.48)	22(37.93)
父亲学历[n(%)]			χ²=1.17	0.279
大专及以下	13(22.41)	9(15.52)
本科及以上	16(27.59)	20(34.48)

项目	SMHL组(n=29)	NH组(n=29)	Z值	P
右耳言语识别率/%
安静	100(96~100)	100(98~100)	1.91	0.560
SNR 5	88(80~92)	92(92~96)	3.90	<0.001
SNR 0	80(74~88)	88(84~92)	2.70	0.007
SNR －5	68(56~78)	84(76~86)	4.05	<0.001
左耳言语识别率/%
安静	96(94~100)	100(96~100)	2.31	0.020
SNR 5	88(80~92)	96(92~96)	3.34	<0.001
SNR 0	80(72~86)	88(84~92)	4.11	<0.001
SNR－5	68(60~76)	84(74~88)	4.61	<0.001

项目	SMHL组(n=29)	NH组(n=29)	统计量	P
MAA[M(P₂₅~P₇₅)]/°	5.00(2.50~5.00)	2.50(2.50~5.00)	Z=3.43	<0.001
粉噪声RMSE[M(P₂₅~P₇₅)]/°	7.08(5.30~10.61)	5.60(3.54~6.21)	Z=3.38	<0.001
言语声RMSE
安静[M(P₂₅~P₇₅)]/°	7.08(6.13~10.90)	7.50(4.67~9.36)	Z=1.20	0.230
SNR5[M(P₂₅~P₇₅)]/°	9.69(8.11~13.12)	9.36(8.11~11.35)	Z=0.94	0.350
SNR0($\bar{x}±s$)/°	12.17±4.29	10.64±3.25	t=1.53	0.133
SNR－5($\bar{x}±s$)/°	13.96±3.04	12.03±3.87	t=2.12	0.039