大连地区217641例新生儿听力筛查结果回顾性分析

目的了解大连地区新生儿听力障碍的发病状况,发现听力筛查过程中存在的主要问题。方法对近5年大连地区出生的新生儿,在出生后3～5天内用畸变产物耳声发射(Disto rtio n pro duct o toacoustic emission,DPOAE)筛查仪进行初筛,初筛不通过者在42天进行复筛,复筛不通过者3个月内进行听觉脑干反应(auditory brainstem response,ABR)、多频听觉稳态反应(auditory steady state response,ASSR)、40Hz相关电位(40Hz-auditory evoked related potentials,40Hz–AERP)、声导抗测听等检查,对患儿进行综合听觉评估。结果 5年时间内大连地区应该筛查新生儿总数233856人,实际筛查217641人,初筛率为93.1%;初筛通过率为90.6%(197254/217641),复筛率为74.3%(漏检率为25.7%,5236/20387),复筛通过率90.5%(12194/15151),复筛不通过2957人;新生儿听力障碍诊治中心接诊2069人,就诊率为70%(2069/2957);确诊为听力障碍373例(607耳),听力障碍发病率为1.71‰;双耳听力障碍234例(轻、中、重、极重度听力障碍发病率分别为0.23‰、0.36‰、0.19‰、0.29‰),单耳听力障碍139例;有45例(45/106)重度-极重度听力障碍患儿6个月内没有确诊,其中9例为初筛不通过而没有进行复筛,36例初筛、复筛均不通过却没有及时就诊。结论大连地区新生儿听力障碍发病率与既往报道类似;完善听力障碍高危儿童的召回制度,提高复筛率和就诊率是减少听力障碍儿童漏诊的关键。     

重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查

目的基于对我院新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿的筛查,初步获得听神经病(auditory neuropathy,AN)在此类人群中患病情况的基本资料,探讨适合于我国国情的NICU新生儿听力筛查模式。方法采用自动听性脑干反应(automated auditory brainstem response,AABR)两阶段筛查方案,即:NICU新生儿在出院前或病情稳定时以AABR进行听力初筛,对未通过者发放复筛通知单,嘱出院1个月后门诊接受AABR复筛。复筛仍未通过者,于3个月内转诊到我院儿童听力中心,进行包括听性脑干反应(ABR)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)和声导抗测试在内的全面听力学诊断评估。如ABR波V反应阈>35dBnHL,则认为有听力损失。AN诊断依据:ABR缺失、严重异常或阈值≥70dBnHL,伴DPOAE正常和声导抗测试鼓室图呈单峰型或双峰型。结果对2007年9月—2009年4月从我院NICU出院的1343名新生儿进行了听力筛查。117例(8.7%)未通过出院前的AABR初筛,其中88例(75.2%)1月后接受了AABR复筛,22例未通过。后者经全面的听力学诊断评估,10例(7.4‰)双侧或单侧ABR阈值>35dBnHL,诊断有听力损失,其中2例(1.5‰)分别表现为双耳ABR缺失和阈值>70dBnHL,而DPOAE正常、鼓室图为单峰型以及镫骨肌声反射未引出,诊断为AN。结论本组NICU新生儿听力损失总发病率(7.4‰)及听神经病发病率(1.5‰)低于已往文献报道。本研究未发现任何可以预测AN发生的听力损失高危因素,这可能与目标人群样本量较小有关。AABR两阶段筛查法是NICU新生儿合适的听力筛查模式。     

台州市610007例新生儿听力筛查结果分析

目的分析2011~2018年台州市新生儿听力筛查结果,探讨该市免费及自费新生儿听力筛查率及耳聋检出率。方法对台州市2010年10月~2018年9月出生的新生儿于出生后48小时后至出院前进行筛查型畸变产物耳声发射(DPOAE)或自动听性脑干反应(AABR)听力筛查(2011~2012年为自费,2013~2018年为免费),初筛未通过者30~42天左右复筛,复筛未通过者3月龄进行听性脑干反应(ABR)、DPOAE、声导抗、听性稳态反应(ASSR)等测试进行听力诊断。结果 2010年10月~2018年9月台州市共出生新生儿621 032例,其中610 007例新生儿进行了听力筛查,筛查率98.22%,共有53 959例未通过初筛,初筛未通过率为8.85%;完成复筛47 794例,复筛率为88.57%;复筛未通过8 051例,复筛未通过率为16.85%,其中6 869例进行了听力学诊断,诊断率为85.32%;共确诊听力障碍患儿979例,听力损失检出率为1.58‰(979/621 032)。采用DPOAE筛查的447 489例中确诊听力障碍患儿728例(1.63%),采用AABR筛查的162 518例中确诊听力障碍患儿251例(1.54%),两种方法听力障碍检出率差异无统计学意义(P>0.05),但两种方法初筛未通过率(10.17%和5.21%)、复筛未通过率(16.28%和19.86%)差异有统计学意义(P<0.01)。2011~2012年为自费组,共有活产新生儿170 806例,有164 894例进行听力初筛,筛查率96.54%;初筛未通过17 822例,其中14 498例进行了复筛,复筛率81.35%;复筛未通过2 948例,其中2 060例进行了听力学诊断,诊断率69.88%;共确诊听力障碍患儿223例,检出率为1.31‰(223/170 806)。2013~2018年度为免费组,共有活产新生儿450 226例,有445 113例进行听力初筛,筛查率98.86%,初筛未通过36 137例,其中33 296例进行了复筛,复筛率92.14%,复筛未通过5 103例,其中4 809例进行了听力学诊断,诊断率94.20%,共确诊听力障碍患儿756,听力损失检出率为1.68‰(756/450 226);自费组和免费组初筛率、复筛率、诊断率、听力损失检出率差异均有统计学意义(P<0.01)。结论由政府出资免费的新生儿听力筛查可以明显提高听力筛查率和耳聋检出率,早期筛查、诊断、康复干预是减少听力障碍所致残疾的关键。     

新生儿听力筛查11 275例分析报告

目的通过新生儿听力筛查,了解先天性听力损失的发病率及其可能的高危因素,探讨早期听力筛查、诊断、干预、随访的可行性办法。方法新生儿出生3天采用畸变产物耳声发射(DPOAE)进行听力初筛;未通过者及有听损伤高危因素的新生儿42天后用DPOAE和快速听性脑干反应(AABR)进行复筛;听力异常者3个月时以听性脑干反应(ABR)进行诊断,6个月时采用ABR和多频稳态反应(ASSR)第二次确诊;确诊有听力损失的患儿立即采取干预措施,并定期随访、进行听力学评估。结果初筛时正常儿未通过率占14.8%、高危儿为21.5%,复筛时大多数正常儿通过,而高危儿仍有半数未通过;就目前进入3个月诊断的患儿分析,先天性听力损失发生率约在2.75‰左右,其中轻、中、重、极重度分别为0.18‰、1.78‰、0.26‰、0.53‰。结论先天性听力损失在新生儿先天性疾患中发病率最高,开展大面积筛查势在必行;做好听损伤高危因素的问卷调查,跟踪随访异常患儿尤为重要。     

兰州地区新生儿听力筛查初步分析

目的 了解兰州地区新生儿听损伤的发病情况及新生儿听力筛查的部分影响因素.方法 自2006年4月至2006年12月应用瞬态诱发耳声发射(transient evoked otoacoustic emission,TEOAE)对兰州地区四家医院产科出生的1 728例新生儿进行听力筛查,于出生后3～7天初筛,初筛未通过者于生后42天行复筛,复筛仍未通过者于生后3个月时行听性脑干反应(auditory brainstem response,ABR)检查进行诊断.结果 初筛通过率为92.8%(1 604/1 728),初筛未通过率7.2%(124/1 728),复筛率59.7%(74/124),复筛通过率83.8%(62/74),复筛未通过率16.2%(12/74).最后经ABR诊断为听损伤者3例.结论 耳声发射是有效的新生儿听力筛查工具,在兰州地区进行新生儿听力筛查势在必行.复筛率低是本次筛查的突出问题,需采取切实可行的措施提高复筛率.     

Titan听力测试平台在新生儿听力筛查及听力诊断中的应用

目的应用Titan对初筛未通过的听力高危新生儿进行复筛,评价Titan在新生儿听力筛查及听力诊断中的作用。方法对223例（446耳）初筛未通过的听力高危新生儿在出生后第40天左右（前后不超过3 d）应用Titan分别行自动听性脑干反应（automated auditory brainstem response, AABR）、耳声发射（otoacoustic emission,OAE）、声导抗检测;AABR、OAE系统自动判断是否通过,声导抗检测采用1 KHz探测音,鼓室压低于-50 dapa、声顺＜0.3 ml认定为异常;统计数据,并分析其结果。结果AABR复筛通过436耳,复筛通过率为97.76%（436/446）,OAE复筛通过348耳,通过率为78.03%（348/446）,二者差异有显著性（χ2=81.59,P<0.05）;声导抗检测异常者共81耳,异常率为18.16%（81/446）,其中在AABR复筛未通过10耳中存在声导抗检测异常者共1耳,异常率为10%（1/10）,OAE复筛未通过98耳中存在声导抗检测异常者共57耳,异常率为58.16%（57/98）,二者差异有显著性（χ2=6.64,P<0.05）。结论Titan是一款集AABR、OAE、声导抗检测于一体的新型听力检测仪器,应用于新生儿听力筛查可有效降低假阳性率,并能及早评价患儿的中耳功能,鼓室负压、咽鼓管功能不良是新生儿听力筛查假阳性率高的一个重要因素。     

海南省新生儿听力筛查结果及听力损失高危因素分析

目的 回顾性分析海南省2021年出生的新生儿听力筛查结果及听力损失高危因素,为临床早期发现、诊断和干预提供指导。方法 对正常新生儿94 118例采用OAE进行听力初筛,初筛未通过者用OAE+AABR进行复筛,复筛仍未通过者采用OAE、ABR、声导抗进行听力诊断。高危儿组2 356例先采用OAE进行初筛,通过者采用AABR进行复筛,未通过者采用OAE+AABR进行复筛,复筛未通过者进行听力学诊断。结果 正常新生儿组94 118例中,初筛未通过率为7.74%(7 284/94 118);复筛率为54.00%(3 933/7 284),复筛未通过率为27.28%(1 073/3 933),确诊听力障碍383例,检出率为0.41%(383/94 118)。高危儿组2 536例中,初筛未通过率为13.76%(349/2 536),复筛率为31.07%(788/2 536),复筛未通过率为16.12%(127/788),确诊听力障碍42例,检出率为1.66%。新生儿听力障碍由高到低的危险因素为存在颅面形态畸形者(包括耳廓、外耳道畸形)、有儿童期永久性耳聋家族史、极低出生体重、高胆红素血症达到换血指...     

高危新生儿听力筛查及听损伤高危因素分析

目的:通过对高危新生儿听力筛查,识别应当接受听力学评估的新生儿;发现和证实高危新生儿听损伤的高危因素.方法:用DPOAE初筛,对初筛未通过者用DPOAE加ABR进行复筛,复筛未通过者进行听力学诊断.应用Logistic逐步回归法分析听力障碍相关高危因素.结果:共筛查327例,初筛未通过率为37.0%;复筛未通过率为11.0%,确诊10例,听力障碍发病率为3.39%.高危因素为窒息、低体重(<1 500 g)和头颈部畸形.结论:①对高危儿进行听力筛查,DPOAE和ABR相结合是一种可靠、可行的筛查方法;②本资料中与听损伤相关的高危因素为窒息、低体重(<1 500 g)和头颈部畸形.     

应用畸变产物耳声发射进行新生儿听力筛查388例报告

目的 早期发现新生儿听力损失,以便进行诊断和干预.方法应用GS170自动耳声发射听力筛查仪,应用畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE）对2006年6月1日～2007年3月31日在广州市天河区中医院出生的388例活产婴儿进行听力初筛,未通过者42天内进行复筛,复筛未通过者行听性脑干反应（ABR）检测进一步确诊.结果 388例新生儿中有387例例接受听力初筛,初筛率99.74%,357例通过初筛,初筛通过率92.25%;复筛19例,复筛率63.33%,复筛通过率100%.结论 DPOAE听力筛查未通过的新生儿应于出生后42天内行ABR检查,进一步确诊.     

韶关市2354例新生儿听力筛查结果分析

目的初步了解韶关市新生儿先天性听力损失发病情况,探讨如何提高新生儿听力筛查率。方法 2007年4月至2009年9月在粤北人民医院出生的2354例新生儿,采用畸变产物耳声发射（DPOAE）筛查仪进行听力初筛,初筛未通过者在42天复筛,复筛仍未通过者,于生后3个月进行诊断性DPOAE、声导抗、听性脑干反应（ABR）检查,进行确诊。结果同期出生新生儿3017人,筛查率78.02%（2354/3017）,初筛通过率为90.02%（2119/2354）,需42天复筛235人,实际复筛138人,复筛率58.72%（138/235）,复筛通过率为73.19%（101/138）。新生儿先天性听力损失的检出率为2.12‰（5/2354）,其中正常足月儿1例,高危因素儿（早产儿、窒息缺氧、高胆红素症、先天性畸形）4例。结论本组新生儿听力初、复筛率偏低,听力高危因素儿的先天性听力损失发生率明显高于正常足月儿;如何提高筛查率和复筛率是目前亟待解决的问题。     

比较单一的DPOAE和DPOAE/AABR联合技术进行的目标新生儿听力筛查方法研究

目的通过单一的畸变产物耳声发射（DPOAE）和DPOAE／自动听性脑干反应（AABR）联合技术进行目标新生儿的听力筛查，以研究目标新生儿听力筛查的敏感性。方法记录出生3～24天的200名新生儿（400耳）的单一畸变产物耳声发射（DPOAE）和DPOAE／AABR联合技术测试的结果。筛查对象来自复旦大学附属儿科医院和上海儿童医学中心新生儿重症监护室（NICU）的有高危听力损害的新生儿。结果在开始的听力筛查中，共有29名新生儿（14．5％）在单一的DPOAE中未通过，而9名（4．5％）在联合运用DPOAE和AABR检查中未通过。在随访的诊断评估中，包括耳科检查、声阻抗、诊断性的听性脑干反应（DABR），6名新生儿11耳（3％）在出生后2个月时最终被诊断为真正的感音神经性听力损失。运用DPOAE和AABR联合测试，使高危儿童听力筛查的敏感性高达98．5％，并能够大大减少假阳性率。在频率分析中发现在通过AABR（短声刺激）测试的23耳中，高频的DPOAE通过率（％）比较高（2562Hz为93％，3187HZ为88％）。没有通过AABR测试的15耳，低频（500、1000和1593Hz）的DPOAE通过率（％）比高频（2562．3187和4031Hz）略高。结论DPOAE和AABR联合测试技术可以广泛运用于新生儿听力筛查，敏感性较高，可以减少假阳性并提供频率特异性。     

新生儿监护病房儿童听力筛查及诊断结果分析

目的对在耳鼻喉科听力诊断中心进行听力诊断评估,并且有新生儿监护病房住院史婴幼儿的听力筛查及诊断结果进行比较分析,旨在评价目前所用听力筛查方法的有效性。方法选取有新生儿监护病房住院史并于耳鼻咽喉科进行听力诊断评估的婴幼儿,分析其自动听性脑干反应(AABR)及畸变产物耳声发射(DPOAE)筛查资料,并与诊断型听性脑干反应(ABR)的结果进行对比分析。结果本组同时完成DPOAE、AABR筛查及诊断型ABR测试,并且资料完整保存者共89例177耳。DPOAE筛查未通过率为45.8%,AABR筛查的未通过率为46.3%。两种筛查方法的一致率为64.4%。AABR的假阴性率为27.9%,DPOAE为16.3%,联合使用两种筛查方法时其假阴性率为4.7%。诊断型ABR测试异常共26例43耳(24.3%),其中轻度听力损失22耳,中度7耳,重度3耳,极重度11耳,听力损失为双侧者17例,单侧者9例,双侧听力损失患者中双耳听力损失程度对称者12例,不对称者5例。本组确诊听力损失婴幼儿中存在的高危因素包括:新生儿重症监护病房(NICU)住院超过5天;早产儿呼吸窘迫综合征;机械通气48h以上;出生体重低于1500g;新生儿窒息(Apgar评分1分钟0~4分或5分钟时0~6分);高胆红素血症胆红素水平达到换血要求;颌面部畸形(小耳、外耳道闭锁或畸形、腭裂);细菌性脑膜炎。结论使用AABR或AABR与DPOAE联合筛查可用于NICU新生儿的听力筛查,有新生儿听力损失高危因素的婴幼儿有转诊进行听力诊断评估的指证。     

A model of two-stage newborn hearing screening with automated auditory brainstem response

Our purpose was to evaluate a two-stage newborn hearing screening program using automated auditory brainstem response (AABR) before discharge and to describe our follow-up program. This study used 4085 infants born in the Seirei-Hamamatsu and Mikatahara General Hospitals during a 2-year period. The initial screening test was performed 2 or 3 days after birth at an intensity of 35 dBnHL. For the infants who were referred from this test, the re-screening test was performed 5 or 6 days after birth. Diagnostic work-up with auditory brainstem response (ABR), otoacoustic emissions (OAE), and a conditioned orientation reflex audiometry (COR) test were performed by the age of 3-6 months. The referral rate was 1.20% (49/4085 infants) in the first test and 0.71% (29/4085 infants) in the two-stage screening. The two-stage screening procedure was able to reduce the false-positive rate from 0.83 to 0.34%. The incidence of bilateral and unilateral congenital hearing loss diagnosed by ABR was 8/4085 (0.20%) infants and 7/4085 (0.17%) infants, respectively. One infant with congenital cytomegalovirus infection, who passed the two-stage AABR tests, was diagnosed with hearing loss 1 month after birth, using ABR. The two-stage measurement of AABR is effective and time efficient due to significant decreases in the referral rate and the false-positive rate.     

Performance of two hearing screening protocols in NICU in Shanghai

Objective

To study the sensitivity and specificity of targeted neonatal hearing screening for the single-session distortion product otoacoustic emissions (DPOAE) technique and the combined DPOAE/automated auditory brain-stem response (AABR) technique.

Methods

3000 high-risk newborns were studied at Children's Hospital of Fudan University. They were required to take two different screening procedures separately. The first procedure consisted of DPOAE alone and the second consisted of DPOAE combined with the AABR. Based upon the etiology in high-risk babies, they were divided into four groups. In group I there were 670 very-low-birth-weight (VLBW) newborns (1340 ears), and in group II there were 890 preterm babies (1780 ears). 850 babies (1700 ears) suffered from hyperbilirubinemia in group III, whereas 790 babies (1580 ears) with asphyxia were in group IV. The babies in groups II, III, and IV came from the neonatal intensive-care unit (NICU) of our hospital. The study protocols consisted of the DPOAE alone and DPOAE combined with AABR hearing screening at an age of less than 1 month, and a diagnostic stage at the age of 2 months.

Results

With single-session DPOAE screening, the referral rate (8% of the NICU babies), the false-positive rate (4.96%) and the false-negative rate (0.8%) were higher. The different etiologies in NICU babies had significantly different referral rates (F-test, p < 0.01). A 4.46% referral rate of hyperbilirubinemi babies was much lower. The combined DPOAE/AABR screening technique revealed a referral rate of 5.03%, a false-positive rate of 2% and a false-negative rate of 0.06%. The false-positive rate was well below the suggested 3% of the American Academy of Pediatric. Comparisons of the referral rate, false-positive rate and false-negative rate of two hearing screening protocols (DPOAE alone and combined DPOAE/AABR) revealed significant differences (t-test, p < 0.05, p < 0.01, p < 0.01). 91 infants (3.03% of the NICU babies) who failed the combined DPOAE/AABR screening were confirmed on hearing impairment. Of 22 babies who passed DPOAE screening but failed the AABR screening had a severe to profound hearing loss based on classic ABR. These patients (24% of the NICU babies with hearing losses) with hyperbilirubinemia and asphyxia problems at newborn stage were diagnosed as auditory neuropathy based on evaluations of DPOAE screening passed, abnormal ABR and absent middle-ear muscle reflexes (MMR).

Conclusion

Our study demonstrates the use of a combination of DPOAE and AABR testing ensures high sensitivity and acceptable specificity, and predict the AN profile in NICU babies. Our efforts identified 22 NICU babies with auditory neuropathy who hopefully will benefit from early remediation of their hearing deficit.     

Evaluation of an automated auditory brainstem response in a multi-stage infant hearing screening

An automated auditory brainstem response (AABR) method, the Maico MB-11 with BERAphone^®, has been developed for hearing screening in newborns. The aim of this study was to test the validity of this automated ABR screening method in a multistage newborn hearing screening (NHS). We applied a “five level” protocol using transient evoked otoacoustic emission (TEOAE), AABR-MB-11 with BERAphone^® and conventional auditory brainstem response (ABR). TEOAE, AABR, and conventional ABR testing were performed by ENT specialists experienced in neonatal screening techniques. Among the 8,671 newborns tested (males 3,889; females 4,782), only 42 newborns were lost to follow-up and the final false-positive rate was of 0.03%. Our experience highlights that for the neonatal period, conventional auditory brainstem response is the most reliable method for assessing the hearing level and minimizing the false-positive rate. Although AABR (performed by ENT specialists experienced in neonatal screening techniques) is easy to use, fast and with a good compliance, the device is unable to provide accurate and certain diagnosis on the degree of hearing loss to allow a proper treatment.     

353例NICU患儿自动听性脑干反应结果分析

目的探讨新生儿重症监护病房(neonatal intensive care unit,NICU)听力筛查模式及容易导致听力损失的高危因素。方法运用自动听性脑干反应(automatic auditory brainstemresponse,AABR)对353例(706耳)重症监护病房的新生儿进行初步听力筛查,随机抽样109例(218耳)正常新生儿为对照组,对比分析不同高危因素对筛查结果的影响。结果筛查NICU患儿353例(706耳),初筛未通过184例(281耳),初筛阳性率39.8%(281/706);筛查正常新生儿组109例(218耳),初筛未通过23例(27耳),初筛阳性率为12.4%(27/218),两组初筛阳性率差异有显著统计学意义(P=0.000),NICU的新生儿听力筛查初筛阳性率远高于正常新生儿。NICU新生儿不同疾病的初筛阳性率分别为:新生儿窒息46.4%,新生儿肺炎45.9%,高胆红素血症38.8%,早产儿38.1%,足月小样儿35.0%,其他34.0%。结论应用AABR技术进行听力筛查是可行的。在NICU中普及听力筛查,并对这些患儿随访、复筛,及时发现其听力损失,是提高新生儿听力损失早期诊断率的重要手段。     

Auditory neuropathy/dyssynchrony as a cause of failed neonatal hearing screening

The prevalence of auditory neuropathy/dyssynchrony (AN/AD) is not exactly known. We retrospectively analysed the prevalence of this condition among 135 infants who failed a neonatal screening. Hearing screening was performed by automated auditory brainstem responses (AABR). Unilateral presence of click-evoked oto-acoustic emissions with absent auditory brainstem responses was found in 4 infants. Magnetic resonance imaging of the posterior fossa showed an aplasia/hypoplasia of the ipsilateral cochlear nerve in these 4 cases. The prevalence of AN/AD was 19% in infants with confirmed hearing loss. Our findings underscore the role of AABR in neonatal hearing screening.     

Newborn hearing screening at a community-based obstetric unit: Screening and diagnostic outcomes

ObjectivePostnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated non-professional screener at a community-based MOU in the Western Cape, South Africa.MethodsUniversal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone™⁾ and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days’ time and were rescreened with the same technology used at their first screen. Those referring the second stage were booked for diagnostic assessments.Results7452 infants were screened including 47.9% (n = 3573) with DPOAE and 52.1% (n = 3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral SNHL among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day).ConclusionsPostnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.     

未通过听力筛查的新生儿诊断测听结果分析

目的通过分析未通过听力筛查的新生儿诊断测听结果,全面了解这些幼儿的听力状况,以便更好地采取应对措施。方法对102例未通过新生儿听力筛查的幼儿进行畸变产物耳声发射（DPOAE）和听性脑干反应（ABR）测试,并参考声导抗测试结果进行听力学诊断。结果双耳听力正常33例（33。7％）;双耳听力异常47例（48％）,其中轻中度听力损失26例（26．5％）、重度以上听力损失21例（21．4％）;单耳听力正常18例（18．4％）。4例只进行了DPOAE测试者未记入最后统计数据。结论在未通过新生儿听力筛查的幼儿中,听力损失表现出一定程度的多样性,部分幼儿的听力有一定的波动。在临床工作中。应根据不同的听力损失情况做出相应处理。     

听力筛查AABR未通过而TEOAE通过高危新生儿的听力追踪

目的了解听力筛查AABR未通过而TEOAE通过高危新生儿的听力变化和特点。方法 2008年至2010年对复筛时AABR未通过而TEOAE通过的23例高危新生儿在3月龄时进行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)以及高频声导抗(high frequency tympanometry,HFT)检查,对ABR异常的患儿在6月龄时复查。结果 3月龄和6月龄时DPOAE各频率基本引出,HFT均为单峰。3月龄时23例患儿中5例双耳ABR反应阈≤35dB nHL,余18例(30耳)单耳或双耳ABR异常,其中8耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;15耳只引出波Ⅴ,反应阈70～97dB nHL;7耳97dB nHL声刺激下无波形引出;符合听神经病(auditory neuropa-thy,AN)诊断12例,双耳8例,单耳4例。ABR异常的18例(30耳)6月龄复查时,1耳反应阈≤35dB nHL,29耳反应阈异常,其中,6例(11耳)ABR反应阈降低,1例(2耳)反应阈升高;29耳中14耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;11耳只引出波Ⅴ,反应阈70～97dB nHL;4耳97dB nHL未引出波形;符合AN诊断9例,双耳4例,单耳5例。23例患儿1～2岁时电话随访,19例对声音反应良好,2例言语发育稍迟缓,2例2岁时仍不会说话,其中1例合并脑瘫,1例CT示脑白质异常,戴助听器均无效。结论本组听力筛查AABR未通过而TEOAE通过的婴儿听力发展不确定,选择治疗方案需慎重,对这类小儿应长期听力追踪至少到3岁。