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。

Results of Hearing Screening and Diagnostic Audiology Assessment in NICU Infants

Objective To evaluate the efficacy of current hearing screening methodology Methods The results of hearing screening (AABR and DPOAE) and auditory diagnostic tests (ABR) in infants with history of admission to the NICU and referral for diagnostic audiology assessment were analyzed Results Included in this study were 89 infants (177 ears) with complete screening AABR and DPOAE and diagnostic ABR test data .The fail rate was 45.8% for DPOAE screening and 46.3% for AABR screening.The rate of agreement between DPOAE and AABR screening was 64.4%.The false negative rate was 27.9% for AABR,16.3% for DPOAE and 4.7% for the combination of the two.Diagnostic ABR was Abnormal in 26 infants (24.3%) (43 ears).Mild hearing loss was found in 22 ears,moderate in 7 ears,severe in 3 ears and profound in 9 ears.Bilateral hearing loss was found in 17 infants and monaural hearing loss in 9 infants.Among those with bilateral hearing loss,hearing loss was symmetrical in 12 infants and asymmetrical in 5.Risk factors for hearing loss in this population included:mechanical ventilation for more than 48 hours,birth weight lower than 1500g,NICU hospitalization time longer than 5 days,hyperbilirubinemia and the serum bilirubin levels requiring exchange transfusion,maxillofacial deformity,bacterial meningitis.Conclusions AABR or combined use of AABR and DPOAE screening can be used in NICU infants.Infants with high-risk factors of hearing loss should be considered for referral to diagnostic audiology assessment.