2062例婴儿的听力检查结果分析

目的探讨3～6月龄婴儿听力障碍的诊断方法。方法对2005年1月～2007年6月在上海交通大学医学院附属上海儿童医学中心就诊的2062例(4124耳)3～6月龄婴儿有选择地进行客观听力测试,包括听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、声导抗等检查,3月龄时诊断为听力异常者6月龄时复查,收集、分析两次听力测试的资料。结果3月龄时13例(20耳)ABR异常、DPOAE正常,504例(825耳)ABR、DPOAE均异常;ABR异常的845耳中,482例(808耳)(37耳失访)6月龄时复查示:13例(20耳)ABR异常、DPOAE正常,406例(702耳)ABR、DPOAE均异常,47例(64耳)ABR、DPOAR均正常,16例(22耳)ABR正常,DPOAR异常;比较两次检查结果显示:698耳(86.4%)听力无变化,90耳(11.1%)听力改善,20耳(2.5%)听力下降;在ABR反应阈正常、DPOAE未通过者中有438耳同时行226Hz及1000Hz探测音声导抗测试,1000Hz探测音声导抗异常183耳(41.8%),226Hz探测音声导抗异常6耳(1.37%)。结论3～6月龄婴儿的听力诊断必须结合ABR、OAE检查结果综合分析判断,必要时进一步行高频声导抗检查;0～6月龄婴儿中耳功能的检查,运用1000Hz探测音声导抗比226Hz的更敏感;对确诊听力障碍者,尤其是有听力障碍高危因素者,必须密切随访,警惕听力波动及进行性的听力下降。

An Analysis of Hearing Test Results in 2062 Infants from Birth to Six Months

Objective To explore the methods of evaluating the hearing status in infants from birth to six months.Methods Infants were evaluated with a series of objective tests including Auditory Brainstem Response(ABR),the Evoked Otoacoustic Emissions(OAE),and tympanometry.3 month old infants with hearing loss need hearing tests again at six months.These hearing test results were collected and analyzed.Results There were 20 ears with abnormal ABR and normal DPOAE,825 ears with abnormal ABR and DPOAE at 3 month old.At six months,the re-assessment found 20 ears with abnormal ABR and normal DPOAE,702 ears with abnormal ABR and DPOAE.In comparison of the two findings of ABR thresholds,we found 86.4% infants with the same result,11.1% with better hearing and 2.5% with worse hearing.438 ears with normal ABR failed DPOAE and they received both 226 Hz and 1 000 Hz tympanometry.183 ears(41.8%)were abnormal at 1 000 Hz tympanometry,and only 6 ears(1.37%)abnormal at 226 Hz.Conclusion Infants with hearing loss were identified by a series of objective tests including Auditory Brainstem Response(ABR),Evoked Otoacoustic Emissions(OAE)and high frequency tympanometry.1 000 Hz tympanometry is more sensitive to the middle ear function in infants than 226 Hz tympanometry.Due to delayed and hereditary sensorineural deafness,the follow-up is important to the infants with hearing loss,especially to the infants with high risk of hearing loss.