耳声发射在新生儿听力筛查中的应用

目的探讨耳声发射在新生儿听力筛查中的作用。方法862名新生儿(包括48例听损伤高危儿)在出院前接受耳声发射测试，未通过者42天回访时复查，仍未通过者，行听性脑干反应检查。结果862名新生儿中，68例未通过耳声发射初筛，9例在42天回访时未通过复筛，经过听性脑干反应测试，1例未通过测试，经全面的听力学诊断，确诊为重度感音神经性聋，48例高危儿耳声发射及听性脑干反应均正常。结论耳声发射在新生儿听力筛查中应为首选方法，高危儿及未通过耳声发射筛查者，应做听性脑干反应检查，并注意跟踪、随访。     

耳声发射用于新生儿听力筛查的体会

目的总结新生儿听力筛查的体会。方法采用丹麦Capella全功能耳声发射仪对出生后48～72h的100例正常新生儿进行听力筛查。结果100例筛查者中，94例达到“通过”标准（可认为听力大致正常），通过率为94.0%。结论耳声发射听力筛查是早期发现新生儿听力障碍的有效方法，选择准确的筛查时间节点可提高筛查正确率。     

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.     

耳声发射在重症监护新生儿听力筛查中的应用

目的 探讨重症监护新生儿(NICU)的合适听力筛查方法.方法 用瞬态诱发耳声发射仪(TEOAE),对263例重症监护新生儿进行听力筛查,未通过者1个月后进行复查,仍未通过者将接受脑干诱发电位(ABR)检查,以确定有无听力损失.结果 263例NICU新生儿中,209例通过了第一次OAE筛查,1个月后43例通过了OAE复查,最后11例行ABR检查,5例确诊有不同程度的听力损失.结论 TEOAE和 ABR联合应用的两步筛查法是NICU新生儿听力筛查的可行方法.     

瞬态诱发耳声发射用于黄疸新生儿的听力筛查

目的：探讨瞬态诱发耳声发射（transient evoked otoacoustic emission,TEOAE)应用于新生儿黄疸听力筛查的可行性及临床意义。方法：采用前瞻性队列研究的方法对新生儿病房277例黄疸新生儿及50例健康新生儿应用CELESTA503耳声发射仪进行TEOAE检测，出院前和3个月后复查。结果：初查时黄疸新生儿TEOAE通过率为64．23％，健康新生儿TEOAE通过率为96％，两组检出率经统计学分析，有非常显著差异（P＜0．01）。第一次复查黄疸新生儿TEOAE通过率为88％，第二次复查黄疸新生儿TEOAE通过率为100％。结论：TEOAE是快速可行的高危新生儿听力筛查方法；新生儿测试耳TEOAE的通过率与黄疸严重程度有关；黄疸对耳蜗的影响是可逆的。     

畸变产物耳声发射用于新生儿听力筛查的影响因素分析

目的 探讨畸变产物耳声发射(DPOAE)用于新生儿听力筛查的影响因素。方法 采用GSI-70全自动便携式耳声发射仪进行新生儿听力筛查，在筛查同时，自制问卷表，对新生儿的出生史，母亲妊娠史，家族史，父母社会阶层等35个因素进行调查，调查结果运用SPSS统计软件进行统计分析。结果 住院期间82．8％的(3242／3944)新生儿通过筛查，通过率右耳高于左耳，女婴高于男婴，单胎高于多胎，足月儿高于早产儿，正常及高出生体重儿高于低出生体重儿，阴道助产高于自然产、剖宫产，P值均小于0．05。多因素logistic回归分析，出生体重、性别、胎数与初筛结果相关。42天复筛，96．4％(3167／3284)通过筛查，影响初筛结果的因素对复筛无影响。结论 新生儿的性别、分娩方式、胎数、孕周、出生体重对应用DPOAE进行的新生儿听力筛查的初筛结果有显著影响。     

高频畸变产物耳声发射在新生儿听力筛查中的应用

目的 探讨高频畸变产物耳声发射(high frequency DPOAE,HFDPOAE)在新生儿听力筛查中的特点及应用价值.方法 对261例(522耳)新生儿(正常对照组93例186耳及疾病组168例336耳)同时进行常频畸变产物耳声发射(conventional frequency DPOAE,CFDPOAE)和HFDPOAE听力筛查测试,分别比较采用CFD-POAE和HFDPOAE的初筛阳性率以及不同组新生儿各频率DPOAE的平均幅值,并进行统计学分析.结果 对照组CFDPOAE的阳性率显著高于HFDPOAE(P=0.000),疾病组采用CFDPOAE和HFDPOAE的阳性率无显著性差异(P＞0.05);采用CFDPOAE时,对照组与疾病组的筛查阳性率无显著性差异(P＞0.05);采用HFD-POAE时,疾病组的筛查阳性率显著高于对照组(P=0.007).DPOAE的幅值在2、8、12和16 kHz频率时各组间有统计学差异;各组DPOAE平均幅值:对照组最高,早产儿和非听损伤危险因素相关疾病组仅次于对照组,其次为新生儿窒息组和黄疸组,具有二种及以上听损伤危险因素相关疾病组最小;各组新生儿频率-幅值函数曲线呈双峰型,在4 kHz为峰值低谷,在2和8～12 kHz分别为二个峰值.结论 HFDPOAE能较敏感地反映听觉的受损情况,并能降低CFDPOAE听力筛查的假阳性率,对高频听力障碍的早期发现可能具有一定的应用价值.     

正常出生新生儿瞬态诱发耳声发射与畸变产物耳声发射听力筛查结果比较

目的 探讨瞬态诱发耳声发射(transient evoked otoacoustic emissions,TEOAE)和畸变产物耳声发射(distortion products otoacoustic emissions,DPOAE)用于新生儿听力筛查特点,为正常出生新生儿听力筛查方法的选择提供参考.方法 于出生后48~72小时,对1 062例正常出生的新生儿分别使用TEOAE和DPOAE进行听力初筛,其中135例未通过初筛者,在42天龄左右,同时进行TEOAE和DPOAE复筛;复筛未通过者3月龄左右进行诊断型听性脑干反应测试. 结果 1 062例新生儿中TEOAE初筛未通过率为11.02%(117/1 062),DPOAE未通过率为13.65%(145/1 062);135例进行了复筛,TEOAE和DPOAE未通过率分别为17.78%(24/135)和20.74%(28/135),DPOAE初、复筛未通过率均高于TEOAE,差异均有统计学意义(P<0.001);TEOAE和DPOAE在初筛和复筛中的一致率分别为96.04%和95.56%,kappa值分别为0.817和0.857.在初筛中TEOAE每耳的平均测试时间为24±25 s,DPOAE为40±34 s;在复筛中TEOAE为52±41 s,DPOAE为73±62 s,配对样本t检验显示两种方法的测试时间差异有统计学意义(P=0.000).复筛的135例中,共有7例(10耳)最终被诊断为不同程度的传导性听力损失(9耳)及感音神经性听力损失(1耳),这10耳TEOAE和DPOAE初、复筛均未通过. 结论 作为正常出生新生儿的听力筛查方法,TEOAE较DPOAE未通过率低,耗时少;作为新生儿听力筛查工具,TEOAE可能比DPOAE有优势.     

未通过听力筛查新生儿的听力跟踪和确认

目的 探讨未通过听力筛查新生儿的听力跟踪的意义。方法 回顾性分析19302名新生儿听力筛查中未通过筛查的56例新生儿的围产期病史和听力学诊断资料。结果 19302名新生儿中未通过新生儿听力筛查者共56例，占筛查儿童的O．290％，以后隔2个月复查畸变产物耳声发射(distortion product otoacoustic emission，DPOAE)和听性脑干反应(auditory brainstem response，ABR)一次，共复查2至3次，其中1例新生儿在7个月龄时，听力达到正常范围，确诊为听力障碍的新生儿共55例，未通过听力筛查新生儿经跟踪确认后，确认听力障碍的比率为98．2％。结论 新生儿听力筛查后，对于未通过听力筛查的新生儿应坚持至少为期6个月的跟踪和随访，才能够确认其听力。     

畸变产物耳声发射与声阻抗在高危新生儿听力筛查中的应用

目的探讨高危新生儿未通过初次筛查是否与外耳道栓塞,中耳病变有关。方法对166例高危新生儿在出生后进行畸变产物耳声发射(DPOAE)检查,未通过的新生儿立即行声阻抗测试。结果初查时有38例新生儿未通过。声阻抗测得鼓室曲线均为A型。结论本研究显示新生儿未通过初次筛查与外耳道栓塞,中耳病变无明显联系。     

听力初筛未通过新生儿二次筛查模式探讨

目的 探讨听力初筛未通过新生儿于出院前进行二次筛查的意义.方法 应用瞬态诱发耳声发射(TEOAE)对3849名新生儿行听力筛查,初次时间为出生3 d,"未通过"者于出院前(生后5～7 d)再次筛查,二次筛查"未通过"者生后30～42 d复查.分别对三次筛查总通过率、不同耳别及分娩方式的通过率进行统计学分析.结果 新生儿出生3 d听力筛查通过率与住院期间两次筛查总通过率相比差异具有统计学意义(x2=38.67,P＜0.01);住院期间两次筛查总通过率与复筛总通过率差异无统计学意义(x2=2.73,P＞0.05).生后3 d初次筛查未通过出院前二次筛查中单耳比双耳通过率高,差异具有统计学意义(x2=34.34,P＜0.01);左耳通过率与右耳比较,差异无统计学意义(x2=0.62,P＞0.05).顺产出生3 d筛查通过率高于剖宫产,差异有统计学意义(x2=35.37,P＜0.05),出生5～7 d以及30～42 d复筛时两种分娩方式总通过率比较,差异无统计学意义(P值均＞0.05).结论 新生儿出生3 d初筛未通过者于出院前再次筛查的住院期间二次筛查模式可降低假阳性率,减少转诊率及失访率,减轻家长精神负担.     

Comparison of two hearing screening programs in the same population: Oto-acoustic emissions (OAE) screening in newborns and behavioral screening when infants

Objective

Hearing screening programs in infancy should identify hearing impairment as early as possible. The two common programs utilize either objective neonatal tests (oto-acoustic emissions (OAE) or automatic auditory brainstem responses (aABR)) or behavioral screening at 7-9 months of age. Most countries employ only one of these options. The uniqueness of this study is the comparison of both hearing screening programs on the same group of children.

Methods

The study was conducted on 1545 children born between the years 1999 and 2003 who were followed up in public well baby clinics in the Jerusalem district. The children were tested with transient oto-acoustic emissions (TEOAE) before discharge from the neonatal ward, and later, at the age of 7-9 months, underwent a behavioral hearing screening test in a public well baby clinic. The results of both hearing screening programs were compared.

Results

The compliance rates were 99.7% for the neonatal testing and 83% for the 7-9 months behavioral testing (p = 0.0001).The failure rate was 4-6% in both screening programs; failure of OAE testing was unilateral in 65% of newborns; at 7-9 months bilateral failure was more common (56%).There was an 11.2% disagreement (kappa coefficient 0.03) between the outcomes of both tests.In another group of 49 known hearing-impaired children, 27 who had undergone newborn screening were diagnosed before the age of behavioral testing. Twelve children had failed either both tests or the only test they underwent. In nine cases, the children had passed one of the hearing screening tests and had failed the other, and one child had passed both tests.

Conclusions

Newborn hearing screening has the advantages of objectivity, early identification, and higher compliance. The major advantage of the later behavioral test is identification of later onset or progressive hearing impairment as well as auditory neuropathy spectrum disorder. Each screening test is testing different entities; hence they are complementary and not interchangeable or superfluous.We recommend a comprehensive two-step hearing screening plan (newborn and later behavioral) with close cooperation between the health care providers involved.     

新生儿动脉血血气分析与听力筛查结果相关性

目的 探讨新生儿动脉血血气分析指标与听力筛查结果的关系。 方法 回顾性分析医学中心新生儿科496例患儿听力筛查结果和入院时动脉血血气分析指标。 结果 自动听觉脑干反应(AABR)、畸变产物耳声发射(DPOAE)和声导抗和总听力筛查通过率分别为61.9%(307/496)、61.3%(304/496)、90.1%(447/496)和56.7%(281/496)。三种听力筛查方法通过率差异有统计学意义(χ2=131.00,P<0.001)。AABR与DPOAE测试结果一致性极强(Kappa=0.817,P<0.001),两者与声导抗测试一致性较弱(Kappa值分别为0.262、0.256,P均<0.001)。单因素Logisitic分析显示乳酸升高(OR=0.544,P=0.001)、二氧化碳分压升高(OR=1.917,P=0.009)、pH降低(OR=1.692,P=0.021)与听力筛查不通过显著相关。多因素Logisitic分析显示,乳酸(OR=0.627,P=0.018)、氧分压(OR=1.493,P=0.047)与听力筛查结果不通过显著相关。二氧化碳分压、pH和血氧饱和度和听力筛查结果无明显相关性(P>0.05)。 结论 新生儿缺氧及其伴随的血气变化可能会影响听力筛查结果。     

An evaluation of BERA for hearing screening in high-risk neonates

Brain stem electric response audiometry (BERA) is evaluated for early detection of hearing loss in high-risk newborns selected from a general hospital population. They receive screening BERA in the nursery and detailed frequency-specific BERA in the Audiology clinic, just before discharge. Three months later, testing is repeated and recommendations are made. From 1364 assessments, 321 at-risk babies were identified; 234 received predischarge tests, and 200 had follow-up tests. Screening BERA with 40 dB nHL clicks is appropriate in the nursery. Screening sensitivity is good, and only 8% of babies failed. Several of these had mild hearing loss, resolving in the first trimester. Follow-up BERA confirmed hearing loss in 8 babies. Parental compliance is high, and the program is well-accepted. In conjunction with the high-risk register, BERA is useful both for screening and for quantitative audiometry in the infant.     

Reversible auditory brainstem responses screening failures in high risk neonates

This work is aimed at assessing the frequency of occurrence of reversible auditory brainstem responses (ABR) abnormalities within a targeted hearing screening program for high risk (HR) newborns. The effect of age on screening is also evaluated and some important clinical issues are highlighted. The audiological records of 1,294 HR neonates were retrospectively reviewed. All children were tested for hearing loss using ABR within a 17-year period. Initial failures were re-examined 4–6 months later. The mean age of infants who scored “pass” and “refer” at initial test, as well as the referral rates were calculated and compared. One hundred and seventy-eight infants (13.8%) demonstrated abnormal recordings at initial screening. From those who were present on re-examination, 64.2% showed complete and 15% partial recovery. Reversible abnormalities have been detected not only for conductive threshold elevation but also for sensorineural losses. Remarkably, 50% of the cases with absent waveforms or ABR threshold ≥80 dBnHL demonstrated complete recovery to normal. Statistically, higher rates of abnormal results were inversely associated with the newborn’s age at initial testing. In conclusion, reversible ABR abnormalities are common among HR infants due to temporary auditory dysfunction, secondary to external and middle ear pathology or retarded central nervous system maturation. The observed high rates of transient ABR abnormalities give rise to some practical questions regarding the implementation time of hearing screening for HR infants. Moreover, given that central nervous system maturation changes may still be in progress, the definite decision for an early cochlear implantation in this pediatric subset should be made after obtaining reliable behavioral hearing tests.     

Newborn hearing screening and genetic testing in 8974 Brazilian neonates

Objective

An early diagnosis has been a priority in the audiological practice. Identifying hearing loss until 3 months old through Universal Newborn Hearing Screening and intervention before 6 months old, minimize the impact of auditory loss in the health and communication development of these children. However, in the clinical practice, despite the help of the risk indicators in the audiological and etiological diagnosis, the integrated services have come up against the challenge of determining the causes of auditory loss, bearing in mind that approximately 50% of the subjects who have congenital loss do not show risk factors in their clinical history. The current research aims introduce together etiologic and audiological diagnosis of newborns.

Methods

We eluted dried blood spots from paper and performed genetic testing for 35delG mutation in 8974 newborns that were also screened for transient otoacoustic emissions (TOAE). In addition, the A1555G and A827G mutations in the MTRNR1 mitochondrial gene were screened in all newborns.

Results

We have found 17 individuals who failed in TOAE. Among them, we detected 4 homozygous newborns for 35delG mutation and 3 individuals with A827G mutation in the MTRNR1 mitochondrial gene. The frequency of 35delG carriers was 0.94% [84/8974]. In all 17 individuals who failed in OAE no other mutation besides those mentioned above was found.

Conclusions

The results greatly contribute to the public health area indicating the etiologic diagnosis, allowing family counseling as well as the early rehabilitation treatment or surgical intervention. Over time that will help to reduce the costs of rehabilitation considerably.     

新生儿听力障碍常见危险因素及听力筛查方法研究进展

听力障碍严重影响新生儿言语和识字能力发育,阻碍儿童社交、认知和学习。影响新生儿听力的因素众多,发病机制和特点各异。新生儿的听力障碍非遗传因素主要包括早产、低出生体质量、新生儿高胆红素血症、新生儿缺氧、感染、耳毒性药物用药史等;遗传因素主要包括GJB2、GJB3、SLC26A4和线粒体基因MT-RNR1变异。耳声发射、自动听觉脑干反应和声导抗检查的联合应用可有效提高新生儿听力障碍筛查的准确率,有助于早期诊断和干预。     

Distortion-product otoacoustic emissions in neonates: normative data.

Distortion-product otoacoustic emissions (DPOEs) are otoacoustic emissions evoked by two pure tones and used in order to provide a frequency specific assessment of the mechanical properties of the cochlea. This paper first reports complete input-output DPOE functions for audiometric frequencies between 867 Hertz and 8 kHz in a normal neonate population (normative data). DPOE results were analyzed as a function of evoked otoacoustic emission (EOE) properties. Neonates having normal EOEs have large DPOEs. DPOE amplitudes in neonates are larger than in adults. Neonates with atypical EOE frequency spectrum without low frequency components had normal DPOE input-output functions only for high frequencies (above 2 kHz). DPOEs could be useful, in association with EOEs, to precisely evaluate the auditory peripheral function in neonates.