北京市居民听力残疾主要原因调查分析

目的 了解北京市居民听力残疾的主要致残原因.方法 2006年4月1日零时～5月底进行北京市第二次全国残疾人抽样调查.此次调查采用分层、多阶段、整群、概率比例抽样方法 对北京市18个区县1 541万常住人口进行抽样,共调查74 795人,其中男性36 753人,女性38 042人;城镇55 773人,农村19 022人.采用分类变量的统计描述方法 对调查数据进行致残原因分析.结果 北京市居民听力残疾(含多重残疾)的前五位致残原因是:老年性聋、原因不明、全身性疾病、噪声和爆震、中耳炎,其致残率分别为1.10%、0.30%、0.30%、0.20%和0.17%.0～14岁听力残疾(含多重残疾)人群的主要致残原因为遗传、原因不明和其他;15～59岁听力残疾(含多重残疾)人群的主要致残原因为原因不明、药物中毒、中耳炎;60岁及以上听力残疾(含多重残疾)人群的主要致残原因为老年性聋、全身性疾病、噪声和爆震及原因不明.男女性以及城乡听力残疾(含多重残疾)人群的首位致残原因均为老年性聋.结论 老年性聋、全身性疾病、噪声和爆震以及中耳炎是北京市居民听力残疾(含多重残疾)的主要致残原因.     

老年性聋听力干预的现状及展望

第二次全国残疾人抽样调查数据显示，我国老年听力残疾现残率达11．04％，其中老年性耳聋占66．87％，是老年听力残疾中最主要的致残因素。老年性聋对患者的身心健康产生极大的影响．严重恶化了他们的生活质量。因此如何依据我国老年性聋的发病病因及听力损失特点提出相应的残疾预防及康复策略，降低老年人听力残疾发生风险应成为目前我们的研究重点。     

中国听力残疾致残原因分析

目的 了解听力残疾的致残原因,为制定听力残疾的防治策略提供可靠的依据.方法 采用统计描述、统计推断等方法对第二次全国残疾人抽样调查数据库中听力残疾数据进行分析.结果 听力残疾的主要致残原因是老年性耳聋、原因不明性耳聋和中耳炎.听力残疾的致残因素在不同年龄段和城乡之间存在差别.0～6岁组听力残疾的主要致残因素为不明原因、遗传及母孕期病毒感染;15～59岁组听力残疾的主要致残因素是中耳炎、耳毒性药物;60岁以上老年人听力残疾的主要致残因素为老年性耳聋、中耳炎和全身性疾病.城乡差异中,老年性耳聋、原因不明性耳聋、中耳炎等导致的听力残疾农村高于城市（P＜ 0.05）;全身性疾病、药物中毒、噪声和暴震导致的听力残疾城市高于农村（P＜0.05）.在听力残疾发病各因素中,母孕期病毒感染、遗传因素等导致的听力残疾以一级和二级居多;老年性聋、中耳炎等导致的听力残疾以三、四级居多.结论 普及爱耳护耳知识、提高全民听力健康意识、预防老年性聋、防治全身性疾病是预防听力残疾的重要措施,同时要加强对耳毒性药物生产、销售和使用的监管,开展遗传咨询等.     

中国听力残疾构成特点及康复对策

目的通过对全国第二次残疾人抽样调查所获得的基础数据进行分析，掌握听力残疾群体的规模、分布、残疾等级及年龄特点，为制订听力残疾的康复策略提供依据。方法依据全国第二次残疾人抽样调查数据库资料，按照描述现状→分析原因→提出对策的思维模式，提出适合于中国国情的听力残疾防治对策。结果全国听力残疾（含多重残疾）人共2780万，其中单纯听力残疾人2004万，多重残疾人中有听力残疾人776万。听力残疾现残率为2．11％，其中城市现残率为1．79％，农村现残率为2．27％，农村高于城市。听力残疾（含多重残疾）以60岁及以上老年人为主，占73．58％，其次是15～59岁组，占24．89％，7～14岁组占1．04％，0～6岁组占0．49％。60岁及以上组昕力残疾三、四级占79．13％，4～6岁组一、二级残疾占67．36％，0～3岁组一、二级残疾占83．90％，可见听力残疾在老年人中以轻、中度聋居多，在儿童中以重度、极重度聋居多；15岁及以上人群以单纯听力残疾为主，占72．65％，0～14岁听力残疾以多重残疾为主，占64．55％；农村听力残疾发生危险性是城市的1．27倍。对策面对2780万庞大的听力残疾群体，亟待建立健全社会保障和专业技术社区服务网络体系。     

老年听力残疾人社区康复探讨

伴随着老龄化社会进程的加快和国民生活方式的改变，近年来我国老年听力残疾人的数量迅速增加，最新的全国残疾人抽样调查数据显示．2004万单纯听力残疾人中．老年性聋的比例高达51.61％．占我国残疾人总数的12．08％，如果将多重残疾中包括听力残疾的部分计算在内，其比例会更高。     

吉林省听力障碍及耳疾流行病学调查研究

目的明确吉林省以人群为基础的耳疾与听力障碍的流行病学情况,为吉林省耳疾的防治工作提供科学依据。方法应用《WHO耳疾与听觉障碍调查方案》,通过容量比例概率抽样(PPS)的方法选择40个调查点,实际调查人数为6976人。耳聋残疾的定义和听觉障碍程度的分级采用WHO/PDH97.3推荐的标准,采用EARFORM V6.2(由WHO提供)软件进行资料输入和基本分析。结果911(13.1%)人有听力减退,311(4.5%)人存在听力残疾;城乡人群听力减退率和听力残疾患病率差异无显著性;男性听力减退和听力残疾患病率明显高于女性,差异有显著性;听力减退和听力残疾主要集中在60岁以上人群;患病率较高的耳疾病有耵聍(1.2%),慢性化脓性中耳炎(0.7%),鼓膜干性穿孔(1.4%),分泌性中耳炎(1.0%);19.3%的调查对象需要耳科或听力干预。结论所有听力减退的人群中,老年性耳聋患病率最高。听力残疾的患病率有上升的趋势,急需制定新的预防和治疗听力障碍和耳疾病的政策。     

从老人院听力调查情况看老人听力康复的重要性

目的通过对南宁市社会福利院的老人进行听力调查，了解老年人听力残疾发生率及残疾程度。方法在本底噪声≤40dB（A）的安静房间内，用Pc—RB便携式听力计，对老人双耳进行纯音测听，取0．5、1、2、4kHz4个频率的平均值作为评定听功能的指标。结果按第二次全国残疾人抽样调查所定听力残疾等级标准进行评定，52例老人中有听力残疾的人数为42例，占80．77％，其中一级听力残疾3例，占5．77％；二级听力残疾3例，占5．77％；三级听力残疾19例，占36．54％；四级听力残疾17例，占32．69％。在听力残疾的42例中，男26例，女16例；听力相对较好者10例，男3例，女7例。结论社会福利院60岁以上的老人相对集中，听力残疾发生率较高，这是老年性聋发生的一个缩影，应引起全社会对老年人的听力保护和康复的重视；老年听力残疾人中男性比女性多，而未定等级的10例中，女性又较男性多，这又为研究老年性聋发生机理，特别是易感基因或长寿基因的研究提供了流行病学调查的依据。     

陕西省听力残疾抽样调查分析

目的调查陕西省听力残疾人的流行现状、致病因素、康复和社会参与等情况,为政府制定有关残疾人的法律法规、政策和规划提供依据。方法采用分层、多阶段、整群、概率比例抽样方法,对全省7.34万人进行调查。结果确诊听力残疾2159人,现患率为2.94%。其中一级听力残疾291例,二级178例,三级729例,四级961例。60岁以上残疾人1496人。主要致残原因分布:老年性聋940人,占43.54%;原因不明430人,占19.92%;中耳炎240人,占11.12%;全身性疾病137人,占6.35%;噪声和爆震88人,占4.08%;遗传性聋77人,占3.57%;药物中毒68人,占3.15%;创伤或意外伤害56人,占2.59%;传染性疾病55人,占2.55%;母孕期病毒感染10人,占0.46%;自身免疫缺陷性疾病4人,占0.19%;新生儿窒息1人,占0.05%;其他53人,占2.45%。结论陕西省听力残疾人现患率较1987年提高,人口年龄结构老化可能是导致听力残疾人数增加的主要原因。农村较重残疾等级(一、二级)多于城市,说明我省听力残疾的防治重点依然在农村。     

社区老年人听力状况调查与社区康复初探

据报道,目前我国老年人口已达到1．3亿,占总人口的近11％,在未来的半个世纪中,我国老年人口将一直呈迅速增长的发展趋势。全国第二次残疾人抽样调查表明,全国听力残疾人共2780万,其中单纯听力残疾人2004万,听力残疾（含多重残疾）以60岁及以上老年人为主,占73．58％．有听力残疾的老年人口为2046万。为了调查听力残疾老年人的具体听力状况和社区康复情况,畅听未来项目组启动了“畅听未来、关注听力”系列活动,     

上海市杨浦区老年人听力残疾调查分析

目的 了解上海市杨浦区老年人听力残疾的主要致残原因.方法 2014年10月1日~2015年9月30日对上海市杨浦区老年人进行问卷调查、耳部检查、听力筛查,分析其听力损失原因.结果 实际调查4 672人,存在听力残疾913人(19.54%),其中听力残疾一级74人(8.11%,74/913),二级95人(10.41%,95/913),三级326人(35.71%,326/913),四级418人(45.78%,418/913).听力残疾者致病因素排在前五位的分别为:老年性聋431人(47.21%),噪声和爆震性聋279(30.56%),全身性疾病(包括高血压、动脉硬化、糖尿病、甲状腺功能低下等)72人(7.89%),中耳炎68人(7.45%),原因不明23人(2.52%).结论 老年性聋、噪声和爆震、全身性疾病以及中耳炎是上海市杨浦区老年人听力残疾(含多重残疾)的主要致残原因.     

北京地区耳聋残疾人群大前庭水管相关SLC26A4基因热点突变分子流行病学调查

目的分析北京耳聋残疾人群中SLC26A4基因热点突变IVS7-2A>G和2168A>G发生频率,初步探讨SLC26A4基因热点突变在北京地区耳聋残疾人群中的分子诊断意义。方法抽查北京地区持耳聋残疾证患者6247例,均抽取外周静脉血并提取DNA,以博奥生物有限公司提供的晶芯九项遗传性耳聋基因检测试剂盒(微阵列芯片)对SLC26A4基因的热点突变IVS7-2A>G和2168A>G进行检测,并对其发生频率进行分析。结果在6247名受检耳聋残疾人群中,携带SLC26A4基因IVS7-2A>G和2168A>G突变的例数共计177例,总阳性检出率为2.83%(177/6247)。IVS7-2A>G突变携带者141例(纯合27例,单杂合突变114例),2168A>G突变携带者26例(纯合4例,单杂合突变22例),SLC26A4基因2168A>G/IVS7-2A>G复合杂合突变携带者10例。针对IVS7-2A>G和2168A>G突变的SLC26A4基因双等位基因突变例数为41例,双等位基因突变率为0.66%(41/6247)。结论 1、在6247例耳聋残疾人中,通过SLC26A4基因热点突变IVS7-2A>G和2168A>G检测能够明确分子学诊断的占总体的0.46%(41/6247);2、在北京地区持证聋人群体中,SLC26A4基因热点突变检出率较我院门诊就诊的耳聋患者低,此项课题的开展,有助于了解北京地区残疾人群中与大前庭水管综合征密切相关的SLC26A4基因热点突变分布情况,在分子水平上为耳聋残疾人群明确诊断或指导进一步诊断,并对IVS7-2A>G和2168A>G突变检测阳性患者的婚配、生育具有一定的指导意义。     

Identifying the barriers and facilitators to optimal hearing aid self-efficacy

Abstract

Objective: Many older adults with hearing impairment are not confident in their ability to use hearing aids (i.e. experience low hearing aid self-efficacy), which has been found to be a barrier to hearing help-seeking and hearing aid use. This study aimed to determine what factors were associated with achieving adequate hearing aid self-efficacy. Design: A retrospective research design was employed wherein hearing aid self-efficacy was the primary outcome. Explanatory variables included personal demographics, visual disability, and experiences related to participants’ hearing ability and hearing aids. Study sample: A total of 307 older adults with hearing impairment participated in the study (147 non hearing aid owners and 160 hearing aid owners). Results: Non-hearing aid owners were more likely to report adequate hearing aid self-efficacy if they reported no visual disability, had experienced hearing loss for longer, reported more positive support from a significant other, and were not anxious about wearing hearing aids. Hearing aid owners were more likely to report adequate hearing aid self-efficacy if they had had a positive hearing aid experience and no visual disability. Conclusions: More research is needed to develop and evaluate intervention approaches that promote optimal levels of hearing aid self-efficacy among older adults with hearing impairment.     

中山市持证听力残疾人群调查分析

目的 了解中山市持证听力残疾人群年龄、残疾等级、城乡分布和致聋原因构成状况,为制定听力康复对策提供依据.方法 采用统计描述及计数等方法对中山市残疾人口基础数据库中的持证听力残疾人群进行分析.结果 中山市持证听力残疾人有695人,占6类持证残疾人的比例为4.18%,持证听力残疾人群以41～65岁组所占比例最高(42.01%),其次为15～40岁组(27.48%),65岁以上组占21.15%,3～14岁组(9.35%).在3～14岁组中一级残疾占72.30%,15～40岁组一级残疾占49.73%,41～65岁组一级残疾占45.89%,65岁以上组中一级残疾占34.69%.致聋因素最多的是老年性耳聋,听力残疾发病率乡镇高于城市.结论 中山市持证听力残疾人数远低于听力残疾发病人数,注重乡镇中老年群体的听力保健和听力干预康复工作至关重要.     

Hearing impairments in middle age: the acceptability, benefit and cost of detection (ABCD).

The major epidemiological investigations of hearing impairment, disability and handicap show that the elderly are the group most disabled by their hearing impairment. There is considerable debate concerning the most efficient way of reducing this inevitable burden of age-related hearing impairments in the next generation. Early fitting of 'targeted' individuals with hearing aids may help but there are a large number of methodological problems associated with conducting and evaluating such a programme of research (especially retrospectively). The logical prerequisite to early fitting as a means of reducing later disability is to ascertain the acceptability of and benefit given by intervention at this early stage. This study therefore set out to investigate the age/sex register provided by the primary physician (GP) as an appropriate base to identify candidates for early aid fitting among a sample of middle-aged patients (50-65 years) living in Roath, Cardiff. Of the 662 who replied to an initial contact letter (1050 were on the age/sex register), 21 already possessed hearing aids. After screening and examination 66 people were offered some form of management which was accepted by 43 during the course of the study. Aid use thereby increased from about 3% to over 9% in this middle-aged group. A 2 year follow-up indicated continued use of the aids, and benefit on a speech reception task was measured. The cost of detecting those who might benefit was calculated using a two-question 'paper and pencil' screen as the first step. A national programme for Wales would cost at least 188,000 pounds per annum at 1990 prices over an initial 5 year span if a criterion which aimed to find at least 45 dB HTL impairments over mid-frequencies was implemented. For a criterion of 35 dB the cost would be 378,000 pounds pa.     

Hearing disability and hearing aid benefit related to type of hearing impairment

This study was designed to investigate whether patients with a conductive hearing impairment derive more benefit from the provision of a hearing aid than comparable individuals with a sensorineural hearing impairment. A secondary aim was to assess the relative hearing disability of those with each type of impairment. Twenty-eight patients with a bilateral, symmetrical conductive impairment were selected. They were matched for age, sex and speech frequency average to individuals with a bilateral, symmetrical sensorineural hearing impairment. Each patient performed free-field audio and audio-visual tests in noise, both with and without a hearing aid, during which the non-test ear was acoustically occluded. When unaided, individuals with a conductive impairment were more disabled than those with a sensorineural impairment. On the other hand, those with a conductive impairment derived more benefit from an aid than those with a sensorineural impairment.     

健听人在不同本底噪声环境中的听阈值分析

目的计算健听人在不同本底噪声环境中的听阈值,通过与在标准测听环境中的结果相比较,确定非标准测听环境中听阈的修正值,探讨听力残疾抽样调查中最低环境本底噪声级的控制值。方法在不同的本底噪声环境中,采用纯音测试和声场测试的方法,对50人(100耳)分别进行测听。结果研究结果显示,在本底噪声分别为45dB(A)、50dB(A)、55dB(A)的测听环境中,健听者的纯音测试听阈值分别为15dBHL、20dBHL、25dBHL,与标准测听环境中的听阈差值分别为10dBHL、15dBHL、20dBHL;声场测试听阈值分别为25dBHL、30dBHL、35dBHL,与标准测听环境中的听阈差值分别为15dBHL、20dBHL、25dBHL;统计结果显示,不同本底噪声环境中,健听人的听阈值具有显著性差异。结论根据健听人在不同本底噪声环境中与在标准测听环境中的听阈差值,可以确定在非标准测听室及相应本底噪声环境中的听阈修正值,也可以确定听力残疾评定允许测听环境最高噪声级。     

Validity of the National Acoustic Laboratories procedure for determining percentage loss of hearing

Abstract

Objective: To evaluate the validity of the National Acoustic Laboratories procedure for determining percentage loss of hearing as a measure of hearing disability. Design: The percentage hearing losses of war veterans who had hearing ranging from normal to profound deafness were determined and compared with their scores on two hearing questionnaires. Study sample: A self-report hearing questionnaire was completed by 282 war veterans and 154 of those veterans were given the hearing measurement scale in the form of a structured interview. Results: A percentage loss of hearing of 0 agreed well with the questionnaire scores representing the limit of normal hearing, and a percentage loss of hearing of 100 agreed well with the questionnaire scores representing total loss of hearing. Percentage loss of hearing accounted for 83% of the variance in scores on the hearing questionnaire and 81% of the variance in scores on the hearing measurement scale. Conclusion: The National Acoustic Laboratories procedure for determining percentage loss of hearing provides a valid measure of hearing disability.     

Epidemiology of congenital hearing loss

This paper deals with congenital hearing loss (genetic, intrauterine and unfavourable perinatal influences). Data on prevalence vary. Confusion concerning terminology and inadequate facilities for diagnosis makes comparisons difficult.

The prevalence of profound deafness in most European and North American countries is about 1:2 000. When partial deafness is included, the prevalence is considerably higher. Few dependable data are available regarding the distribution of types and degrees of hearing loss and these vary from country to country. Information is better known within the congenitally hearing impaired population. The relation between aetiology and the type of hearing loss helps this knowledge. Sex distribution has been studied recently by the author and data are given. The relative distribution of causes is fairly well known and described in the paper.

The natural history of many types of congenital hearing loss has been inadequately studied. The pathology has been described but the processes leading to hearing loss are little understood. Progress has been made which will enable us to prevent several types of congenital hearing loss.

Certain rehabilitative measures enhance the propagation of the genetic type. Integration into the normal society should decrease this. Genetic counselling should help prevention. Probably unsuspected mutagenic agencies anhance the propagation of genetic hearing loss.

Social conditions influence many aspects of the condition. Movements of populations expose to infection those unprotected immunologically. They change the genetic composition of populations. Migrant populations create difficulties in rehabilitation because of different language backgrouds.

A disabled child always means a disabled family. The basic sociopolitical aspects of rehabilitation depend largely on the attitudes of society to the disability. Deafness still rates low in the hierarchy of disabilities in the estimation of society.

Population studies conducted at an acceptable standard are long overdue. International agreement on terminology and on identification is called for.