新生儿听力普遍筛查模式的初步探讨

目的寻找适合于中国国情的新生儿听力普遍筛查模式,获得新生儿听力损失发病的基本资料.方法新生儿在出院前接受耳声发射(otoacousticemissions,OAE)测试,通过者予以出院;对未通过者在1个月后再次复查OAE,仍未通过者行听性脑干反应(auditorybrainstemresponse,ABR)检查.所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估,以确定听力损失的性质和程度.耳声发射测试采用畸变产物耳声发射(distortionproductotoacousticemissions,DPOAE),通过标准1.5～6kHz的5个测试频率中的4个信噪比大于6dB.ABR通过测试的标准为波V反应阈值≤35dBnHL.结果2998例新生儿中2710位通过出院前的OAE测试,1个月后288例复查OAE,其中263例通过.需要ABR检查者共有25例,未通过者6例.经过全面的听力学诊断和评估,6例婴儿(占全体新生儿的2‰)有听力损失.结论新生儿听力普查十分必要,OAE和ABR联合应用的两步筛查法是较合适的筛查模式.     

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 1 930 2名新生儿听力筛查中未通过筛查的 5 6例新生儿的围产期病史和听力学诊断资料。结果　 1 930 2名新生儿中未通过新生儿听力筛查者共 5 6例 ,占筛查儿童的 0 2 90 % ,以后隔 2个月复查畸变产物耳声发射 (distortionproductotoacousticemission ,DPOAE)和听性脑干反应 (auditorybrainstemresponse,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 5 5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。     

新生儿普遍听力筛查假阴性分析

目的 探讨耳声发射作为新生儿普遍听力筛查方法的可靠性及出现假阴性的原因，说明对高危儿进行听力监测的重要性。方法 收集2002年1月～2005年12月参加上海市新生儿听力筛查，并在上海儿童医学中心听力障碍诊治中心确诊为听力障碍者的资料，报道分析5例通过新生儿听力筛查、而在6～30月龄期间在该中心诊断为听力障碍者的病史、临床表现、听力学及影像学检查的结果。结果 通过新生儿听力筛查但被确诊为听力障碍者共5例，2例确诊为中重度感音神经性聋，3例确诊为极重度感音神经性聋，其中1例确诊为听神经病。耳声发射作为新生儿听力筛查方法，灵敏度是99．88％，假阴性率是0．12％。结论 耳声发射是灵敏度较高的新生儿听力筛查方法，但是有一定的假阴性率，对于各种原因造成的蜗后听觉通路病变所致的耳聋可能会漏诊。另外，对新生儿听力筛查阴性者，要警惕遗传性聋和迟发性聋的发生，尤其对高危儿应该定期随访。     

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。     

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。     

新生儿黄疸患儿听力筛查分析

目的探讨新生儿黄疸患儿耳蜗功能及听觉传导通路受损情况及其影响因素。方法应用畸变产物耳声发射(DPOAE)、听性脑干反应(ABR)检查对195例(390耳)正常新生儿及452例(904耳)新生儿黄疸患儿进行听力筛查。结果正常组与新生儿黄疸组比较,听力筛查的通过率、DPOAE信号水平(Level)、信噪比(SNR)均有显著性差异;病理性黄疸和核黄疸组ABR阈值高于正常组(P<0.05);ABR阈值增高的48耳中,有32耳DPOAE正常。结论新生儿黄疸患儿耳蜗损害程度与血中胆红素浓度增高呈正相关性;血中胆红素浓度增高除损害耳蜗外,还可能损伤听觉传导通路;对有高危因素的新生儿,单一的听力检查不能全面反应听功能状况,最好结合两种以上检查方法,防止漏诊。     

TEOAE与AABR在高危新生儿听力筛查中的联合应用

目的探讨联合应用瞬态诱发性耳声发射(TEOAE)和自动听性脑干反应(AABR)在高危新生儿听力筛查中的应用。方法对新生儿科NICU高危新生儿200例（400耳）,运用AccuScreen听力筛查仪,同时进行TEOAE和AABR联合听力筛查,根据TEOAE初次筛查结果通过与否,分为双耳TEOAE初筛均未通过组(A组)和双耳TEOAE初筛均通过组（B组）,共2组,每组100例（200耳）,其中3个月时任何一项检查未通过者均在患儿6个月时进行听性脑干反应、声导抗测试等诊断性检查。结果A组：3个月时TEOAE未通过12例（22耳）,AABR未通过2例（2耳）,联合筛查未通过22例。6月龄时确诊1例（2耳）分泌性中耳炎,该两耳均为3次TEOAE筛查未通过、AABR筛查通过者,本组高危新生儿听力损伤现患率为1.7%（2/120）;B组：3个月时TEOAE未通过2例（2耳）,AABR未通过5例（5耳）,联合筛查未通过5例（5耳）。6月龄时确诊2例（2耳）诊断为蜗后性耳聋,该两耳均为3次AABR筛查未通过、TEOAE筛查通过者,本组高危新生儿听力损伤现患率为1.4%（2/146）,每组在定期复筛时均有部分失诊患儿。结论通过TEOAE和AABR联合筛查,可以检出中耳、蜗性及蜗后听损伤,证实了TEOAE和AABR是听力筛查的有效组合方式,AABR和TEOAE联合筛查应用可以优势互补,降低漏诊、误诊率。     

应用耳声发射技术对48041名新生儿进行听力筛查的汇总分析

目的评价在新生儿听力筛查中耳声发射方法的真实性及开展新生儿听力普遍筛查的意义。方法采用文献法收集相关数据，用汇总分析进行评价。结果OAE总的筛查阳性率为1．762％，筛查新生儿中听力障碍率为9．49‰(包括感音性和传导性，单、双耳及轻度的听力损失)，确诊人数占阳性人数的44．09％；听力障碍诊断率病理组略高于正常组，但两组之间无显著性差异；OAE的灵敏度、特异度分别为99．51％、68．60％，假阳性率、假阴性率分别为31．40％、0．49％。阳性预测值、阴性预测值分别为43．28％、99．82％。结论耳声发射(OAE)是一种灵敏度较好的筛查方法。高危组与正常组听力障碍的发生率无显著性差异，可见，这项筛查应针对所有新生儿，这样才可以提高听力障碍的早期识别率，从而达到早发现、早诊断、早康复的目的。     

3592例新生儿听力筛查回顾性分析

目的了解新生儿听力损失的发病情况。方法回顾性分析了2013年至2014年在我院出生的3592例新生儿听力筛查的结果,其中包括正常足月儿2891例,早产儿166例,低体重儿61例,轻中度窒息儿69例,以及宫内窘迫儿405例,采用瞬态诱发性耳声发射筛查仪进行初复筛。对于复筛仍未通过者,再行耳声发射、声导抗、听性脑干反应(ABR)检查,进行听力学综合评估后确诊。结果出生后48~72小时接受初筛3592例,初筛率达到99.42%。初筛未通过人数457例,其中单侧未通过299例,双侧未通过158例,初筛未通过率平均13.26%。产后42 d应复筛人数为457例,实际复筛人数360例,实际复筛率78.77%,复筛未通过人数79例,复筛未通过率21.94%,正常足月儿听力初筛通过率为90.10%(2601/2891),早产儿为72.8%(121/166),低体重儿为75.4%(46/61),轻、中度窒息儿为69.5%(48/69),宫内窘迫儿为83.9%(340/405)。确诊听力损失的患儿15例,正常足月儿共5例,占这类新生儿的0.17%,听力障碍高危因素儿(早产儿、低体重儿及轻、中度窒息儿、宫内窘迫儿)10例,占该类新生儿的1.43%。结论早产儿、低体重儿及轻、中度窒息儿、宫内窘迫儿听力初筛的通过率明显低于正常足月儿,且确诊为听力损失的患儿所占比例显著高于正常新生儿。     

耳声发射应用于新生儿听力筛选的研究

目的 研究瞬态诱发耳声发射（ｔｒａｎｓｉｅｎｔ ｅｖｏｋｅｄ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｉｓｓｉｏｎｓ,ＴＥＯＡＥ）产畸变产物耳声发射（ｄｉｓｔｏｒｔｉｏｎ ｐｒｏｄｕｃｔ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｉｓｓｉｏｎｓ,ＤＰＯＡＥ）应用于新生儿听力筛选的可行性,控诉听力筛选的标准。方法 应用Ｃｅｌｅｓｔａ５０３型耳声发射分析仪对１０８名新生儿（２１６耳）进行ＴＥＯＡＥ和ＤＰＯＡＥ听力筛选,与听性脑     

Towards a universal newborn hearing screening

Hearing loss is a common problem which, if remaining undetected during early childhood, could affect the patient's linguistic and mental abilities permanently. Although recommended, mass hearing screening has so far been problematic or even impossible due to several reasons. The available otoacoustic emission devices appear to be effective tools for universal hearing screening. The aim of this study is to evaluate the reliability and practicability of a new device for recording click-evoked otoacoustic emissions (cEOEs) on a pediatric population. Sixty children aged between 6 days and 14 years were evaluated audiologically both by auditory brainstem responses (ABR) and otoacoustic emissions. The latter were obtained by using the well-known ILO88v3.92 otoacoustic analyser and a new, portable device ('Echocheck', Otodynamics Ltd, UK). Sensitivity and specificity of cEOEs recorded by 'Echocheck'was found to be 93% and 91%, respectively, when compared to ABR results. Additionally, 'Echocheck' recordings were proved to be much easier to perform, needing considerably less time in comparison with those of the ILO88 system. In our opinion, 'Echocheck' as well as all similar portable devices--screeners--may represent a much-desired solution for implementing universal hearing screening programmes.     

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.     

Making universal newborn hearing screening a success

OBJECTIVE: Following a long period of pilot study, Iaso maternity hospital established a universal newborn hearing screening program based on transiently evoked otoacoustic emissions (TEOAEs). The aim of this study is to present the improvement of outcome measures of this program, comparing the results of two groups of newborns screened successively. METHODS: We analyzed data from two groups of full-term newborns screened at our setting. The first group included all newborns born and screened during the initial 3 years of application of the program and the second group included all newborns born and screened during the next 2 years. TEOAEs were performed during the first days after birth. All newborns who failed the initial test underwent repeat testing with TEOAEs before hospital discharge. Newborns with absence of otoacoustic emissions were referred to follow-up test after 1 month. Results were compared between the two groups. RESULTS: The first group included 22,195 newborns-examined during 3 years and the second group included 25,032 newborns-examined during 2 years, due to reduction of the rate of newborns who missed screening. Refer rate was 3.1% for the first group and 2.1% for the second group. "Missed to follow-up" rate was reduced from 72.2% in the first group to 58.2% in the second group. CONCLUSIONS: The rate of newborns who did not undergo screening and the rate of "missed to follow-up" newborns were reduced in time, due to various modifications of the protocol. Universal newborn hearing screening may be, thus, a feasible and cost effective method of identifying congenital hearing loss.     

Importance of newborn hearing screening

US Preventive Services Task Force recommends universal screening of all newborns for early detection of hearing impairment and early intervention to prevent its effects on normal development and acquisition of language skills. During comparison of universal screening of all newborns versus targeted screening of high risk cases to detect hearing impairment, it emphasized the importance of Universal newborn hearing screening (UNHS) among neonatologists, pediatricians as well as ENT specialists taking care of newborns and young children. Among those who had early versus late confi rmation of hearing loss and those who had undergone universal newborn screening versus none, better language outcomes at school age were found than those not screened. Infants identifi ed with hearing loss through universal newborn screening had earlier referral, diagnosis, and treatment than those not screened. Targeted screening of newborns with high risk criteria missed 50% of cases of hearing impairment, either because infants were hearing impaired but did not meet any of the high- risk criteria, or because they developed hearing loss after the newborn period.