不同日龄新生儿诱发性耳声发射测试

对20例正常新生儿在出生后第1～5天逐日行瞬态诱发性耳声发射(TEOAE)和畸变产物耳声发射(DPOAE)的测试.了解不同日龄新生儿畸变产物耳声发射(DPOAE)和瞬态诱发性耳声发射(TEOAE)的特征,探讨应用OAE作新生儿听力筛查的最佳时机.随新生儿日龄的增加,其TEOAE和DPOAE检出率和反应幅值逐步提高,新生儿生后第1～2天的检出率和反应幅值显著低于第3～5天,至生后第3～5天,TEOAE和DPOAE检出率接近或达到100%,反应幅值也趋于稳定.结论应用TEOAE和DPOAE进行新生儿听力筛查时,其日龄至少应在3天或3天以上,测试TEOAE和DPOAE快速、方便,不失为普遍性新生儿听力筛查首选方法.     

新生儿及新生儿疾病

04 4 2 4 2　新生儿疾病诊治进展 /杜立中∥中国实用儿科杂志 . 2 0 0 4 ,19(5 ) . 2 6 4～ 2 6 50 4 4 2 4 3　不同日龄新生儿诱发性耳声发射测试 /周涛…∥新生儿科杂志 . 2 0 0 4 ,19(1) . 10～ 12对 2 0例正常新生儿在生后第 1～ 5d逐日行瞬态诱发性耳声发射 (TEOAE)和畸变产物耳声发射 (DPOAE)测试 ,了解不同日龄新生儿DPOAE和TEOAE的特征。结果 :随日龄的增加 ,其TEOAE和DPOAE检出率和反应幅值逐步提高 ,生后 1～ 2d的检出率和反应幅值显著低于第 3～ 5d ,至生后第 3～ 5d ,TEOAE和DPOAE检出率接近或达到 10 0 % ,反…     

耳声发射在黄疸新生儿听力筛选中的应用

通过瞬态诱发耳声发射 (TEOAE)和畸变产物耳声发射 (DPOAE) ,探讨其在黄疸新生儿听力筛选中的临床意义。应用Celesta 50 3型耳声发射仪对 1 1 5名黄疸新生儿及对照组正常足月新生儿 1 41名 (共 51 2耳 )进行TEOAE和DPOAE听力测定。结果 2 56名新生儿中有 64名双耳听力异常 ,其中正常新生儿占 1 8 44%(2 6/ 1 41 ) ,黄疸新生儿占 3 3 0 4%(3 8/ 1 1 5) ,p <0 0 1 ,有显著意义。生后 3月再次接受OAE复查 ,2例高胆红素患儿听力仍异常。新生儿高胆红素血症是听损伤的高危因素 ,应作听力随访。耳声发射是 1种快而有效的新生儿听力筛选方法之一。     

耳声发射在黄疸新生儿听力筛选中的应用

通过瞬态诱发耳声发射(TEOAE)和畸变产物耳声发射(DPOAE),探讨其在黄疸新生儿听力筛选中的临床意义.应用Celesta 503型耳声发射仪对115名黄疸新生儿及对照组正常足月新生儿141名(共512耳)进行TE0AE和DPOAE听力测定结果256名新生儿中有64名双耳听力异常,其中正常新生儿占18.44%(26/141),黄疸新生儿占33.04%(38/115),p<O.01,有显著意义生后3月再次接受(OAE复查,2例高胆红素患儿听力仍异常.新生儿高胆红素血症是听损伤的高危因素,应作听力随访.耳声发射是1种快而有效的新生儿听力筛选方法之一.     

耳声发射在高危新生儿的应用探讨

为探讨某些高危因素对新生儿听力的影响，尽早发现听力障碍，应用丹麦产Madsen Capeila耳声发射仪，对124名高危新生儿测试瞬态耳声发射(TEOAE)和畸变耳声发射(DPOAE)，对其中一项不能通过者一月后复查，仍不能通过者3个月复查，如仍不能通过行OAE 脑干诱发电位(ABR)检查，明确听力障碍的原因并行干预治疗。结果显示：单耳TEOAE异常者28例次，DPOAE异常者33例次，双耳TEOAE异常者26例次，DPOAE异常者23例次。生后第一次查OAE124人，未能通过69人，生后一月复查65人，未能通过者26人；生后3个月复查，未能通过者2人，生后6个月复查，1人未通过，异常率0．8％，经ABR检查为单耳轻度听力损害。结论：(1)高危儿听力障碍的发生率为0．8％；(2)对第一次不能通过OAE的婴儿，尚不能断定为听力障碍，要定期复查和随访。(3)应对所有出生的新生儿都进行听力筛查，不能只限于高危儿。(4)对巨细胞病毒感染，生后虽OAE正常，但需进一步随访和复查。     

耳声发射在高危新生儿的应用探讨

为探讨某些高危因素对新生儿听力的影响,尽早发现听力障碍,应用丹麦产Madsen Capeila耳声发射仪,对124名高危新生儿测试瞬态耳声发射(TEOAE)和畸变耳声发射(DPOAE),对其中一项不能通过者一月后复查,仍不能通过者3个月复查,如仍不能通过行OAE+脑干诱发电位(ABR)检查,明确听力障碍的原因并行干预治疗.结果显示单耳TEOAE异常者28例次,DPOAE异常者33例次,双耳TEOAE异常者26例次,DPOAE异常者23例次.生后第一次查OAE 124人,未能通过69人,生后一月复查65人,未能通过者26人;生后3个月复查,未能通过者2人,生后6个月复查,1人未通过,异常率0.8%,经ABR检查为单耳轻度听力损害.结论(1)高危儿听力障碍的发生率为0.8%;(2)对第一次不能通过OAE的婴儿,尚不能断定为听力障碍,要定期复查和随访.(3)应对所有出生的新生儿都进行听力筛查,不能只限于高危儿.(4)对巨细胞病毒感染,生后虽OAE正常,但需进一步随访和复查.     

高危新生儿听性脑干反应和瞬态声诱发耳声发射两种听力损伤监测结果比较

目的探讨将听性脑干反应(ABR)和瞬态声诱发耳声发射(TEOAE)应用于高危新生儿听力损伤监测中的特点、差异和意义。方法分别应用MADSENCapella+型全功能耳声发射分析仪和MADSENERA2260型听性脑干反应仪对171例(342耳)不同病因导致的高危新生儿同时进行TEOAE和ABR测试,将2种测试方法进行比较。结果在171例(342耳)患儿中,TEOAE初筛通过率为66.96%(229/342耳),ABR通过率92.99%(318/342耳),两者共同阴性率为70.47%(241/342耳),TEOAE初筛的假阳性率为84.07%(95/113耳),假阴性率为2.62%(9/229耳)。结论ABR测试是可靠的新生儿听力筛查方法,TEOAE具有方便、客观、快速、无创等特点,为较好的新生儿听力筛查方法,但假阳性率高。二者需相互结合,相互补充。     

听觉脑干反应和耳声发射在高危儿听力筛查中的应用

目的：耳声发射(OAE)和听觉脑干反应(ABR) 是新生儿听力筛查的常用方法。该研究旨在探讨畸变产物耳声发射(DPOAE) 和ABR应用于重症监护病房(NICU)高危新生儿听力筛查的差异和意义。方法：分别应用Smart-EP型听觉脑干诱发电位仪和Smart-OAE畸变产物耳声发射检查仪对600例(1 200耳)不同病因所致的高危儿同时进行DPOAE和ABR检查,将两种方法取得的检测结果进行比较。结果：在600例(1 200耳)高危新生儿中,ABR的异常率(78.6%,943/1 200耳)远高于DPOAE的未通过率(22.3%,268/1 200耳);二种检查的共同阴/阳性率分别为20.8%(241/1 200耳)和21%(252/1 200耳)。1 200耳中有493耳DPOAE和ABR的测试结果一致,占41.1%;707耳的测试结果不一致,占58.9%。DPOAE测试的假阳性率为6.0%(16/268耳),假阴性率为74.1%(691/932耳)。结论： DPOAE仅反映耳蜗功能,单独用于高危新生儿听功能筛查的价值有限。ABR检查果相对可靠,NICU高危新生儿听力筛查应先做ABR检查,ABR异常者再做OAE检查。ABR和OAE二种检测方法相互结合,方能提高高危新生儿听力筛查的准确性。     

正常幼儿畸变产物耳声发射听力筛查

目的探讨畸变产物耳声发射(DPOAE)在幼儿听力筛查中的应用。方法应用DPOAE对100名幼儿园儿童(200耳)进行听力筛查,纯音对2、3、4 kHz 3个频率两次测试,耳声发射响应点在通过/转介线以上,信噪比>10 dB为筛查通过。结果94名儿童双耳通过筛查,4名儿童因耵聍栓塞双耳未通过筛查,取出耵聍后复筛通过;2名儿童单耳因分泌性中耳炎未通过筛查,治疗后复筛通过。结论DPOAE适用于幼儿听力筛查,建议将其列为每年的幼儿体检项目。     

听性脑干反应和耳声发射在足月新生儿高胆红素血症听力筛查中的应用

目的探讨听性脑干反应(ABR)和畸变产物耳声发射(DPOAE)应用于高胆红素血症新生儿听力筛查中的差异和意义。方法对197例诊断为高胆红素血症的新生儿同时进行ABR和DPOAE检查,异常者于生后3～4个月进行随访。结果 197例患儿临床上无明显胆红素脑病表现,ABR和DPOAE的总异常率分别为76.65%和14.47%;血清胆红素水平越高,ABR异常率越高(P<0.01),而DPOAE异常率与黄疸程度无明显相关性;DPOAE异常者多并存潜在的围生期其他导致听力损伤的高危因素。重度ABR异常者在生后3～4个月复查时仍有40.7%无改善。结论临床上无明显胆红素脑病表现的高胆红素血症新生儿ABR异常率高,对此类患儿进行听力检查应先ABR后DPOAE或者两者同时进行以避免漏诊。     

How do we identify hearing impairment in early childhood?

This review discusses the need for universal neonatal hearing screening. Historical background is given concerning conventional childhood hearing screening programmes in western countries. Direct studies on the effects of very early habilitation programmes on speech and language development are cited. Measurement of otoacoustic emissions (OAE) as a tool for neonatal hearing screening is presented. The state of neonatal hearing screening programmes in the US and in Europe, particularly in Sweden, is discussed.     

Prediction of permanent hearing loss in high-risk preterm infants at term age

The aim of this series was to assess hearing screenings; auditory brainstem responses (ABR), transient evoked otoacoustic emissions (TEOAE) and free field auditory responses (FF) for the prediction of permanent bilateral hearing loss in high-risk preterm infants at term post-conceptional age. A total of 51 preterm infants (gestational age <34 weeks, birth weight <1500 g) underwent examinations at term and hearing, speech and neurological development were followed up until a corrected age of 18 months. Significant hearing defects were verified by broader ABR examinations under sedation and by clinical ward observation including responsiveness to sounds and enhancement of hearing using an amplification device. Seven bilateral fails in ABR were found, together with nine bilateral fails in TEOAE and four fails in FF screening at term age. Six preterm infants were later confirmed to have a significant permanent bilateral hearing loss, four of whom had also cerebral palsy. Bilateral failure in ABR screening predicted hearing loss with a sensitivity of 100% and a specificity of 98%, TEOAE with a sensitivity of 50% and a specificity of 84% and in the FF examination at the levels of 50% and 98%, respectively. Conclusion Transient evoked otoacoustic emissions alone seem not to be so applicable to the neonatal screening of hearing in high-risk preterm infants as shown earlier in full-term infants, possibly because a hearing defect may be due to retrocochlear damage. Consequently, auditory brainstem response screening seems to be more suitable for very low birth weight preterm infants. Received: 21 September 1999 / Accepted: 5 January 2000     

The Milan Project: a newborn hearing screening programme

Aim: Since 1997 a newborn hearing screening programme has been implemented by the U.O. Neurologia-Neurofisiopatologia and Dipartimento di Neonatologia of the Istituti Clinici di Perfezionamento ICP in Milan for both babies with no risk and those at risk of hearing impairment. This programme was named the Milan Project. Methods: The protocol for no-risk babies consisted of three stages: in the first two stages, newborns were tested with transient click-evoked otoacoustic emissions (TEOAE), in the third one with conventional auditory brainstem responses (ABR). The first TEOAE test was performed by 36 h of age, before discharge, the second one after 15-30 d in case of referral, and the third one, by ABR, for those babies who failed the second TEOAE stage. Newborns at audiological risk were submitted to conventional ABR before the third month of corrected age. Some of this latter population was also submitted to the TEOAE test. The entire tested population (no-risk babies and newborns at audiological risk) consisted of 19 777 babies: 19 290 without risk (“no risk”) and 487 at risk (“at risk”). Results: During the course of the Milan Project, hearing impairment (ABR threshold equal to or greater than 40 dB nHL) was identified in 63 newborns (19 from the no-risk and 44 from the at-risk population), with a prevalence of 0.32%. Bilateral hearing impairment (BHI) was found in 33 newborns (10 from the no-risk and 23 from the at-risk population), corresponding to 0.17%. Among infants with bilateral hearing impairment, 30.3% had no risk factors. The prevalence of hearing impairment was determined on days 15-30 after birth.

Conclusions: The results show that the implementation of a hospital-based, universal neonatal hearing screening programme for babies with and without audiological risk is feasible and effective. The effectiveness of the programme has increased as a function of the years since its inception, with a strong decrease in the referral rate. Further improvement is obtained if the TEOAE measurements are repeated in cases of referral scoring before discharge.     

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

OBJECTIVES: To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as a first stage in-hospital hearing screening tool in this population. STUDY DESIGN: The study group was a cohort of 346 VLBW infants born in 1998-2000 at The Sheba Medical Center. The prevalence of hearing impairment in the study group was compared with that of all other newborn infants participating in a universal newborn hearing screening programme during the same period. To evaluate the effectiveness of TEOAE, a control group of 1205 healthy newborns who had no known risk factors for hearing impairment was selected. The results and follow up of hearing screening for these infants were examined retrospectively. RESULTS: Only one VLBW infant (0.3%) was diagnosed with bilateral sensory-neural hearing loss. In addition, nine infants (2.7%) were diagnosed with conductive hearing loss. Bronchopulmonary dysplasia and low Apgar score were the most significant factors for predicting the occurrence of conductive hearing loss. The percentage of VLBW infants who successfully passed the in-hospital TEOAE screening was 87.2, compared with 92.2% in the full term control group. No false negative cases were detected on follow up. CONCLUSIONS: The study shows a low incidence of sensory-neural hearing loss in a cohort of VLBW infants and a relatively high incidence of conductive hearing loss. TEOAE screening was found to be an effective first stage in-hospital hearing screening tool in this population.     

脑干听觉诱发电位与畸变产物耳声发射在听觉通路损伤患儿中的应用研究

目的　采用客观听力检测技术 ,分析听觉通路病损患儿的临床听力学特点 ,评价感音神经性聋患儿的蜗性及蜗后病变特征。方法　对感音神经性聋患儿共 310例 (5 0 0耳 ,年龄 1个月至 6岁 ,平均 2 4 2个月 )进行临床分析 ,其中中枢神经系统 (CNS)病变伴听力障碍 10 5例 (2 0 5耳 ) ,将其分为核黄疸 脑瘫组、额叶发育不良组和其他中枢性病变 3组。同年龄段对照组 6 0例 (10 4耳 )。同时检测脑干听觉诱发电位 (BAEP)和畸变产物耳声发射(DPOAE) ,对比不同组别间BAEP波V阈值及DPOAE各自的特点、同一组间不同BAEP波V阈值耳DPOAE的变化特征。结果　 (1)全组感音神经性聋患儿中有CNS病变者比例较高 (10 5例 2 0 5耳 /310例 5 0 0耳 )。 (2 )CNS病变患儿中核黄疸 脑瘫组可见严重的蜗后性听力损失 ,耳蜗功能也轻度受累 ;额叶发育不良组仅出现轻度蜗后听力损失 ;其他中枢性病变一般不累及耳蜗功能。 (3)蜗性听力损失者 ,BAEP波V阈值达 6 0nHLdB时 ,DPOAE幅值明显下降 ;达 70nHLdB以上者 ,DPOAE幅值严重下降或消失。结论　CNS病变伴感音神经性聋患儿听力障碍表现为多样性 ,临床上需联合听力专科采用不同客观听力检测技术进行综合评估 ,才能作出正确诊断。     

Neonatal hearing screening during the first and second day of life

AIM: Congenital or acquired hearing loss in infanthood has been associated with lifelong deficits in speech and language acquisition, poor school performances and emotional and social maladjustments. The identification of hearing loss through neonatal and infant life can prevent or reduce many of these adverse consequences, permitting early intervention. METHODS: We performed the screening of hearing loss with a technical device, echo-screen Madsen, based on transient evoked otoacoustic emissions (TEOAE). The screening was carried out in 50 newborns during the 1st day of life and in 80 newborns during the 2nd day of life. RESULTS: The 2nd day of life showed a significant better stability of the test and a better symmetry (P<0.001), and less incidence of artefacts (P<0.001). CONCLUSIONS: The results obtained confirm that the 2nd day of life is the most appropriate time for the neonatal hearing assessment with TEOAE.     

Ototoxicity from cisplatin therapy in childhood cancer

Cisplatin has been associated with hearing damage. It is usually irreversible, bilateral, and characterized by high-frequency sensorineural hearing loss. This study was carried out to identify impairment of hearing function in children and adolescents with cancer after cisplatin therapy. Twenty-three survivors of childhood cancer treated with cisplatin at our Unit from 1991 to 2004 performed tympanometry, pure tone audiometry, transient otoacoustic emissions, and distortion product otoacoustic emissions (DPOAE). The median age at diagnosis was 12.3 years and the median total dose of cisplatin received was 406 mg/m2. Fifty-two percent of patients had bilateral and in the high frequencies range hearing loss on audiometry. Transient otoacoustic emission and DPOAE abnormalities were detected in 22% and in 71% of the patients, respectively. We found a high concordance between the findings of audiometry and DPOAE (P=0.01). There was no influence of sex and number of ototoxic drugs other than cisplatin on hearing loss. There was a trend for younger age and higher cumulative dose of cisplatin to be associated with greater severity of hearing damage. Our data provide further evidence on hearing damage due to cisplatin therapy in children. The high incidence of patients with hearing function abnormalities found in this study and in previous reports highlights the importance of monitoring hearing function in children and adolescents undergoing cisplatin therapy, or as early as possible at follow-up. This study also demonstrates that DPOAE should be used for screening of hearing abnormalities and, once hearing damage is identified, patients require expert audiologic pediatric evaluation and (where indicated) use of hearing aids and/or speech therapy.