正常新生儿畸变产物耳声发射

目的研究新生儿畸变产物耳声发射（ＤＰＯＡＥ）听力筛选的最佳时机,了解正常新生儿ＤＰＯＡＥ的基本特征;方法应用Ｃｅｌｅｓｔａ５０３型耳声发射分析仪对２０名正常新生儿出生后１～５天逐日进行ＤＰＯＡＥ测试。结果随新生儿天龄的增加,ＤＰＯＡＥ的检出率及反应幅值逐渐提高。ｆ０为０．５ｋＨｚ时,ＤＰＯＡＥ的检出率较低,且反应不稳定。ｆ０≥０．７５ｋＨｚ时,ＤＰＯＡＥ的检出率迅速接近或达到１００％,大部分测试频率在出生１～２天的反应幅值显著低于后几天,至出生后第３天,ＤＰＯＡＥ的检出率及反应幅值均趋于稳定;结论新生儿ＤＰＯＡＥ听力筛选的适宜天龄应在其出生后３天或３天以上。０．５ｋＨｚ不宜作为新生儿ＤＰＯＡＥ的听力筛选频率。ＴＥＯＡＥ和ＤＰＯＡＥ相应频谱的反应幅值有显著相关性。两种耳声发射在新生儿听力筛选中各有优缺点     

新生儿耳声发射的检出率

目的：了解瞬态诱发耳声发射(TEOAE)在新生儿中的检出率。方法：用ILO-92耳声发射仪对2596例新生儿进行测试。根据出生天数分成3组：第1组测试在新生儿出生后第1天;第2组测试在新生儿出生后第2天;第3组测试在新生儿出生后第3天。如果未检出TEOAE,将在新生儿出院前(出生后第4～5天)复检;仍未检出者,3个月后随访进行第3次TEOAE测试。结果：第1、2、3组的TEOAE检出率分别为88．1％、95．1％、95．6％。结论：对新生儿进行测试最好选在出生后第3天及以后进行;新生儿出生后第4～5天TEOAE测试阴性可以作为新生儿未来患中耳积液的高危因素。     

215例正常新生儿瞬态诱发耳声发射测试分析及随访研究

目的：进一步了解正常新生儿瞬态诱发耳声发射（TEOAE）的特征，为新生儿听力筛查提供帮助。方法：采用ILO96型耳声发射仪，对出生后0（出生当天）-8d的215例（425耳）正常新生儿进行TEOAE测试，并跟踪随访结果：TEOAE总检出率为89%，检出率与检测时的天龄有一定的关系。新生儿出生后0-3d检出率平均为72%，4-8d为97%，分娩方式，左右耳，孕龄36至41周间的差异对检出率无明显影响；女性的检出率显著高于男性，快速扫描较TEOAE测试敏感，经随访确诊有1耳听力损害。结论：新生儿听力筛查应在出生后≥4d出院前进行；分娩方式对耳蜗功能无明显影响；人耳蜗毛细胞的成熟是在怀孕36周以前；快速扫描不能代替TEOAE测试；对于1耳或双耳未检出TEOAE的受测者必须跟踪随访和复检，并结合ABR测试尽早确诊。     

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.     

浙江省新昌县18444例新生儿听力筛查结果分析

目的：了解浙江省新昌县2010～2014年新生儿听力筛查情况。方法以2010～2014年新昌县正常产新生儿18444例为研究对象,所有新生儿于出生后48～72 h接受TEOAE听力初筛,初筛未通过者出生后42 d左右进行TEOAE复筛,复筛未通过者转诊到上级听力筛查中心进行听力学诊断。结果5年间新昌县正常活产新生儿18444例中接受听力初筛18027例,初筛率97．7％（18027／18444）,初筛未通过率15．1％（2730／18444）,复筛率80．9％（2208／2730）,确诊听力损失48例,左耳12例,右耳7例,双耳29例;新生儿先天性听力损失检出率2．7‰（48／18027）。结论2010～2014年新昌县新生儿听力损失检出率为2．7‰,该县新生儿听力筛查复筛率低,失访率较高。     

9971例新生儿瞬态诱发性耳声发射听力筛查结果分析

目的 分析瞬态诱发性耳声发射(transient evoked otoacoustic emission,TEOAE)进行新生儿听力筛查通过率的影响因素及听力障碍的检出情况.方法 采用瞬态诱发性耳声发射在生后2～5天对2006年10月～2009年3月出生正常新生儿8 319例(正常组)和因各种疾病转入新生儿科治疗者1 652例(高危组)进行听力筛查,初筛未通过者,生后42天复筛,复筛未通过者,3个月左右行听性脑干反应(ABR)诊断性检查.结果 可筛总数10 523例,实际筛查9 971例,初筛率94.75%;初筛未通过790例,阳性率7.92%(790/9 971),初筛通过率女婴高于男婴,右耳高于左耳,正常组高于高危组;实际复筛290例,复筛率36.71%(290/790);复筛未通过57例,阳性率19.66%(57/290);实际接受诊断性ABR检查46例,确诊听力障碍人数35例,其中双耳听力损失22人,单耳听力损失13人;重度听力损失者6例.高危儿先天性听力损失检出率6.05‰(10/1 652)明显高于正常新生儿(3.01‰,25/8 319).结论 应用TEOAE进行新生儿听力初筛的通过率与性别、耳别、高危因素等有关,本组新生儿先天性听力损失的检出率约为3.51‰(35/9 971).     

窒息新生儿与正常新生儿听力筛查结果分析

目的 应用畸变产物耳声发射(DPOAE)对窒息新生儿与正常新生儿进行听力筛查,比较其听力损失的发生率.方法 使用MAICO ERO SCAN新生儿筛查型耳声发射仪对195例窒息新生儿和3 002例正常新生儿进行DPOAE听力筛查.根据1分钟Apgar评分,将195例窒息新生儿分为轻度(177例)和重度(18例)窒息.窒息新生儿初筛在病情稳定后进行,正常新生儿在出生后1～5天进行,窒息新生儿通过及未通过者均于出生后1、3、6、12个月分别再测试,监测有无迟发性耳聋的发生;正常新生儿未通过者在出生后42天进行复筛,两组两次检测仍未通过者在出生后3个月时用听性脑于反应(ABR)、40 Hz-AERP和声导抗进行诊断性听力评估.采用SPSS10.0软件进行统计学分析.结果 195例窒息新生儿,初筛通过148例,初筛通过率为75.90%(148/195),未通过47例,未通过率为24.10%(47/195);3 002例正常新生儿,初筛通过2 504例,初筛通过率为86.41%(2 504/3 002),正常新生儿初筛通过率显著高于窒息新生儿(P＜0.01).轻度窒息新生儿177例,初筛通过138例,初筛通过率77.97%(138/177),重度窒息新生儿18例,初筛通过10例,初筛通过率55.56%(10/18),轻度窒息新生儿初筛通过率高于重度窒息新生儿(P＜0.05).窒息新生儿复筛通过率为92.59%(25/27),正常新生儿复筛通过率为97.49%,两者差异无统计学意义(X2=0.916,P＞0.05).确诊窒息新生儿听力损伤1例,听力损失检出率5.13‰(1/195);正常新生儿听力损失6例,听力损伤检出率为2.00‰(6/3 002),两者差异无统计学意义(X2=0.574,P＞0.05).结论 正常新生儿听力初筛通过率显著高于窒息新生儿,复筛通过率两组元差异,窒息新生儿与正常新生儿听力损失检出率无显著性差异,DPOAE可作为窒息新生儿与正常新生儿听力筛查的一种有效方法.     

淄博市2010～2011年新生儿听力筛查结果分析

目的分析淄博市未通过听力复筛并转诊婴儿的听力诊断结果。方法 2010年1月至2011年12月,淄博地区出生的80 957例新生儿中共73 623例在出生后3～7天进行了TEOAE听力筛查,初筛未通过的于42天行TEOAE复筛,复筛未通过的3月龄时采用ABR、DPOAE、1 000Hz声导抗、ASSR进行听力诊断。结果淄博市新生儿听力初筛率90.94%(73 623/80 957),初筛未通过率10.24%(7 536/73 623),复筛率56.17%(4 233/7 536),复筛未通过率37.18%(1 574/4 233),转诊率40.85%(643/1 574),最终新生儿听力损失检出率4.13‰(304/73 623),其中双耳143例,单耳161例;轻度127例,中度128例,重度37例,极重度12例;双耳中度以上听力损失99例。结论淄博市新生儿听力损失检出率为4.13‰,应尽量提高复筛未通过婴儿的转诊率。     

湘潭市2365例新生儿听力筛查结果分析

目的了解湘潭市新生儿先天性听力损失的发病率。方法对2008年1月～2010年6月在湘潭市中心医院出生的2 365名新生儿(正常新生儿1 354例及NICU新生儿1 011例)进行听力筛查,正常新生儿出生后3～7天进行DPOAE初筛,NICU新生儿于出生后3～28天接受初筛,无论初筛通过与否,42天后运用DPOAE与AABR复筛,有一项以上未通过者3月龄进行听力学诊断。结果初筛时正常组未通过率8.05%(109/1 354)、NICU组未通过率14.05%(142/1 011);复筛率64.95%(1 536/2 365),复筛未通过25例,其中DPOAE未通过18例,AABR未通过5例,DPOAE+AABR均未通过2例;3月龄听力诊断时确诊听力损失7例(2.96%,7/2 365),其中单耳听力损伤2例、双耳5例;正常组1例,NICU组6例;轻度听力损失2例,中度3例,重度2例。其中2例NICU患儿初筛通过,复筛AABR未通过。结论湘潭地区先天性听力损失检出率为2.96‰(7/2 365)。     

2298例新生儿听力筛查假阳性的初步分析

目的探讨和分析新生儿听力筛查中初筛和复筛未通过的原因。方法应用瞬态诱发耳声发射(transientevokedotoacousticemission,TEOAE)和自动判别听性脑干听觉诱发电位(automatedauditorybrainstemresponse,AABR)对2003年12月-2006年1月在我院产科出生的2298例活产新生儿进行新生儿普遍听力筛查。初次接受听力筛查为出生后2～3天,只进行TEOAE测试;出生后42天进行第二次听力筛查,复筛时应用TEOAE和AABR进行测试。复筛仍“未通过”者,在出生后3个月时做诊断性检查评估听力水平。结果2298例新生儿在住院期间全部接受初次筛查,其中2152例通过了初筛,通过率为93.6%。初筛“未通过”的146例中有96例新生儿在42天进行复筛,复筛通过79例,通过率为82.3%。复筛仍未通过的17例,其中3例已经确诊为听力损失,在2298例新生儿中听力损失的发病率为0.13%。另有14例正在进行随访,尚未诊断。初筛的假阳性率占5.7%。结论总结听力筛查中出现假阳性的原因;归纳TEOAE和AABR的优势和不足。     

新生儿自发性耳声发射与瞬态诱发性耳声发射的相关性

目的分析自发性耳声发射（spontaneous otoacoustic emission,SOAE）与瞬态诱发性耳声发射（transient evoked otoacoustic emission,TEOAE）之间的相关性。方法新生儿112例（224耳）,其中女59例,男53例,出生后2～4天内行SOAE及TEOAE检测。结果每耳SOAE信号峰数量与其TEOAE强度相关（r=0.43,P〈0.001）。每耳最大SOAE波幅与其TEOAE强度相关（r=0.49,P〈0.001）。不同耳依据其SOAE信号峰数量将其分为4组：I组无SOAE信号峰;II组为单SOAE信号峰;III组为2～3个SOAE信号峰;IV组为3个以上信号峰。I组TEOAE强度为（10.96±3.77）dBSPL,II组（12.87±3.27）dBSPL,III组（15.61±3.23）dBSPL,IV组（17.100±4.51）dBSPL,各组间的TEOAE强度差异均具有统计学意义。II组SOAE最大强度（-13.54±9.21）dBSPL,III组（-4.56±7.22）dBSPL,IV组（1.00±7.35）dBSPL,各组间最大SOAE波幅差异具有统计学意义。结论SOAE信号峰数量、最大SOAE波幅与TEOAE强度之间存在正相关关系,SOAE信号峰越多,最大SOAE波幅也越强,同时TEOAE强度也越强。     

正常新生儿畸变产物耳声发射测试

目的　了解正常新生儿畸变产物耳声发射基本特点及影响测试结果的因素。方法　采用耳声发射分析仪Celesta 5 0 3对正常新生儿 112耳及正常听力成人 12 6耳进行DPOAE听力图测试 ,Medisoft96统计学分析。结果　正常新生儿DPOAE总检出率为 86 6 % ,DPOAE听力图在 75 0、10 0 0、2 0 0 0、40 0 0Hz点与对照组检出率统计学无显著性差异。在 75 0和 40 0 0Hz各有一高峰 ,3 0 0 0Hz有一低谷 ,出生五天后DPOAE检出率明显高于出生五天内的新生儿 ,DPOAE听力图测试耗时 11分钟左右。结论　DPOAE结果受新生儿活动、新生儿天龄 ,探头放置及本底噪声等因素影响。在大群体新生儿听力筛选时 ,选择DPOAE听力图的 75 0、10 0 0、2 0 0 0及 40 0 0四个频率点作为筛选频率 ,筛选时机选择出生五天后 ,可能有较大的价值     

缺氧缺血性脑病新生儿瞬态诱发耳声发射测试

目的了解应用瞬态诱发性耳声发射（ｔｒａｎｓｉｅｎｔｅｖｏｋｅｄｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｉｏｎｓ,ＴＥＯＡＥ）对正常新生儿高危新生儿行听力筛查的可行性。方法采用ＳＦ－Ⅰ型耳声发射接受器与ＣｏｍｐａｃｔＡｕｄｉｔｏｒｙＴＩＰ－３００电反应测听仪联合记录,对２０名正常新生儿及３６名缺氧缺血性脑病（ｈｙｐｏｘｉａ－ｉｓｃｈｅｍｉｃｅｎｃｅｐｈａｌｏｐａｔｈｙ,ＨＩＥ）新生儿进行ＴＥＯＡＥ和ＡＢＲ测试。结果ＨＩＥ患儿ＴＥＯＡＥ多表现为阈值升高或波缺失,ＴＥＡＯＥ能否出现与ＡＢＲ之Ｖ波阈值密切相关,重度ＨＩＥ的ＴＥＯＡＥ出波率较轻度者明显减低。结论ＴＥＯＡＥ可早期发现缺氧等高危因素所致听力损伤,因此有可能成为早期监测新生儿及高危儿听力的一种方法。     

Growth of Evoked Otoacoustic Emissions during the First Days Postpartum: A Preliminary Report

Evoked otoacoustic emissions (EOAEs) were recorded twice in 20 ears of 15 newborns. The recordings were performed in a room of the well baby ward, using the ILO88 in its default setting, i.e. with click stimulation. On the first test occasion, the infants were between 3 and 51 h of age, and EOAEs were identified in 10 ears. On the second test occasion, while the infants were at least 1 day older (range 42–107 h), EOAEs were present in all ears. The second EOAE was stronger, so the EOAE appeared to grow in the first days postpartum. This might be due to middle ear clearance of amniotic fluid, shortly after birth. The results of the EOAEs of the second examination were compared with 10 EOAEs in adult ears. The response levels of the newborns were significantly higher than in the adults. The (cross-)correlation peak value of the two tests' waveforms is over 0.75, however sometimes only after filtering around the most pronounced emission frequencies. The study proves that newborns failing the EOAE screen in the first 24 h after birth can pass if retested 1 day later, simply because of growth of EOAE strength.     

Growth of evoked otoacoustic emissions during the first days postpartum. A preliminary report.

Evoked otoacoustic emissions (EOAEs) were recorded twice in 20 ears of 15 newborns. The recordings were performed in a room of the well baby ward, using the ILO88 in its default setting, i.e. with click stimulation. On the first test occasion, the infants were between 3 and 51 h of age, and EOAEs were identified in 10 ears. On the second test occasion, while the infants were at least 1 day older (range 42-107 h), EOAEs were present in all ears. The second EOAE was stronger, so the EOAE appeared to grow in the first days postpartum. This might be due to middle ear clearance of amniotic fluid, shortly after birth. The results of the EOAEs of the second examination were compared with 10 EOAEs in adult ears. The response levels of the newborns were significantly higher than in the adults. The (cross)-correlation peak value of the two tests' waveforms is over 0.75, however sometimes only after filtering around the most pronounced emission frequencies. The study proves that newborns failing the EOAE screen in the first 24 h after birth can pass if retested 1 day later, simply because of growth of EOAE strength.     

Effects of intrauterine hypotrophy and perinatal hypoxia on cochlear function evaluated by click evoked otoacoustic emissions (TEOAE)

The authors evaluated mutual relationships between transiently evoked otoacoustic emissions (TEOAE) and various parameters defining perinatal period focusing mostly on hypotrophic newborns. TEOAE was collected using 2.5-12.5 msec time-window. TEOAE amplitude and responses (S/N ratio) from various frequency bands calculated using off-line analysis were collected using ILO 88 ECHOPORT Otodynamics. Half-octave frequency bands centered at 1.0, 1.5, 2.0, 3.0, and 4.0 kHz were included to this study. All 370 newborns, 1 to 5 days old, were tested bilaterally. The relationship between TEOAE and birth weight in all newborns showed positive correlation. Weaker TEOAE amplitudes and off-line calculated responses at low and middle frequency bands were associated with middle ear status and with immaturity of the cochlea. This tendency was specifically strong in preterm neonates with very low birth weight. The separated subgroup of hypotrophic newborns with Apgar score <7 was characterized by statistically significant weakening TEOAE amplitude and off-line calculated responses at the whole frequency band. Such results may suggest that perinatal hypoxia affect the outer hair cell function at the whole length of the basilar membrane. Co-existing factors such as intrauterine hypotrophy and perinatal hypoxia affect the cochlear function significantly deeper than each of them working separately.     

背景噪声对新生儿瞬态诱发耳声发射的影响

目的 分析背景噪声对新生儿瞬态诱发耳声发射(TEOAE)的影响.方法 对122例通过听力筛查的新生儿(244耳,女62例,男60例)分别以短声刺激行TEOAE检测,用quick TEOAE模式,叠加次数大于100次.并以背景噪声分组,比较安静组与噪声组之间TEOAE差异.结果 ①新生儿TEOAE的背景噪声为(33.94...     

Characteristics of normal newborn transient-evoked otoacoustic emissions: ear asymmetries and sex effects

Transient-evoked otoacoustic emissions (TEOAEs) were recorded from more than 30000 newborns over a six year period. Analysis was performed on all the TEOAEs that passed the bedside universal hearing screen (n=60431), in order to characterize the normal properties of neonatal TEOAEs and to study ear and sex effects. Short recording times (median=33 s) were observed in combination with high entire TEOAE level (median=18.8 dB SPL for an 81.8 dB SPL peak stimulus), and high reproducibility (median=86%). Signal-to-noise ratio (S/N) of the TEOAE was highly frequency-dependent, being poorer at low frequencies. Prolonged averaging increased median reproducibility to 97%, but the minor S/N-improvement at low frequencies did not justify the longer test time. Highly significant mean lateral asymmetries (right >left) and sex differences (female >male) existed in entire TEOAE level, S/N TEOAE, and in half-octave frequency bands (700-4000 Hz). Mean lateral and sex entire TEOAE level differences were 1.1 dB and 1.3 dB, respectively. Stimulus levels were not affected by ear or sex. Hence, physiological differences at the level of organ of Corti were demonstrated in newborns.