用瞬态诱发性耳声发射对新生儿进行听力筛选

目的：用瞬态诱发性耳声发射（transient evoked otoacoustic emissions,TEOAE）对新生儿进行听力筛选。方法：用英国OTodynamic公司生产ILO－92耳声发射仪进行测试，刺激声为疏波短声，声强度为73－86dB SPL，脉冲宽度为80μs，刺激方式为“3＋1”（三个正相波后接一个3倍振幅的负相波）非线性模式。结果：共对773例新生儿进行TEOAE听力筛选，3例诊断为双耳轻－中度感音神经性耳聋，2例为单耳感音性听力下降；另有12例被诊断为传导性听力下降，系中耳渗液所致。结论：TEOAE用于生儿听力筛选具有快速、简单、客观、无创的优点，不仅可查出感音神经性聋，还可查出传导性听力下降。     

足月新生儿瞬态诱发性耳声发射能量谱分析

本文对115例足月新生儿,230耳,以瞬态诱发性耳声发射的快速筛查方法进行测试。分析500～5657Hz的各半倍频程的反应和噪声的能量谱,结果显示反应能量和检出率最高的四个频带为1 414Hz、2 000Hz、2 828Hz、4 000Hz,检出率最低的频带为500Hz与707Hz,反应能量最低的三个频带为5 657Hz、707Hz和500Hz;噪声水平最高的三个频带依次为500Hz、1000Hz与707Hz。左右耳的反应能量在1 000Hz、1 414Hz、2 000Hz与2 828Hz等频带有显著性差异。除2 000Hz外,各频带反应能量不存在性别差异。     

足月新生儿的瞬态诱发性耳声发射与听性脑干反应分析

本研究通过对听功能正常 2 2例 (42耳 )和异常 5 5例 (110耳 )的足月新生儿 TEOAEs和 ABR检测 ,将两种方法的主要参量进行对比分析和验证 ,发现 :1以 ABRs阈值≥ 40 d Bn HL为新生儿听损伤标准 ,TEOAEs四项参量指标和四项参量综合指标均为有效指标 ,其符合率如下 :TEOAEs反应强度为 98.6 8% ;TEOAEs反应波的重复率为96 .71% ;TEOAEs反应波 1～ 4k Hz频率范围 (1.0、1.5、2 .0、3.0、4.0 k Hz)的重复率为 96 .71% ;1～ 4k Hz频率范围(1.0、1.5、2 .0、3.0、4.0 k Hz) TEOAEs反应波的信噪比为 98.6 8% ;四项参量综合指标为 97.37% ;2听觉功能异常的足月新生儿中单侧耳听力受损伤 (5 8.18% )多于双侧耳 (41.82 % ) ;3TEOAEs测试结果存在假阴性率为 1.32 % ,假阳性率为 1.32 %。     

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。     

诱发性耳声发射应用于新生儿听力筛选

新生儿听力筛选可以及时发现婴幼儿听力损害 ,以便早期进行干预。因此 ,一种快速而行之有效的新生儿听力筛选方法———耳声发射技术 (ＯＡＥ) ,近几年来正成为国内外耳科常用技术之一。本文就近几年来ＯＡＥ在新生儿听力筛选中的研究进展作一介绍。1　新生儿听力筛选的必要性在我国听力言语残疾居五类残疾之首。我国现有听力言语残疾人 2 0 0 0万 ,0～ 7岁的聋哑儿童约 74万 ,且以每年约 2～ 4万新发生的聋儿递增[1] 。目前 ,由于没有一个有效的方法作普遍性的新生儿听力筛选 ,一般到 2～ 3岁才发现其听力障碍 ,结果导致言语发育障碍 ,智力…     

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.     

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...     

正常新生儿瞬态诱发耳声发射

本文对20名正常新生儿在出生后1～5天每天进行一次瞬态诱发耳声发射(Transientevoked otoacoustic emissions,TEOAE)测试.结果表明,随着新生儿天龄的增加,其TEOAE检出率及反应幅值逐步提高.新生儿1～2天的检出率显著低于后几天,至出生后第3天,TEOAE检出率可达97.4%,反应幅值也趋于稳定,提示应用TEOAE进行新生儿听力筛选时,其天龄至少应在3天或3天以上.对第5天的TEOAE反应进行统计,发现其频谱范围主要在1～4kHz,反应幅值显著高于正常听力青年人,性别差异对新生儿TEOAE无显著性影响.     

新生儿瞬态诱发耳声发射通过率的影响因素分析

目的　探讨新生儿瞬态诱发耳声发射（transient evoked otoacoustic emissions,TEOAE）通过率的影响因素。方法　对17 131名新生儿进行TEOAE检测,对新生儿听力筛查资料进行Logistic回归分析和χ 2 检验。结果　在多因素logistic回归分析中,胎数比较差异无统计学意义;听力损失高危因素、胎龄和性别比较差异均有统计学意义。在χ2 检验中,胎数经分组分析P >0.05;高危因素、胎龄和性别的分组分析,P 均＜0.05。结论　性别是TEOAE通过率的影响因素,目前尚不能认为听力损失高危因素和胎龄是TEOAE通过率的影响因素。     

瞬态性诱发性耳声发射在围产期新生儿听力监测中…

瞬态性诱发性耳声发射（ｔｒａｎｓｉｅｎｔｅｖｏｋｅｄｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｓｉｏｎＴＥＯＡＥ）是诱发性耳声发射（ｅｖｏｋｅｄｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｓｉｏｎ，ＥＯＡＥ）的一种，以其快速，客观，敏感，无创等特点，在成为多种新生儿听功能监测手段的一种，并有广泛的应用前景，本就其应用于围产期新生儿听功能监测的可行性，特点，监测方向和技术要点进行了献综述，指出瞬态诱发性耳声发射可以成为中     

Distortion evoked otoacoustic emission using GSI 70 analyzer for neonatal screening

OBJECTIVE: Following the recommendation of the United State National Institute of Health Consensus Conference in 1993, otoacoustic emissions (OAE) are now used internationally for hearing screening. The GSI 70 OAE screener provides the means for carrying out OAE recordings within a short period of time and includes an automatic evaluation of results. The aim of this study was to determine the reliability of recordings in comparison with available standards in brainstem audiometry. METHOD: OAE recorded in 29 hearing-impaired suspected infants and young children (aged 1 months-7 years old) in order to compare the result of the GSI 70 screener with the result of ABR. This study was conducted in the outpatient clinic of the Tokyo University Hospital. RESULT: Our study showed that the GSI 70 screener has higher false negative rate compared with ABR results (P<0.01). Consequently, an OAE measuring method, is also provides high sensitivity and easy to use. However, there was no trend toward increased refer rates with increased age. CONCLUSION: Our findings show that the GSI 70 screener can meet the demands of systematic hearing screening in infants and young children, although there is a tendency to miss cochlear impaired cases.     

Click evoked otoacoustic emissions in neonatal screening

Seven hundred and twenty-three neonates under intensive care have been tested by evoked otoacoustic emissions (EOAE) and the auditory brain stem response (ABR) to investigate the use of EOAE as a test for hearing impairment. Three hundred and thirty-one have had follow-up tests to the age of at least 2 years. The EOAE test has been found to be practical and quick to perform. The proportion of NICU infants producing a recordable EOAE is 80%, and the sensitivity and selectivity to the ABR result in the period up to 3 months post due date is 93 and 84%, respectively. These figures are high enough and the reduction in time compared to ABR is sufficient for the EOAE to be considered as the primary screen. The follow-up data show mixed results with both false positives and false negatives present. The incidence of severe hearing impairment is close to that expected from retrospective studies at 2 in 331 (1 bilateral, 1 unilateral). Firm conclusions on the sensitivity of EOAE to long-term hearing impairment await the results from larger numbers of infants and further follow up data.     

Delayed evoked otoacoustic emissions--an ideal screening test for excluding hearing impairment in infants

A screening test is badly needed with which cochlear hearing impairment in small children and newborns can be detected. Delayed evoked otoacoustic emissions (DEOAEs) have been found in laboratory research to be a very useful tool to test the normality of cochlear preprocessing. The characteristics of a simple apparatus for clinical use to measure DEOAEs are described together with typical examples of emissions. Many case studies have already demonstrated the clinical usefulness of DEOAEs in neonates and small children. Five cases are explained in detail and the advantages of such an early screening test discussed.     

Transiently evoked otoacoustic emissions as a prognostic indicator in idiopathic sudden hearing loss

Idiopathic sudden sensorineural hearing loss (ISHL) remains a controversial topic. So far, there are no proven objective auditory factors to establish prognosis. Otoacoustic emissions reflect the functional integrity of the outer hair cells. The aim of this study was to assess the presence of transiently evoked otoacoustic emissions (TEOAEs) in the early stages of ISHL cases as a prognostic indicator. Thirty patients hospitalized for ISHL were included in the study. All patients underwent pure-tone audiometry (PTA) and TEOAE recordings on the admission day and at least three measures on the subsequent eight days. The audiometric threshold improvement at each frequency was correlated with the TEOAE parameters on each measure. Finally, the presence of TEOAEs on early examination was correlated with PTA threshold improvement. Twenty-three out of 30 patients experienced hearing recovery. Fourteen of the recovered patients had recordable TEOAEs or acceptable TEOAE peak amplitudes in some frequency bands on the first two measures, despite having audiometric thresholds greater than 40 dB HL. It thus seems that TEOAEs might serve as a clinical tool for prediction of recovery in ISHL cases.     

Identification of neonatal hearing impairment: evaluation of transient evoked otoacoustic emission, distortion product otoacoustic emission, and auditory brain stem response test performance

OBJECTIVES: The purpose of this study was to compare the performance of transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and auditory brain stem responses (ABRs) as tools for identification of neonatal hearing impairment. DESIGN: A total of 4911 infants including 4478 graduates of neonatal intensive care units, 353 well babies with one or more risk factors for hearing loss (Joint Committee on Infant Hearing, 1994) and 80 well babies without risk factor who did not pass one or more neonatal test were targeted as the potential subject pool on which test performance would be assessed. During the neonatal period, they were evaluated using TEOAEs in response to an 80 dB pSPL click, DPOAE responses to two stimulus conditions (L1 = L2 = 75 dB SPL and L1 = 65 dB SPL L2 = 50 dB SPL), and ABR elicited by a 30 dB nHL click. In an effort to describe test performance, these "at-risk" infants were asked to return for behavioral audiologic assessments, using visual reinforcement audiometry (VRA) at 8 to 12 mo corrected age, regardless of neonatal test results. Sixty-four percent of these subjects returned and reliable VRA data were obtained on 95.6% of these returnees. This approach is in contrast to previous studies in which, by necessity, efforts were made to follow only those infants who "failed" the neonatal screening tests. The accuracy of the neonatal measures in predicting hearing status at 8 to 12 mo corrected age was determined. Only those infants who provided reliable, monaural VRA test results were included in the analysis. Separate analyses were performed without regard to intercurrent events (i.e., events between the neonatal and VRA tests that could cause their results to disagree), and then after accounting for the possible influence of intercurrent events such as otitis media and late-onset or progressive hearing loss. RESULTS: Low refer rates were achieved for the stopping criteria used in the present study, especially when a protocol similar to the one recommended in the National Institutes of Health (1993) Consensus Conference Report was followed. These analyses, however, do not completely describe test performance because they did not compare neonatal screening test results with a gold standard test of hearing. Test performance, as measured by the area under a relative operating characteristic curve, were similar for all three neonatal tests when neonatal test results were compared with VRA data obtained at 8 to 12 mo corrected age. However, ABRs were more successful at determining auditory status at 1 kHz, compared with the otoacoustic emission (OAE) tests. Performance was more similar across all three tests when they were used to identify hearing loss at 2 and 4 kHz. No test performed perfectly. Using either the two- or three-frequency pure-tone average (PTA), with a fixed false alarm rate of 20%, hit rates for the neonatal tests, in general, exceeded 80% when hearing impairment was defined as behavioral thresholds > or =30 dB HL. All three tests performed similarly when a two-frequency (2 and 4 kHz) PTA was used as the gold standard; OAE test performance decreased when a three-frequency PTA (adding 1 kHz) was used as the gold standard definition. For both PTA and all three neonatal screening measures, however, hit rate increased as the magnitude of hearing loss increased. CONCLUSIONS: Singly, all three neonatal hearing screening tests resulted in low refer rates, especially if referrals for follow-up were made only for the cases in which stopping criteria were not met in both ears. Following a protocol similar to that recommended in the National Institutes of Health (1993) Consensus Conference report resulted in refer rates that were less than 4%. TEOAEs at 80 dB pSPL, DPOAE at L1 = 65, L2 = 50 dB SPL and ABR at 30 dB nHL measured during the neonatal period, and as implemented in the current study, performed similarly at predicting behavioral hearing status at 8 to 12     

Neonatal hearing screening: a combined click evoked and tone burst otoacoustic emission approach

OBJECTIVE: This study evaluated an alternative transient evoked otoacoustic emissions method for screening hearing in newborn babies that may reduce the referral rate of initial screening. METHODS: A total of 1,033 neonates (2,066 ears) from two hospitals were recruited. Subjects had their hearing screened in both ears using a combined approach-both click evoked OAEs (CEOAEs) and 1kHz tone burst evoked OAEs (TBOAEs). RESULTS: 1kHz TBOAEs were more robust than CEOAEs in terms of emission response level and signal-to-noise ratio (SNR) at both 1 and 1.5kHz frequency bands. The prevalence rate for CEOAE and TBOAE responses in these two frequency bands was significantly different. The combined protocol significantly reduced the referral rate-by almost 2 percentage points for first time screening. CONCLUSIONS: The implementation of a combined 1kHz TBOAE/CEOAE screening protocol is a feasible and effective way to reduce referral rates, and hence false positive rates, in neonatal hearing screening programs.     

Universal newborn hearing screening and transient evoked otoacoustic emission: new concepts in Brazil.

The goal of this paper is to present a Brazilian universal newborn hearing screening (UNHS) program based on transient evoked otoacoustic emission (TEOAE) and study the hearing impairment prevalence in this population. From September 1996 to August 1999, 4631 babies were born at the maternity ward of Hospital Israelita Albert Einstein in Sao Paulo, Brazil and 4196 (90.6%) had a hearing screening test performed before discharge. The equipment ILO88, 'quickscreen' mode and the 2 stages protocol were used. From the 4196 babies tested, 4123 (98.2%) had a normal test and 73 (1.8%) failed at the first stage screening. The follow-up was performed in 60 (82%) of those 73 babies and 10 (2.3-1000 live births) had a confirmed hearing loss, three without hearing risk factors. The TEOAE UNHS program was a feasible and accurate method to detect hearing disorders at an early stage.     

Neonatal hearing screening: evaluation of tone-burst and click-evoked otoacoustic emission test criteria

OBJECTIVE: Click-evoked otoacoustic emissions (CEOAEs) are widely used in universal neonatal hearing screening programs. A common finding in many such programs is a relatively high false-positive rate. This is often due to infant physiological noise adversely affecting the emission recording, leading to a "refer" screening outcome. In an attempt to reduce false-positive screening outcomes related to the effects of noise on otoacoustic emission response detection, tone-burst-evoked otoacoustic emissions (TBOAEs) were included in a neonatal hearing screening program because TBOAEs may elicit a greater signal-to-noise ratio than CEOAEs. The research project compared the pass/refer rate for a CEOAE-based test using established pass/refer criteria with the pass/refer rate for screening criteria that were based on TBOAE results alone or on combined CEOAE and TEOAE results. DESIGN: Neonates were recruited at the Hong Kong Adventist Hospital, and both CEOAEs and TBOAEs were performed. Six passing criteria were used in this study, based on CEOAEs only; CEOAEs plus 1 kHz TBOAEs; CEOAEs plus 2 kHz TBOAEs; CEOAEs plus 3 kHz TBOAEs; CEOAEs plus 1, 2, and 3 kHz TBOAEs; and TBOAEs only. RESULTS: Data from 298 neonates (546 ears) were obtained. Criteria set 1, using CEOAEs only, demonstrated a pass rate of 79.1%, and 114 ears were referred. Criteria set 2, using CEOAEs together with TBOAEs recorded at 1 kHz, passed 39 more ears than Protocol 1, and the pass rate was 86.3%. Hence, the overall referral rate for total number of screened ears decreased by 7.2 percentage points. Criteria set 3, using CEOAEs together with TBOAEs recorded at 2 kHz, and Criteria set 4, using CEOAEs in conjunction with TBOAEs recorded at 3 kHz, gave pass rates similar to Criteria set 1. Criteria set 5, using TBOAE information at frequencies where CEOAEs were not rated as "pass," raised the pass rate from 79.1 to 87.6%, reducing the overall referral rate by 8.5 percentage points. Criteria set 6, in which neonates were screened with TBOAEs recorded at 1, 2, and 3 kHz, gave a pass rate of 78.4%, similar to results for the CEOAE-only procedure. CONCLUSIONS: Both Criteria sets 2 and 5, which combined CEOAE and TBOAE recordings, gave significantly higher pass rates than Criteria sets 1, 3, 4, and 6. The results suggest that the introduction of combined CEOAE and TBOAE protocols may assist in the reduction of refer outcomes, and hence the false-positive rates, of neonatal hearing screening programs.     

Transient evoked otoacoustic emission input-output function variation in a large sample of neonates and implications for hearing screening

We performed a retrospective analysis of TEOAEs from 1415 neonatal ears to investigate whether the application of linear averaging techniques may provide greater screening specificity than conventional nonlinear averaging techniques. Pass criteria were based on correlations between replicate averages, and pass rates were compared between linear and nonlinear averaging techniques. The linear averaging technique gave a higher pass rate as hypothesized, so that 35% of ears that passed using the linear method failed using the nonlinear method. In addition, lack of saturation was more evident for the short-latency components of the TEOAE. These results, from a large sample of recordings obtained under field conditions, indicate that there is potential to improve specificity of neonatal TEOAE screening using linear averaging techniques. A combination of linear and nonlinear techniques for the long and short latency components of the TEOAE, respectively, may offer further advantages.