Test accuracy and prognostic validity of multiple auditory steady state responses for targeted hearing screening

The test accuracy and prognostic validity of Multiple Auditory Steady State Responses (MSSR) and click Auditory Brainstem Responses (cABR) was compared within the context of a targeted screening protocol. A sample of 508 high-risk babies was first screened using cABR and MSSR (500 and 2000?Hz). All children (failed/pass) were called back at three to four years of age to determine their hearing status (pure-tone audiometry). Although both methods showed an equally good test performance in the first screen (sensitivity: 100% and specificity: 92–95%), the MSSR may have some potential advantage to identify low-frequency hearing loss. Furthermore, the confirmatory audiometry with MSSR predicted the child hearing status more accurately than the cABR. In conclusion, the MSSR can provide valuable information for the diagnosis and management of infants earlier detected by a screening protocol and further developed might be also useful as a screening test.

Sumario

Se comparó la eficiencia diagnóstica y el valor pronóstico de los potenciales evocados auditivos de estado estable a múltiples frecuencias (MSSR, siglas en inglés) con los potenciales evocados auditivos de tallo cerebral con clicks (cABR, siglas en inglés) en el contexto de un programa de tamizaje auditivo de niños con factores de riesgo. Inicialmente se realizó un tamizaje con cABR y MSSR (0.5 y 2 kHz) a una muestra de 508 bebés de alto riesgo. Todos los niños (los que pasaron y los que fallaron) se reevaluaron a los 3 o 4 años de edad para determinar su estado auditivo (audiometría tonal). Aunque los dos métodos mostraron igualmente buen desempeño en el primer tamizaje (sensibilidad: 100% y especificidad: 92–95%) los MSSR pueden tener una ventaja potencial para identificar hipoacusias en tonos graves. Además la prueba audiométrica confirmatoria con MSSR predijo el status auditivo del niño con mas precisión que los cABR. En conclusión, los MSSR pueden proporcionar información valiosa para el diagnóstico y tratamiento de niños previamente detectados por un programa de tamizaje y en un futuro pueden ser también útiles como prueba de tamizaje.     

Comparison of transient evoked otoacoustic emissions and distortion product otoacoustic emissions when screening hearing in preschool children in a community setting

OBJECTIVE: The first purpose of this study was to compare transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) to determine if they resulted in equivalent signal-to-noise ratios (SNRs) when used for hearing screening in a preschool population in a community setting. The second purpose was to determine if the OAE methods would result in equivalent pass/refer rates. The third purpose was to determine the agreement between the pass/refer rates from a tympanometric screening and the pass/refer rates from each OAE method. METHODS: Thirty-three preschool children ages 4 months to 4 years, 4 months were tested using DPOAE and TEOAE. The frequencies 800-4000Hz were compared. The tympanometric gradient was obtained from a tympanogram done on each ear. A multivariate statistic was used to compare the emission SNR from both methods. A chi(2) statistic was used to compare the pass/refer rates from both methods. The agreement between the pass/refer rates from the OAE screens and from the tympanometric gradient were compared. RESULTS: TEOAE and DPOAE SNRs were significantly different in the low frequency however, there were no significant differences found in the high frequencies. There were no significant pass/refer differences found between the methods at any frequency. When comparing the agreement between the OAE methods with the tympanometry, both methods produced nearly equivalent agreement with tympanometric gradient. However, the overall correspondence between OAE findings and tympanometry was not perfect. CONCLUSIONS: Both methods are effective and especially equivalent in the high frequencies and can be recommended for use in a preschool population in the field. Tympanometric gradient disagreed with both OAE screening results about 25% of the time. Finally, our study also found that higher refer rates can be expected when young (<3 years) preschool children are included in the screen.     

新生儿听力障碍常见危险因素及听力筛查方法研究进展

听力障碍严重影响新生儿言语和识字能力发育,阻碍儿童社交、认知和学习。影响新生儿听力的因素众多,发病机制和特点各异。新生儿的听力障碍非遗传因素主要包括早产、低出生体质量、新生儿高胆红素血症、新生儿缺氧、感染、耳毒性药物用药史等;遗传因素主要包括GJB2、GJB3、SLC26A4和线粒体基因MT-RNR1变异。耳声发射、自动听觉脑干反应和声导抗检查的联合应用可有效提高新生儿听力障碍筛查的准确率,有助于早期诊断和干预。     

Evoked otoacoustic emissions and auditory brainstem responses: concordance in hearing screening among high-risk children

Objective Evoked otoacoustic emissions (OAEs) and diagnostic auditory brainstem responses (ABRs) were determined in 379 high-risk children referred for hearing screening.

Material and Methods This was a retrospective, cross-sectional study. The records of 379 children referred for hearing screening between January 2002 and March 2003 at the Ear Unit of the Philippine General Hospital were evaluated.

Results Of the 379 children, 53.6% were male and 46.4% were female and the mean age was 41±47 months. The age distribution was as follows: ≤12 months, 32.2%; 12–24 months, 52.2%; and>24 months, 11%. Out of 229 right and 232 left ears, 111 (48.5%) and 112 (48.3%) had “pass” responses and 113 (49.3%) and 116 (50.5%) had “refer” responses, respectively. Five right and four left ears had “noise” responses. Out of 266 right and 209 left ears, the ABR results showed 72 (27.1%) and 30 (14.4%) with normal auditory pathways and 194 (72.9%) and 179 (85.6%) with abnormal auditory pathways, respectively. Of the 131 children whose parents gave their consent for concomitant OAE and ABR testing, agreements were observed between the two tests in terms of classifying the results as normal or abnormal of 78.9% (κ=0.51; p=0.00) in right and 78.6% (κ=0.51; p=0.00) in left ears. When the children were classified as either “with hearing loss—bilateral abnormal ABRs” or “at least one normal ABR”, there was an observed agreement of 81% (κ=0.6; p=0.00). OAEs had a sensitivity of 76.9% (95% CI 66.7–84.8%) and a specificity of 90% (95% CI 75.4–96.7%).

Conclusion There is good concordance between OAE and ABR results among high-risk children referred for hearing screening.     

Evaluation of auditory brainstem responses for hearing screening of high-risk infants

Auditory brainstem responses (ABR) were recorded in 30 normal and 60 high-risk neonates with gestational age between 30 and 45 weeks. The normative data of normal group as regard to age, sex and various parameters of ABR were compared with high-risk group. ABR parameters especially wave V and interwave V-I intervals were significantly prolonged in high-risk infants. An infant was considered to “pass” the ABR test if an identifiable and replicable wave V response was present at 30 dB HL in both ears. All the normal neonates had click thresholds consistent with normal hearing. 12 of the highrisk neonates showed mild to moderate hearing impairment (absent replicable wave V at 30–60 dB HL) and 2 of them showed severe to profound hearing impairment (absent replicable wave V at 70 dB HL). 9 of the “failed” group were reevaluated within 3 months and several times thereafter if the abnormal responses persisted. 2 (3.3%) infants showed persistent hearing loss, which was confirmed later by behavioral audiometry.     

听性脑干反应联合听觉多频稳态诱发反应在儿童听力筛查和诊断中的应用

目的利用听觉稳态诱发反应（auditory steady state evoked response,ASSER）联合听性脑干反应（auditory brainstem response,ABR）测试对婴幼儿进行听力检测,评价两种方法对婴幼儿听力损伤早期发现及损失程度评估的作用。方法对7 6例（1 5 2耳）畸变产物耳声发射（distortion product otoacoustic emission,DPOAE）复筛未通过的婴幼儿及门诊就诊疑有听力损失的婴幼儿进行ASSER和ABR测试,对结果进行比较。结果7 6例（1 5 2耳）婴幼儿ABR反应阈与ASSER高频反应阈比较,差异无统计学意义（P＆lt;0.0 5）。ABR在最大输出无反应而ASSER测试中各频率能引出反应。结论ASSER联合ABR检查可以更全面的评估婴幼儿的真实听力情况,对ABR无反应的患儿还应进行ASSER测试,有助于全面评估其听力损失程度。     

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

OBJECTIVE: Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure. MATERIALS AND METHODS: From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old. RESULTS: The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant. CONCLUSIONS: Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.     

Screening strategy and time points for newborn hearing re‐screening with high risk factors

ObjectiveTo compare and analyze the pass rate and screening strategy of hearing rescreening for newborns with high risk factors.MethodsRetrospective chart review of high‐risk newborns who failed their initial newborn hearing screen and subsequently underwent secondary hearing tests from June 2011 to June 2018 in Guangzhou Women and Children''s Medical Center were performed.ResultsEight hundred and sixty‐eight newborns with high risk factors were included in the study. The 57‐70 days (83.5%) and 71‐84 days (83.4%) group had the highest pass rate compared with 42‐56 days (75.8%) and < 42 days (68.3%) group. As for different screening strategies, the pass rate of OAE(otoacoustic emissions), AABR (auto auditory brainstem response) and OAE + AABR was the highest in 57–70 days group and 71‐84 days group, respectively. The OAE + AABR had the lowest pass rate compared to the other two modalities. When the pass rate was compared as different risk factors, the 57–70 days and 71–84 days group also had the highest pass rate compared with 42–56 days and < 42 days group and the pass rate had no significant differences among various risk factors group.ConclusionOur results showed that all the pass rate of OAE, AABR and OAE + AABR was the highest in 57–70 days group and 71–84 days group with significant difference, suggesting that the delayed screening time (>57 days) may increase the re‐screening pass rate and reduce anxiety of parents, which is of great significance for clinical work.     

畸变产物耳声发射在伪聋和夸大性聋检测中的应用

目的：探讨畸变产物耳声发射（DPOAE）对伪聋和夸大性聋的鉴别诊断作用。方法：采用ILO 96耳动态分析仪对外伤后诉听力下降,而又不配合纯音听阈（PTT）检测的患者进行DPOAE检测与分析。结果：经PTT检测的129例（150耳）外伤性听力下降患者中,有102例（121耳）,作DPOAE检测结果显示伪聋占66．12％（80／121）,夸大性聋占33．88％（41／121）。经ABR检测反应阈值,证实DPOAE检测结果客观、可靠。结论：DPOAE作为外伤后听力损失鉴别诊断的常规检测方法,可对伪聋和夸大性聋作出客观、可靠的诊断和鉴别诊断。     

2035例婴儿听性脑干反应与多频稳态反应阈值的比较

目的 探讨婴儿听性脑干反应(auditorybrainstem response,ABR)与多频稳态反应(auditorysteady-state response,ASSR)的关系.方法 对2035例婴儿进行ABR和ASSR检测,结果采用SPSS 17.0进行相关分析、t检验和直线回归分析.结果 ①ABR反应阈与ASSR不同频率反应阈值的相关系数为0.732～0.915 (P＜0.05).②在t检验中,ABR反应阈值与ASSR 4 kHz反应阈值差异无统计学意义(P＞0.05),其余比较差异均有意义(P＜0.05).③ABR预测ASSR0.5、1、2、4 kHz、高频均值、均值的回归方程分别为:y=0.979x-6.921,y=0.909x-1.705,y=0.948x-3.647,y=1.117x-5.113,y=1.033x-4.380,y=0.988x-4.346.结论 婴儿ABR与ASSR反应阈值具有较好的相关性,其主要是反映ASSR 4 kHz的反应阈值.     

Prediction of hearing outcomes by distortion product otoacoustic emissions in patients with idiopathic sudden sensorineural hearing loss

Objective

To investigate whether distortion product otoacoustic emissions (DPOAEs) can be a prognostic indicator of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL).

Methods

Seventy-eight consecutive patients with ISSNHL were enrolled. DPOAEs were measured at the first hospital visit. Two primary pure tones with a frequency ratio (f2/f1) of 1.2 were used at non-equal sound pressure levels (L1/L2 = 80/70 dB SPL). The DPOAE amplitude was measured at the 11 frequencies of 2f1-f2 with f2 varying from 593 to 6031 Hz. All the patients received steroid administration in combination with hyperbaric oxygen (HBO) therapy. Hearing recovery was evaluated by the improvement in hearing compared to the unaffected contralateral ear. Correlations between the hearing improvement rate and five potential prognostic factors (the DPOAE amplitude, patient's age, days from onset to the start of treatment, initial hearing level, and presence of vertigo) were examined by simple and multiple regression analyses.

Results

The net DPOAE amplitude in patients with hearing improvement rate ≥50% was significantly larger than that with hearing improvement rate <50% at f2 frequencies of 3031 and 4812 Hz (unpaired Student's t-test, p < 0.05). A simple regression analysis showed that the hearing improvement rate significantly correlated with the net DPOAE amplitude at f2 frequencies of 3031 and 4812 Hz, but not with that at the other f2 frequencies tested. The correlation coefficients were 0.528 and 0.522 for 3031 and 4812 Hz, respectively, with p values <1 × 10⁻⁶. In a multiple regression analysis, the partial correlation coefficients of the net DPOAE amplitude were 0.308 and 0.246 with p values of 0.008 and 0.036 for 3031 and 4812 Hz, respectively.

Conclusion

The significant correlation between hearing recovery and DPOAEs measured before treatment indicates that DPOAEs are a potentially useful means of predicting hearing prognosis in ISSNHL.     

Audiologic evaluation of neonates with severe hyperbilirubinemia using transiently evoked otoacoustic emissions and auditory brainstem responses

OBJECTIVES: To audiologically clarify the lesion site and to test the reliability of transiently evoked otoacoustic emissions (TEOAEs) in hearing screening of hyperbilirubinemic neonates. STUDY DESIGN: Eleven neonates with severe hyperbilirubinemia who had exchange transfusion in the neonatal intensive care unit of an academic hospital over a 3-year period were included in this study. They were tested with auditory brainstem response (ABR) and TEOAEs after exchange transfusion during hospitalization or at an immediate follow-up visit after discharge. Follow-up ABR tests were performed when infants showed significant hearing loss. METHODS: ABR and TEOAE tests were performed on the 11 neonates with severe hyperbilirubinemia after exchange transfusion. Follow-up ABR tests were carried out in 3-month intervals in the four neonates who showed abnormal or no response on initial ABR. RESULTS: Four neonates showed abnormal or no response and the other seven demonstrated normal response in ABR. All 11 neonates passed TEOAEs. Two neonates showed improvement in auditory function at 3- or 6-month follow-up ABR. CONCLUSION: The results of this study indicate that the site of lesion in hearing loss caused by hyperbilirubinemia may be at the retrocochlear location while the cochlea remains intact. TEOAEs may have limitations in evaluation of hearing in the neonates with hyperbilirubinemia.     

effects of glutamate on distortion-product otoacoustic emissions and auditory brainstem responses in guinea pigs

Objective To investigate changes in evoked potentials and structure of the guinea pig cochleae during whole cochlear perfusion with glutamate. Methods CM, CAP, DPOAE, and ABR were recorded as indicators of cochlear functions during whole cochlear perfusion. The morphology of the cochlea was studied via transmission electron microscopy. Results There were no significant changes in DPOAE amplitude before and after glutamate perfusion. CM I/O function remained nonlinear during perfusion. ABR latencies were delayed following glutamate perfusion. The average CAP threshold was elevated 35 dB SPL following glutamate perfusion.. The OHCs appeared normal, but the IHCs and afferent dendrites showed cytoplasmic blebs after glutamate perfusion. Conclusions While being a primary amino acid neurotransmitter at the synapses between hair cells and spiral ganglion neurons, excessive glutamate is neurotoxic and can destroy IHCs and spiral ganglion neurons. The technique used in this study can also be used to build an animal model of auditory neuropathy.     

Comparison of hearing screening programs between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response

OBJECTIVE: To compare the efficacy between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response (AABR) in a newborn hearing screening program. We investigated their differences in referral rate, the accurate identification rate of congenital hearing loss (HL), and cost effectiveness. METHOD: From November 1998 to December 2004, a total of 21,273 healthy newborns were screened for HL in Mackay Memorial Hospital, Taipei. In the periods from November 1998 to January 2004 and from February 2004 to December 2004, the screening tools used were TEOAE alone (n = 18,260) and TEOAE plus AABR (n = 3,013), respectively. RESULTS: A statistically significant decrease of referral rate was achieved in the group using TEOAE and AABR as screening tools when compared with TEOAE alone (1.8% vs. 5.8%). The accurate identification rate of congenital HL was 0.45% in TEOAE protocol and 0.3% in TEOAE and AABR protocol, which was not statistically significant. The total direct costs per screening were 10.1 U.S. dollars for the program using TEOAE alone and 8.9 U.S. dollars for the TEOAE plus AABR program. The intangible cost, however, was much higher in the earlier program because of the higher referral rate. CONCLUSION: In terms of the efficacy of a hearing screening program using the one step TEOAE and two step TEOAE and AABR programs, the later significantly decreased the referral rate from 5.8% to 1.8%. No significant difference was noted between the accurate identification rates of congenital HL. The total costs, including expenditures and intangible cost, were lower in the protocol with TEOAE plus AABR.     

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。     

89例瞬态声诱发耳声发射筛查未通过婴幼儿听力学特点分析

目的 探讨听力筛查未通过而短声(click)诱发听性脑干反应阈值正常婴幼儿的听力学特点,进一步分析畸变产物耳声发射(DPOAE)不同频率异常与其他客观听力检查异常之间的关系.方法 瞬态声诱发耳声发射(TEOAE)听力筛查未通过而接受包括DPOAE、短声ABR、40 Hz听觉相关电位、226 Hz声导抗、1000 Hz声导抗和声反射等诊断性听力学检查的患儿共695例,以其中诊断性短声诱发ABR阈值正常的新生儿及婴幼儿89例(123耳)作为研究对象,根据DPOAE频率异常的不同分为A组(全频正常)、B组(低频异常)、C组(高频异常)和D组(全频异常).对比各项听力检查结果,分析DPOAE频率异常各组与其他5项客观听力检查(ABR Ⅰ波潜伏期、40 Hz听觉相关电位、226 Hz鼓室声导抗、1000 Hz鼓室声导抗及声反射)之间的相互关系.结果 123耳中所有6项听力检查均正常者7耳(5.7%);6项听力检查中有一项或一项以上异常者116耳(94.3%).男婴的异常率为93.9%(77/82),女婴的异常率为95.1%(39/41),二者差异无统计学意义(P＞0.05);左耳异常率为93.1%(54/58),右耳异常率为95.4%(62/65),二者差异无统计学意义(P＞0.05).各组耳数所占比例由高到低分别是D组48.0%(59/123)、B组27.6%(34/123)、A组16.3%(20/123)和C组8.2%(10/123).A组、B组和D组中异常率最高的检查项目均为声反射,异常率分别为40.0%,55.9%和66.1%;而C组中异常率最高的项目为ABR Ⅰ波潜伏期(50.0%).各组低频听力损失均以轻度为主,在B组中有1耳为中度听力损失,D组中有6耳为中度听力损失,1耳为重度听力损失.结论 听力筛查未通过而短声ABR反应阈值正常的婴幼儿,如果DPOAE全频异常,需要及时进行全面的听力学评估,而DPOAE全频正常、低频异常或高频异常者,需要进行跟踪随访.

Abstract：

Objective The presnt study was to evaluate the audiological characteristics of infants with normal auditory brainstem response thresholds in click and abnormal transiently evoked otoacoustic emissions. Relationships between test results of distortion product otoacoustic emissions(DPOAE) and other hearing testing methods were also evaluated. Methods The participants consisted of eighty-nine infants,with a total of 123 ears. All participants' TEOAE screening results were abnormal but diagnostic click ABR results were normal. The participants were classified into the following goups based on the test results from distortion product otoacoustic emissions: group A (normal all-frequency ), group B (abnormal lowfrequency), group C (abnormal high-frequency ), and group D (abnormal all-frequency ). Results Obtained from these groups were compared to results of other hearing tests including the latency of ABR wave Ⅰ, 40 Hz auditory event related potential (40 Hz AERP), 226 Hz and 1000 Hz tympanometry, and acoustic reflex. Results In six hearing tests in the 123 ears, seven ears (5.7%) were normal, while 116ears (94. 3% ) were abnormal. No significantly differences were detected between boys (93.9%) and girls (95. 1% ), as well as between left (93. 1% ) and right ears (95.4%). The proportion of abnormal test results ranked as follows: 59 ears in group D (48.0%), 34 ears in group B (27.6%), 20 ears in group A (16. 3% ), and 10 ears in group C (8.2%). The highest abnormal rates in groups A, B and D were acoustic reflex, which were 40. 0% for group A, 55.9% for group B and 66. 1% for group D respectively.The highest abnormal rate in group C was the latency of ABR wave Ⅰ ( 50. 0% ). Distribution of lowfrequency hearing loss in each group was mainly mild. However, one ear in group B was moderate hearing loss, six ears in group D were moderate hearing loss, and one ear in group D was severe hearing loss.Conclusions The present study showed that, of which infants with normal thresholds of ABR failed the hearing screening, comprehensively audiology assessment is needed. And of which infants with normal DPOAE in full frequency or abnormal in high frequency region or low frequency region need to be followed up.     

NICU中新生儿听力筛查结果及多因素影响的分析

目的分析新生儿重症监护病房(NICU)中患儿耳声发射筛查结果及多因素对耳声发射筛查结果的影响。方法对保健院244例NICU中新生儿进行瞬态诱发耳声发射(TEOAE)筛查,对2次筛查异常者行听力学跟踪和确诊,并对多种耳聋高危因素相互影响进行统计学分析。结果初筛通过率85.7%(209/244),复筛通过率71.4%(25/35)。复筛不通过的10人行2次间隔2个月以上听力学检查:其中2人双耳听力正常,3人双耳听力下降,5人单耳听力下降。NICU中新生儿耳聋患病率32.8‰(8/244)。多因素统计学分析发现,新生儿同时有2种或2种以上耳聋高危因素(窒息病史、高胆红素血症、肺部疾病等)初筛通过率显著降低,与不伴有该类疾病史者相比差异有统计学意义(P<0.05)。结论应高度重视2种或2种以上耳聋高危因素对NICU中新生儿听力损伤,积极预防和治疗,降低新生儿耳聋患病率。     

Prediction of auditory brainstem reflex screening referrals in high-risk infants

OBJECTIVES/HYPOTHESIS: The objectives of this study were to 1) quantify the relative importance of established risk factors for congenital hearing loss (HL), 2) identify other risk factors for congenital HL, and 3) create a prognostic system that can predict the chance of an infant having HL. METHODS: The authors conducted a retrospective cohort study with validation of a prognostic system. The authors used a medical record review on 1,863 infants admitted to level II and level III nurseries who underwent auditory brainstem reflex (ABR) hearing screening from 1998 to 1999 (derivation cohort). The primary outcome was hearing screening referral (i.e., hearing screening failure) classified as mild to moderate, moderate to severe, and severe to profound loss. To validate the prognostic system, a medical record review of a separate cohort of 437 infants admitted to a level III nursery who underwent ABR hearing screening in 2002 (validation cohort) was performed. RESULTS: In the derivation cohort, 1,513 infants (81%) passed the ABR screen at 30 dB, 77 (4%) had a unilateral referral, 243 (13%) had a bilateral referral, and 30 (1.6%) did not have a complete screening. In multivariable analysis, the following risk factors were clinically and statistically significant: craniofacial abnormalities, cytomegalovirus infection, bronchopulmonary dysplasia (BPD), maternal ethanol use, syndromes, hydrocephalus, and hyperbilirubinemia. CONCLUSIONS: Our results reaffirm the importance of several established risk factors for congenital HL, but suggest that BPD is an important predictor in high-risk populations. Whether these risk factors are causal or merely associated in congenital HL remains to be determined.     

高危新生儿听力筛查及听损伤高危因素分析

目的:通过对高危新生儿听力筛查,识别应当接受听力学评估的新生儿;发现和证实高危新生儿听损伤的高危因素.方法:用DPOAE初筛,对初筛未通过者用DPOAE加ABR进行复筛,复筛未通过者进行听力学诊断.应用Logistic逐步回归法分析听力障碍相关高危因素.结果:共筛查327例,初筛未通过率为37.0%;复筛未通过率为11.0%,确诊10例,听力障碍发病率为3.39%.高危因素为窒息、低体重(<1 500 g)和头颈部畸形.结论:①对高危儿进行听力筛查,DPOAE和ABR相结合是一种可靠、可行的筛查方法;②本资料中与听损伤相关的高危因素为窒息、低体重(<1 500 g)和头颈部畸形.