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.     

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。     

诱发畸变耳声发射法对4996例新生儿听力筛查结果分析

目的探讨早期发现小儿听力障碍的筛查方法.方法采用诱发畸变耳声发射法(DPOAE)对4996例新生儿进行听力筛查,连续监测异常者,最后由脑干听觉诱发电位(ABR)确诊.结果DPOAE法筛查阳性36例(0.72%)经ABR确诊10例听觉障碍,其中单耳聋4例,双耳聋6例;轻度听觉障碍1例,中度4例,重度5例.结论DPOAE测试法适合于新生儿听力筛查,是可靠、有效、快速、简便的好方法;新生儿科工作者必须重视小儿听力筛查,早期干预,以达聋而不哑.     

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.     

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(I)POAE)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。     

Auditory brainstem response and otoacoustic emissions in hearing screening of full term infants with hyperbilirubinemia

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.     

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。     

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。     

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。     

2367例新生儿听力筛查初步报告

目的　筛查新生儿听力障碍。方法　采用诱发畸变耳声发射（ＤＰＯＡＥ）对２ ３６７ 例新生儿进行听力筛查，连续监测异常者，最后由脑干听觉诱发电位（ＡＢＲ） 确诊。结果　５ 例听觉障碍，其中单耳聋２ 例，双耳聋３ 例。中度听觉障碍２例，重度听觉障碍３ 例。结论　ＤＰＯＡＥ测试是适合于新生儿听力筛查可靠、有效、快速、简便的好方法。     

东莞地区新生儿听力筛查的多中心研究

目的：探索适合于新生儿听力筛查的临床策略,通过多中心合作获得新生儿听力损失发病的基本资料。方法：应用畸变产物耳声发射技术(DPOAE)进行听力普遍筛查。对复筛未通过者,于生后3个月左右采用听性脑干反应(ABR)和40Hz听性相关电位(40HzAERP)技术诊断。结果：该研究实际筛查17360例,筛查率为89.1%。初筛通过15624例(90.0%)。需复筛的1736例,实际复筛1597例,复筛率92%,复筛通过1491例,复筛通过率93.4%。41例复查ABR其中确诊新生儿先天性听力损失39例,减去2例假阳性,该组新生儿先天性听力损失的发生率为2.25‰。结论：新生儿听力普查十分必要。DPOAE是一种快速行之有效的新生儿听力初筛方法,两步筛查法可及早发现听力损失,听力筛查、诊断、康复统筹运作是使聋儿得以康复的重要保证。     

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     

Otoacoustic emissions as a screening test for hearing impairment in children recovering from acute bacterial meningitis

OBJECTIVES: To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss. METHODS: Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold >/=30 dB. The results of OAE screening were compared with the gold standard of ABR threshold. RESULTS: Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold >/=30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0. 44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00). CONCLUSIONS: OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.     

Ligurian experience on neonatal hearing screening: clinical and epidemiological aspects

AIM: Early identification and rehabilitation of newborns with congenital hearing impairment (HI) by Universal Neonatal Hearing Screening (UNHS). METHODS: The neonatal population was divided into two groups: babies with No Audiological Risk (NAR), and babies With Audiological Risk (WAR). NAR neonates underwent OAE testing, and in case of a doubtful (Refer) result, ABR testing was carried out. All WAR newborns underwent ABR testing within the third month of life. RESULTS: Between February 1, 2002 and December 31, 2004, UNHS was carried out on 32 502 newborns at the 13 regional birth centres, representing 98.7% of the whole regional neonatal population. The prevalence of HI in the population we tested was estimated at about 1 per thousand, while Bilateral Hearing Impairment (BHI) was estimated at 0.65 per thousand. A 3.7% prevalence of HI and a 2.8% prevalence of BHI was observed among the WAR population. Median age at the end of the diagnostic procedures was 6.7 months in the WAR population and 6.9 months in the NAR population. CONCLUSIONS: Our project is based on two levels of testing, which resulted in a 0.28% false-positive rate with 100% sensitivity and 99% specificity. Our screening is the first Italian experience that has been extended to a whole region and the results prove that regional neonatal hearing screening is feasible.     

先天性巨细胞病毒感染对婴幼儿听力及智力影响的研究

目的　探讨先天性巨细胞病毒 (CMV)感染对婴幼儿生长发育、听力及智力的影响。方法　对 65例先天性CMV感染儿及 82例非感染儿于新生儿期进行生长发育及听力的检测 ,并于生后 6个月至 4岁进行随访。随访内容包括 :体格检查、发育商测试及听力测试。结果　两组生长发育状况无显著性差异。感染组发育商落后8例 ,对照组仅 1例 ,二者有显著性差异。感染组新生儿期、随访时分别有 7例 9耳、9例 11耳未通过TEOAE听力测试 ,对照组均为 1例 1耳未通过 ,未通过率感染组明显高于对照组。新生儿期、随访时双耳反应能量感染组明显低于对照组。 14例进行了ABR检测 (感染组 12例 ,对照组 2例 ) ,其中感染组 9例 17耳听力异常 ,对照组 1例 1耳听力异常。结论　先天性CMV感染对婴幼儿生长发育可能无明显影响 ,但对听力、智力的损害却不容忽视     

Universal neonatal hearing screening: the Siena (Italy) experience on 19,700 newborns

BACKGROUND: Hearing loss (HL) is likely to be the most common congenital abnormality in humans, with a reported prevalence of 1 to 3 per 1000 live births. Early detection and intervention is critical to prevent the adverse consequences of a delayed diagnosis on speech, language and cognitive development. As 33-50% of all congenital HLs cannot be detected in a selective hearing risk, use of universal neonatal hearing screening (UNHS) programs is expanding. AIMS: We tested the value of a UNHS protocol, based on a two-stage strategy of Transient Evoked Otoacoustic Emissions (TEOAEs) in all infants, followed by diagnostic auditory brainstem response (ABR) testing in those infants who did not meet TEOAE pass criteria and those infants at high risk for hearing loss. METHODS: TEOAES (292 DP Echoport OAE Analyzer) served as the initial screen, followed by diagnostic ABR (Amplaid MK12) in newborns that did not meet pass criteria for TEOAEs. Additionally, all infants at high audiologic risk according to the Joint Committee on Infant Hearing received a diagnostic ABR evaluation. Of 21,125 total live births, 19,700 were tested (April 1, 1998-July 31, 2006). Accuracy of the UNHS strategy in predicting congenital HL was evaluated by calculating sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: Prevalence for all HLs in the neonatal period was 1.78/1000 l.b. (35/19,700), with bilateral HL in 1.42/1000 l.b. (28/19,700) [low risk rate: 0.43/1000 l.b. (8/18,356); high risk infants rate: 14.88/1000 l.b. (20/1344)]. All the HL infants were diagnosed <3 and received intervention <6 months age. ROC curves results showed 100% sensitivity (95% C.I.: 89.0-100) and 99.3% specificity (95% C.I.: 99.2-99.4) of the two-stage strategy in detecting congenital HLs [area under the ROC curve: 0.997 (95% C.I.: 0.995-0.997)]. CONCLUSIONS: (1) The epidemiology of congenital HLs widely justifies UNHS; (2) a two-stage TEOAE and diagnostic ABR screening for congenital HL is feasible, minimally invasive and accurate in the early detection of congenital HL; and (3) a congenital HL screening strategy based exclusively on the use of TEOAEs should always consider the possibility of false negative cases.