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.     

6681例新生儿听力筛查结果分析

目的分析6 681例新生儿听力筛查结果。方法对2008年3月～2010年3月出生的无高危因素新生儿4 454例(正常儿组)、高危因素新生儿2 227例(高危儿组)在出生后3～5天用DPOAE进行听力初筛,对未通过者42天时利用DPOAE+AABR进行复筛,复筛仍未通过者3月龄时借助耳内镜+声导抗(1 000 Hz)+ABR+DPOAE+CT进行初步诊断,对ABR波Ⅴ反应阈值大于35 dB nHL者于6月龄利用耳内镜+声导抗(1 000 Hz)+ABR+DPOAE+ASSR+CT或MRI进行确诊。确诊为听功能异常者8月龄时进行医学干预。结果正常儿组初筛未通过133例,未通过率2.99%(133/4 454),高危儿组初筛未通过416例,未通过率18.68%(416/2 227);正常儿组复筛未通过6例,未通过率4.51%(6/133);高危儿组复筛未通过142例,未通过率34.13%(142/416)。高危儿组6月龄行听力学确诊异常者37例,占1.66%(37/2 227),其中,CT示内耳畸形3例,包括大前庭水管综合征1例,Mondini畸形1例,Michel畸形1例;听功能损伤家族史组、母孕期宫内感染组、颅面畸形组、低体重组、高胆红素血症组、母孕期应用耳毒性药物组、新生儿细菌性脑膜炎组、出生时的Apgar评分异常组、机械通气过长组、新生儿NICU≥48小时组、早产儿组听功能异常率分别为4.76%、10.08%、7.89%、1.23%、1.84%、2.00%、1.45%、1.12%、1.09%、0.75%、0.61%。无高危因素新生儿听力异常4例,占0.09%(4/4 454)。结论高危新生儿听功能异常率明显高于正常儿,有高危因素的新生儿应列为新生儿听力筛查的重点监控对象。     

新生儿监护病房儿童听力筛查及诊断结果分析

目的对在耳鼻喉科听力诊断中心进行听力诊断评估,并且有新生儿监护病房住院史婴幼儿的听力筛查及诊断结果进行比较分析,旨在评价目前所用听力筛查方法的有效性。方法选取有新生儿监护病房住院史并于耳鼻咽喉科进行听力诊断评估的婴幼儿,分析其自动听性脑干反应(AABR)及畸变产物耳声发射(DPOAE)筛查资料,并与诊断型听性脑干反应(ABR)的结果进行对比分析。结果本组同时完成DPOAE、AABR筛查及诊断型ABR测试,并且资料完整保存者共89例177耳。DPOAE筛查未通过率为45.8%,AABR筛查的未通过率为46.3%。两种筛查方法的一致率为64.4%。AABR的假阴性率为27.9%,DPOAE为16.3%,联合使用两种筛查方法时其假阴性率为4.7%。诊断型ABR测试异常共26例43耳(24.3%),其中轻度听力损失22耳,中度7耳,重度3耳,极重度11耳,听力损失为双侧者17例,单侧者9例,双侧听力损失患者中双耳听力损失程度对称者12例,不对称者5例。本组确诊听力损失婴幼儿中存在的高危因素包括:新生儿重症监护病房(NICU)住院超过5天;早产儿呼吸窘迫综合征;机械通气48h以上;出生体重低于1500g;新生儿窒息(Apgar评分1分钟0~4分或5分钟时0~6分);高胆红素血症胆红素水平达到换血要求;颌面部畸形(小耳、外耳道闭锁或畸形、腭裂);细菌性脑膜炎。结论使用AABR或AABR与DPOAE联合筛查可用于NICU新生儿的听力筛查,有新生儿听力损失高危因素的婴幼儿有转诊进行听力诊断评估的指证。     

正常和重症监护病房新生儿听力筛查结果分析

目的分析正常和重症监护室(NICU)新生儿听力筛查的结果,了解其初、复筛率及听力损失检出率。方法应用DPOAE对2009年1月1日～2010年12月29日出生的正常和NICU新生儿进行听力筛查,正常新生儿于生后2～5天初筛,NICU新生儿在病情稳定后进行初筛;初筛未通过者于42天行DPOAE复筛,复筛仍未通过者于3月龄行ABR和/或ASSR检查。结果正常新生儿3 778例,接受筛查3 668例,初筛率97.09%(3 668/3 778),初筛未通过342例(9.32%,342/3 668),复筛144例(42.11%,144/342),复筛未通过40例(27.78%,40/144),转诊25例,最终确诊先天性听力损失7例(1.91‰,7/3 668)。NICU新生儿2 665例,全部接受初筛,初筛率100%,初筛未通过330例(12.38%,330/2 665),复筛46例(13.94%,46/330),复筛未通过8例(17.39%,8/46),实际转诊6例,最终确诊先天性听力损失2例(0.75‰,2/2 665),其中1例为缺血缺氧性脑病,另1例为新生儿窒息。两组听力损失检出率1.42‰(9/6 333),其中中度6例,重度2例,极重度1例;单耳3例,双耳6例。结论本组正常和NICU新生儿听力筛查复筛率明显低于推荐标准,NICU新生儿听力损失的检出率低于其它地区。     

未通过听力筛查新生儿的听力跟踪和确认

目的　探讨未通过听力筛查新生儿的听力跟踪的意义。方法　回顾性分析 1 930 2名新生儿听力筛查中未通过筛查的 5 6例新生儿的围产期病史和听力学诊断资料。结果　 1 930 2名新生儿中未通过新生儿听力筛查者共 5 6例 ,占筛查儿童的 0 2 90 % ,以后隔 2个月复查畸变产物耳声发射 (distortionproductotoacousticemission ,DPOAE)和听性脑干反应 (auditorybrainstemresponse,ABR)一次 ,共复查 2至 3次 ,其中 1例新生儿在 7个月龄时 ,听力达到正常范围 ,确诊为听力障碍的新生儿共 5 5例 ,未通过听力筛查新生儿经跟踪确认后 ,确认听力障碍的比率为 98 2 %。结论　新生儿听力筛查后 ,对于未通过听力筛查的新生儿应坚持至少为期 6个月的跟踪和随访 ,才能够确认其听力。     

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).     

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)。     

天津市新生儿听力筛查及信息化建设

目的通过对新生儿听力筛查及信息化管理,早期发现和诊断先天性听力损失,及时干预。方法新生儿出生3～5d采用畸变产物耳声发射(distoetion product otoacoustic emissions,DPOAE)进行初筛;42d用DPOAE和自动判别听性脑干反应(auto auditory brainstem response,AABR)进行复筛;3个月和6个月分别用听性脑干反应(auditory brainstem responses,ABR)、多频稳态反应(auditory steady state response,ASSR)和声导抗检查进行两次诊断;有听力障碍的患儿适时干预措施,并定期复查和随访。结果 2009～2010年在天津市出生活产婴儿106547人,104224例生后3d开始进行听力测试,全市建立了新生儿听力筛查信息化网络管理。初筛率为97.82%;初筛时正常新生儿未通过率为9.12%(9075/99484),高危儿为23.65%(1121/4740),高危儿未通过率明显高于正常新生儿(χ2=1.082,P<0.01);42d复筛率为53.44%;3个月接受第一次诊断的有362例;6个月接受诊断的有117例,其中100例(161耳)有不同程度听力损失,中重度和极重度听力障碍患儿在6个月确诊后进行干预。结论①通过建立新生儿听力筛查信息网络化管理系统,初筛率达97%以上;②42d新生儿听力复筛采用DPOAE和AABR检测技术联合应用,减少了漏筛和漏诊;③高危新生儿初筛阳性率为23.65%,明显高于正常新生儿。     

耳声发射和听性脑干反应在高危新生儿听力筛查中的应用

目的 探讨听性脑干反应(auditory brainstem response，ABR)和畸变产物耳声发射(distortion product otoacoustic emissions，DPOAE)应用于高危新生儿听力筛查中的特点、差异和意义。方法 分别应用Amplaid MK22型诱发电位仪和GS160型DPOAE测试仪对200例(400耳)不同病因所致的高危新生儿同时进行DPOAE和ABR检查，将两种方法的检测结果进行比较。结果 在200例(400耳)患儿中，DPOAE的通过率为64％(256／400耳)，ABR的通过率为88．25％(353／400耳)。400耳中DPOAE和ABR测试结果的共同阴性率为61．50％(246／400耳)，共同阳性率为9．25％(37／400耳)。DHOAE测试中假阳性率为74．31％(107／144耳)，假阴性率为3．91％(10／256耳)。结论 DHOAE测试具有方便、快速、无创、灵敏、客观等优点，为较好的新生儿听功能筛查方法，但其只能反映耳蜗功能，同时由于假阳性率较高，对未能通过DPOAE筛选者不能立即作出听力损伤的结论，ABR测试为比较可靠的新生儿听力筛查工具．对高危新生儿进行常规ABR测试是有价值的。因此在高危新生儿听力筛查中ABR和DPOAE检测需相互结合，相互补充，能提高高危新生儿听力筛查的精确性、可靠性，并应跟踪随访。     

2062例婴儿的听力检查结果分析

目的探讨3～6月龄婴儿听力障碍的诊断方法。方法对2005年1月～2007年6月在上海交通大学医学院附属上海儿童医学中心就诊的2062例(4124耳)3～6月龄婴儿有选择地进行客观听力测试,包括听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、声导抗等检查,3月龄时诊断为听力异常者6月龄时复查,收集、分析两次听力测试的资料。结果3月龄时13例(20耳)ABR异常、DPOAE正常,504例(825耳)ABR、DPOAE均异常;ABR异常的845耳中,482例(808耳)(37耳失访)6月龄时复查示:13例(20耳)ABR异常、DPOAE正常,406例(702耳)ABR、DPOAE均异常,47例(64耳)ABR、DPOAR均正常,16例(22耳)ABR正常,DPOAR异常;比较两次检查结果显示:698耳(86.4%)听力无变化,90耳(11.1%)听力改善,20耳(2.5%)听力下降;在ABR反应阈正常、DPOAE未通过者中有438耳同时行226Hz及1000Hz探测音声导抗测试,1000Hz探测音声导抗异常183耳(41.8%),226Hz探测音声导抗异常6耳(1.37%)。结论3～6月龄婴儿的听力诊断必须结合ABR、OAE检查结果综合分析判断,必要时进一步行高频声导抗检查;0～6月龄婴儿中耳功能的检查,运用1000Hz探测音声导抗比226Hz的更敏感;对确诊听力障碍者,尤其是有听力障碍高危因素者,必须密切随访,警惕听力波动及进行性的听力下降。     

助听器的声场验配法

在声场测听条件下，对17名儿童（33耳）进行助听前和助听后的声场听阈测试。以助听后听阈值能否进入言语香蕉图范围来评价助听效果，为使助听效果满意，在测试时可调节助听器的各种调节使扭；测试结果显示，该法不失为助听器验配的有效方法之一。本文亦对影响本方法的一些因素做了讨论。     

畸变产物耳声发射幅值与超高频纯音听阈的关系

目的 探讨畸变产物耳声发射（ｄｉｓｔｏｒｔｉｏｎ ｐｒｏｄｕｃｌｓ ｏｔｏａｃｏｕｓｔｉｃ ｅｍｍｉｓｓｉｏｎ，ＤＰＯＡＥ）与超高频纯音听阈用于早期耳蜗性听力损害的听力监测的可能性。方法 ＤＰＯＡＥ以配对初始音诱发，两音强度均为７０ｄＢ ＳＰＬ，频率比为１：１．２，频率范围０．５￣８ｋＨｚ。测定常规频率（１２５Ｈｚ￣８ｋＨｚ）及超高频率（９￣２０ｋＨｚ）的纯音听阈。比较正常听阈组与不正常听阈值的Ｄ     

Hearing Aid Fitting by Prescription

A procedure for the specification of hearing aid response characteristics is described. Thresholds of discomfort and most comfortable levels for narrow bands of noise centered at 0.25, 0.5, 1, 2, 3 and 4 kHz are determined. The thresholds of discomfort relate to the maximum power output of the hearing aid and the most comfortable levels determine the gain and frequency response that will be required. The data derived from these measurements are given to the hearing aid dispenser who provides a hearing aid that matches the prescribed response characteristics

This technique requires less time than the conventional hearing aid evaluation procedure, and it provides the audiologist with measures of auditory function that can be directly related to hearing aid parameters     

加强前庭神经鞘瘤手术听力保留研究

随着显微外科技术、神经电生理监测及神经影像相关技术的发展,前庭神经鞘瘤的治疗目标已经从挽救患者生命转变为神经功能的保留。近年来,前庭神经鞘瘤全切除和保留面神经功能已达到相对稳定水平,听力保留成为继二者后研究热点。本文就手术治疗前庭神经鞘瘤听力保留的现状及相关进展作简要介绍,以期鼓励更多相关研究,促进听力保留工作的进展。     

Organic solvents and hearing loss: The challenge for audiology

Organic solvents have been reported to adversely affect human health, including hearing health. Animal models have demonstrated that solvents may induce auditory damage, especially to the outer hair cells. Research on workers exposed to solvents has suggested that these chemicals may also induce auditory damage through effects on the central auditory pathways. Studies conducted with both animals and humans demonstrate that the hearing frequencies affected by solvent exposure are different to those affected by noise, and that solvents may interact synergistically with noise. The present article aims to review the contemporary literature of solvent-induced hearing loss, and consider the implications of solvent-induced auditory damage for clinical audiologists. Possible audiological tests that may be used when auditory damage due to solvent exposure is suspected are discussed.

Sumario

Se ha reportado que los solventes orgánicos afectan adversamente la salud humana, incluyen la salud auditiva. Los modelos animales han demostrado que los solventes pueden inducir daño auditivo, especialmente en las células ciliadas externas. La investigación en trabajadores expuestos a solventes sugiere que estos productos químicos pueden también inducir daño auditivo afectando las vías auditivas centrales. Los estudios conducidos en animales y en humanos demuestran que las frecuencias auditivas afectadas por la exposición a solventes son diferentes de las afectadas por el ruido, y que los solventes pueden actuar en sinergia con el ruido. El presente artículo pretende revisar la literatura contemporánea sobre hipoacusia inducida por solventes, y hacer consideraciones clínicas para el audiólogo sobre el daño auditivo inducido por solventes. Se discuten posibles pruebas auditivas que pueden ser utilizadas cuando se sospecha daño auditivo debido a la exposición a solventes.     

Active Communication Education (ACE): A Program for Older People with Hearing Impairment

The threshold-duration function of the acoustic reflex was investigated in 5 male and 5 female adult, normal-hearing humans and in 3 adult male subjects with hearing loss of cochlear etiology. Reflex threshold was obtained at stimulus durations of 10, 20, 50, 100, 200, and 500 msec and at frequencies of 500, 1 000, 2 000, 3 000, and 4 000 Hz. Three commercially available acoustic bridges were employed, the Madsen ZO-70 and Grason-Stadler 1720 electroacoustic bridges, and the Grason-Stadler-Zwislocki model 3 mechanical-acoustic bridge. A probe-tone frequency of 220 Hz was used in all measures. The reflex threshold-duration function for normal-hearing subjects was found to encompass a much greater range of intensity than the psychophysically assessed auditory threshold temporal integration function. A sex difference was found which may be explained by subclinical noise-induced cochlear pathology in the male subjects with subsequent truncation of the reflex threshold-duration function. The function was also found to be truncated in the 3 subjects with hearing loss diagnosed to be of cochlear etiology. The implications of these findings for control of stimulus duration in clinical reflex measurement are discussed     

Association between cytogenetic alteration and the audiometric profile of individuals with Turner syndrome

IntroductionTurner syndrome is a frequent genetic disorder that affects female individuals and covers a large phenotypic variability. Scientific literature suggests an association between hearing loss and Turner syndrome, but it remains a controversial topic.ObjectiveTo associate the cytogenetic alteration with the audiometric profile of individuals with Turner syndrome.MethodsCross-sectional study, with a hospital-based, convenience sample. Patients diagnosed with Turner syndrome were included and those with difficulty understanding the audiometry and/or other associated syndromes were excluded. The participants were studied with pure tone audiometry.ResultsOf the 65 patients included, 36.9% had X chromosome monosomy and 63.0% had other alterations. Regarding the audiometry, 64.6% had normal thresholds and 35.3% had hearing impairment. Of these, 30.4% had hybrid hearing loss, 26.0% alteration at 6 and/or 8 kHz, 17.3% had conductive hearing loss, 13.0% sensorineural loss and 13.0% had mixed hearing loss. We observed that the mild degree was the most frequent one. There was no statistically significant association between the cytogenetic type of Turner syndrome and the presence or absence of hearing loss, or with the type and degree of hearing loss.ConclusionThe cytogenetic alteration in Turner syndrome was not associated with the audiometric profile, which showed variability regarding the type and degree of hearing loss.     

Self-reported hearing difficulty and hearing Okamoto/Nakanishi/Tatara impairment in Japanese people living in a community

Nine hundred and eighteen people aged 40 years and over were examined to assess the relationship between self-reported hearing difficulty and hearing impairment at 1 kHz and 4 kHz during annual health check-ups. After adjustment for potential confounding factors of selfreported hearing difficulty such as age, sex, noise exposure, ear disease and tinnitus, the odds ratios for self-reported hearing difficulty at 1 kHz compared with a hearing threshold of 30 dB were 1.74, 3.37 and 4.97 for hearing thresholds of 40 dB, 50 dB, and over 50 dB, respectively ( p-value for trend = 0.003). At 4 kHz, the respective odds ratios for self-reported hearing difficulty were 1.53, 2.59 and 1.83 ( p-value for trend = 0.012). These results suggest that self-reported hearing difficulty is closely associated with the severity of hearing impairment at 1 kHz and 4 kHz in a community-residing population and that people with hearing impairment at 1 kHz would be more sensitive to their hearing difficulty than those with hearing impairment at 4 kHz.

Sumario Novecientas dieciocho personas con edades de 40 an?os o ma´s fueron evaluadas para establecer la relacio´n entre la dificultad auditiva auto-reportada y un trastorno auditivo real en 1 kHz y 4 kHz, durante sus evaluaciones anuales de salud. Luego de hacer ajustes para posibles factores de confusio´n en el auto-reporte de la dificultad para escuchar, como la edad, el sexo, la exposicio´n al ruido, la enfermedad otolo´gica o el acu´feno, se establecio´ que la razo´n de posibilidades (odds ratio) para la dificultad auditiva en 1 kHz comparada con un umbral auditivo de 30 dB, fue de 1.74, 3.37 y 4.97 para umbrales auditivos de 40 dB, 50 dB y por encima de 50 dB, respectivamente (valor p de la tendencia igual a 0.003). A 4 kHz, las razones de posibilidad respectivas para la dificultad auditiva auto-reportada fueron 1.53, 2.59 y 1.83 (valor p de la tendencia igual a 0.012). Estos resultados sugieren que la dificultad auditiva auto-reportada esta´ estrechamente asociada con la severidad del trastorno auditivo en 1 kHz y en 4 kHz, en una poblacio´n de residentes de una comunidad, y que las personas con trastornos auditivos en 1 kHz seri´an ma´s sensibles a su dificultad auditiva que aquellos con alteraciones en 4 kHz.     

Effect of Hearing Rehabilitation Therapy Program in Hearing Aid Users: A Prospective Randomized Controlled Study

ObjectivesDespite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement.MethodsIn this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups.ResultsAfter completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (P<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups.ConclusionEven after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.