多种听力方法组合在婴幼儿听力诊断中的应用

目的:探讨多种联合检查方法在婴幼儿听力诊断中的临床应用。方法:选择2004年5月～2008年5月住院出生3～7天,经耳声发射(otoacoustic emissions,OAE)听力筛查(初筛、复筛)均未通过的180例婴幼儿,分别在3月龄～6月龄进行听力测试,方法如下:①畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)+听性脑干反应(Auditorybrainstem response,ABR)+声导抗(acoustic immittance measurement,AIM);②畸变产物耳声发射(DPOAE)+听性脑干反应(ABR)+多频稳态听觉诱发反应(auditory steady-state responses,ASSR)+声导抗(AIM);③听性脑干反应(ABR)。结果:180例新生儿3～6月龄两次全部完成ABR测试,其中360耳中299耳正常,占83.06%,38例(61耳)异常,占16.94%(61/360耳)。听力损失程度:轻度2耳、中度15耳、重度20耳和极重度24耳,重度和极重度占总听力障碍72.13%(44/61耳)。ASSR测试结果60例(120耳),0.5～4kHz平均反应阈,听力损失程度基本与ABR相符,异常12例(22耳),占18.33%;120例(240耳)DPOAE测试,其中189耳通过,占78.75%(189/240耳),51耳未通过,占21.25%。声导抗(AIM)测试120例,鼓室曲线为A型104例,为B型或C型55耳,异常39例,异常率23.00%。结论:在婴幼儿听力诊断评估中,以ABR v波反应阈作为听力损失指标,但不能作为听力损失诊断唯一工具;只有多种联合听力检测才能有效的提高准确率,确保整个筛查诊断过程中不出现假阴性及听神经病的漏诊;同时有助于确诊婴幼儿听力损失的性质和程度,提高干预效果。

Application of multiple hearing measures in hearing diagnosis of infants

Objective:To explore the clinical application of multiple hearing measures in hearing diagnosis of infants.Methods:Hearing test was carried out on 180 infants aged 3～6 months who failed the otoacoustic emission hearing screening in 3～7 days after birth either in the preliminary screening or in the secondary screening.The methods of hearing test were listed as follow: ①distortion product otoacoustic emissions(DPOAE),auditory brainstem response(ABR) and acoustic immittance measurement(AIM);②DPOAE,ABR,auditory steady-state responses(ASSR) and AIM;③ABR.Results:All the infants finished ABR test,299 of the 360 ears were normal,accounting for 83.06%.38 cases(61 ears) were diagnosed as abnormal hearing,accounting for 16.94%(61/360).Hearing loss level: 2,15,20,24 ears were found to be mild,moderate,severe and profound hearing loss,respectively.Moreover,severe-extremely severe cases in the hearing disorders accounted for 72.13%(44/61).ASSR test showed that in the 60 cases(120 ears),mean response thresholds was at 0.5～4KHz.Hearing loss level accorded with ABR.12 cases were diagnosed as abnormal hearing(22 ears),accounting for 18.33%.DPOAE was conducted on 120 cases(240 ears),189 ears passed,accounting for 78.75%(189/240);51 ears failed,accounting for 21.25%.AIM was conducted on 120 cases,the tympanic curves of 104 cases was pattern A,the rest 55 ears were pattern B or C,and 39 ears were abnormal,the rate of abnormal ears was 23.00%.Conclusion:In hearing diagnosis and evaluation of infants,V response threshold is a indication of hearing loss,but not be the unique tool;in order to improve the accuracy rate and reduce missed diagnosis effectively,the multiple hearing measures should be taken in the diagnosis of hearing loss,furthermore,it is also helpful to diagnose the nature and degree of hearing loss in infants and improve the intervention effect.