听力筛查未通过婴幼儿相关高危因素及听力评估结果转归分析

目的：探讨不同高危因素下听力筛查未通过婴幼儿听力特点及其转归情况。方法：对2次听力筛查未通过而转诊我科的婴幼儿采用ABR、畸变产物耳声发射（DPOAE）、鼓室声导抗和镫骨肌反射等客观听力测试。首次听力评估异常者依照听力损失情况，建议复诊时间一般1～3个月，以不超过6个月龄为限。分析未通过听力筛查的婴幼儿在不同年龄、不同筛查结果、不同高危因素下的听力测试的特点及转归情况。结果：听力筛查不通过的802例（1179耳）中，单耳不通过组初次听力评估正常的比例为53．2％，高于双耳不通过组（39．5％），P％0．05。而初评为重度听力异常的比例在两组问无明显差异（P〉0．05）；高胆红素血症导致的听力筛查不通过占25．8％，远高于其他已知的高危因素（P％0．05）；先兆流产组未发现有重度听力异常患儿；有耳聋家族史的婴幼儿导致重度听力损失的比例（40．9％）远高于其他高危因素，其次为同时有2种以上高危因素者（10．8％）；听力筛查不通过者中，56．9％未发现有高危因素，其中有54．7％初次评估听力异常；而有高危因素的婴幼儿中，42．3％初次评估听力为正常；所有2次评估的96例（138耳）中，轻度异常好转比例为40．9％，中度为74．3％，重度为33．3％，P％0．05。有7耳出现听力损失加重现象。各种不同高危因素导致的听力异常中，中度异常好转的比例均较轻度异常高；802例（1179耳）中，有10例（12耳）诊断为听神经病。结论：未通过听力筛查的婴幼儿围产期病史及听力损失程度和年龄等均是决定追踪随诊次数的重要因素，仍存在许多未知的听力损害高危因素，实现新生儿聋病易感基因的普遍筛查应该是今后努力的方向。

The audiological characteristics of infants failed in hearing screening

Objective:To investigate the characteristic and the hearing change of hearing thresholds of the infants failing in the hearing screening.Method:802 infants(1179 ears) with hearing screening record were reviewed in the study. They had hearing screened by otoacoustic emissions (OAE).However, they failed in the first or & and second hearing screening. Auditory brainstem response (ABR) , distortion product otoacoustic emissions(DPOAE) and acoustic immittance measurement were examined. Subjects with abnormal hearing-evaluation were retested during the following 1-3 months (before 6-month-old). To analysis the characteristic and the hearing change of hearing thresholds of the tests.Result:Among 802 cases(1179 ears),the ratio of single-ear(53.2%) is higher than both-ears(39.5%), P<0.05. And there are no significance between the two groups in the ration of severe abnormal hearing-evaluation ;25.8% infants once suffered from hypercholesterolenia failed in the hearing screening,which was higer than the other known risk factors.P＜0.05; Threatened abortion group has found no cases of severe hearing abnormalities; The ratio of severe abnormal hearing-evaluation in family history hearing loss group (40.9%) was higher than other high-risk factors, followed by two or more risk fators group(10.8%);56.9% of the infance who did not pass the hearing screening were found none risk factors, 42.3% of the infances who had high risk factors was normal hearing level;96 cases(138 ears) undergone twice assesement, in morderat disorder group, more cases(74.3%) changed better , and less disorder group(40.9%), severe disorder group (33.3%).Seven ears became worse; Among abnormal hearing induced by different high-risk factors, the proportion of hearing improvement in children with moderate abnormal hearing was higher than that in children with slight abnormal hearing. Ten cases(12 ears) diagnosised auditory neuropathy.Conclusion:The important factors make the follow-up decision incluing perinatal history,hearing level and age.Maybe some high-factors we did not realized. Gene screening should be paied more attention in the future work.