畸变产物耳声发射对2968例新生儿听力筛查的临床分析

目的探讨畸变产物耳声发射(DPOAE)与听性脑干反应(ABR)联合应用用于新生儿听力筛查的可行性。方法应用Bio-logic自动耳声发射仪对2968例新生儿进行听力筛查,经3次筛查不合格的新生儿应用GSI诱发电位仪进行检查,并随机抽样60例120耳新生儿连续进行1~5d跟踪筛查。结果2968例新生儿有2852例分别于出生的1~5d及5d~1个月(提前出院而延筛),经1~3次DPOAE筛查通过,通过率为96.09%。116例未通过,经ABR检测有5例不合格,假阳性率为3.74%。出生在第2天、第3天通过率相差显著(P<0.01),第3天以后通过率之间差别无统计学意义(P>0.05)。结论DPOAE测试具有方便、快速、无创、客观等优点,筛查时间以生后第3天及3d以后为宜。但其只能反映耳蜗功能,不能用来诊断听神经或中枢听觉通路病损,同时由于假阳性率较高,对未通过DPOAE筛查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,联合DPOAE和ABR听力筛查技术,使其相互补充,能提高新生儿听力筛查的精确性、可靠性。

Clinical analysis of distortion product otoacustic emmision in hearing screening of 2968 newborns

Objective:To investigate the feasibility of distortion product otoacustic emmision (DPOAE) combining with auditory brainstem response (ABR) used in hearing screening of newborns.Methods:Hearing screening of 2 968 newborns were conducted with Bio-logic Auto-OAE. ABR were recorded with GSI auditory evoked potential for those failed in screening by three times. 60 newborns selected randomly were screened consecutively for five days.Results:Of 2 968 newborns, 2 852 newborns had passed 1~3 times DPOAE screenings successfully from the first day to the fifth day or the fifth day to the one months after birth (percent passing 96.09%).Among 116 newborns did not passed, 5 cases were incompetence with ABR detection (false positive rate 3.74%).There was significant difference in percent passing of DPOAE between the second and the third day after birth (P<0.01), but no significant differences after the third day after birth (P>0.05).Conclusion:The DPOAE test is simple, quick, non-invasive and objective method fitted for detection at/after the third day after birth, which is not used in diagnosis of auditory nerve or central auditory pathway lesion because it only reflects the function of the cochlea and has high false positive.The newborns can not be diagnosed as hearing injury only be DPOAE.ABR test as a reliable method for neonatal hearing screening combining with DPOAE can improve the accuracy and reliability of hearing screening of newborns.