新生儿听力普遍筛查模式的初步探讨

目的 寻找适合于中国国情的新生儿听力普遍筛查模式，获得新生儿听力损失发病的基本资料。方法 新生儿在出院前接受耳声发射（otoacoustic emissions,OAE)测试，通过者予以出院；对未通过者在1个月后再次复查OAE，仍未通过者行听性脑干反应（auditory brainstem response,ABR)检查。所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估，以确定听力损失的性质和程度。耳声发射测试采用畸变产物耳声发射（distortion product otoacoustic emissions,DPOAE)，通过标准：1．5－6kHz的5个测试频率中的4个信噪比大于6dB。ABR通过测试的标准为波V反应阈值≤35dBnHL。结果 2998例新生儿中2710位通过出院前的OAE测试，1个月后288例复查OAE，其中263例通过。需要ABR检查者共有25例，未通过者6例。经过全面的听力学诊断和评估，6例婴儿（占全体新生儿的2‰）有听力损失。结论 新生儿听力普查十分必要，OAE和ABR联合应用的两步筛查法是较适合的筛查模式。

A preliminary study of a hearing screening model for newborn]

OBJECTIVE: To search for a hearing screening model for newborn and to investigate the prevalence of newborn hearing loss in our country. METHODS: The distortion product otoacoustic emissions (DPOAE) was used to test the hearing in 2,998 of 3,075 newborns before discharge. Otoacoustic emissions (OAE) was again used for cases failed in the hospital screening 4 weeks later. Those cases failed in both screening steps were finally tested by auditory brainstem response (ABR). All infants failed in ABR test received diagnostic evaluation audiologically to identify the category and degree of hearing loss. The pass criterion of DPOAE was defined as signal-noise-ratio (SNR) exceeding 6 dB in 4 of 5 frequencies between 1.5-6 kHz. The pass criterion of ABR was the presence of wave V in response to 35 dB nHL click stimuli. RESULTS: The OAE screening in the hospital showed that 2,710 (90.4%) newborns passed the first test. Two hundred and sixty three of 288 newborns passed the second OAE screening after one month. Six of 25 infants failed in ABR test were eventually identified to be hearing impaired. CONCLUSION: Two-stages screening, combining OAE and ABR tests, may be an ideal model for newborn hearing screening. The prevalence of congenital hearing loss is similar to that reported in the literature.