听力筛查AABR未通过而TEOAE通过高危新生儿的听力追踪

目的了解听力筛查AABR未通过而TEOAE通过高危新生儿的听力变化和特点。方法 2008年至2010年对复筛时AABR未通过而TEOAE通过的23例高危新生儿在3月龄时进行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)以及高频声导抗(high frequency tympanometry,HFT)检查,对ABR异常的患儿在6月龄时复查。结果 3月龄和6月龄时DPOAE各频率基本引出,HFT均为单峰。3月龄时23例患儿中5例双耳ABR反应阈≤35dB nHL,余18例(30耳)单耳或双耳ABR异常,其中8耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;15耳只引出波Ⅴ,反应阈70～97dB nHL;7耳97dB nHL声刺激下无波形引出;符合听神经病(auditory neuropa-thy,AN)诊断12例,双耳8例,单耳4例。ABR异常的18例(30耳)6月龄复查时,1耳反应阈≤35dB nHL,29耳反应阈异常,其中,6例(11耳)ABR反应阈降低,1例(2耳)反应阈升高;29耳中14耳可辨出波Ⅰ、Ⅲ、Ⅴ,反应阈40～60dB nHL;11耳只引出波Ⅴ,反应阈70～97dB nHL;4耳97dB nHL未引出波形;符合AN诊断9例,双耳4例,单耳5例。23例患儿1～2岁时电话随访,19例对声音反应良好,2例言语发育稍迟缓,2例2岁时仍不会说话,其中1例合并脑瘫,1例CT示脑白质异常,戴助听器均无效。结论本组听力筛查AABR未通过而TEOAE通过的婴儿听力发展不确定,选择治疗方案需慎重,对这类小儿应长期听力追踪至少到3岁。

Follow-up Examination for Infants with AABR-Fail/TEOAE-Pass in Neonatal Hearing Screening

Objective The goals were to investigate the hearing thresholds changes and characteristics of the developmental hearing of the infants who failed AABR but passed TEOAE in the neonatal hearing screening in the NICUs. Methods From 2008 to 2010,the newborn hearing screenings were performed with automatic auditory brainstem response(AABR) and transient evoked otoacoustic emission(TEOAE) for the infants in the NICUs.After rescreening,23 neonates failed AABR test but passed TEOAE.1 000 Hz tympanometry(HFT),ABR and DPOAE were carried out to the infants at 3 months old.18 infants with abnormal ABR results were followed up using the same measure at 6 months old. Results Among the 23 infants at 3 months old,there were 5 infant with normal ABR thresholds and 18 with abnormal ABR.There were 8 ears with waveⅠ,Ⅲ,Ⅴ and ABR thresholds between 40 and 60 dB nHL,15 ears with only wave Ⅴ and ABR thresholds between 70 and 97 dB nHL,and 7 ears with no discernible waveform at 97 dB nHL.At 6 months old,there were 14 ears with waveⅠ,Ⅲ,Ⅴ and ABR thresholds between 40 and 60 dB nHL,11 ears with only Ⅴ waves and ABR thresholds with 70～97 dB nHL,and 4 ears with no discernible waveform at 97 dB nHL.The ABR thresholds increased for one infant and decreased in 6 infants. The latencies of waveⅠincreased significantly compared with those of normal control group.When they were between 1 and 2 years old,follow up phone calls indicated that 19 infants had normal hearing,2 infants with slight language delay and 2 infants without speech(one with cerebral and the other with leukoenphalopathy). Conclusion The characteristics of hearing development of infants with AABR-fail/TEOAE-pass in the neonatal hearing screening in the NICUs were not certain although transient hearing loss was noted.It was essential to design appropriate treatment programs carefully and to follow-up the infants at least to 3 years old.