听觉脑干反应和耳声发射在高危儿听力筛查中的应用

目的：耳声发射(OAE)和听觉脑干反应(ABR) 是新生儿听力筛查的常用方法。该研究旨在探讨畸变产物耳声发射(DPOAE) 和ABR应用于重症监护病房(NICU)高危新生儿听力筛查的差异和意义。方法：分别应用Smart-EP型听觉脑干诱发电位仪和Smart-OAE畸变产物耳声发射检查仪对600例(1 200耳)不同病因所致的高危儿同时进行DPOAE和ABR检查,将两种方法取得的检测结果进行比较。结果：在600例(1 200耳)高危新生儿中，ABR的异常率(78.6%，943/1 200耳)远高于DPOAE的未通过率(22.3%，268/1 200耳)；二种检查的共同阴/阳性率分别为20.8%(241/1 200耳)和21%(252/1 200耳)。1 200耳中有493耳DPOAE和ABR的测试结果一致,占41.1%；707耳的测试结果不一致,占58.9%。DPOAE测试的假阳性率为6.0%(16/268耳),假阴性率为74.1%(691/932耳)。结论： DPOAE仅反映耳蜗功能，单独用于高危新生儿听功能筛查的价值有限。ABR检查果相对可靠，NICU高危新生儿听力筛查应先做ABR检查，ABR异常者再做OAE检查。ABR和OAE二种检测方法相互结合,方能提高高危新生儿听力筛查的准确性。

A comparison of auditory brainstem responses and otoacoustic emissions in hearing screening of high-risk neonates

Objective Otoacoustic emissions(OAE) and auditory brainstem responses(ABR) are tests widely used in neonatal hearing screening.This study aimed to investigate the differences and clinical value of distortion product otoacoustic emissions(DPOAE) and ABR in hearing screening of high-risk neonates admitted to a neonatal intensive care unit(NICU).Methods DPOAE and ABR were measured with the Smart-OAE analyser and the Smart-EP brain-stem electric response audiometry apparatus,respectively,in 600 high-risk neonates(1 200 ears).The testing results of DPOAE and ABR were compared.Results Of the 600 neonates(1 200 ears),the incidence of ABR abnormality(78.6%,943/1 200) was remarkably higher than that of DPOAE abnormality(22.3%,268/1 200).Two hundred and forty-one ears(20.8%) were negative and 252(21%) were positive in both DPOAE and ABR tests.A total of 707 ears(58.9%) presented with a discordant result in DPOAE and ABR.The false positive and false negative rates of the DPOAE test were 6.0%(16/268) and 74.1%(691/932) respectively.Conclusions In high-risk neonates the diagnostic value of DPOAE for identification of hearing loss,when used alone,is limited.The ABR test appears to be more reliable for hearing screening in high-risk neonates.It is suggested that hearing screening for high-risk neonates should be conducted with ABR first,followed by OAE after failure on ABR.