耳声发射和听性脑干反应在高危新生儿听力筛查中的应用

Otoacoustic Emissions and Auditory Brainstem Response in High Risk Neonatal Hearing Screening

目的 探讨听性脑干反应 (auditorybrainstemresponse,ABR)和畸变产物耳声发射 (distortionproductotoa cousticemissions,DPOAE)应用于高危新生儿听力筛查中的特点、差异和意义。方法 分别应用AmplaidMK2 2型诱发电位仪和GSI6 0型DPOAE测试仪对 2 0 0例 ( 4 0 0耳 )不同病因所致的高危新生儿同时进行DPOAE和ABR检查 ,将两种方法的检测结果进行比较。结果 在 2 0 0例 ( 4 0 0耳 )患儿中 ,DPOAE的通过率为 6 4 % ( 2 5 6 4 0 0耳 ) ,ABR的通过率为 88.2 5 % ( 35 3 4 0 0耳 )。 4 0 0耳中DPOAE和ABR测试结果的共同阴性率为 6 1.5 0 % ( 2 4 6 4 0 0耳 ) ,共同阳性率为9.2 5 % ( 37 4 0 0耳 )。DPOAE测试中假阳性率为 74 .31% ( 10 7 14 4耳 ) ,假阴性率为 3.91% ( 10 2 5 6耳 )。结论 DPOAE测试具有方便、快速、无创、灵敏、客观等优点 ,为较好的新生儿听功能筛查方法 ,但其只能反映耳蜗功能 ,同时由于假阳性率较高 ,对未能通过DPOAE筛选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 ,对高危新生儿进行常规ABR测试是有价值的。因此在高危新生儿听力筛查中ABR和DPOAE检测需相互结合 ,相互补充 ,能提高高危新生儿听力筛查的精确性、可靠性 。

Objective To investigate the character 、difference and clinical meaning of distortion product otoacoustic emissions(DPOAE) and auditory brainstem respons(ABR) in high risk neonates with.Methods DPOAE and ABR were recorded with amplaid MK 22 and GSI60 in 200(400ears) high risk neonates, then compared the results.Results Of 200(400ears) newborns, the presence of DPOAE was 64%(256/400 ears), the presence of ABR was 88.25%(353/400 ears). The co-negativity and co-positivity of DPOAE and ABR were 61.50%(246/400 ears)and 9.25%(37/400 ears). The false negative and false positive of DPOAE were 3.91%(10/256 ears)and 74.31%(107/144 ears).Conclusion The DPOAE test is simple,quick,harmless,sensitive and objective. Because it only reflects the function of the cochlea and has high false positive, we can't make the diagnosis of hearing loss immediately when newborns don't pass the DPOAE test.The ABR test is a reliable method for neonatal hearing screening. The combination of DPOAE and ABR in high risk neonatal hearing screening could increase the accuracy and reliability of the test and retest results.