未通过听力筛查的婴幼儿听力追踪分析

Follow-up study for newborns and infants who failed hearing screening

目的探讨未通过听力筛查的婴幼儿听力变化及其特点。方法2001年1月至2003年10月期间在北京市海淀区妇幼保健院接受瞬态诱发耳声发射(transiente voked otoacousticemission,TEOAE)进行听力筛查的新生儿14785名,未通过者106例转诊至北京同仁医院北京市耳鼻咽喉科研究所进行听力诊断性检查和跟踪随访1年,最终以听性脑干反应、畸变产物耳声发射(distortion producto toacoustic emission,DPOAE)、声导抗和行为测听的结果进行综合评估和确认。结果106例婴幼儿最后确认双耳听力正常65例,占61.3%,听力损失39例,占36.8%,2例未接受最后听力确认,患儿家长接受了电话随访,占1.9%。39例中传导性听力损失15例(14.2%),感音性听力损失24例(22.6%);39例中轻度13例(12.3%),中度14例(13.2%)、重度6例(5.7%),极重度6例(5.7%)。本组资料提示,各种听力损失(包括单耳和双耳)的患病率为0.264%(39/14785)。从初诊到最后确认,重度和极重度以上听力损失者的听力基本无改变,而轻中度听力损失者的听力有改善和正常化的趋势。结论重度以上听力损失者,3个月内的早期诊断和6个月内的早期干预是可行的;轻中度听力损失者,应进行至少2次以上听力检测和至少6个月以上的跟踪随访,综合分析各项检测结果后才可得出正确诊断。

Objective To study the audiological characteristics of newborns and infants who failed hearing screening. Methods One hundred and six infants failed hearing screening received follow-up study with routine audiological evaluations （auditory brainstem response, distortion product otoacoustic emission, tympanometry and visual reinforcement audiometry）. Results Sixty-five infants （ 61.3% ） of this group were normal hearing subjects and 39（36. 8% ） of the infants had hearing loss. Two cases （ 1.9% ） received follow-up by phone. Fifteen cases （14. 2% ）with conductive hearing loss and 24 cases （22. 6% ） with sensorineural hearing loss. Thirteen（ 12. 3% ） ,14（13.2% ） , 6（5.7% ） , and 6（5.7% ）cases were found to be mild , moderate, severe and profound hearing loss respectively. Diagnosis of hearing loss in the thirty- nine infants conducted a prevalence of 0. 264% （39/14 785 ） of congenital hearing loss （ both binaural and monaural）. The hearing level of those cases with severe and profound hearing loss basically did not change, but that of cases with mild and moderate hearing loss changed. Conclusions Early identification and intervention of infants with severe and profound hearing loss by 6 months of age were successful. Infants with mild and moderate hearing loss should be followed up to six or eight months and received routine audiologic evaluations.