听力筛查阳性患儿听觉稳态诱发反应的测试

Test of audition steady-state evoked response in infants failing to pass hearing screening

目的:利用听觉稳态诱发反应测试听力筛查未通过的婴幼儿听反应阈,了解听力筛查未通过的婴幼儿的听力损失情况,比较该方法与声场视觉强化测听之间阈值的差异。方法:①选取2002-01/2004-12在广东省妇幼保健院听力中心进行听觉稳态诱发电位检查的0～3岁婴幼儿321例。②在睡眠状态下测试了321例听力筛查未通过的婴幼儿,分析各年龄组听觉稳态诱发反应不同频率反应阈值分布范围。③2岁以上者进行声场视觉强化测听,将听觉稳态诱发反应与声场听阈(视觉强化)进行比较。④评估标准:正常反应阈<30dB;轻度听力损失反应阈31～50dB;中度听力损失反应阈51～70dB;重度听力损失反应阈71～90dB;极重度听力损失反应阈>91dB。结果:①经听力初筛、复筛后未通过的321例婴幼儿,47.4%反应阈<30dB。②听力正常组以及轻度听力损失组、中度听力损失组听觉稳态诱发反应反应阈与视觉强化测听听阈之差为6～18dB,二者有高度的相关性。③极重度和重度听力损失组听觉稳态诱发反应反应阈与视觉强化测听听阈之差小于5dB,极重度听力损失组和中重度听力损失组的阈值之差为5～13dB。结论:经听力初筛、复筛后未通过的婴幼儿,仍有约半数婴幼儿的听阈是在正常范围。听觉稳态诱发反应是一种具有频率特性的客观测听方法,在睡眠状态下反应结果稳定,是一种对于新生儿听力筛查后续的听力学评估理想的听力损失定量诊断方法。

AIM： Audition steady state evoked response （ASSR） was used to test response threshold of those who failed the initial screening and secondary screening. So as to explore the circs of hearing loss in infants that failed the initial screening and secondary screening, and to compare the results with that of visual reinforcement audiometry （VRA）. METHODS： ①321 infants of 0-3 years old between January 2002 and December 2004, who received check of audition steady state evoked response, were selected from the Center of Audition, Institute for Maternal and Child Health of Guangdong Provinee.②Ears of 321 infants were testeel while they were asleep, and the distribution range of response threshold at different frequency of ASSR in subjects of all age groups were analyzed.③Infants older than 2 years were tested by VRA, whose ASSR and the VRA were compared. ④Evaluation criteria： normal as the response threshold 〈 30 dB, low hearing loss as between 31 and 50 dB, mid hearing loss as between 51 and 70 dB, severe as between 71 and 90 dB and extremely severer as 〉 91 dB. RESULTS： ①321 infants failed in the initial hearing screening and secondary screening, and 47.4% of them got a response threshold 〈 30 dB. ② The discrepancy in response threshold between ASSR and VRA in normal audition group, low and mid hearing loss groups was 6-18 dB, which had high correlation with each other. ③The discrepancy in response threshold between ASSR and VRA was less than 5 dB between severe hearing loss group and extremely severer hearing loss group, and that between extremely severer hearing loss group and mid hearing loss group was between 5 and 13 dB. CONCLUSION： About half of the auditory thresholds in infants failed in the initial and secondary hearing screening are still in normal range. ASSR is a promising objective audiometry, which is characteristic of frequency-specific information for hearing diagnosis with steady results undar sleeping. It is an ideal quantitative diagnostic method for hearing loss in audiological evaluation of newborn infants after screening.