新生儿普遍听力筛查假阴性分析

An Analysis on False Negative Findings in Universal Newborn Hearing Screening

目的 探讨耳声发射作为新生儿普遍听力筛查方法的可靠性及出现假阴性的原因，说明对高危儿进行听力监测的重要性。方法 收集2002年1月～2005年12月参加上海市新生儿听力筛查，并在上海儿童医学中心听力障碍诊治中心确诊为听力障碍者的资料，报道分析5例通过新生儿听力筛查、而在6～30月龄期间在该中心诊断为听力障碍者的病史、临床表现、听力学及影像学检查的结果。结果 通过新生儿听力筛查但被确诊为听力障碍者共5例，2例确诊为中重度感音神经性聋，3例确诊为极重度感音神经性聋，其中1例确诊为听神经病。耳声发射作为新生儿听力筛查方法，灵敏度是99．88％，假阴性率是0．12％。结论 耳声发射是灵敏度较高的新生儿听力筛查方法，但是有一定的假阴性率，对于各种原因造成的蜗后听觉通路病变所致的耳聋可能会漏诊。另外，对新生儿听力筛查阴性者，要警惕遗传性聋和迟发性聋的发生，尤其对高危儿应该定期随访。

Objective To study the validity of the use of otoacousitc emission in newborn hearing screening and the causes for false negative findings. It is important to monitor the hearing in infants at high risk. Methods Collected were the data of inflints identified with heating impairment in our hearing center from January, 2002 to December, 2005. 5 cases of newborns who passed the hearing screening were found to have hearing impairment. Their case histories, clinical examinations, audiometry and imaging testing results were carefully analyzed. Results Among the 5 patients, 2 cases were found with moderately severe sensory hearing loss and 3 cases with profound sensory hearing loss, including 1 case with auditory neuropathy. Auditory screening by OAE showed 99.38% sensitivity,0.62% false negative rate. Conclusion Auditory screening by OAE had high sensitivity, but also there were a few false negative cases in practices. Some cases with hearing loss due to retrocoehlear disease would be missed. In addition, it＇ s necessary to pay attention to delayed and hereditary sensorineural deafness. This should be given adequate attention in hearing screening.