TEOAE和AABR联合应用在婴幼儿听力复筛中的意义

The Significance of Combined using TEOAE and AABR Tests in Universal Newborn Hearing Screening

目的探讨联合应用瞬态诱发性耳声发射(transient evoked otoacoustic emission,TEOAE)和自动听性脑干反应(automated auditory brainstem response,AABR)在婴幼儿听力筛查中的意义。方法对2004年6月至2006年11月在外院听力初筛未通过而转至我院儿童听力诊断中心的270例(540耳)婴幼儿,运用AccuScreen听力筛查仪,同时进行TEOAE和AABR联合听力复筛,其中任何一项检查未通过者均在患儿3个月时进行听性脑干反应、40 Hz听觉相关电位、听性稳态反应、声导抗测试等诊断性检查。结果在540耳(270例)中,450耳通过TEOAE和AABR联合筛查,进入随访阶段;53耳未通过TEOAE和AABR联合筛查,其中,有17耳诊断为分泌性中耳炎,6耳诊断为大前庭水管综合征,30耳诊断为感音神经性聋;TEOAE通过而AABR未通过的2耳,诊断为小儿听神经病;TEOAE未通过而AABR通过的35耳中,17耳诊断为分泌性中耳炎,18耳听力正常。结论AABR和TEOAE联合应用可以优势互补,降低漏诊、误诊率,有利于听力障碍患儿的早期发现、早期诊断、早期干预。

Objective The aim of this study is to assess the clinical applications of the combined use of TEO- AN and AABR in universal newborn hearing screening. Methods The clinical data of 540 ears （270 infants） from June 2004 to November 2006 were retrospectively reviewed and analyzed. These infants failed the initial hearing screening in the local hospitals and were referred to the Paediatric Audiology Center for follow--ups. Each referred infant received both TEOAE and AABR at the same time. Those who failed the rescreening were tested with ABR, 40 Hz and ASSR and other audiological battery. Results Among the 540 ears rescreened, 450 passed both TEOAE and AABR tests. 53 ears failed to pass in both tests, among which 17 eras were diagnosed as secretary otitis media, 6 ears as enlarged vestibular aqueduct syndrome, and 30 as sensorineural hearing loss. It was interesting to note that 2 ears that passed TEOAE but failed AABR were finally diagnosed as auditory neuropathy. For 35 ears that failed TEOAE but passed AABR, 17 had secretary otitis media and 18 were normal. Conclusion The combined use of TEOAE and AABR in universal newborn hearing screening are complementary each other in screening, and will enhance the accuracy of hearing screening.