瞬态诱发耳声发射在住院新生儿听力筛查中的临床应用

Clinical application of transient evoked otoacoustic emissions to the screening of inpatients newborn hearing.

目的研究瞬态诱发耳声发射(Transient evoked otoacoustic emissions,TEOAE)应用于新生儿听力筛查的可行性。方法应用瞬态诱发耳声发射和脑干听觉诱发电位(Automatic auditory brainstem re-sponse,AABR)对本院产科出生及新生儿科收治的986例活产新生儿进行听力筛查。初筛时间为出生后2-5 d,用TEOAE进行;复筛应用TEOAE和AABR于出生后42 d进行。复筛"未通过"者于3个月龄时做诊断性检查评估听力水平,并跟踪随访6个月。结果筛查新生儿986例,初筛、复筛通过953例,通过率为96.65%。33例未通过初筛的新生儿进行了第3阶段筛查,通过30例,通过率为90.91%。3例未通过TEOAE和AABR筛查的新生儿在6个月龄时进行AABR测试及其他耳科学检查,最后确诊听力损失为2例,均为单侧耳聋,占所有筛查新生儿人数的2.03‰。其中中度耳聋1例,中重度耳聋1例。正常儿三组不同初筛时间通过率的比较差异有统计学意义(P<0.05)。生后4-6 d初筛通过率明显高于生后24 h-3 d和生后7-10 d的初筛通过率(P<0.05),生后24 h-3 d和生后7-10 d的初筛通过率比较无统计学意义。TEOAE筛查986例,假阳性30例,假阳性率为3.04%;第3阶段筛查33例,3例进入诊断程序,其中1例正常,复筛的假阳性率为3.03%。整个TEOAE筛查程序的灵敏度为100.00%,特异度为96.65%,假阳性率为3.14%。结论对新生儿应进行早期听力筛查,TEOAE、AABR测试有利于新生儿先天性耳聋的及时发现和早期干预,提高聋儿生活质量。

Objective To study the feasibility of transient evoked otoacoustic emissions （TEOAE） in the screening of newborn heating. Methods 986 newborns who were in neonatus department and maternity department. They were tested in hearing screening by TEOAE and automatic auditory brainstem response （AABR）. TEOAE was used for primary hearing screening in 2 days - 3days after birth, both TEOAE and AABR were used for these secondary hearing screening at 42 days after birth. Diagnostic hearing tests were used to assess the hearing of those who failed these secondary hearing screening in 3 months after birth. They had been followed up for six months. Results All the 986 newborns had the primary hearing screening. 953 of them passed the primary and secondary hearing screening, the rate was 96.65%. 33 newborns failed primary hearing screening when they underwent the third screening. 30 of them were passed, and the rate was 90.91%. Two cases failed TEOAE and AABR who were diagnosed with hearing loss, the morbidity of 986 newborns was 2.03‰. 986 cases were tested by TEOAE, 30 of them were false positive. The false positive rate was 3.14%. One case was moderate deafness; one case was moderate to severe hearing loss; two cases were unilateral deafness. It has statistical difference among three groups about the rate of primary heating screening in different time （ P 〈 0.05）. The rate of primary hearing screening in 4 - 6 days after birth group was higher than that of in 24 hours - 3 days after birth group and in 7 - 10 days after birth group （ P 〈 0.05）. It has no statistical difference both in 24 hours - 3 days after birth group and in 7 - 10 days after birth group about the rate of primary hearing screening. 33 newborns had the third hearing screening. Three cases accessed to diagnostic procedures, and one newborn was normal. The false positive rate was 3.03% of the secondary screening. The sensitivity of whole TEOAE process was 100.00%, the specificity was 96.65%, and the false positive rate was 3.14%. Conclusion The TEOAE and AABR screening were proved to be an effective method for hearing screening respectively in newborn, which estabilshes a foundation to interfere in congenital hearing loss in early stage.