未通过听力筛查婴幼儿的听力诊断及随访

Audiological follow up in infants who have failed hearing screening

目的探讨未通过听力筛查的新生儿和婴幼儿的听力变化及其特点,为听力评估及临床诊断和随访工作提供参考,为早期诊断,早期干预提供较为科学的依据。方法 2003年9月至2009年11月由我省各地州市接受了出生后初筛或复筛2次或2次以上听力筛查双耳或单耳未通过,转诊到我听力中心进行听力诊断性检查的婴幼儿143例,最终以听性脑干反应(auditory brainstem response,ABR)、40Hz听觉相关电位(40Hz auditory eventrelated potentials,40Hz-AERP)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)、声导抗结果进行评估和确认。对确诊为双耳重度和极重度听力损失的婴幼儿填写聋人调查表,进行跟踪随访,提出早期干预方案。结果 143例婴幼儿中确认听力损失者110例,占76.92%。其中单耳72例,占65.45%,双耳38例,占34.55%。听力损失中轻度31例,占28.18%;中度27例,占24.55%;重度27例,占24.55%;极重度25例,占22.72%。110例听力异常者有14例复查,占12.73%。复查者中双耳听力损失6例,单耳听力损失8例。14例双耳重度、极重度耳聋患儿,有10例配戴助听器,这些患儿正在接受语言康复训练。结论耳声发射和听性脑干反应联合应用于新生儿及婴幼儿听力筛查,能提高其听力筛查的精确性和可靠性,对未通过听力筛查的婴幼儿,有必要在出生后3个月左右接受听性脑干反应和40Hz听觉相关电位检查,以确保较为科学而可行的早期诊断、早期干预。本组听力异常患儿复查率低和失访率高仍是目前亟待解决的问题。

Objective To study characteristics of infants who have failed otoacoustic emission hearing screening to provide useful information for early diagnosis and intervention in this population. Methods One hundred and forty three infants who had failed hearing screening in one or two ears received a full audiological test battery consisting of auditory brainstem responses （ABRs）, 40 Hz auditory event related potential （40Hz-AERP）, distortion product otoacoustic emis-sions （DPOAEs） and tympanometry. The Guizhou Province Deafness Survey form was completed in those infants who were diagnosed with bilateral severe or profound hearing loss. Follow-up was implemented in these infants and early interven-tion measures recommended. Results Of the 143 infants, 110 were confirmed to have hearing loss, which was either uni-lateral （n=72, 65.45%） or bilateral （n=38, 34.55%）. Hearing loss ranged from mild （n=31, 28.18%）, moderate （n=27, 24.55%） and severe （n=27, 24.55%） to profound （n=25, 22.72%）. Testing was repeated in 14 （12.73%） of these 110 infants with hearing loss, and confirmed unilateral loss in 8 and bilateral loss in 6. In 14 infants with bilateral severe or profound hearing loss, 10 were fitted with hearing aids and enrolled in an auditory rehabilitation program. Conclusion For infants who have failed newborn hearing screening, combined DPOAE and ABRs evaluation at 3 months may help de-termine hearing status for possible early diagnosis and intervention. However, poor follow up compliance remains an ob-stacle in such efforts.