耳声发射和自动听性脑电反应联合对新生儿听力筛查的临床价值

Clinical value of otoacoustic emission combined with auto auditory brainstem response in neonatal hearing screening

目的观察耳声发射(OAE)与自动听性脑电反应(AABR)及两者联合应用于新生儿听力筛查的结果并进行比较,以期为临床诊疗提供数据参考。方法对采用OAE和AABR及二者联合对600例新生儿听力进行筛查,依据筛查方法的不同分为OAE组200例、AABR组200例、联合组200例。对所有参与筛查的新生儿3月后依据常规脑干诱发电位(ABR)和声阻抗检查为金标准判断是否合并听力障碍,依据观察并比较3种听力筛查方法的灵敏度、特异度、漏诊率、误诊率。结果单独OAE听力筛查灵敏度高于单独AABR听力筛查,特异度低于AABR听力筛查;联合OAE和AABR听力筛查灵敏度及特异度均高于单独OAE、AABR听力筛查,漏诊率及误诊率均低于单独OAE、AABR听力筛查。结论采用单独OAE进行新生儿听力筛查存在较高的漏诊率,单独AABR进行新生儿听力筛查存在较低的灵敏度,联合OAE和AABR听力筛查能够显著提高灵敏度及特异度,有效降低漏诊率及误诊率。

Objective To observe and compare the results of neonatal hearing screening by otoacoustic emission （ OAE）, auto auditory brainstem response （AABR） , combined application of OAE and AABR, provide data reference for clinical diagnosis and treatment. Methods OAE, AABR, and combined application of OAE and AABR were used for hearing screening in 600 neonates. All the neonates were divided into OAE group, AABR group, and combined group, 200 neonates in each group. After three months, auditory brainstem response （ABR） and acoustic impedance examination were used as gold standards to judge combining with hearing impairment or not. The sensitivi- ties, specificies, missed diagnostic rates, and misdiagnostic rates in the three groups were observed and compared. Results The sensitivity in OAE group was higher than that in AABR group, the specificity in OAE group was lower than that in AABR group. The sensitivity and specificity in combined group were higher than those in OAE group and AABR group, the missed diagnostic rate and misdiagnostic rate in combined group were lower than those in OAE group and AABR group. Conclusion OAE has high missed diagnostic rate in neonatal hearing screening, AABR has low sensitivity in neonatal hearing screening, OAE combined with AABR can significantly improve sensitivity and specificity, effectively reduce missed diagnostic rate and misdiagnostic rate.