3~6岁儿童不同听力筛查方法比较

A Comparative Analysis of 3 Hearing Screening Methods for Children Aged 3 to 6 Years

目的探讨适合3~6岁年龄段儿童的听力筛查方法。方法对590例3~6岁儿童进行听力筛查,筛查方法包括:家长调查问卷(由其监护人填写)、筛查型畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)和便携式听觉评估仪筛查,任意一项筛查未通过者转诊进行听力诊断;同时按年龄将其分为3~岁组(157例)、4~岁组(235例)和5~6岁组(198例),比较三种方法在三个年龄组间的配合度和通过率。结果①590例中,三种方法的配合度由高到低依次为筛查型DPOAE(100%)、家长调查问卷(98.14%)、便携式听觉评估仪筛查(73.05%),两两间差异有统计学意义(P<0.001);家长调查问卷、筛查型DPOAE在三个年龄组间配合度的差异均无统计学意义(P>0.05);便携式听觉评估仪筛查在3~岁组、4~岁组、5~6岁组的配合度分别为28.03%、81.70%和98.48%,随着年龄增加,便携式听觉评估仪筛查的配合度增加,且差异有统计学意义(P<0.001)。②家长调查问卷、筛查型DPOAE和便携式听觉评估仪三种方法的听力筛查通过率分别为100%、86.10%和97.22%,差异有统计学意义(P<0.001)。③任意一项筛查未通过者88例(其中筛查型DPOAE82例,便携式听觉评估仪筛查11例),接受听力诊断53例,最终确诊听力异常17例,其中单侧轻-中度感音神经性听力损失1例(1.69‰,1/590),分泌性中耳炎16例(2.71%,16/590)。结论3~4岁儿童适宜用筛查型DPOAE进行听力筛查,5~6岁儿童可采用筛查型DPOAE和/或便携式听觉评估仪进行听力筛查,家长调查问卷的配合度虽好,但假阴性率过高,不适用于3~6岁儿童听力筛查。

Objective To study the appropriate method of hearing screening for children aged 3 to 6 years.Methods A total of 590 children aged 3~6 years were included for hearing screening.The methods included questionnaires,screening distortion product otoacoustic emission(DPOAE),and portable audiometer.Children were divided into three groups:3~years old,4~years old and 5~6 years old.This study was a contrastive analysis of the compliance and the pass rate with the three methods in different groups.Results①The compliance for questionnaires,screening distortion otoacoustic emission and portable audiometer accounted for 98.15%,100%and 73.05%,respectively(P<0.001).Questionnaires,and screening DPOAE in 3 groups were not significantly different(P=0.1).The portable audiometer in 3 groups accounted for 28.03%,81.70%and 98.48%,respectively(P<0.001).②The pass rate of questionnaires,screening DPOAE and portable audiometer accounted for 100%,86.10%and 97.22%(P<0.001).③Fifty-three of 88 children who referred the screening were diagnosed,accounting for 60.22%(53/88),1 child(5.88%)was diagnosed as unilateral mild to moderate sensorineural hearing loss,accounting for 1.69‰(1/590),16 children(48.48%)were diagnosed otitis media,20 children(37.74%)were normal.Conclusion Screening DPOAE is appropriate for 3~years old group,distortion otoacoustic emission and/or portable auditory assessor are appropriate for 4~6 year-old group.Questionnaires with good compliance but high false pass rate thus are recommended as a reference for medical history collection and screening.