语言发育迟缓儿童听力评估模式的探讨

Hearing assessment model for children with language retardation

目的探讨自动听性脑干反应(AABR)与畸变产物耳声发射(DPOAE)联合检测模式在语言发育迟缓儿童听力评估中的应用价值。方法2022年1~10月在上海市儿童医院初诊为语言发育迟缓的470例儿童,随机分为诊断组与筛查组。诊断组235例患儿,应用听性脑干反应(ABR)行听力诊断评估。筛查组235例患儿,应用DPOAE+AABR先行听力筛查评估,后行ABR检测。将两组听力评估的结果及测试时间进行比较分析。结果筛查组235例(470耳)患儿中,听力筛查阳性率为7.45%(35/470)。确诊听力障碍16例(31耳),听力诊断阳性率为6.60%(31/470)。以ABR结果为标准,AABR联合DPOAE的灵敏度为100%(31/31),特异度为99.01%(435/439)。在诊断组235例(470耳)患儿中,听力诊断阳性率为5.53%(26/470)。将两组评估模式结果进行比较,组间筛查阳性率与诊断阳性率无显著差异性(χ^(2)=1.420,P=0.233)。将两组测试时间比较,诊断组ABR测试时间(39.02±3.52)min显著高于筛查组DPOAE和AABR(8.40±2.03)min(P<0.001)。结论AABR+DPOAE联合筛查模式能可靠的评估语言发育迟缓儿童的听觉能力,可高效筛选出需进入诊断程序的患儿,进一步优化语言发育迟缓患儿的听力评估流程,使患儿尽早明确病因,早期康复。

OBJECTIVE To explore the application value of automatic auditory brainstem response(AABR)and distortion product otoacoustic emissions(DPOAE)in hearing assessment of children with language retardation.METHODS From January 2022 to October 2022,470 children with language retardation were randomly divided into diagnosis group and screening group.In the diagnosis group,235 children were evaluated by brainstem auditory evoked potential(ABR).In the screening group,235 children were evaluated with DPOAE+AABR for combined hearing screening.At the same time,diagnostic tests of ABR were performed for each child.The results and test time of the two groups of hearing assessment models were compared and analyzed.RESULTS In the screening group of 235 children(470 ears),the positive rate of hearing screening was 7.45%(35/470).16 cases(31 ears)were diagnosed with hearing impairment,and the positive rate of hearing diagnosis was 6.60%(31/470).Based on the ABR results,the sensitivity of AABR combined with DPOAE was 100%(31/31),and the specificity was 99.01%(435/439).In the diagnostic group of 235 children(470 ears),the positive rate of hearing diagnosis was 5.53%(26/470).Comparing the results of the two evaluation modes,there was no significant difference in the screening positive rate and diagnostic positive rate between the groups(χ^(2)=1.420,P=0.233).Comparing the test time between the two groups,the ABR test time in the diagnostic group[(39.02±3.52)minutes]was significantly higher than that in the screening group DPOAE and AABR[(8.40±2.03)minutes,P<0.001].CONCLUSION The AABR+DPOAE combined screening model can objectively and reliably evaluate the hearing ability of children with language retardation,effectively screen out children who need to enter the diagnostic procedure,further optimize the hearing evaluation processand enable children to identify the cause as soon as possible and recover early.