BACKGROUND: Auditory steady-state evoked response (ASSR) is one of the new objective electrophysiological methods to test hearing in infants. It can provide a reliable and complete audiogram with specific frequency to...BACKGROUND: Auditory steady-state evoked response (ASSR) is one of the new objective electrophysiological methods to test hearing in infants. It can provide a reliable and complete audiogram with specific frequency to help the hearing diagnosis and rehabilitation of hearing and languaging following auditory screening. OBJECTIVE: To compare the response threshold of ASSR with auditory threshold of visual reinforcement audiometry (VRA) in infants failed in the hearing screening for investigating their hearing loss. DESIGN: A comparative observation. SETTINGS: Maternal and child health care hospitals of Guangdong province, Shunde city, Nanhai city and Huadu district. PARTICIPANTS: Totally 321 infants of 0-3 years undergoing ASSR test were selected from the Hearing Center of Guangdong Maternal and Child Health Care Hospital from January 2002 to December 2004. Informed consents were obtained from their guardians. There were 193 cases (60.2%) of 0-6 months, 31 cases (9.7%) of 7-12 months, 17 cases (5.3%) of 13-18 months, 14 cases (4.4%) of 19-24 months, 33 cases of 25-30 months, and 33 cases (10.2%) of 31-36 months. METHODS: ① The 321 infants failed in the hearing screening were tested under sleeping status, the ranges of response threshold distribution in ASSR of different frequencies were analyzed in each age group. ② The infants above 2 years old were also tested with VRA, and their response thresholds were compared between VRA and ASSR. ③ Evaluative standards: The response threshold was < 30 dB for normal hearing, 31-50 dB for mild hearing loss, 51-70 dB for moderate hearing loss, 71-90 dB for severe hearing loss, and > 91 dB for extremely severe hearing loss. MAIN OUTCOME MEASURES: ① ASSR results of the infants failed in the screening; ② Proportion of cases of each response threshold in each age group; ③ Comparison of ASSR response thresholds and VRA auditory thresholds in the infants of 2-3 years old. RESULTS: ①The response threshold was < 30 dB in 47.4% of the 321 infants failed in the initial hearing screening and secondary screening after 42 days. ② Severe to extremely severe hearing loss was detected in only 16 cases (8.3%) of the 193 infants of 0-6 months, in 9 cases (27.3%) of the 33 infants of 25-30 months, and 13 cases (39.4%) of the 33 infants of 31-36 months. Of the 193 infants of 0-6 months old who failed in the initial screening and the second screening after 42 days, the ASSR auditory threshold was < 30 dB in 97 cases (50.26%), 31-50 dB in 63 cases (32.6%), 51-70 dB in 17 cases (8.8%), 71-90 dB in 7 cases (3.6%), and > 91 dB in 9 cases (4.7%). ③ Among the 321 infants failed in the screening, the auditory threshold in the 6 age groups was < 30 dB in 47.4%, 31-50 dB in 27.1%, 51-70 dB in 8.4%, 71-90 dB in 6.2%, and > 91 dB in 10.9%. ④ The difference between ASSR response threshold and VRA auditory thresholds was 6-18 dB in the normal hearing group, mild and moderate hearing loss groups, and there was high correlation between them. The difference of ASSR and VRA thresholds was less than 5 dB between extremely severe and severe hearing loss groups, 5-13 dB between extremely severe and moderate-to-severe hearing loss groups (P < 0.05), and there was no significant differences between severe and moderate-to-severe hearing loss groups (P > 0.05). CONCLUSION: ① The hearing was normal in about half of the infants, although they failed in the primary screening and secondary screening. ② The proportion of the severity of hearing loss was increased along with aging. ③ Mild and moderate hearing losses are dominant in infants. ④ ASSR is reliable to evaluate the hearing of infants.展开更多
Background Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children...Background Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods. Methods Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy, tympanometry, air-conduction auditory steady-state responses （AC-ASSR）, and computerized tomography （CT） before adenoidectomy. Results About 73.4% （304/414） of ears were confirmed to have middle ear effusion （MEE） by otoscopy; 75.4% （312/414） of ears revealed M EE by CT. CT scan correctly predicted all the myringotomy results, giving 100% accuracy on the diagnosis of MEE. Additionally, CT revealed two children with inner ear malformations. Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%. Type C tympanogram with peak pressure 〈-200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE. We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% （223/410） of ears were confirmed of hearing loss. Furthermore, 5.2% （16/310） of the ears with MEE suffered from severe to profound hearing loss. The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz （P 〈0.001） frequencies; 29.7% （92/310） of ears with MEE were regarded as normal hearing level. About 55.8% （173/310） of ears with MEE were classified as having slight-mild hearing loss. Conclusions The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy. CT scan is good for the assessment of MEE before ventilation tube insertion.展开更多
基金a grant from Medical Scientific Research Foundation of G uangdong Bureau of Hygiene,No.W STJJ2001111044082219581224001
文摘BACKGROUND: Auditory steady-state evoked response (ASSR) is one of the new objective electrophysiological methods to test hearing in infants. It can provide a reliable and complete audiogram with specific frequency to help the hearing diagnosis and rehabilitation of hearing and languaging following auditory screening. OBJECTIVE: To compare the response threshold of ASSR with auditory threshold of visual reinforcement audiometry (VRA) in infants failed in the hearing screening for investigating their hearing loss. DESIGN: A comparative observation. SETTINGS: Maternal and child health care hospitals of Guangdong province, Shunde city, Nanhai city and Huadu district. PARTICIPANTS: Totally 321 infants of 0-3 years undergoing ASSR test were selected from the Hearing Center of Guangdong Maternal and Child Health Care Hospital from January 2002 to December 2004. Informed consents were obtained from their guardians. There were 193 cases (60.2%) of 0-6 months, 31 cases (9.7%) of 7-12 months, 17 cases (5.3%) of 13-18 months, 14 cases (4.4%) of 19-24 months, 33 cases of 25-30 months, and 33 cases (10.2%) of 31-36 months. METHODS: ① The 321 infants failed in the hearing screening were tested under sleeping status, the ranges of response threshold distribution in ASSR of different frequencies were analyzed in each age group. ② The infants above 2 years old were also tested with VRA, and their response thresholds were compared between VRA and ASSR. ③ Evaluative standards: The response threshold was < 30 dB for normal hearing, 31-50 dB for mild hearing loss, 51-70 dB for moderate hearing loss, 71-90 dB for severe hearing loss, and > 91 dB for extremely severe hearing loss. MAIN OUTCOME MEASURES: ① ASSR results of the infants failed in the screening; ② Proportion of cases of each response threshold in each age group; ③ Comparison of ASSR response thresholds and VRA auditory thresholds in the infants of 2-3 years old. RESULTS: ①The response threshold was < 30 dB in 47.4% of the 321 infants failed in the initial hearing screening and secondary screening after 42 days. ② Severe to extremely severe hearing loss was detected in only 16 cases (8.3%) of the 193 infants of 0-6 months, in 9 cases (27.3%) of the 33 infants of 25-30 months, and 13 cases (39.4%) of the 33 infants of 31-36 months. Of the 193 infants of 0-6 months old who failed in the initial screening and the second screening after 42 days, the ASSR auditory threshold was < 30 dB in 97 cases (50.26%), 31-50 dB in 63 cases (32.6%), 51-70 dB in 17 cases (8.8%), 71-90 dB in 7 cases (3.6%), and > 91 dB in 9 cases (4.7%). ③ Among the 321 infants failed in the screening, the auditory threshold in the 6 age groups was < 30 dB in 47.4%, 31-50 dB in 27.1%, 51-70 dB in 8.4%, 71-90 dB in 6.2%, and > 91 dB in 10.9%. ④ The difference between ASSR response threshold and VRA auditory thresholds was 6-18 dB in the normal hearing group, mild and moderate hearing loss groups, and there was high correlation between them. The difference of ASSR and VRA thresholds was less than 5 dB between extremely severe and severe hearing loss groups, 5-13 dB between extremely severe and moderate-to-severe hearing loss groups (P < 0.05), and there was no significant differences between severe and moderate-to-severe hearing loss groups (P > 0.05). CONCLUSION: ① The hearing was normal in about half of the infants, although they failed in the primary screening and secondary screening. ② The proportion of the severity of hearing loss was increased along with aging. ③ Mild and moderate hearing losses are dominant in infants. ④ ASSR is reliable to evaluate the hearing of infants.
文摘Background Otitis media with effusion is a highly concurrent disease in young children with adenoid hypertrophy. The aim of this study was to assess the middle ear effusion and audiological characteristics in children with adenoid hypertrophy and compare the various assessment methods. Methods Two hundred and seven candidates who were to undergo adenoidectomy were analyzed using otoscopy, tympanometry, air-conduction auditory steady-state responses （AC-ASSR）, and computerized tomography （CT） before adenoidectomy. Results About 73.4% （304/414） of ears were confirmed to have middle ear effusion （MEE） by otoscopy; 75.4% （312/414） of ears revealed M EE by CT. CT scan correctly predicted all the myringotomy results, giving 100% accuracy on the diagnosis of MEE. Additionally, CT revealed two children with inner ear malformations. Type B tracing tympanogram provided a sensitivity of 91.7% and a specificity of 92.2%. Type C tympanogram with peak pressure 〈-200 daPa indicated effusion; type C tympanogram having acoustic stapedius reflex could exclude MEE. We excluded the AC-ASSR results of the 4 ears with malformation; 54.4% （223/410） of ears were confirmed of hearing loss. Furthermore, 5.2% （16/310） of the ears with MEE suffered from severe to profound hearing loss. The average threshold level in the 0.25 kHz frequency of children was found to have poorer hearing thresholds than those in the 0.5, 1, 2, and 4 kHz （P 〈0.001） frequencies; 29.7% （92/310） of ears with MEE were regarded as normal hearing level. About 55.8% （173/310） of ears with MEE were classified as having slight-mild hearing loss. Conclusions The practitioners should pay much attention to the middle ear condition and be aware of a possible development of severe to profound hearing loss during the course of MEE in young children with adenoid hypertrophy. CT scan is good for the assessment of MEE before ventilation tube insertion.
