1479例未通过新生儿听力筛查的婴幼儿听力评估结果分析  

The Analysis of the Audiologic Outcomes of 1479 Newborns Failed in the Universal Hearing Screening Programs

作　　者：于多娇[1] 管国芳[1] 苏凯[1] 张德军[1] 文连姬[1] 李琴[2] 

机构地区：[1]吉林大学第二医院耳鼻咽喉科,长春130041 [2]中国残疾人辅助器具中心,北京100050

出　　处：《中国听力语言康复科学杂志》2016年第6期417-420,共4页Chinese Scientific Journal of Hearing and Speech Rehabilitation

摘　　要：目的采用“两步骤诊断法”对长春地区1479例初筛、复筛未通过听力筛查的婴幼儿进行听力学评估，以鉴定其听力障碍的发病情况，并确定听力障碍类型及听力损失程度。方法研究对象为2011年7月～2016年6月在长春市妇幼保健院进行新生儿听力筛查2次未通过、疑为听力障碍并转诊到我院听力筛查鉴定中心就诊的婴幼儿，共1479例，常规行“两步骤诊断法”进行听力鉴定：第一步采用畸变产物耳声发射（DPOAE）＋自动听性脑干反应（AABR）＋声导抗检查做初步诊断，对未通过初诊者进入第二步骤（确定诊断），包括听性脑干反应（ABR）、多频听性稳态反应（ASSR）进行听力学评估及鉴定，必要时辅助颞骨高分辨CT扫描。对所有病例都进行密切的跟踪随访。结果我院共接诊由长春市妇幼保健院转诊的婴幼儿1479例，经初步诊断法通过1360例（视为听力正常者），通过率为92％；经第二诊断步骤确诊听力障碍者119例，占8．0％，其中传导性聋44例：包括分泌性中耳炎40例，先天性外耳道闭锁4例，其中双耳2例，单耳2例，确诊感音神经性聋75例，40例为重度听力损失，35例为极重度听力损失，影像学资料确诊为大前庭导水管综合征15例。结论①新生儿听力筛查目前仍存在较高的假阳性率，采用畸变产物耳声发射（DPOAE）＋自动听性脑干反应（AABR）＋声导抗联合初步诊断法可以快速、便捷、准确的排除假阳性结果。②“两步骤诊断法”对于听力障碍的婴幼儿可以做到早发现、早诊断，利于早期干预。Objective To assess the hearing results of 1479 infants in Changchun who did not pass the preliminary and secondary hearing screening, to find the incidence of hearing impairment, and to determine the types and degrees of hearing loss. Methods 1479 infants participated in this study, who failed hearing screening. They were seen initially at the Changchun Maternal and Child Care Service Centre and later were referred to our hospital from July 2011 through June 2016. Two step diagnostic evaluation protocol was used that the first step was primary assessed using DPOAE, AABR and acoustic immittance examination, and when there were abnormal results, then we performed the second examination including ABR and ASSR, HRCT scan if necessary. All patients were followed up. Results 1360 patients were normal through the first step. 119 patients were confirmed with hearing impairment, including 44 cases of conductive deafness（40 cases of secretory otitis media and 4 cases of congenital aural atresia ） , and 75 cases of sensorineural hearing loss （including 40 cases of severe sensorineural hearing loss and 35 cases of profound hearing loss,15 cases were confirmed Large Vestibular Aquduct Syndrome according to image）.Conclusions The high percentage of false positive is prevalent in the screening. The combination of DPOA, AABR and Acoustic Immittance examination can reduce false positive results accurately. This can reduce patients＇ pain, financial cost and psychology of parents. The two step diagnosis method, facilitating early intervention, is helpful for hearing impaired infants to receive fast treatment after the early identification.

关 键 词：新生儿 听力筛查 听力评估 

分 类 号：R764[医药卫生—耳鼻咽喉科]