群组声刺激听性脑干反应在新生儿听力复筛中的应用价值  

Application of Chained-stimuli Auditory Brainstem Response to Newborns Hearing Rescreening

作　　者：张燕梅[1] 宗亚静 周蕊 陈丽[1] 曾镇罡[1] 刘玉和[1] Zhang Yanmei;Zong Yajing;Zhou Rui;Chen Li;Zeng Zhengang;Liu Yuhe(Department of Otorhinolaryngology Head&Neck Surgery,Peking University First Hospital,Beijing,100034,China)

机构地区：[1]北京大学第一医院耳鼻咽喉头颈外科

出　　处：《听力学及言语疾病杂志》2019年第5期481-486,共6页Journal of Audiology and Speech Pathology

摘　　要：目的探讨群组声刺激听性脑干反应(chained-stimuli auditory brainstem response,CsABR)在新生儿听力复筛中的应用价值。方法对接受听力复筛的295例婴幼儿,在应用畸变产物耳声发射(DPOAE)和自动听性脑干反应(AABR)筛查的基础上增加CsABR测试,复筛未通过的婴幼儿转诊到听力诊断中心,进行1 000 Hz声导抗、DPOAE、诊断型听性脑干反应(ABR)、听性稳态反应(ASSR)等综合听力诊断评估,比较复筛未通过与通过婴幼儿CsABR阈值的差异,分析CsABR阈值与诊断型ABR阈值的相关性和差异,并根据临床诊断结果分析CsABR的敏感性和特异性。结果295例(579耳)均完成CsABR阈值测试,每例婴幼儿完成双耳CsABR测试的时间约为5分钟,其中39例(78耳)完成听力诊断评估;听力复筛未通过的婴幼儿(77耳)CsABR阈值较听力复筛通过者高(P<0.001);CsABR阈值与诊断型ABR阈值显著相关(rs=0.861,P<0.001);CsABR阈值≤70 dB nHL的64耳其平均阈值高于诊断型ABR阈值5.5±8.9 dB;以临床诊断结果(指综合诊断结果,而不是指诊断型ABR结果)作为标准,CsABR阈值大于30 dB nHL为异常,则CsABR的敏感性为95.7%(44/46),特异性为59.4%(19/32);CsABR阈值大于70 dB nHL的13耳中11耳(84.6%)诊断为重度或极重度听力损失。结论CsABR操作简单、测试时间短,是新生儿听力筛查阶段预测听力损失程度的快捷方法,可用于听力筛查未通过婴幼儿的快速听力评估。Objective To explore the application of chained-stimuli auditory brainstem response(CsABR)to newborns hearing rescreening.Methods A total of 295 infants referred by the first hearing screening received CsABR,AABR and DPOAE tests.The infants who failed the rescreening received diagnostic examination in the hearing diagnostic center,including diagnostic ABR,DPOAE,ASSR and 1 000 Hz tympanometry.Results The time required to complete two chained-stimuli runs was about 5 minutes.A total of 579 ears completed the CsABR test.The average thresholds of the ears that failed hearing rescreening were increased compared with the ears that had passed the screening.A total of 78 ears completed the audiometric evaluation.There was a significant correlation between CsABR threshold and diagnostic ABR threshold(rs=0.861,P0.001).The average threshold of CsABR was 5.5±8.9 dB,which was higher than that of the diagnostic ABR.Based on the diagnostic audliological results,the sensitvity of CsABR was 95.7%(44/46),the specificity was 59.4%(19/32).Among the 132 ears with CsABR threshold greater than 70 dB nHL,11 ears(84.6%)were severe or profound hearing loss.Conclusion Chained-stimuli ABR is an easy and fast method for predicting the degree of hearing loss for newborn hearing screening.It can be used as a rapid hearing assessment for infants who have not passed the hearing screening.

关 键 词：听性脑干反应 新生儿 听力筛查 听力损失 

分 类 号：R764.05[医药卫生—耳鼻咽喉科]