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目的分析听力筛查未通过婴幼儿的干扰因素及临床听力学特征。方法选取2004年8月—2006年1月广州市及周边地区妇幼保健院系统出生并行耳声发射(otoacoustic emissions,OAE)新生儿听力筛查,因二次听力筛查未通过转诊本院的患儿,月龄2～6个月,共166例(315耳)。详细询问并登记病史,按其首次听力评估时的月龄分为2～3个月组和4～6个月组,行听性脑干反应(auditory brainstem response,ABR)、畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)、鼓室声导抗和镫骨肌反射等客观听力测试。首次听力评估异常者,建议1～3个月后(以不超过6个月龄为限)进行第二次听力评估,比较前后两次 ABR、DPOAE、鼓室声导抗曲线和静态声顺值的转归情况,并确定诊断。结果①166例听力筛查未通过婴幼儿中,有新生儿高胆红素血症史者比例最高(34例,20.5%);其次为有新生儿窒息史(10例,6.0%)。②4～6个月组鼓室声导抗 B 型曲线的比例(13例,17耳,17.9%)高于2～3个月组(11例,14耳,8.0%),X~2=26.22,P<0.01。③4～6个月组 ABR 正常的比例(24例,29耳,37.2%)明显高于2～3个月组(34例,45耳,23.4%),X~2=5.27,P<0.05;在有两次评估记录的受试者中(24例,45耳),第二次 ABR 测试结果较第一次测试结果好转的比例为56.0%(11例,14耳)。④4～6个月组 DPOAE 正常的比例(19例,31耳,39.7%)略低于2～3个月组(50例,81耳,42.2%),X~2=0.14,P>0.05;在有两次评估记录的受试者中(24例,45耳),第二次 DPOAE 测试结果较第一次好转的比例为32.0%(6例,8耳)。⑤166例听力筛查末通过受检者中,有4例(4耳)诊断为听神经病,均为单耳发病。结论在新生儿听力筛查未通过婴幼儿中,存在中耳因素对听力筛查结果和评估的影响,同时低月龄婴幼儿听觉神经系统存在发育完善的过程。对筛查和评估结果应作充分、恰当的解释,避免加重患儿家长的心理负担。
Objective To analyze the disturbing factors and clinical audiological features of hearing screening without passing through infants and young children. Methods The neonatal hearing screening of orthotopic otoacoustic emissions (OAE) was performed in Guangzhou Maternal and Child Health Hospital of Guangzhou City from January 2004 to January 2006. The hearing screening failed to pass the second hearing screening Children, aged 2 to 6 months, a total of 166 cases (315 ears). Inquire and register the medical history in detail. According to the age of the first hearing evaluation, they were divided into 2 to 3 months group and 4 to 6 months group. Auditory brainstem response (ABR), distortion product otoacoustic emissions (distortion product otoacoustic emissions, DPOAE), tympanic acoustic impedance and stapedius reflex objective hearing test. The first hearing assessment of abnormal persons, it is recommended 1 to 3 months after (no more than 6 months of age) for the second hearing assessment, compared before and after two ABR, DPOAE, tympanogram and static acoustic compliance curve Go to the situation, and determine the diagnosis. Results ①166 cases of hearing screening did not pass infants and young children, with the highest proportion of neonatal hyperbilirubinemia (34 cases, 20.5%); followed by neonatal asphyxia (10 cases, 6.0%). ② The proportion of B-curve of tympanostar in 4 to 6 months group was higher than that in 2 to 3 months group (11 cases, 14 ears, 8.0%), X 2 = 26.22 (13 cases, 17 ears, 17.9% P <0.01. The proportion of normal ABR in 24 months, 29 ears and 37.2% in 4-6 months group was significantly higher than that in 2 ~ 3 months group (34 cases, 45 ears and 23.4%), X ~ 2 = 5.27, P <0.05; In subjects with two assessments (24 cases, 45 ears), the second ABR test improved 56.0% (11 patients, 14 ears) over the first test. The DPOAE normal proportion (19 cases, 31 ears, 39.7%) in 4-6 months group was slightly lower than that in 2-3 months group (50 cases, 81 ears, 42.2%), X ~ 2 = 0.14, P> 0.05; In subjects with two assessment records (24 cases, 45 ears), the second DPOAE test was found to be 32.0% (6 cases, 8 ears) better than the first. ⑤166 cases of hearing screening at the end of the subjects, 4 cases (4 ears) diagnosed as neuropathy, are single-ear disease. Conclusion In the neonatal hearing screening did not pass through infants and young children, there is the influence of middle ear factors on hearing screening results and assessment. At the same time, the auditory nervous system of infants and young children with low age has a well-developed process. The screening and evaluation results should be fully and properly explained, to avoid increasing the psychological burden of children’s parents.