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目的:探讨多种联合检查方法在婴幼儿听力诊断中的临床应用。方法:选择2004年5月～2008年5月住院出生3～7天,经耳声发射(otoacoustic emissions,OAE)听力筛查(初筛、复筛)均未通过的180例婴幼儿,分别在3月龄～6月龄进行听力测试,方法如下:①畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)+听性脑干反应(Auditorybrainstem response,ABR)+声导抗(acoustic immittance measurement,AIM);②畸变产物耳声发射(DPOAE)+听性脑干反应(ABR)+多频稳态听觉诱发反应(auditory steady-state responses,ASSR)+声导抗(AIM);③听性脑干反应(ABR)。结果:180例新生儿3～6月龄两次全部完成ABR测试,其中360耳中299耳正常,占83.06%,38例(61耳)异常,占16.94%(61/360耳)。听力损失程度:轻度2耳、中度15耳、重度20耳和极重度24耳,重度和极重度占总听力障碍72.13%(44/61耳)。ASSR测试结果60例(120耳),0.5～4kHz平均反应阈,听力损失程度基本与ABR相符,异常12例(22耳),占18.33%;120例(240耳)DPOAE测试,其中189耳通过,占78.75%(189/240耳),51耳未通过,占21.25%。声导抗(AIM)测试120例,鼓室曲线为A型104例,为B型或C型55耳,异常39例,异常率23.00%。结论:在婴幼儿听力诊断评估中,以ABR v波反应阈作为听力损失指标,但不能作为听力损失诊断唯一工具;只有多种联合听力检测才能有效的提高准确率,确保整个筛查诊断过程中不出现假阴性及听神经病的漏诊;同时有助于确诊婴幼儿听力损失的性质和程度,提高干预效果。
Objective: To explore the clinical application of multiple joint examinations in the diagnosis of infant hearing. Methods: A total of 180 infants and young children who did not pass auditory screening (primary screening and re-screening) of otoacoustic emissions (OAE) were selected from May 2004 to May 2008 and were hospitalized for 3 to 7 days. Hearing tests were conducted at 3 months to 6 months of age as follows: ① Distortion product otoacoustic emissions (DPOAE) + Auditory brainstem response (ABR) + Acoustic immittance measurement (AIM ); ② Distortion product otoacoustic emissions (DPOAE) + Auditory brainstem response (ABR) + Multi-frequency auditory steady-state responses (ASSR) + Acoustic conduction (AIM); ③ Auditory brainstem Reaction (ABR). RESULTS: All of the 180 newborns completed ABR test at 3 to 6 months of age. Of the 360 ears, 299 ears were normal, accounting for 83.06%, and 38 ears (61 ears) were abnormal, accounting for 16.94% (61/360 ears). The degree of hearing loss: mild 2 ears, moderate 15 ears, severe 20 ears and very heavy 24 ears, severe and very severe accounted for 72.13% (44/61 ears) of total hearing loss. ASSR test results 60 cases (120 ears), 0.5 ~ 4kHz average response threshold, the degree of hearing loss basically consistent with the ABR, abnormalities in 12 cases (22 ears), accounting for 18.33%; 120 cases (240 ears) DPOAE test, , Accounting for 78.75% (189/240 ears), 51 ears did not pass, accounting for 21.25%. AIM was performed in 120 cases. The tympanogram was type A in 104 cases, type B or type C in 55 cases, with abnormalities in 39 cases and anomalous rate of 23.00%. Conclusion: ABR v-wave response threshold is an index of hearing loss in the diagnostic evaluation of infants and young children, but it can not be used as the only tool for the diagnosis of hearing loss. Only a variety of combined hearing tests can effectively improve the accuracy and ensure that the whole screening diagnosis process Not false negative and auditory neuropathy missed diagnosis; at the same time help to diagnose the nature and extent of infant hearing loss, improve the intervention effect.