山东大学耳鼻喉眼学报 ›› 2022, Vol. 36 ›› Issue (1): 43-47.doi: 10.6040/j.issn.1673-3770.0.2021.378

• • 上一篇    下一篇

1 000 Hz声导抗在高危新生儿听力筛查中的应用

倪坤,孙世冰,李晓艳   

  1. 上海市儿童医院 耳鼻咽喉头颈外科, 上海 200062
  • 出版日期:2022-01-10 发布日期:2022-02-22
  • 通讯作者: 李晓艳. E-mail:chhshent@163.com

Application of 1 000 Hz acoustic immittance in hearing screenings of high-risk newborns

NI Kun, SUN Shibing, LI Xiaoyan   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Shanghai Children's Hospital, Shanghai 200062, China
  • Online:2022-01-10 Published:2022-02-22

PDF (PC)

228

摘要： 目的 探讨1 000 Hz声导抗检查联合自动听性脑干反应(AABR),畸变产物耳声发射(DPOAE)检查用于高危新生儿听力筛查的意义。 方法 纳入高危新生儿318例(636耳)作为研究对象,采用AABR+DPOAE+1 000 Hz声导抗三联的听力筛查方案,筛查未通过的新生儿在3个月进行诊断性听力检查,计算三联筛查结果的灵敏度、特异度、漏诊率、误诊率和正确率。其中本研究中三联筛查结果正常包括AABR(-)DPOAE(+)声导抗(+),AABR(-)DPOAE(-)声导抗(+),AABR(-)DPOAE(-)声导抗(-)三种情况,三联筛查异常包括AABR(+)DPOAE(+)声导抗(+),AABR(+)DPOAE(+)声导抗(-),AABR(+)DPOAE(-)声导抗(+),AABR(-)DPOAE(+)声导抗(-),AABR(+)DPOAE(-)声导抗(-)。 结果 共纳入318例高危新生儿(636耳),使用三联筛查的灵敏度(96.77%)高于单一AABR筛查方法(80.64%)和单一DPOAE筛查方法(83.87%),与AABR+DPOAE两联筛查方法(96.77%)灵敏度一致。使用三联筛查的特异度(91.24%)高于AABR+DPOAE两联筛查方法(87.44%),三联筛查方法可进一步降低二联筛查假阳性率,适用于高危新生儿筛查。 结论 1 000 Hz声导抗联合AABR和DPOAE进行高危新生儿听力筛查,筛查灵敏度高,漏诊率低,三联听力检查可应用于高危新生儿听力筛查,早期即可筛出部分单纯中耳功能异常的假阳性婴儿,可一定程度缓解家长焦虑。

关键词: 高危儿, 听力筛查, 自动听性脑干反应, 畸变产物耳声发射, 1 000 Hz声导抗, 联合筛查

Abstract: Objective To explore the significance of the 1 000 Hz acoustic immittance test combined with automatic auditory brainstem response(AABR)and distortion product otoacoustic emission(DPOAE)in hearing screenings of high-risk newborns. Methods A total of 318 high-risk newborns(636 ears)were included as the research subjects. The triple hearing screening scheme of AABR + DPOAE + 1 000 Hz acoustic immittance was adopted. The newborns who failed the screening test were examined for diagnostic hearing at 3 months of age, and the sensitivity, specificity, missed diagnosis rate, false diagnosis rate, and accuracy of the triple screening results were calculated. In this study, the normal triple screening results included AABR(-)DPOAE(+)acoustic immittance(+), AABR(-)DPOAE(-)acoustic immittance(+), and AABR(-)DPOAE(-)acoustic immittance(-). The abnormal triple screening results include AABR(+)DPOAE(+)acoustic immittance(+), AABR(+)DPOAE(+)acoustic immittance(-), AABR(+)DPOAE(-), AABR(-)DPOAE(+)acoustic immittance(-), and AABR(+)DPOAE(-)acoustic immittance(-). Results A total of 318 high-risk newborns(636 ears)were included. The sensitivity of triple screening(96.77%)was higher than that of the AABR-only screening method(80.64%)and DPOAE-only screening method(83.87%), which was consistent with that of the double AABR + OAE screening method(96.77%). The specificity of triple screening(91.24%)was higher than that of AABR + OAE double screening(87.44%). Triple screening can further reduce the false-positive rate of double screening and is suitable for high-risk neonatal screening. Conclusion Triple screening has high sensitivity and a low missed diagnosis rate for hearing screening of high-risk newborns. Triple hearing examinations can be applied to hearing screening of high-risk newborns. Some false-positive infants with simple middle-ear dysfunction can be screened out in the early stage, which can alleviate parental anxiety.

Key words: High-risk infants, Hearing screening, Automated auditory brainstem response, Distortion product otoacoustic emission, 1 000 Hz acoustic immittance, Combined screening

中图分类号: 

  • R764
[1] 黄丽辉.解读2010年版新生儿听力筛查技术规范[J].听力学及言语疾病杂志,2011,19(6):495-496.
[2] 陈惠球, 陈敬国, 黄超. 早产儿AABR听力筛查初筛时间探讨[J]. 实用临床护理学电子杂志, 2017, 2(11): 124-125. doi:10.3969/j.issn.2096-2479.2017.11.097. CHEN Huiqiu, CHEN Jingguo, HUANG Chao. The effect of different initial screening times on the rate of spontaneous auditory brainstem response in preterm infants[J]. Journal of Clinic Nursing's Practicality, 2017, 2(11): 124-125. doi:10.3969/j.issn.2096-2479.2017.11.097.
[3] 史冬梅, 益欢欢, 史霞, 等. 自动听性脑干反应及耳声发射联合使用在新生儿听力筛查中临床意义[J]. 中华耳科学杂志, 2018, 16(2): 199-204. doi:10.3969/j.issn.1672-2922.2018.02.014. SHI Dongmei, YI Huanhuan, SHI Xia, et al. Combined automatic auditory brainstem response and otoacoustic emissions hearing screening in newborns with different disease statuses and gestational ages[J]. Chinese Journal of Otology, 2018, 16(2): 199-204. doi:10.3969/j.issn.1672-2922.2018.02.014.
[4] 倪道凤. 婴幼儿分泌性中耳炎[J]. 中国医学文摘(耳鼻咽喉科学), 2007, 22(1): 11-13. doi:10.19617/j.issn1001-1307.2007.01.008.
[5] 江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京: 人民卫生出版社, 2015.
[6] 刘敏, 李晓璐, 张璐, 等. 自动听性脑干反应联合声导抗鼓室图在疑似听力障碍婴幼儿中的应用[J]. 中国儿童保健杂志, 2018, 26(9): 1038-1041. doi:10.11852/zgetbjzz2018-26-09-29. LIU Min, LI Xiaolu, ZHANG Lu, et al. Application of automated auditory brainstem response combined with acoustic immitance testing in infants with suspected hearing loss[J]. Chinese Journal of Child Health Care, 2018, 26(9): 1038-1041. doi:10.11852/zgetbjzz2018-26-09-29.
[7] 王肃旸, 丁文娟, 才让卓玛, 等. 甘南州1 378例DPOAE联合AABR新生儿听力筛查结果分析[J]. 中国医学文摘-耳鼻咽喉科学, 2018, 33(4): 309-311. doi:10.19617/j.issn1001-1307.2018.04.309. WANG Suyang, DING Wenjuan, CAI Rangzhuoma, et al. Research on the incidence of newborns hearing impairment by DPOAE and AABR in Gannan state: an analysis of 1 378 neonates[J]. Chinese Medical Digest(Otorhinolaryngology), 2018, 33(4): 309-311. doi:10.19617/j.issn1001-1307.2018.04.309.
[8] Akinpelu OV, Funnell WRJ, Daniel SJ. High-frequency otoacoustic emissions in universal newborn hearing screening[J]. Int J Pediatr Otorhinolaryngol, 2019, 127: 109659. doi: 10.1016/j.ijporl.2019.109659.
[9] Iley KL, Addis RJ. Impact of technology choice on service provision for universal newborn hearing screening within a busy district hospital[J]. J Perinatol, 2000, 20(1): S122-S127. doi:10.1038/sj.jp.7200443.
[10] Ravi R, Gunjawate DR, Yerraguntla K, et al. Follow-up in newborn hearing screening-A systematic review[J]. Int J Pediatr Otorhinolaryngol, 2016, 90: 29-36. doi:10.1016/j.ijporl.2016.08.016.
[11] 许安廷,张长平,杜尊民.新生儿听力筛查中的假阳性问题[J].山东大学耳鼻喉眼学报,2005,19(6):357-359. XU Anting, ZHANG Changping, DU Zunmin. False positives in newborn hearing screening[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2005, 19(6): 357-359.
[12] Zaitoun M, Nuseir A. Parents' satisfaction with a trial of a newborn hearing screening programme in Jordan[J]. Int J Pediatr Otorhinolaryngol, 2020, 130: 109845. doi: 10.1016/j.ijporl.2019.109845.
[13] 周佳霖, 黄振云, 钟建文, 等. 36个月内婴幼儿1 000 Hz和226 Hz探测音声导抗的特点和意义[J]. 中华耳科学杂志, 2014, 9(3): 455-459. doi:10.3969/j.issn.1672-2922.2014.03.027. ZHOU Jialin, HUANG Zhenyun, ZHONG Jianwen, et al. Tympanometry at 1 000 Hz and 226 Hz in 1 645 infants[J]. Chinese Journal of Otology, 2014, 9(3): 455-459. doi:10.3969/j.issn.1672-2922.2014.03.027.
[14] de Lyra-Silva KA, Sanches SGG, Neves-Lobo IF, et al. Middle ear muscle reflex measurement in neonates: comparison between 1 000 Hz and 226 Hz probe tones[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(9): 1510-1515. doi:10.1016/j.ijporl.2015.06.039.
[15] 张国军, 龚松阳. 骨导ABR与1 000 Hz声导抗对婴儿传导性聋检出率比较[J]. 中华耳科学杂志, 2016, 14(3): 374-377. doi:10.3969/j.issn.1672-2922.2016.03.012. ZHANG Guojun, GONG Songyang. Comparison between bone-conduction ABR and 1 000 Hz tympanomentry in detecting conductive hearing loss[J]. Chinese Journal of Otology, 2016, 14(3): 374-377. doi:10.3969/j.issn.1672-2922.2016.03.012.
[16] 刘敏, 李晓璐, 张璐, 等. 自动听性脑干反应联合声导抗鼓室图在疑似听力障碍婴幼儿中的应用[J]. 中国儿童保健杂志, 2018, 26(9): 1038-1041. doi:10.11852/zgetbjzz2018-26-09-29. LIU Min, LI Xiaolu, ZHANG Lu,et al. Application of automated auditory brainstem response combined with acoustic immitance testing in infants with suspected hearing loss[J]. Chinese Journal of Child Health Care, 2018, 26(9): 1038-1041. doi:10.11852/zgetbjzz2018-26-09-29.
[17] 姚寿国, 史波宁, 陈淑飞, 等. 1 000 Hz探测音声导抗检查在新生儿听力筛查中的应用价值[J]. 听力学及言语疾病杂志, 2020, 28(6): 653-655. doi:10.3969/j.issn.1006-7299.2020.06.010. YAO Shouguo, SHI Boning, CHEN Shufei, et al. Application value of 1 000 Hz high frequency immitance test in newborn hearing screening[J]. Journal of Audiology and Speech Pathology, 2020, 28(6): 653-655.doi:10.3969/j.issn.1006-7299.2020.06.010.
[18] Kanji A, Khoza-Shangase K, Moroe N. Newborn hearing screening protocols and their outcomes: a systematic review[J]. Int J Pediatr Otorhinolaryngol,2018,115:104-109. doi: 10.1016/j.ijporl.2018.09.026.
[1] 盘琳琳, 方旭华, 翟丰, 桂一丁, 边洲亮, 陈洁. 新生儿动脉血血气分析与听力筛查结果相关性[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 20-24.
[2] 盘琳琳,孔令漪综述翟丰,陈洁审校. 新生儿听力障碍常见危险因素及听力筛查方法研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 131-137.
[3] 李元超,吴玮,王刚,屈昌北,王磊,芦文俊,李丹,韩浩伦,刘钢. 模拟失重及飞船内稳态噪声对大鼠听功能的影响[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 11-16.
[4] 王国强, 赵春红, 霍红, 龚志云, 宋伟伟, 严丽霞, 李雪华, 王伟丽. 早产儿听力筛查结果及其听力障碍危险因素[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 7-10.
[5] 周晓娓, 王跃建, 段光荣, 虞幼军. 听力诊疗网络平台的开发[J]. 山东大学耳鼻喉眼学报, 2014, 28(6): 79-84.
[6] 余崇仙，杨克林，张晓敏，汪平 . 听力筛查未通过婴幼儿的客观听力评估[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 38-41.
[7] 刘志奇1，2，刘立思1，杨琨3 . 新生儿听力筛查11894例结果分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(2): 8-12.
[8] 张恩东，李大建，苗乐杰. 重症监护病房与母婴同室新生儿听力筛查比较[J]. 山东大学耳鼻喉眼学报, 2011, 25(2): 29-31.
[9] 张俊瑶 朱富高 孙美红. 6159例新生儿听力筛查结果分析[J]. 山东大学耳鼻喉眼学报, 2009, 23(4): 38-40.
[10] 杨 琨,刘志奇,黄治物 . 正常新生儿226Hz及1000Hz探测音鼓室导抗测试[J]. 山东大学耳鼻喉眼学报, 2008, 22(5): 420-423 .
[11] 曲 玲 . 243例未通过听力筛查的婴幼儿ABR结果分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 189-190 .
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 马宝峰,党光福 . 折叠式人工晶状体经巩膜缝线固定术16例[J]. 山东大学耳鼻喉眼学报, 2008, 22(4): 376 -378 .
[2] 封新荣,张红霞,许贞姬,曲君君 . 射频消融术治疗慢性肥厚性鼻炎[J]. 山东大学耳鼻喉眼学报, 2006, 20(3): 225 -226 .
[3] 张秋贵,何海燕 . 青岛地区变应性鼻炎常见变应原调查分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 520 -521 .
[4] 李海燕,赵秋良,韩晓攀,于丽 . 阻塞性睡眠呼吸暂停综合征患者自由基损伤与高血压的关系[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 527 -529 .
[5] 宋西成,张华,张庆泉 . 血循环DNA的检测与头颈部肿瘤的诊断[J]. 山东大学耳鼻喉眼学报, 2006, 20(5): 385 -387 .
[6] 詹善强,孔凡俐,操文娟,汤杰,沈菊,詹文波 . 电刀切除扁桃体236例[J]. 山东大学耳鼻喉眼学报, 2006, 20(6): 559 -560 .
[7] 张 虎,艾 琴 . 甲状腺癌再手术15例[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 166 -167 .
[8] 胡 明,李招娜,李云杰,陶祥臣 . 硬性透气性角膜接触镜对圆锥角膜的塑形作用[J]. 山东大学耳鼻喉眼学报, 2007, 21(2): 171 -173 .
[9] 娄 锋 . 喉上神经阻滞预防喉显微手术心血管反应[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 173 -175 .
[10] 陈伟雄 王跃建 曾勇 何发尧 张剑利 郑立岗 汤苏成. 胸骨上小切口无注气内镜甲状腺手术的临床体会[J]. 山东大学耳鼻喉眼学报, 2009, 23(4): 24 -26 .
网站版权所有 © 2018 《山东大学耳鼻喉眼学报》编辑部　
地址：山东省济南市山大南路27号（250100）电话：+86-0531-88366912 E-mail: ebhxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发