摘要
目的:探讨耳声发射法在新生儿听力筛查中对漏诊率的影响。方法:选取2018年1月-2020年12月抚州市妇幼保健院新生儿1 000例,采取瞬态诱发耳声发射方法检测,所有新生儿均最终采用听性脑干反应测试进行确诊。分析瞬态诱发耳声发射法的通过、未通过结果,分析瞬态诱发耳声发射法未通过新生儿的复筛结果,分析1 000例新生儿耳声发射法检测的确诊率、漏诊率。结果:1 000例新生儿瞬态诱发耳声发射法初筛通过率为86.7%(867/1 000),未通过率为13.3%(133/1 000)。日龄>5 d的新生儿通过率最高,日龄1 d的新生儿通过率最低。133例未通过新生儿中,双耳未通过51例(38.3%),单耳未通过82例(61.7%)。出生后30~40 d复筛,51例初筛双耳未通过者复筛通过47例,未通过4例;82例初筛单耳未通过者复筛通过30例,复筛未通过52例。133例初筛未通过新生儿中77例复筛通过(57.9%),56例复筛未通过(42.1%)。1 000例新生儿经瞬态诱发耳声发射法进行听力初筛与复筛,最终56例未通过,其中,双耳4例未通过,单耳52例未通过,6个月后初步诊断为先天性听力障碍患儿,通过听性脑干反应检测最终确诊,结果显示52例单耳异常,4例双耳异常,与瞬态诱发耳声发射法检测结果一致;944例初筛通过的新生儿听性脑干反应检测最终确诊,943例正常,1例诊断为先天性听力障碍患儿。听性脑干反应检测最终确诊1 000例新生儿中共57例新生儿患有先天性听力障碍,经耳声发射法检测确诊56例,漏诊1例,确诊率为99.9%(999/1 000),漏诊率为1.8%(1/57)。结论:新生儿听力筛查中应用耳声发射法,具有客观性、无创、安全、简便、快速的优势,一定程度上能够诊断出先天性听力障碍,但存在漏诊现象,因此,耳声发射法初筛中即使检测通过,若在出生3个月内发现听觉异常表现,需马上进行听性脑干反应测试进一步确诊检测,最大程度使先天性听力障碍患儿能够被早发现、早干预。
Objective:To investigate the effect of otoacoustic emission on missed diagnosis rate in neonatal hearing screening.Method:A total of 1 000 neonates from January 2018 to December 2020 in Fuzhou Maternal and Child Health Hospital were selected.Transient induced otoacoustic emission was used to detect the neonates.All neonates were confirmed by auditory brainstem response test.The results of passing and failing the transient induced otoacoustic emission method were analyzed.The results of re-screening of neonates who failed the transient induced otoacoustic emission method were analyzed.The diagnosis rate and missed diagnosis rate of 1 000 neonates were analyzed.Result:The primary screening pass rate of transient induced otoacoustic emission was 86.7% (867/1 000) and the failure rate was 13.3% (133/1 000).Neonates aged > 5 d had the highest passing rate,while neonates aged 1 d had the lowest passing rate.Among 133 neonates who did not pass the examination,51 cases (38.3%) did not pass the examination in both ears,and 82 cases (61.7%) did not pass the examination in one ear.At 30 to 40 d after birth,of the 51 patients who did not pass the primary screening of both ears,47 cases passed the re-screening,and 4 cases failed to pass the re-screening;of the 82 patients who failed to pass the primary screening of single ear,30 passed the re-screening and 52 failed the re-screening.Among 133 neonates who failed primary screening,77 neonates passed re-screening (57.9%) and 56 neonates failed re-screening (42.1%).1 000 cases of newborn by the transient evoked oaes method after hearing screening and early screening,56 cases failed finally,among them,4 cases of binaural failed,and 52 cases of monaural failed,6 months after initial diagnosis of children with congenital hearing impairment,by listening to brainstem response testing final diagnosis,which showed 52 cases of monaural abnormalities and 4 cases of binaural abnormalities.The results were consistent with those obtained by transient induced otoacoustic emission method.Of the 944 neonates who passed primary screening,943 cases were normal and 1 case was diagnosed as congenital hearing impairment.A total of 57 newborns with congenital hearing impairment were finally diagnosed by auditory brainstem response,56 cases were diagnosed by otoacoustic emission and 1 case was missed,the diagnosis rate was 99.9% (999/1 000) and the missed diagnosis rate was 1.8% (1/57).Conclusion:Newborn hearing screening in the application of ear acoustic emission technique,has the objectivity,noninvasive,safe,convenient,fast advantage,to some extent can diagnosis of congenital hearing impairment,but exists misdiagnosis phenomenon,therefore,ear even in early screening test by acoustic emission method,if found abnormal auditory within three months of birth,listen to the brainstem response test should be carried out immediately to further confirmed,To the greatest extent,children with congenital hearing impairment can be found early and early intervention.
作者
刘远秀
LIU Yuanxiu(Fuzhou Maternal and Child Health Hospital,Jiangxi Province,Fuzhou 344000,China)
出处
《中国医学创新》
CAS
2022年第3期140-143,共4页
Medical Innovation of China
关键词
瞬态诱发耳声发射法
听觉异常
先天性听力障碍
新生儿听力筛查
听性脑干反应测试
Transient evoked otoacoustic emission
Abnormal hearing
Congenital hearing impairment
Newborn hearing screening
Auditory brainstem response test
