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目的:对2次听力筛查不通过耳进行听力评估,分析其ABR与鼓室导抗图的特征,探讨听力筛查不通过耳的客观听觉状况及听力筛查和评估干扰因素。方法:选取2005年8月~2007年11月因进行耳声发射(OAE)新生儿听力筛查2次筛查未通过而转诊到儿童听力中心的患儿为研究对象,年龄在48 d~6个月,共94例(144耳)。详细询问并记录病史,按首次听力评估时的月龄分为~3个月及~6个月组,并行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、鼓室声导抗和蹬鼓肌反射等客观听力测试。结果:①2次听力筛查未通过婴幼儿的鼓室导抗曲线仍以单峰A型为主(77耳,53.4%);双峰次之(23耳,16.0%);单峰Ad型(20耳,13.9%);单峰As型(16耳,11.1%);B型图亦占有一定的比例(6耳,4.2%)。②其ABR以正常及轻度异常为主(分别为44.4%及40.3%),中度、重度及极重度异常比例相对较少(分别为8.3%、2.1%及4.9%),且随着年龄增长,轻度异常比例增加,中度及以上异常比例下降。③ABR正常组单峰A型鼓室图有32耳(50%),考虑存在假阴性结果。正常及轻度听力异常者B型曲线比例分别为4.7%和3.4%,高于中度及以上异常者。结论:中耳因素及低龄婴幼儿听觉神经系统发育的不完善是导致听力筛查未能通过的比较重要的原因,同时,226 Hz的鼓室声导抗在评估婴幼儿中耳疾病时存在较大的假阴性,因此在对2次听力筛查未通过婴幼儿进行听力评估时应充分考虑到上述因素的影响。
OBJECTIVE: To analyze the characteristics of ABR and tympanogram without hearing evaluation of two hearing screening, and to investigate the objective auditory function of hearing screening without hearing aids and hearing screening and evaluate the interference factors. Methods: From August 2005 to November 2007, children who were referred to the Hearing Center of Children for the second screening of neonatal hearing screening of otoacoustic emission (OAE) were enrolled in this study. Their ages ranged from 48 days to 48 days. 6 months, a total of 94 cases (144 ears). Inquire and record the history in detail. According to the age of the first hearing evaluation, they were divided into 3 months and 6 months group, and their auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE) And musk drum reflex objective hearing test. Results: (1) The tympanic conductance curve of infants who did not pass the second hearing screening was still dominated by monomodal A type (77 ears, 53.4%), followed by bimodal (23 ears, 16.0%), monomodal Ad type Ears, 13.9%); unimodal As type (16 ears, 11.1%); B type also occupy a certain proportion (6 ears, 4.2%). (2) The ABR were mainly normal and mild abnormalities (44.4% and 40.3% respectively), while the proportion of moderate, severe and severe abnormalities was relatively low (8.3%, 2.1% and 4.9% respectively) Increase, mild abnormal increase in the proportion of moderate and above the proportion of abnormal decline. ③ABR normal group unimodal A tympanogram has 32 ears (50%), consider the existence of false negative results. The proportion of type B curves in patients with normal and mild hearing deficits were 4.7% and 3.4%, respectively, higher than those with moderate or severe abnormalities. CONCLUSIONS: Middle-ear factors and the development of auditory nervous system in infants and young children are the most important reasons leading to the failure of hearing screening. At the same time, 226 Hz tympanometry has a significant effect in evaluating middle ear diseases in infants and young children Of the false negatives, so in the second hearing screening did not pass the hearing assessment of infants and young children should take full account of the above factors.