Newton V E, Macharia I, Mugwe P, Ototo B, Kan S W
Centre for Human Communication and Deafness, University of Manchester, Oxford Road, M13 9PL, Manchester, UK.
Int J Pediatr Otorhinolaryngol. 2001 Mar;57(3):229-34. doi: 10.1016/s0165-5876(00)00453-5.
In developing countries, there is a lack of trained personnel and testing equipment to facilitate the early detection of hearing impairment in children. A questionnaire offers a low cost option and the value of this for detecting hearing impairment in pre-school children was determined in several districts in Kenya. The questionnaire was completed by either teachers, parents/carers or community nurses. The children were subsequently tested using pure tone audiometry and visual examination of the ear by ENT Clinical Officers, who were not given prior access to the results of the questionnaire. A total of 757 (88%) questionnaires were completed. Of the 735 children, who could be tested using pure tone audiometry, four were found to have a unilateral hearing impairment and one was detected by the questionnaire. A total of 13 children had a bilateral hearing impairment >40 dB HL. All were detected using the questionnaire. There were eight males and five females with ages ranging from 4.2 to 6.9 years, mean age 5.7 years and median age 5.8 years. Eight had a sensorineural hearing impairment and two a mixed hearing impairment. Three of the children with a sensorineural hearing loss had a family history of hearing impairment. No question detected all children with a hearing impairment and some questions were more discerning than others. There was 100% sensitivity for the questionnaire when a hearing loss of >40 dB was considered, but specificity was lower at 75%. Negative predictive value was 100%, but the positive predictive value was low, 6.75%. It was concluded that a questionnaire of this nature could be usefully applied at Primary Health Care level for detecting hearing impairment at the pre-school stage. There would be need for services available for diagnosis, treatment and habilitation before a screening programme was introduced.
在发展中国家，缺乏训练有素的人员和检测设备来促进儿童听力障碍的早期发现。问卷调查提供了一种低成本的选择，并且在肯尼亚的几个地区确定了其在检测学龄前儿童听力障碍方面的价值。问卷由教师、家长/照顾者或社区护士填写。随后，耳鼻喉科临床医生使用纯音听力测定法和耳部视觉检查对儿童进行测试，这些医生事先未获取问卷结果。总共完成了757份（88%）问卷。在735名可用纯音听力测定法进行测试的儿童中，发现4名有单侧听力障碍，其中1名通过问卷检测出。共有13名儿童有双侧听力障碍>40 dB HL。所有这些儿童均通过问卷检测出。有8名男性和5名女性，年龄范围为4.2至6.9岁，平均年龄5.7岁，中位数年龄5.8岁。8名有感音神经性听力障碍，2名有混合性听力障碍。3名有感音神经性听力损失的儿童有听力障碍家族史。没有一个问题能检测出所有有听力障碍的儿童，并且有些问题比其他问题更具辨别力。当考虑听力损失>40 dB时，问卷的敏感性为100%，但特异性较低，为75%。阴性预测值为100%，但阳性预测值较低，为6.75%。得出的结论是，这种性质 的问卷可有效地应用于初级卫生保健层面，以检测学龄前阶段的听力障碍。在引入筛查计划之前，需要有诊断、治疗和康复服务。
