Vatovec J, Velickovic Perat M, Smid L, Gros A
University Department of Otorhinolaryngology and Cervicofacial Surgery, Clinical Center, 1525 Zaloska 2, Ljubljana, Slovenia.
Int J Pediatr Otorhinolaryngol. 2001 Apr 27;58(2):139-45. doi: 10.1016/s0165-5876(01)00419-0.
The importance of early hearing screening has long been recognized, as the prognosis for the hearing impaired child is improved when the diagnosis is made as early as possible, and the intervention is begun immediately. For clinical screening of hearing impairment, the recording of otoacoustic emissions was recommended. As some risk factors for early brain damage are at the same time also risk factors for dysfunction of auditory system, we presumed that infants at risk for brain damage have hearing impairment more frequently than the rest of the population of the same age. We were interested in the role of otoacoustic emission testing during the assessment of auditory function in these infants. There were 110 infants at risk for brain damage included in the study. After thorough otorhinolaryngological examination, auditory function was estimated by recording of otoacoustic emissions, tympanometry, pure tone audiometry and, when necessary, auditory brainstem responses. Otoacoustic emissions were recorded by Madsen-Electronics Celesta 503 in an acoustically treated sound room. We registered spontaneous as well as transient and distortion product otoacoustic emissions. The neurologist formed two groups with different degrees of neurological risk. The collected results of auditory function were compared with the degree of neurological risk. For the statistical analysis, the procedure chi(2) and Fischer test were used. Spontaneous otoacoustic emission was detected in 38.2% of examinees. Evoked otoacoustic emissions were registered in 87.3% of infants. The testing had to be repeated in 32.7% of infants. We observed evoked otoacoustic emissions to be present also in a child with sensorineural hearing impairment and no auditory brainstem responses. Up to 32.7% of infants at risk for brain damage were hard of hearing. Conductive hearing loss was discovered with 25.4% of infants, and eight (7.3%) had sensorineural hearing impairment. In the group of examinees with only risk factors 3.6% had sensorineural impairment and in a group with abnormal motor development, there were 18.5% with that kind of hearing loss. Fischer test confirmed a statistically significant difference between the groups. Infants at risk for brain damage have more frequently impaired auditory function than their peers. For this reason, it is especially important to focus attention on the hearing condition when dealing with this population. Recording of evoked otoacoustic emissions is very helpful in pediatric audiometry, but any interpretation of the results should consider the possibility of auditory neuropathy.
早期听力筛查的重要性早已得到认可，因为尽早做出诊断并立即开始干预，听力受损儿童的预后会得到改善。对于听力障碍的临床筛查，推荐记录耳声发射。由于早期脑损伤的一些风险因素同时也是听觉系统功能障碍的风险因素，我们推测有脑损伤风险的婴儿比同龄其他人群更易出现听力障碍。我们关注耳声发射测试在评估这些婴儿听觉功能中的作用。该研究纳入了110名有脑损伤风险的婴儿。经过全面的耳鼻喉科检查后，通过记录耳声发射、鼓室图、纯音听力测定，必要时还通过听觉脑干反应来评估听觉功能。耳声发射由Madsen-Electronics Celesta 503在经过声学处理的隔音室中记录。我们记录了自发性以及瞬态和畸变产物耳声发射。神经科医生将其分为两组，神经风险程度不同。将收集到的听觉功能结果与神经风险程度进行比较。统计分析采用卡方检验和费舍尔检验。38.2%的受检者检测到自发性耳声发射。87.3%的婴儿记录到诱发耳声发射。32.7%的婴儿需要重复测试。我们观察到一名感音神经性听力障碍且无听觉脑干反应的儿童也存在诱发耳声发射。高达32.7%有脑损伤风险的婴儿存在听力障碍。25.4%的婴儿发现有传导性听力损失，8名（7.3%）有感音神经性听力障碍。在仅有风险因素的受检者组中，3.6%有感音神经性损伤，在运动发育异常的组中，18.5%有此类听力损失。费舍尔检验证实两组之间存在统计学显著差异。有脑损伤风险的婴儿比同龄人更易出现听觉功能障碍。因此，在处理这类人群时，特别要关注听力状况。诱发耳声发射的记录在小儿听力测定中非常有用，但对结果的任何解读都应考虑听觉神经病的可能性。
