Wang Yi-Fen, Wang Sun-Sang, Tai Chun-Ching, Lin Lih-Ching, Shiao An-Suey
Department of Otolaryngology, Taipei Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2002 Jun;65(6):285-92.
Hearing loss is a prevalent chronic problem among adults of all ages. Early identification and intervention for hearing loss will reduce the magnitude of functional disability. Hearing screening is an important item of physical examination. The purpose of this study is to evaluate the validity of hearing screening by means of the portable screening pure-tone audiometer and distortion-product otoacoustic emissions (DPOAE) measurement.
This prospective study recruited 64 subjects visiting Taipei Veterans Hospital for physical examination. They underwent hearing tests performed with screening pure-tone audiometer, DPOAE and conventional pure-tone audiometer. The results of conventional pure-tone audiometry were used for "gold standards" and the normal auditory function was defined as the threshold less than or equal to 20 dB. Compared with the "gold standards," we used kappa statistic to assess the agreement of hearing results measured with screening pure-tone audiometer and DPOAE.
For screening pure-tone audiometry, the kappa values at the 5 tested frequencies (0.5, 1, 2, 4, 8 kHz) ranged from 0.79 to 0.93 and the agreement with the gold standards was classified as "excellent." The sensitivity, specificity and test accuracy values ranged from 91.8-98.5%, 88.0-96.3% and 89.8-96.9%, respectively. For DPOAE measurement, the kappa values at the 3 tested frequencies (1, 2, 4 kHz) ranged from 0.62 to 0.78. The agreement was classified as "good" at 1, 4 kHz and "excellent" at 2 kHz. The sensitivity, specificity and test accuracy values ranged from 91.7-98.5%, 62.3-86.8% and 81.3-89.1%.
We recommend a hearing screening measured at 0.5, 1, 2, 4, 8 kHz with screening pure-tone audiometer in a simple-type soundproof chamber and performed by a screening assistant. The DPOAE measurement may be used as an auxiliary tool to provide more information for early identification and differential diagnosis of hearing loss in clinical application.
听力损失在各年龄段的成年人中都是一个普遍存在的慢性问题。对听力损失进行早期识别和干预将减少功能残疾的程度。听力筛查是体格检查的一项重要内容。本研究的目的是通过便携式筛查纯音听力计和畸变产物耳声发射（DPOAE）测量来评估听力筛查的有效性。
这项前瞻性研究招募了64名到台北荣民总医院进行体检的受试者。他们接受了使用筛查纯音听力计、DPOAE和传统纯音听力计进行的听力测试。将传统纯音听力测试的结果用作“金标准”，正常听觉功能定义为阈值小于或等于20分贝。与“金标准”相比，我们使用kappa统计量来评估用筛查纯音听力计和DPOAE测量的听力结果的一致性。
对于筛查纯音听力测试，在5个测试频率（0.5、1、2、4、8千赫）处的kappa值范围为0.79至0.93，与金标准的一致性被归类为“优秀”。灵敏度、特异度和测试准确度值分别范围为91.8 - 98.5%、88.0 - 96.3%和89.8 - 96.9%。对于DPOAE测量，在3个测试频率（1、2、4千赫）处的kappa值范围为0.62至0.78。在1、4千赫处的一致性被归类为“良好”，在2千赫处为“优秀”。灵敏度、特异度和测试准确度值分别范围为91.7 - 98.5%、62.3 - 86.8%和81.3 - 89.1%。
我们建议在简易型隔音室内由筛查助手使用筛查纯音听力计在0.5、1、2、4、8千赫进行听力筛查。在临床应用中，DPOAE测量可作为辅助工具，为听力损失的早期识别和鉴别诊断提供更多信息。
