Hamill-Ruth Robin J, Ruth Roger A
Department of Anesthesiology, University of Virginia Health Systems, Charlottesville 22908-0100, USA.
Crit Care Med. 2003 Sep;31(9):2271-7. doi: 10.1097/01.CCM.0000079611.28968.CF.
To assess hearing impairment in adults admitted to a university surgical intensive care unit in order to identify patients at risk for impaired receptive communication.
Prospective, clinical, observational study within the continuing quality improvement program.
Ten-bed adult surgical intensive care unit at a university hospital.
Patients were 442 adult patients admitted to the surgical intensive care unit for trauma, a critical illness, or postoperative monitoring.
As part of a continuing quality improvement protocol, adults admitted to the surgical intensive care unit were screened for hearing loss. Screening included otoscopy, tympanometry, and distortion product otoacoustic emissions as near the time of admission as was possible. Testing was available only on weekdays.
Audiologic testing was performed on day 1.7 +/- 3.0 and took 9.3 mins (range, 5-17 min). The women studied (n = 177, 56.2 +/- 18.2 yrs) were significantly older than the men (n = 265, 51.2 +/- 17.8 yrs, p <.0001). We found that 71.4% of patients had normal otoscopy. Only 42.5% of patients passed tympanometry. True failures accounted for 37.3% of patients and technical failures for 20.2%. Distortion product otoacoustic emission (DPOAE) testing was performed on 97.4% of ears. Only 36.2% of patients passed; 58.4% of ears failed, suggesting clinically significant auditory impairment. DPOAE results correlated with age. The pass rate was approximately 60% for patients <40 yrs of age but declined steadily by decade to <7% in patients >80 yrs. The mean age of passed DPOAE (44.2 +/- 16.2 yrs) was significantly younger than patients who failed DPOAE (60.0 +/- 16.6 yrs, p <.0001).
Adult patients admitted to the surgical intensive care unit for trauma, postoperative monitoring, or critical illness are at significant risk of impaired auditory reception. Almost two thirds of patients studied failed the screening protocol. Risk of failure increases with age and male gender. Screening with otoscopy, tympanometry, and DPOAE is an efficient and sensitive way to identify patients at risk for impaired auditory acuity.
评估入住大学外科重症监护病房的成年人的听力障碍情况，以识别存在接受性沟通受损风险的患者。
在持续质量改进项目中的前瞻性、临床、观察性研究。
大学医院的一间拥有10张床位的成人外科重症监护病房。
442名因创伤、危重病或术后监测而入住外科重症监护病房的成年患者。
作为持续质量改进方案的一部分，对入住外科重症监护病房的成年人进行听力损失筛查。筛查尽可能在入院时进行，包括耳镜检查、鼓室图检查和畸变产物耳声发射检查。检测仅在工作日进行。
在第1.7±3.0天进行听力测试，耗时9.3分钟（范围为5 - 17分钟）。所研究的女性患者（n = 177，年龄56.2±18.2岁）显著比男性患者（n = 265，年龄51.2±17.8岁，p <.0001）年龄大。我们发现71.4%的患者耳镜检查正常。仅42.5%的患者鼓室图检查通过。真正未通过的患者占37.3%，技术原因未通过的占20.2%。97.4%的耳朵进行了畸变产物耳声发射（DPOAE）测试。仅36.2%的患者通过；58.4%的耳朵未通过，提示存在具有临床意义的听觉障碍。DPOAE结果与年龄相关。年龄<40岁的患者通过率约为60%，但每增加十岁通过率稳步下降，80岁以上患者通过率<7%。通过DPOAE测试患者的平均年龄（44.2±16.2岁）显著低于未通过DPOAE测试的患者（60.0±16.6岁，p <.0001）。
因创伤、术后监测或危重病入住外科重症监护病房的成年患者存在显著的听觉接收受损风险。几乎三分之二的研究患者筛查方案未通过。未通过风险随年龄和男性性别增加。通过耳镜检查、鼓室图检查和DPOAE进行筛查是识别存在听觉敏锐度受损风险患者的有效且敏感的方法。
