Holtby I, Forster D P
South Tees Health Authority, Poole Hospital, Middlesbrough, Cleveland, United Kingdom.
J Epidemiol Community Health. 1992 Feb;46(1):21-5. doi: 10.1136/jech.46.1.21.
The aims were (1) to evaluate impedance measurements against pure tone audiometry as a screening method for the detection of middle ear changes associated with hearing loss in infant school children; (2) to estimate the costs of the health authority of each method.
The study involved two stage screening in which both methods were offered, pure tone audiometry being carried out by school nurses and impedance screening by a doctor.
18 infant or primary schools in Langbaurgh, Cleveland, UK.
610 previously unscreened infant school children took part in the study.
Main outcome measures were the sensitivity, specificity, and predictive value of each screening method, using clinical assessment and action as the validating technique. The sensitivity and the predictive value of a positive test in two stage impedance screening was markedly superior to that of pure tone audiometry. The specificity was similar using the two methods. In addition the impedance methods was more rapid and estimated to consume less resource as a screening procedure than pure tone audiometry.
The superiority of the use of impedance screening established in this study should be confirmed in a subsequent audit carried out purely by school nurses.
目标为（1）评估与纯音听力测定法相比，阻抗测量作为检测幼儿学校儿童中耳变化与听力损失相关的筛查方法；（2）估算卫生当局采用每种方法的成本。
该研究涉及两阶段筛查，两种方法均被采用，纯音听力测定由学校护士进行，阻抗筛查由医生进行。
英国克利夫兰朗堡的18所幼儿或小学。
610名此前未接受过筛查的幼儿学校儿童参与了该研究。
主要结局指标是每种筛查方法的敏感性、特异性和预测值，采用临床评估和行动作为验证技术。两阶段阻抗筛查中阳性检测的敏感性和预测值明显优于纯音听力测定法。两种方法的特异性相似。此外，作为一种筛查程序，阻抗方法比纯音听力测定法更快，且估计消耗的资源更少。
本研究中确立的使用阻抗筛查的优越性应在随后仅由学校护士进行的审计中得到证实。
