Lo Phoebe S Y, Tong Michael C F, Wong Eric M C, van Hasselt C Andrew
Division of Otorhinolaryngology, Department of Surgery and Institute of Human Communicative Research, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, People's Republic of China.
Eur J Pediatr. 2006 Dec;165(12):851-7. doi: 10.1007/s00431-006-0181-5. Epub 2006 Jul 22.
This study aimed to evaluate the parental suspicion of hearing loss in children with otitis media with effusion (OME). As part of a population-based survey in a screening programme among 6- to 7-year-old Chinese children in Hong Kong, OME cases and controls were studied for the value of parental observations in the prediction of OME and hearing test results.
Prior to the otoscopic and tympanometric examination of the children on school premises, a self-administered binary-choice question was sent to the parents asking whether there was any suspicion of hearing impairment. Positive screens and randomly selected negative screens were seen in a hospital clinic for the confirmation of case and control status 2 to 3 weeks after the school screening. Aural examination under microscopy, repeated tympanometry and stapedial reflex testing, and pure-tone audiometry (PTA) were conducted, and 117 cases and 159 controls were included in this study.
The average PTA conductive threshold levels in the individual children with OME ranged from 3.8 dB to 40.0 dB with a group mean of 17.0 dB in the better-hearing ears. Parental suspicion of hearing deficit was significantly associated with OME (p<0.001) but not PTA findings (p=0.686). The sensitivity of parent-suspected hearing impairment to detect OME however was very low (19.7%).
In other words, if we had relied on parental suspicion as the first screening, at least 80% of the OME cases would have been missed. We conclude that the parental suspicion of hearing loss is inadequate for the identification of mild hearing loss as caused by OME. Health education is recommended to improve parental awareness of the disease.
本研究旨在评估患有中耳积液（OME）儿童的家长对听力损失的怀疑情况。作为香港一项针对6至7岁中国儿童的筛查项目中基于人群调查的一部分，对OME病例和对照进行研究，以探讨家长观察在预测OME和听力测试结果方面的价值。
在学校对儿童进行耳镜检查和鼓室图检查之前，向家长发送一个自行填写的二元选择问题，询问他们是否怀疑孩子有听力障碍。在学校筛查后的2至3周，将筛查呈阳性的儿童以及随机选择的筛查呈阴性的儿童送至医院门诊，以确认病例和对照状态。进行了显微镜下耳科检查、重复鼓室图检查和镫骨肌反射测试，以及纯音听力测定（PTA），本研究纳入了117例病例和159例对照。
患有OME的个体儿童的平均PTA传导阈值水平在3.8分贝至40.0分贝之间，听力较好耳朵的组平均水平为17.0分贝。家长对听力缺陷的怀疑与OME显著相关（p<0.001），但与PTA结果无关（p=0.686）。然而，家长怀疑有听力障碍对检测OME的敏感性非常低（19.7%）。
换句话说，如果我们将家长的怀疑作为首次筛查依据，那么至少80%的OME病例将会被漏诊。我们得出结论，家长对听力损失的怀疑不足以识别由OME导致的轻度听力损失。建议开展健康教育以提高家长对该疾病的认识。
