Ohl Christine, Dornier Liliane, Czajka Cécile, Chobaut Jean-Claude, Tavernier Laurent
ENT Department, University Hospital of Besançon, Besançon Cedex, France.
Int J Pediatr Otorhinolaryngol. 2009 Dec;73(12):1691-5. doi: 10.1016/j.ijporl.2009.08.027. Epub 2009 Sep 30.
This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007.
All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management.
Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss.
Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.
本文介绍了2001年至2007年在法国贝桑松大学医院对有听力障碍风险的婴儿进行新生儿听力筛查的结果。
所有有听力障碍风险的新生儿均按照婴儿听力联合委员会（JCIH）推荐的方法进行检测：采用两步自动耳声发射（AOAE）程序，对于听力障碍的阳性诊断，再通过听性脑干反应（ABR）进行补充检测。筛查最早在出生后第三天开始进行AOAE检测。如果一只或两只耳朵的AOAE检测结果为阴性，则对婴儿进行重新检测，此时若AOAE再次呈阳性，则进行ABR检测。当ABR阈值达到40dB或更高时，将婴儿转诊至专门诊治婴儿耳聋的听力学家处进行诊断确认和治疗。
在此期间，共对1461名婴儿进行了筛查，其中4.55%被诊断为耳聋或听力障碍。近10%的婴儿失访。46名儿童患有感音神经性听力障碍，其中34名是双侧的，并在6个月龄前接受了治疗。感音神经性听力损失的风险因素（按统计学意义排序）依次为：严重出生窒息；神经系统疾病；已知与听力损失相关的综合征；TORCH（弓形虫病、风疹、巨细胞病毒、疱疹）感染；耳聋家族史；筛查时的年龄；以及两种或更多风险因素的联合。然而，出生体重低于1500g和妊娠34周前早产对感音神经性听力损失未显示出统计学上的显著影响。颅面畸形（主要是腭裂和耳部发育不全）是传导性听力损失的一个重要因素。
我们对有风险的婴儿进行的听力筛查使60名耳聋儿童能够获得早期治疗。然而，有太多儿童失访；这表明必须向家长和医护人员提供关于听力损失风险的更好信息，并且需要进行普遍的新生儿筛查。这项研究最重要的结果是，在听力受损儿童群体中，其发病率接近普遍报道的水平，多种风险因素的联合被证明是听力障碍的一个显著额外风险因素。
