Geal-Dor Miriam, Adelman Cahtia, Levi Haya, Zentner Gary, Stein-Zamir Chen
Audiology and Speech Pathology Clinic, Hadassah University Medical Center and Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel.
Int J Pediatr Otorhinolaryngol. 2010 Dec;74(12):1351-5. doi: 10.1016/j.ijporl.2010.08.023. Epub 2010 Sep 24.
Hearing screening programs in infancy should identify hearing impairment as early as possible. The two common programs utilize either objective neonatal tests (oto-acoustic emissions (OAE) or automatic auditory brainstem responses (aABR)) or behavioral screening at 7-9 months of age. Most countries employ only one of these options. The uniqueness of this study is the comparison of both hearing screening programs on the same group of children.
The study was conducted on 1545 children born between the years 1999 and 2003 who were followed up in public well baby clinics in the Jerusalem district. The children were tested with transient oto-acoustic emissions (TEOAE) before discharge from the neonatal ward, and later, at the age of 7-9 months, underwent a behavioral hearing screening test in a public well baby clinic. The results of both hearing screening programs were compared.
The compliance rates were 99.7% for the neonatal testing and 83% for the 7-9 months behavioral testing (p=0.0001). The failure rate was 4-6% in both screening programs; failure of OAE testing was unilateral in 65% of newborns; at 7-9 months bilateral failure was more common (56%). There was an 11.2% disagreement (kappa coefficient 0.03) between the outcomes of both tests. In another group of 49 known hearing-impaired children, 27 who had undergone newborn screening were diagnosed before the age of behavioral testing. Twelve children had failed either both tests or the only test they underwent. In nine cases, the children had passed one of the hearing screening tests and had failed the other, and one child had passed both tests.
Newborn hearing screening has the advantages of objectivity, early identification, and higher compliance. The major advantage of the later behavioral test is identification of later onset or progressive hearing impairment as well as auditory neuropathy spectrum disorder. Each screening test is testing different entities; hence they are complementary and not interchangeable or superfluous. We recommend a comprehensive two-step hearing screening plan (newborn and later behavioral) with close cooperation between the health care providers involved.
婴儿听力筛查项目应尽早识别听力障碍。两种常见的项目分别采用客观的新生儿测试（耳声发射（OAE）或自动听性脑干反应（aABR））或在7至9个月大时进行行为筛查。大多数国家只采用其中一种方法。本研究的独特之处在于对同一组儿童的两种听力筛查项目进行比较。
该研究对1999年至2003年间出生、在耶路撒冷地区公共健康婴儿诊所接受随访的1545名儿童进行。这些儿童在新生儿病房出院前接受了瞬态耳声发射（TEOAE）测试，之后在7至9个月大时，在公共健康婴儿诊所接受了行为听力筛查测试。对两种听力筛查项目的结果进行了比较。
新生儿测试的依从率为99.7%，7至9个月行为测试的依从率为83%（p = 0.0001）。两种筛查项目的失败率均为4%至6%；耳声发射测试失败在65%的新生儿中为单侧；在7至9个月时双侧失败更为常见（56%）。两种测试结果之间存在11.2%的不一致（kappa系数0.03）。在另一组49名已知听力受损的儿童中，27名接受过新生儿筛查的儿童在行为测试年龄之前被诊断出来。12名儿童两项测试均失败或仅接受的一项测试失败。在9例中，儿童通过了其中一项听力筛查测试而另一项测试失败，1名儿童两项测试均通过。
新生儿听力筛查具有客观性、早期识别和更高依从性的优点。后期行为测试的主要优点是识别迟发性或进行性听力障碍以及听神经病谱系障碍。每种筛查测试检测的是不同的情况；因此它们是互补的，不是可互换或多余的。我们建议采用全面的两步听力筛查计划（新生儿期和后期行为筛查），相关医疗保健提供者之间密切合作。
