Bielecki Ireneusz, Horbulewicz Anna, Wolan Teresa
Department of Pediatric Surgery, Division of Laryngology, Medical University of Silesia, Upper Silesian Center for Child Health, Medykow 16 str., 40-752 Katowice, Poland.
Int J Pediatr Otorhinolaryngol. 2011 Jul;75(7):925-30. doi: 10.1016/j.ijporl.2011.04.007. Epub 2011 May 14.
The aim of our study was to evaluate the frequency of risk factors and their influence on - the distribution and manifestation of - hearing loss in infants. The study was conducted at the Department of Laryngology in the Upper Silesian Center for Child Health in Katowice (Poland), as part of the Polish National Universal Neonatal Hearing Screening, conducted from 2003 to 2009.
The selected population included every newborn that twice tested positive on the transient evoked otoacoustic emission (TEOAE) screening test, as well as all neonates with one or more risk factors as defined by the Joint Committee of Infant Hearing in 2000 (JCIH). The following procedures were used with each neonate: otolaryngological examination (with otoscopy), tympanometry, automated otoacoustic emission (AOAE), and auditory brainstem response (ABR). A total of 5282 infants were examined. Subjects were categorized into two groups: the first group consisted of 2986 (56.53%) neonates with risk factors of hearing loss, while the second group included 2296 (43.47%) neonates without any known risk factors, but who twice tested positive on the TEOAE screening.
Among all infants examined (5282), sensorineural hearing loss (SNHL) was identified in 240 cases (4.54%), and conductive hearing loss (CHL) in 40 cases (0.76%), while normal hearing (NH) appeared in 5002 cases (94.70%). In the first group, SNHL was identified in 128 neonates (4.29%), and CHL in 28 (0.94%), while NH appeared in 2830 (94.78%). The largest percentage of SNHL (15.52%) appeared in children with identified or suspected syndromes associated with hearing loss. The next highest frequency of SNHL was comprised of children subjected to mechanical ventilation for a period in excess of 5 days (11.45%). Only a small percentage (2.86%) of SNHL appeared to be due to the use of ototoxic medications, despite the fact that this factor is the most prevalent (33.13%) of all analyzed risk factors of hearing impairment. After ototoxic medications, the frequencies of risk factors are as follows: premature birth (16.21%); low birth weight (12.04%); intensive care in excess of 7 days (10.64%). Furthermore, as the number of coexisting risk factors increases, the probability of SNHL in infants is seen to also increase. For children with one to four coexisting risk factors, the probability of SNHL ranges from 3.15% to 5.56%; for five or more risk factors the probability nearly doubles.
Our results indicate that syndromes associated with hearing loss and mechanical ventilation for more than 5 days were statistically significant risk factors in the occurrence of hearing loss. The most common risk factors are ototoxic medications, premature birth, low birth weight, and intensive care in excess of 7 days. As the number of risk factors an infant is exposed to grows, the probability of hearing impairment increases. The large percentage of children with sensorineural hearing loss in the absence of any known risk factors demonstrates the necessity of hearing examinations in all neonates.
我们研究的目的是评估危险因素的出现频率及其对婴儿听力损失的分布和表现的影响。该研究在卡托维兹（波兰）上西里西亚儿童健康中心的耳鼻喉科进行，作为2003年至2009年开展的波兰全国新生儿听力普遍筛查的一部分。
选定的人群包括在瞬态诱发耳声发射（TEOAE）筛查试验中两次检测呈阳性的每一名新生儿，以及所有具有2000年婴儿听力联合委员会（JCIH）定义的一种或多种危险因素的新生儿。对每名新生儿采用以下检查程序：耳鼻喉科检查（包括耳镜检查）、鼓室图、自动耳声发射（AOAE）和听性脑干反应（ABR）。共检查了5282名婴儿。受试者分为两组：第一组由2986名（56.53%）有听力损失危险因素的新生儿组成，而第二组包括2296名（43.47%）无任何已知危险因素但在TEOAE筛查中两次检测呈阳性的新生儿。
在所有接受检查的婴儿（5282名）中，确诊感音神经性听力损失（SNHL）的有240例（4.54%），传导性听力损失（CHL）的有40例（0.76%），听力正常（NH）的有5002例（94.70%）。在第一组中，确诊SNHL的有128名新生儿（4.29%），CHL的有28名（0.94%），NH的有2830名（94.78%）。SNHL比例最高（15.52%）的是患有已确诊或疑似与听力损失相关综合征的儿童。SNHL出现频率其次高的是接受机械通气超过5天的儿童（11.45%）。尽管耳毒性药物是所有分析的听力损害危险因素中最常见的（33.13%），但似乎只有小比例（2.86%）的SNHL是由耳毒性药物引起的。在耳毒性药物之后，危险因素的出现频率如下：早产（16.21%）；低出生体重（12.04%）；重症监护超过7天（10.64%）。此外，随着共存危险因素数量的增加，婴儿出现SNHL的可能性也会增加。对于有一至四个共存危险因素的儿童，SNHL的可能性在3.15%至5.56%之间；对于五个或更多危险因素，可能性几乎翻倍。
我们的结果表明，与听力损失相关的综合征以及机械通气超过5天是听力损失发生的统计学显著危险因素。最常见的危险因素是耳毒性药物、早产、低出生体重和重症监护超过7天。随着婴儿接触的危险因素数量增加，听力损害的可能性也会增加。在没有任何已知危险因素的情况下，有很大比例的儿童患有感音神经性听力损失，这表明对所有新生儿进行听力检查是必要的。
