Xu Zheng-Min, Cheng Wen-Xia, Yang Xiao-Lin
Department of Otolaryngology, Children's Hospital of Fudan University, Shanghai 201102, PR China.
Int J Pediatr Otorhinolaryngol. 2011 Oct;75(10):1225-9. doi: 10.1016/j.ijporl.2011.07.004. Epub 2011 Jul 28.
To study the sensitivity and specificity of targeted neonatal hearing screening for the single-session distortion product otoacoustic emissions (DPOAE) technique and the combined DPOAE/automated auditory brain-stem response (AABR) technique.
3000 high-risk newborns were studied at Children's Hospital of Fudan University. They were required to take two different screening procedures separately. The first procedure consisted of DPOAE alone and the second consisted of DPOAE combined with the AABR. Based upon the etiology in high-risk babies, they were divided into four groups. In group I there were 670 very-low-birth-weight (VLBW) newborns (1340 ears), and in group II there were 890 preterm babies (1780 ears). 850 babies (1700 ears) suffered from hyperbilirubinemia in group III, whereas 790 babies (1580 ears) with asphyxia were in group IV. The babies in groups II, III, and IV came from the neonatal intensive-care unit (NICU) of our hospital. The study protocols consisted of the DPOAE alone and DPOAE combined with AABR hearing screening at an age of less than 1 month, and a diagnostic stage at the age of 2 months.
With single-session DPOAE screening, the referral rate (8% of the NICU babies), the false-positive rate (4.96%) and the false-negative rate (0.8%) were higher. The different etiologies in NICU babies had significantly different referral rates (F-test, p<0.01). A 4.46% referral rate of hyperbilirubinemi babies was much lower. The combined DPOAE/AABR screening technique revealed a referral rate of 5.03%, a false-positive rate of 2% and a false-negative rate of 0.06%. The false-positive rate was well below the suggested 3% of the American Academy of Pediatric. Comparisons of the referral rate, false-positive rate and false-negative rate of two hearing screening protocols (DPOAE alone and combined DPOAE/AABR) revealed significant differences (t-test, p<0.05, p<0.01, p<0.01). 91 infants (3.03% of the NICU babies) who failed the combined DPOAE/AABR screening were confirmed on hearing impairment. Of 22 babies who passed DPOAE screening but failed the AABR screening had a severe to profound hearing loss based on classic ABR. These patients (24% of the NICU babies with hearing losses) with hyperbilirubinemia and asphyxia problems at newborn stage were diagnosed as auditory neuropathy based on evaluations of DPOAE screening passed, abnormal ABR and absent middle-ear muscle reflexes (MMR).
Our study demonstrates the use of a combination of DPOAE and AABR testing ensures high sensitivity and acceptable specificity, and predict the AN profile in NICU babies. Our efforts identified 22 NICU babies with auditory neuropathy who hopefully will benefit from early remediation of their hearing deficit.
研究单阶段畸变产物耳声发射（DPOAE）技术以及联合DPOAE/自动听性脑干反应（AABR）技术用于新生儿听力筛查的敏感性和特异性。
对复旦大学附属儿科医院的3000例高危新生儿进行研究。他们需要分别接受两种不同的筛查程序。第一种程序仅包括DPOAE，第二种程序包括DPOAE联合AABR。根据高危婴儿的病因，将他们分为四组。第一组有670例极低出生体重（VLBW）新生儿（1340耳），第二组有890例早产儿（1780耳）。第三组有850例患有高胆红素血症的婴儿（1700耳），而第四组有790例窒息婴儿（1580耳）。第二、三、四组的婴儿来自我院新生儿重症监护病房（NICU）。研究方案包括在小于1月龄时进行单独的DPOAE以及DPOAE联合AABR听力筛查，以及在2月龄时进行诊断阶段。
采用单阶段DPOAE筛查时，转诊率（NICU婴儿的8%）、假阳性率（4.96%）和假阴性率（0.8%）较高。NICU婴儿的不同病因导致的转诊率有显著差异（F检验，p<0.01）。高胆红素血症婴儿的转诊率为4.46%，要低得多。联合DPOAE/AABR筛查技术的转诊率为5.03%，假阳性率为2%，假阴性率为0.06%。假阳性率远低于美国儿科学会建议的3%。两种听力筛查方案（单独的DPOAE和联合的DPOAE/AABR）的转诊率、假阳性率和假阴性率比较显示有显著差异（t检验，p<0.05，p<0.01，p<0.01）。联合DPOAE/AABR筛查未通过的91例婴儿（占NICU婴儿的3.03%）被确诊有听力障碍。在通过DPOAE筛查但AABR筛查未通过的22例婴儿中，根据经典ABR检查有重度至极重度听力损失。这些在新生儿期有高胆红素血症和窒息问题的患者（占NICU听力损失婴儿的24%），根据DPOAE筛查通过、ABR异常和中耳肌反射（MMR）缺失的评估，被诊断为听神经病。
我们的研究表明，联合使用DPOAE和AABR检测可确保高敏感性和可接受的特异性，并可预测NICU婴儿的听神经病特征。我们的研究发现了22例NICU听神经病婴儿，他们有望从听力缺陷的早期治疗中获益。
