School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Ear Hear. 2012 Nov-Dec;33(6):745-56. doi: 10.1097/AUD.0b013e31825b1cd9.
The aim of this study was to investigate whether there was evidence-based support for targeted surveillance programs using a risk-factor registry to detect postnatal hearing loss or whether other programs were available that may be more effective than targeted surveillance. Particularly, it addressed questions that arose along the targeted surveillance pathway, including: (1) the risk factors used to determine a referral, (2) referral frequencies, (3) the relationship between risk factors and a postnatal hearing loss, and (4) other systems that may be more efficient than the use of risk factors.
A systematic literature review was completed in peer-reviewed and non-peer-reviewed databases.
Publications were obtained using the databases MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Excerpta Medica on line, and by inspecting the reference lists of relevant articles and expert-committee papers. Quality assessment ratings and data extraction were completed by the research team.
In total, 40 articles met the inclusion criteria and were included in this review. The outcomes drawn from these studies were inconclusive as they were based on small sample sizes and largely from single sites only. With this in mind, from the information obtained: (1) gestational age, low-birth weight, toxoplasmosis, other infections, rubella, cytomegalovirus (CMV), herpes simplex virus infections, craniofacial anomalies, respirator support, and the administration of aminoglycosides were the more commonly reported risk factors in programs; (2) referral frequency for monitoring appointments was approximately 3%; and (3) CMV, extracorporeal membrane oxygenation, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn were associated with postnatal hearing loss, whereas, preauricular skin tags and ear pits, low-birth weight, and toxoplasmosis were not. The review also identified that second-phase universal screening programs, CMV screening, and genetic screening should be explored as potential additions or alternatives to targeted surveillance using risk factors.
Further large-scale, population-based research on available programs for the detection of postnatal hearing loss should be conducted to improve present practice and assist with the development of evidence-based guidelines for hearing monitoring.
本研究旨在调查是否有循证医学支持使用风险因素登记册来检测产后听力损失的靶向监测计划，或者是否有其他可能比靶向监测更有效的计划。特别是，它解决了沿着靶向监测途径出现的问题，包括：（1）用于确定转诊的风险因素，（2）转诊频率，（3）风险因素与产后听力损失之间的关系，以及（4）可能比使用风险因素更有效的其他系统。
在同行评议和非同行评议数据库中完成了系统文献回顾。
使用数据库 MEDLINE、 Cumulative Index of Nursing and Allied Health Literature 和 Excerpta Medica on line 以及查阅相关文章和专家委员会文件的参考文献列表获取出版物。研究团队完成了质量评估评级和数据提取。
共有 40 篇文章符合纳入标准并包含在本综述中。由于这些研究的样本量较小且主要来自单一地点，因此得出的结果没有定论。考虑到这一点，从获得的信息中：（1）胎龄、低出生体重、弓形虫病、其他感染、风疹、巨细胞病毒（CMV）、单纯疱疹病毒感染、颅面畸形、呼吸机支持和氨基糖苷类药物的使用是在计划中更常报告的风险因素；（2）监测预约的转诊频率约为 3%；（3）CMV、体外膜氧合、先天性膈疝和新生儿持续性肺动脉高压与产后听力损失相关，而耳前皮肤标签和耳窝、低出生体重和弓形虫病则不相关。该综述还确定，第二阶段普遍筛查计划、CMV 筛查和遗传筛查应作为使用风险因素进行靶向监测的潜在补充或替代方案进行探索。
应该对现有的产后听力损失检测程序进行进一步的大规模、基于人群的研究，以改进当前的实践，并协助制定基于证据的听力监测指南。
