使用新生儿听力筛查转诊婴儿的 click 听觉脑干反应预测听力损失类型。

Audiology Department, Whipps Cross University Hospital, London, United Kingdom.

Ear Hear. 2014 Jan-Feb;35(1):1-9. doi: 10.1097/AUD.0b013e31829e0718.

OBJECTIVES

This study examined the ability of click auditory brainstem response (ABR) undertaken below the age of 6 months (from expected date of delivery) to differentiate between conductive and sensorineural hearing loss (SNHL), using the latency of wave V measured 20 dB above threshold.

DESIGN

Subjects were recruited if they had an ABR threshold of ≥ 40 dB nHL and ≤ 70 dB nHL in one or both ears measured below the age of 6 months and they had also attended follow-up appointments for behavioral assessment of their hearing in which the type of hearing loss had been confirmed. Forty-five children (84 ears) with SNHL, 82 children (141 ears) with temporary conductive hearing loss (TCHL), and 5 children (10 ears) with permanent conductive hearing loss (PCHL) were recruited. The differences between mean wave V latencies measured 20 dB above ABR threshold were examined using the independent t-test for the groups of cases with SNHL, TCHL, and PCHL. Signal-detection theory was used to examine the relationship between sensitivity and specificity when the latency of wave V 20 dB above threshold was used to identify the presence of SNHL. Receiver operating characteristics were generated and the coordinates of the curve examined for the best compromise between sensitivity and false-alarm rate. The specificity, positive predictive value, and probability of missing a true case were determined for the most promising criteria.

RESULTS

There were significant differences between the two groups with SNHL and TCHL. The mean latency of wave V 20 dB above threshold was 1 msec shorter in those with SNHL compared with those with TCHL. There were significant differences between children with PCHL and SNHL but no difference between those with PCHL and TCHL. When a criterion of < 7.6 msec was chosen to predict the presence of SNHL the test sensitivity was 0.98, test specificity 0.71, and positive predictive value was 0.66. Nine out of 10 of those with a latency 20 dB above threshold of < 7.0 msec had an SNHL.

CONCLUSIONS

The latency of wave V 20 dB above threshold measured using click ABR is a useful indicator of the type of hearing loss in babies referred from newborn hearing screening.

目的

本研究通过测量阈值以上 20dB 处波 V 的潜伏期，来检验在 6 个月龄以下（从预期出生日期开始）进行的听性脑干反应（ABR）在区分传导性和感音神经性听力损失（SNHL）方面的能力。

设计

本研究招募了在 6 个月龄以下，一只或双耳的 ABR 阈值≥40dBnHL 且≤70dBnHL，并且也参加了后续行为听力评估的婴儿。这些婴儿的听力损失类型已得到确认。本研究共招募了 45 名（84 耳）SNHL 患儿、82 名（141 耳）暂时性传导性听力损失（TCHL）患儿和 5 名（10 耳）永久性传导性听力损失（PCHL）患儿。使用独立 t 检验比较 SNHL、TCHL 和 PCHL 患儿组的平均波 V 潜伏期差异。使用信号检测理论，当阈值以上 20dB 处的波 V 潜伏期用于识别 SNHL 时，检验其敏感性和特异性之间的关系。生成受试者工作特征曲线，并检查曲线坐标，以找到敏感性和假警报率之间的最佳折衷。为最有希望的标准确定特异性、阳性预测值和漏诊率。

结果

SNHL 和 TCHL 两组之间存在显著差异。SNHL 患儿阈值以上 20dB 处波 V 的平均潜伏期比 TCHL 患儿短 1ms。PCHL 患儿与 SNHL 患儿之间存在显著差异，而 PCHL 患儿与 TCHL 患儿之间无差异。当选择<7.6ms 的标准来预测 SNHL 的存在时，该检测的敏感性为 0.98，特异性为 0.71，阳性预测值为 0.66。在阈值以上 20dB 处潜伏期<7.0ms 的 10 名婴儿中，有 9 名患有 SNHL。