Chen Hsiao-Chuan, Wang Nan-Mai, Chiu Wen-Chen, Liu Shu-Yu, Chang Yi-Ping, Lin Pei-Yu, Chung King
Graduate Institute of Audiology and Speech Therapy, National Kaohsiung Normal University, Kaohsiung, Taiwan, ROC.
School of Speech Language Pathology and Audiology, Chung Shan Medical University, No. 110, Section 1, Jiangou North Road, Taichung City 40201, Taiwan, ROC.
Int J Pediatr Otorhinolaryngol. 2014 Oct;78(10):1677-85. doi: 10.1016/j.ijporl.2014.07.018. Epub 2014 Jul 21.
Individuals with disabilities are often reported to have a high prevalence of undetected hearing disorders/loss, but there is no standardized hearing test protocol for this population. The purposes of this study were (1) to examine the hearing status of students with special needs in Taiwan, and (2) to investigate the use of an on-site hearing test protocol that would adequately detect hearing problems in this population and reduce unnecessary referrals for off-site follow-up services.
A total of 238 students enrolled in two schools for special education and one habilitation center participated in the study. Most students had intellectual disabilities and some also had additional syndromes or disorders. A hearing screening protocol including otoscopy, tympanometry, and distortion product otoacoustic emissions was administered to examine students' outer, middle, and inner ear functions, respectively. Pure tone tests were then administered as an on-site follow-up for those who failed or could not be tested using the screening protocol.
Only 32.4% of students passed. When administered alone, the referral rate of otoscopy, tympanometry, and otoacoustic emissions were 38.7%, 46.0%, and 48.5%, respectively. The integration of these subtests revealed 52.1% of students needed follow-up services, 11.8% could not be tested, 2.5% had documented hearing loss, and 1.3% needed to be monitored because of negative middle ear pressure. The inclusion of pure tone audiometry increased the passing rate by 9.9% and provided information on hearing sensitivity for an additional 8.6% of students.
Hearing assessments and regular hearing screening should be provided as an integral part of health care services for individuals with special needs because of high occurrences of excessive cerumen, middle ear dysfunction, and sensorineural hearing loss. The training of care-givers and teachers of students with special needs is encouraged so that they can help identify hearing problems and reduce the negative impact of hearing disorders and hearing loss. The screening protocol needs to include subtests that examine the status of different parts of their auditory system. The addition of pure tone audiometry as an on-site follow-up tool reduced the rate of off-site referrals and provided more information on hearing sensitivity.
据报道，残疾个体中未被发现的听力障碍/听力损失患病率往往较高，但针对该人群尚无标准化的听力测试方案。本研究的目的是：（1）检查台湾特殊需求学生的听力状况；（2）调查一种现场听力测试方案的使用情况，该方案能够充分检测出该人群的听力问题，并减少不必要的转介至场外后续服务。
共有238名就读于两所特殊教育学校和一个康复中心的学生参与了本研究。大多数学生有智力障碍，有些还伴有其他综合征或疾病。实施了一项包括耳镜检查、鼓室图检查和畸变产物耳声发射检查的听力筛查方案，以分别检查学生的外耳、中耳和内耳功能。然后，对那些筛查方案检查未通过或无法进行检查的学生进行纯音测试作为现场后续检查。
只有32.4%的学生通过。单独进行耳镜检查、鼓室图检查和耳声发射检查时，转介率分别为38.7%、46.0%和48.5%。这些子测试综合起来显示，52.1%的学生需要后续服务，11.8%的学生无法进行测试，2.5%的学生有记录在案的听力损失，1.3%的学生因中耳负压需要进行监测。纳入纯音听力测定使通过率提高了9.9%，并为另外8.6%的学生提供了听力敏感度信息。
由于耵聍过多、中耳功能障碍和感音神经性听力损失的发生率较高，应将听力评估和定期听力筛查作为特殊需求个体医疗保健服务的一个组成部分。鼓励对特殊需求学生的护理人员和教师进行培训，以便他们能够帮助识别听力问题，并减少听力障碍和听力损失的负面影响。筛查方案需要包括检查其听觉系统不同部位状况的子测试。增加纯音听力测定作为现场后续工具降低了场外转介率，并提供了更多关于听力敏感度的信息。
