Chan Kit Tsui-Yan, Wong Eddie Chi Ming, Law Chi Wai, Chong Hou Ming, McPherson Bradley
Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong SAR, China.
Ear, Nose and Throat Department, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, China.
Int J Pediatr Otorhinolaryngol. 2015 Nov;79(11):1920-5. doi: 10.1016/j.ijporl.2015.09.008. Epub 2015 Sep 24.
Universal newborn hearing screening is an established practice among Hong Kong public hospitals using a 2-stage automated auditory brainstem response (AABR) screening protocol. To enhance overall efficiency without sacrificing program accuracy, cost reduction in terms of replacing the initial ear coupler-based screening with a more economical ear insert-based screening procedure was considered. This study examined the utility of an insert-based AABR initial screening approach and the projected cost-effectiveness of a combined probe-based plus follow-up ear coupler AABR screening procedure.
Following prenatal maternal consent, newborn hearing screening was conducted with 167 healthy neonates using a cross-sectional, repeated measures study design. The neonates were screened with AABR sequentially; using ear coupler and ear probe (insert) procedures, in both ears, with two different but comparable AABR instruments. Testing took place in the antenatal ward of a department of obstetrics and gynaecology, at a large public hospital.
With the specific combination of instruments deployed for this study insert-based AABR screening generated a five-fold higher rescreen rate and took an additional 50% screening time compared to coupler-based AABR screening. Although the cost of consumables used in a 2-stage AABR screening protocol would reduce by 9.87% if the combined procedure was implemented, the findings indicated AABR screening when conducted with an ear probe has reduced utility compared with conventional ear coupler screening.
Significant differences may occur in screening outcomes when changes are made to coupler method. Initiating a 2-stage AABR screening protocol with an ear insert technique may be impracticable in newborn nurseries given the greater number of false positive cases generated by this approach in the present study and the increased time required to carry out an insert-based procedure.
在香港公立医院中，普遍采用两阶段自动听性脑干反应（AABR）筛查方案进行新生儿听力筛查。为了在不牺牲筛查准确性的前提下提高整体效率，考虑通过采用更经济的耳内探头筛查程序取代最初基于耳塞的筛查来降低成本。本研究探讨了基于耳内探头的AABR初始筛查方法的实用性，以及基于探头加后续耳塞的AABR联合筛查程序的预期成本效益。
在获得产前母亲同意后，采用横断面重复测量研究设计，对167名健康新生儿进行听力筛查。使用两种不同但性能相当的AABR仪器，依次对新生儿双耳进行AABR筛查，先采用耳塞程序，后采用耳内探头程序。检测在一家大型公立医院妇产科的产前病房进行。
对于本研究中所采用的特定仪器组合，与基于耳塞的AABR筛查相比，基于耳内探头的AABR筛查的复筛率高出五倍，且筛查时间增加了50%。虽然如果实施联合筛查程序，两阶段AABR筛查方案中消耗品的成本将降低9.87%，但研究结果表明，与传统的耳塞筛查相比，使用耳内探头进行AABR筛查的实用性较低。
改变耳塞方法时，筛查结果可能会出现显著差异。鉴于本研究中该方法产生的假阳性病例较多，且采用基于耳内探头的程序所需时间增加，在新生儿病房采用耳内探头技术启动两阶段AABR筛查方案可能不切实际。
