Kanji Amisha, Khoza-Shangase Katijah
Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
J Am Acad Audiol. 2018 Jun;29(6):495-502. doi: 10.3766/jaaa.16155.
The ideal hearing screening measure is yet to be defined, with various newborn hearing screening protocols currently being recommended for different contexts. Such diverse recommendations call for further exploration and definition of feasible and context-specific protocols.
The aim of the study was to establish which combinations of audiological screening measures provide both true-positive (TP) and true-negative (TN) results for risk-based hearing screening, at and across time.
A longitudinal, repeated-measures design was employed.
Three-hundred and twenty-five participants comprised the initial study sample. These participants comprised newborns and infants who were discharged from the neonatal intensive care unit and high care wards to "step down" wards at two public sector hospitals within an academic hospital complex.
Transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and automated auditory brainstem response (AABR) were conducted at the initial and repeat hearing screening. Diagnostic audiological assessments were also conducted. Results from combinations of audiological screening measures at the initial and repeat hearing screening were analyzed in relation to the final diagnostic outcome (n = 91). Participants were classified as presenting with an overall "refer" if the outcome for any one test was "refer." The overall screening outcomes for different test combinations were compared using McNemar's test for paired data. Proportions across different test combinations were compared by the z-test for proportions.
Because of the absence of participants with hearing loss in the current study sample, analysis could only be conducted in relation to TN findings (specificity) and not TP findings (sensitivity). The percentage of TN findings was highest at the repeat hearing screening using any test or combination of tests when compared with findings from the initial hearing screening. TEOAE combined with AABR (TEOAE/AABR) (p < 0.0001), DPOAE combined with AABR (DPOAE/AABR) (p < 0.0001), and the combination of all three screening measures (p < 0.0001) yielded the highest percentage specificity at the repeat hearing screening when compared with the initial hearing screening.
The best specificity was noted at the repeat hearing screening. Within a resource stricken context, where availability of all screening measures options may not be feasible, current study findings suggest the use of a two-stage AABR protocol or TEOAE/AABR protocol.
理想的听力筛查方法尚未确定，目前针对不同情况推荐了各种新生儿听力筛查方案。如此多样的建议需要进一步探索和确定可行的、因地制宜的方案。
本研究的目的是确定哪些听力学筛查措施的组合能在基于风险的听力筛查中在不同时间点都给出真阳性（TP）和真阴性（TN）结果。
采用纵向重复测量设计。
325名参与者构成了初始研究样本。这些参与者包括从新生儿重症监护病房和高级护理病房出院后转至学术医院综合体内两家公立医院“降级”病房的新生儿和婴儿。
在初次和重复听力筛查时进行了瞬态诱发耳声发射（TEOAE）、畸变产物耳声发射（DPOAE）和自动听性脑干反应（AABR）测试。还进行了诊断性听力学评估。根据最终诊断结果（n = 91）分析了初次和重复听力筛查时听力学筛查措施组合的结果。如果任何一项测试结果为“转诊”，则参与者被归类为总体“转诊”。使用配对数据的McNemar检验比较不同测试组合的总体筛查结果。通过比例z检验比较不同测试组合的比例。
由于当前研究样本中没有听力损失的参与者，因此只能针对TN结果（特异性）而非TP结果（敏感性）进行分析。与初次听力筛查结果相比，在重复听力筛查时使用任何一种测试或测试组合时，TN结果的百分比最高。与初次听力筛查相比，TEOAE与AABR联合使用（TEOAE/AABR）（p < 0.0001）、DPOAE与AABR联合使用（DPOAE/AABR）（p < 0.0001）以及所有三种筛查措施联合使用（p < 0.0001）在重复听力筛查时产生的特异性百分比最高。
在重复听力筛查时观察到最佳特异性。在资源匮乏的情况下，可能无法采用所有筛查措施选项，当前研究结果表明可使用两阶段AABR方案或TEOAE/AABR方案。
