Arnold B, Schorn K, Stecker M
Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke, Ludwig-Maximilians-Universität München.
Laryngorhinootologie. 1995 Mar;74(3):172-8. doi: 10.1055/s-2007-997713.
Early identification of hearing impairment in children poses a major problem for clinical research and development. In the last two years we determined the hearing sensitivity of 1202 newborns, small infants and children. 52.4% of the children exhibited risk factors for hearing impairment in their medical history. The majority of children was referred to our department by pediatricians (52%), who first suspected hearing impairment, 40% by parents, 3.5% by otolaryngologists, 3% by educators, and 1.5% by general practitioners. The following examinations were performed: transiently evoked otoacoustic emissions (TEOAE), impedance audiometry, auropalpebralreflex, behavioral observation audiometry, and, if necessary, auditory brain stem response (ABR) with air and bone-conducted clicks as well as frequency-following responses at 500 Hz tone burst. In 378 children TEOAE were recorded on both sides, in 151 at least on one side. These results were confirmed by the other techniques. Only three children presented false negative results of TEOAE on one side. Two of these children had a middle ear effusion and a threshold of 35 dB, one had retrocochlear hearing loss. The absence of TEOAE in both ears in 155 children as well as in one ear in 16 children was detected by ABR. Seventy-seven patients showed no response on both sides, 25 on one side, although a hearing impairment more than 25 dB could not be verified by ABR. This high number of false positive results is explained in 77 cases (76%) by a middle ear dysfunction during the recording of TEOAE, when ABR was performed following adenotomy and paracentesis.(ABSTRACT TRUNCATED AT 250 WORDS)
儿童听力障碍的早期识别对临床研究与发展而言是个重大问题。在过去两年里,我们测定了1202名新生儿、小婴儿及儿童的听力敏感度。52.4%的儿童在病史中存在听力障碍风险因素。大多数儿童由儿科医生转诊至我们科室(52%),儿科医生首先怀疑有听力障碍,40%由家长转诊,3.5%由耳鼻喉科医生转诊,3%由教育工作者转诊,1.5%由全科医生转诊。进行了以下检查:瞬态诱发耳声发射(TEOAE)、声阻抗测听、耳睑反射、行为观察测听,必要时还进行了气导和骨导短声听性脑干反应(ABR)以及500Hz短纯音频率跟随反应。378名儿童双侧记录到TEOAE,151名儿童至少一侧记录到。这些结果通过其他技术得到证实。仅3名儿童一侧TEOAE出现假阴性结果。其中2名儿童有中耳积液且阈值为35dB,1名有蜗后听力损失。ABR检测到155名儿童双耳及16名儿童单耳未引出TEOAE。77名患者双侧无反应,25名单侧无反应,尽管ABR无法证实听力损失超过25dB。在77例(76%)中,大量假阳性结果是由于记录TEOAE时存在中耳功能障碍,在腺样体切除和鼓膜穿刺后进行ABR检查时出现这种情况。(摘要截选至250字)