Silman S, Silverman C A, Arick D S
Department of Speech, Brooklyn College, CUNY, New York.
J Am Acad Audiol. 1994 May;5(3):173-82.
The purpose of this prospective investigation was to evaluate the sensitivity of pure-tone screening of children with middle-ear effusion (MEE) and to describe the short-term audiometric and otologic follow-up of children with MEE who pass versus fail a pure-tone screen. Eighty-two ears of 54 children with MEE based on pneumotoscopy/microtoscopy were investigated. A complete otolaryngologic evaluation, pure-tone screen, then complete audiologic evaluation were performed at the initial test. Retesting was done at 6-8 weeks post initial test. The sensitivity of the ASHA (1985) pure-tone screen to MEE was 54 percent when 500 Hz was excluded, 85 percent when 500 Hz was included, and 89 percent when 250 Hz was also included. Significant air-bone gaps were present in 100 percent of the MEE group that failed and in 92 percent of the MEE group that passed the screen (excluding 500 Hz). Of the cases with MEE at the initial test that returned for the retest, 53 percent to 54 percent continued to show MEE. The mean speech-recognition threshold (SRT) was in best agreement with the hearing-threshold levels at the low frequencies, regardless of the pure-tone screen outcome. The results suggest that 500 Hz, as well as 1000-4000 Hz, should be used in a pure-tone screen at 20 dB HL for detection of MEE. The results also question the assumption in the ASHA (1985) screening guidelines that passing a pure-tone screen at 1000-4000 Hz puts one at low risk for hearing impairments that "interfere with or have the potential for interfering with communication" (ASHA, 1985).
这项前瞻性研究的目的是评估纯音筛查对中耳积液（MEE）患儿的敏感性，并描述通过或未通过纯音筛查的MEE患儿的短期听力测定和耳科随访情况。对54例经充气耳镜/显微镜检查确诊为MEE的患儿的82只耳朵进行了研究。在初次检查时进行了完整的耳鼻喉科评估、纯音筛查，然后进行了完整的听力评估。在初次检查后6 - 8周进行了重新测试。当排除500Hz时，美国言语、语言和听力协会（ASHA，1985年）纯音筛查对MEE的敏感性为54%；当纳入500Hz时，敏感性为85%；当同时纳入250Hz时，敏感性为89%。未通过筛查的MEE组100%存在明显的气骨导差，通过筛查的MEE组（排除500Hz）92%存在明显的气骨导差。在初次检查时有MEE且回来进行重新测试的病例中，53%至54%仍显示有MEE。无论纯音筛查结果如何，平均言语识别阈值（SRT）与低频听力阈值水平最为一致。结果表明，在20dB HL的纯音筛查中应使用500Hz以及1000 - 4000Hz来检测MEE。研究结果还对ASHA（1985年）筛查指南中的假设提出了质疑，该假设认为在1000 - 4000Hz通过纯音筛查意味着听力障碍风险较低，而这种听力障碍“会干扰或有可能干扰交流”（ASHA，1985年）。
