Watkin P M
Audiology Services, Forest Healthcare, Whipps Cross Hospital, Leytonstone.
Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F158-68. doi: 10.1136/fn.75.3.f158.
To assess universal neonatal screening for bilateral hearing impairments averaging 40 dBHL or worse in the better ear, using transient evoked otoacoustic emission screening (TEOAE) testing.
A three year cohort (14,353 infants born from January 1992 to 1995) was screened and subsequently followed up by hearing surveillance methods, including a distraction test screen from 7 months of age. The entire cohort was used to evaluate the outcome of the screen. A subcohort of 8172 district residents was used to evaluate the continuing worth of the distraction test programme.
Nineteen infants (1.3/1000) with a targeted hearing impairment failed the neonatal TEOAE test. Six profoundly deaf infants identified by the TEOAE screen, were fitted with hearing aids at a median age of 16 weeks. One remained without an aid. Of 12 infants with a moderate impairment, only seven accepted hearing aid fitting and the median age of being fitted with an aid increased to 42 weeks. By the time of the analysis 22 children with a targeted hearing impairment (1.5/1000) had been identified from the cohort. Of the three missed neonatally, one was cared for elsewhere, another had a progressive loss, and the third had central deafness. Twenty children were ascertained with a congenital peripheral deafness. Of these, eight (40%) had risk factors identifiable neonatally. Only the child with central deafness was missed by TEOAE screening and subsequently identified by behavioural tests in infancy. The TEOAE screen outperformed the distraction test in terms of processes and yield and was 25% less expensive.
The analysis confirmed the worth within the district of the TEOAE hearing screen. It will thus be continued as a universal neonatal screen with the distraction test being retained as a selective screen in the latter half of infancy.
采用瞬态诱发耳声发射筛查（TEOAE）测试评估对双耳听力损失平均达40 dBHL或更严重（较好耳）的新生儿进行普遍筛查的效果。
对一个三年队列（1992年1月至1995年出生的14353名婴儿）进行筛查，随后采用听力监测方法进行随访，包括从7个月大开始的注意力分散测试筛查。整个队列用于评估筛查结果。一个8172名地区居民的子队列用于评估注意力分散测试项目的持续价值。
19名（1.3/1000）有目标听力损失的婴儿新生儿TEOAE测试未通过。TEOAE筛查出的6名极重度聋婴儿，在中位年龄16周时佩戴了助听器。1名仍未佩戴。在12名中度听力损失的婴儿中，只有7名接受了助听器佩戴，佩戴助听器的中位年龄增加到42周。到分析时，从队列中已识别出22名（1.5/1000）有目标听力损失的儿童。在新生儿期漏诊的3名儿童中，1名在其他地方接受治疗，另1名听力进行性下降，第3名患有中枢性耳聋。确定有20名儿童患有先天性周围性耳聋。其中，8名（40%）有新生儿期可识别的危险因素。只有中枢性耳聋的儿童通过TEOAE筛查漏诊，随后在婴儿期通过行为测试得以识别。在流程和产出方面，TEOAE筛查优于注意力分散测试，成本低25%。
分析证实了TEOAE听力筛查在该地区的价值。因此，它将作为普遍的新生儿筛查继续进行，而注意力分散测试将作为婴儿后期的选择性筛查保留。
