- 期刊
如何降低新生兒聽力初篩轉介率：從OAE到AABR之經驗
An Appropriate Hearing Screening Protocol and Techniques to Reduce the Referral Rate During Newborn Hearing Screening: The Experience from OAE to AABR
摘要
背景：新生兒聽力篩檢近年來逐漸獲得重視，耳聲傳射(OAE)及自動聽性腦幹反應(AABR)爲不同的篩檢工具，所獲得到的偽陽性結果也有所差異，也因此轉介率也有所不同。偽陽性篩檢的結果，對新生兒父母親會造成不必要的焦慮與精神壓力，也造成醫療資源的浪費。本文研究目的，在瞭解合適的初篩工具爲何，及探討說明降低轉介率之技巧爲何。 方法：本研究從1998年11月至2008年3月，分爲前期、中期、後期三階段，分別進行只以短暫音誘發之耳聲傳射(TEOAE)、先以TEOAE而後未通過再用AABR、只以AABR來對嬰兒室新生兒聽力篩檢，計算各不同篩檢方法下的偽陽性率，以及進一步的轉介率。 結果：從1998年11月至2008年3月，總共篩檢了32727名嬰兒，而前期（1998年11月至2004年1月）、中期（2004年2月至2005年2月）、後期（2005年3月至2008年3月）三者的需轉介率分別爲5.8%、1.6%、0.9%。 結論：根據本研究，利用AABR進行新生兒聽力篩檢，比起TEOAE或TEOAE+AABR，更能減少偽陽性結果，進而降低轉介率；除了避免新生兒父母親無謂的焦慮，也可減少因後續檢查所造成的社會成本浪費，所以建議全面使用AABR作爲新生兒聽力篩檢的工具。
並列摘要
BACKGROUND: Universal Newborn Hearing Screening (UNHS) has been highly emphasized in recent years. Each different screening method yields a different falsepositive rate and further referral rate. According to some studies, a high false-positive result rate not only brings about unnecessary anxiety and mental stress to the parents, but also causes a waste of medical-social resources. The aims of this study are to define either OAE or AABR, as the better initial hearing screening tool based on a suitable lower referral rate, and to identify technical modifications that reduce the referral rate with both methods. MATERIALS AND METHODS: The study was divided into three periods, November 1998 to January 2004, February 2004 to February 2005, and March 2005 to March 2008, during which we applied UNHS using transient evoked otoacoustic emmisions (TEOAE) only, TEOAE with automated auditory brainstem response (AABR), or just AABR respectively. The resulting false-positive rates and further referral rates of the different screening methods were calculated and analyzed. RESULTS: From 1998 to 2008, there were 32727 newborns screened. The referral rates for the three periods using TEOAE, TEOAE plus AABR, and AABR were 5.8%, 1.6%, and 0.9% respectively. CONCLUSION: According to our study, compared with the TEOAE alone or the TEOAE with AABR, using AABR for the UNHS gave the lowest referral rate. Therefore we highly suggest that AABR should be used alone. At the same time, the use of appropriate protocols and skillful techniques can also reduce the referral rate when using OAE as an initial hearing screening tool.