變頻耳聲傳射新生兒聽力篩檢

Newborn Hearing Screening with Distortion Product Otoacoustic Emission

蔡易錚(Yih-Jeng Tsai) ； 梁家光(Jia-Guang Liang) ； 陳明秀(Ming-Hsiu Chen) ； 陳美齡(Mei-Ling Chen) ； 陳瑛雀(Yin-Chueh Chen)

《台灣耳鼻喉頭頸外科雜誌》 39卷5期 (2004/11) Pp. 177-183

https://doi.org/10.6286/2004.39.5.177

摘要

目的：選用變頻耳聲傳射(Distortion Product Otoacoustic Emission; DPOAE)為篩檢工具，建立新生兒聽力篩檢流程，以及早發現先天性聽障嬰兒，達到對聽障兒早期診斷、早期療育的目標。
方法：自2002年3月至2003年3月間，本院出生的嬰兒共1688例自費接受新生兒聽力篩檢，其中男嬰897例，女嬰791例。除DPOAE外，我們同時進行短暫誘發耳聲傳射(Transient Evoked Otoacoustic。Emission; TEOAE)及聽力危險因子篩檢做爲參考。篩檢時機爲出生後48小時，但仍有少數因提早出院於出生後12小時內執行。儀器使用Biologic Scout Sport System，DPOAE測量f2 2K,3K,4K及5K處，測量值於各單頻必需大於-6,-5,-8,及-7dBSPL,且高於背景噪音5dB，才能視為陽性反應。篩檢通過定義為4個頻率至少有3個符合上述條件。如果第一次DPOAE聽力篩檢未通過，則在出院後l個月回診複檢，仍未通過則以中耳鼓室圖(Tympanogram), clicks及500 Hztone bursts誘發聽性腦幹電位反應(Auditory Brainstem Response)檢查診斷，若聽性腦幹反應結果閾值異常，則於滿3個月時再施行聽性腦幹反應以及合適的行爲聽力測驗，確認聽力狀况，做爲助聽器選配的依據。
結果：參加聽力篩檢者佔本院總出生人數的46.4%，第一次通過篩檢1541例(9l.3%)，第二次回診複檢通過109例(6.4%)，經過初篩與第一次複檢後通過共計1650例(97.7%)。未通過DPOAE篩檢轉診38例(2.3%)。其中 23例(l.4%)診斷為聽力障礙，其餘15例(0.9%)偽陽性，聽力障礙其中包含單側聽障6名(0.4%)，兩側聽障17名(1.01%)，兩側聽障中，輕度3名(0.18%)，中度9名(0.53%)，重度 5名(0.3%)。此外，聽力危險因子陽性者共76例，其中6例診斷爲聽障，之中以遺傳性聽障家族史3例最多，次爲唇顎裂 2例，多胞胎1例，及唐氏症1例（同時具遺傳性聽障家族史）。其餘70例為偽陽性。TEOAE篩檢第一次雙耳未通過者 486例，佔篩檢總人數的28.8%。
結論：變頻耳聲傳射為穩定、分頻的新生兒聽力篩檢工具，且具有高準確率，低轉介率的優點。單一使用聽力危險因子來作篩檢的僞陽性率偏高，易導致過高的轉介率，浪費醫療資源，但因簡單實施，同時也發現具危險因子者聽障比例的確較一般新生兒高出許多，因此可以作爲變頻耳聲傳射篩檢外輔助的參考。

關鍵字

變頻耳聲傳射 ； 新生兒聽力篩檢

並列摘要

PURPOSE: Early diagnosis of congenitally hearing-impaired infants with a newborn hearing screening program using Distortion Product Otoacoustic Emission (DPOAE).
METHOD: A total of 1688 infants received hearing screening at Shin-Kong Wu-Ho-Su Memorial Hospital between March 2002 and March 2003. The screened infants included 897 boys and 791 girls. In addition to the DPOAE, Transient Evoked Otoacoustic Emission (TEOAE) and risk factor registration of congenital hearing impairment were employed as references. The screening was done 48 hours after birth except for a few screenings, which were done within 12 horns after birth due to early discharge. If the newborn did not pass the first DPOAE screening, a second screening was done 1 month later. If the baby failed the second screening, a tympanogram and auditory brainstem response (ABR) evoked with click and 500Hz tone burst were performed.
RESULT: Newborn hearing screening was done for 46.4% of babies born in our hospital. Altogether, 1541 (91.3%) babies passed the initial screening and 109 (6.4%) passed the follow up examination. A total of 1650 (97.7%) passed after 2 screenings. Thirty-eight infants (2.3%) who failed the DPOAE screening were referred for further testing. Of those who were referred, 23 (1.4%) were diagnosed with hearing impairment including 6 (0.4%) with unilateral hearing impairment and 17 (1.01%) with bilateral hearing impairment. Of those who had bilateral impairment, the hearing losses were mild in 3 (0.18%) babies, moderate in 9 (0.53%), and severe in 5 (0.3%). Of the 76 infants with hearing-impaired risk factor registration, 6 were diagnosed with hearing impairment including 3 with a family history of hereditary hearing impairment, 2 with cleft palate, 1 in a multiple pregnancy and 1 with Down syndrome (with a family history of hereditary hearing impairment). The other 70 infants were false positives. There were 486 cases covering 28.8% of the total population who failed the first TEOAE screen.
CONCLUSION: DPOAE is a stable and frequency-differential tool in newborn hearing screening. It has the advantages of high accuracy and low referral rate. The risk factor registration for congenital hearing impairment has a high false positive rate resulting in a higher referral rate. However, because it is easy to perform and the positive rate of hearing impairment in babies with risk factor is noted higher than the general newborn, it could be used as a reference in newborn hearing screening.

並列關鍵字

distortion product otoacoustic emission ； newborn hearing screening