TEOAE應用於全面性新生兒聽力篩檢工具之探討

本院自87年11月起和雅文聽語文教基金會合作，使用TEOAE為最初的篩檢工具建立一套全面性新生兒篩檢計劃，針對在本院出生的新生兒實施聽力篩檢。此研究的目的在評估台灣的醫院執行新生兒出院前實行全面性新生兒聽力篩檢的可行性。此計畫的流程分為3階段，第一、二階段以TEOAE為篩檢工具，第三階段則採用TEOAE和ABR。自87年11月至88年9月共2727名平均出生年齡50.46小時(範圍從9小時到430小時大)的正常新生兒接受聽力篩檢。在第一次篩檢未通過的個案會在其出院前重複再測試。出院時仍未通過TEOAE篩檢的個案則在新生兒一個月大作TEOAE測試及診斷性ABR檢查。最後診斷出其中有5名新生兒為雙耳先天性聽障，安排其作行為聽力檢查及選配戴助聽器並轉介家長開始參與聽能復健的課程。另外有6名新生兒為單耳先天性聽障，除給予衛教單告知注意事項外並請其定期回門診做追蹤。篩檢結果平均測試時間為每耳39.42秒(範圍從9秒到437秒)，波的再現率(reproducibility)平均為76.3％(範圍從6.5％到99)，刺激音量平均85.27dBpeSPL(範圍從73到96dBpeSPL)，通過之個案反應音強20.22dB(範圍從0.1dB到39.2dB)。最後出院前整個通過率為94.72％(2583人)，亦即轉介回門診做診斷性聽覺評估的比率為5.28％(143人)。使用TEOAE來作全面性新生兒聽力篩檢為篩檢先天性聽障兒童的有效且可行的方式。我們期望在台灣未來有更多醫院加入全面性新生兒聽力篩檢的計劃。

關鍵字

全面性新生兒聽力篩檢；短暫誘發耳聲傳射；再現率

並列摘要

Mackay Memorial Hospital and the Children's Hearing Foundation have established a universal newborn hearing screening program using transient evoked otoacoustic emissions (TOAE's) as the initial screening tool. The goal of this project was to assess the feasibility of implementing universal newborn hearing screening prior to discharge in the birthing hospitals of Taiwan. The program employed a three stage hearing screening protocol with TEOAE for the first two stages and OAE and ABR in the third stage. 2727 full term newborns were screened for hearing impairment using TEOAE's. Multiple rescreens were performed prior to discharge on those babies who did not pass the initial screening. Those who had not passed the TEOAE screen at the time of discharge were referred for repeat OAE testing and diagnostic ABR at the one month immunization appointment. 5 newborns were identified with permanent bilateral hearing impairment in need of amplification and a family centered early intervention program. 6 newborns were identified with permanent unilateral hearing impairment in need of regular follow-up and family counseling with regard to hearing tactics for unilateral losses. The mean TEOAE sampling time per ear was 39.42 seconds. The mean stimulus amplitude was 85.27dBpeSPL. The mean TEOAE response amplitude was 20.22dB. The mean reproducibility of the response was 76.3%. The overall pass rate at time of discharge was 94.7%. Thus achieving an acceptable referral rate of 5 .3% for diagnostic audiological assessments. Universal newborn hearing screening using TOAE's proved to be a cost effective and feasible method of identifying congenital hearing loss. We hope to see more of Taiwan's birthing hospitals adopting universal newborn hearing screening in the near future.

並列關鍵字

Universal newborn hearing screening ； transient evoked otoacoustic emission ； reproducibility

參考文獻

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