Audiometric Diagnosis of Hearing Loss in Young Infants in a Universal Newborn Hearing Screening Program

新生兒聽力篩檢確診階段的客觀型聽力檢查

張家維(Chai-Wai Chang) ； 李奕輝(Yi-Hui Lee) ； 徐欣健(Hsin-Chien Hsu) ； 黃弘孟(Hung-Meng Huang)

《台灣耳鼻喉頭頸外科雜誌》 50卷2期 (2015/06) Pp. 74-81

https://doi.org/10.6286/2015.50.2.74

摘要

目的：本研究主要是在討論新生兒聽力篩檢計畫中，6個月內的嬰兒被使用來作為診斷的工具之間的閾值相關性與成效，例如聽性穩定狀態反應（Auditory Steady-State Response, ABR）與腦幹聽性反應檢查（Auditory Brainstem Response, ASSR）的相關性，和聽性穩定狀態反應與行為聽力閾值（Behavioral Hearing Threshold, BHT）的相關性。研究方法：自2009年8月到2013年6月，其間共有31名新生兒（共計46耳）無法通過新生兒聽力篩檢。完整的聽力確診檢查中包含了ABR、ASSR、BHT等。而其中確診的嬰兒年紀由1.10個月大到6.0個月大都有（平均約4.07個月大）。我們的研究中，ABR與ASSR兩者是在同一天內完成，而BHT則是會盡量選在同一天內以EAR-3A insertion phones在個別耳朵完成檢查，或者在完成ASSR之後，盡快安排時間做檢查。所有的數據比較，都是利用皮爾森相關係數（Pearson's correlation coefficient）來做比較，並對資料完成線性回歸的分析。結果：Click ABR與ASSR之間的相關係數在500 Hz, 1,000 Hz, 2,000 Hz, 4,000 Hz分別為0.35 (p ≤ .05, low), 0.36 (p ≤ .01, moderate), 0.79 (p ＜ .001, high), and 0.80 (p ＜ .001, high)。而BHT與ASSR之間的相關係 數在上述各個頻率分別為0.76 (p ＜ .001), 0.76 (p ＜ .001), 0.78 (p ＜ .001), and 0.80 (p ＜ .001)。結果發現 click ABR與ASSR之間，在高頻率有明顯的高度相關；而BHT與ASSR之間，則是在各個頻率之間 都有著高度的相關。結論：ASSR、click ABR、BHT兩兩交互比對，在特定頻率都可以呈現高度相關性，對於6個月內的小孩，可以很有效的應用於新生兒聽力篩檢的確診階段。

關鍵字

新生兒 ； 聽力篩檢 ； 聽性穩定狀態反應 ； 腦幹聽性反應檢查 ； 行為聽力閾值

並列摘要

OBJECTIVES: The aim of the study was to evaluate audiological diagnostic assessments by comparing the threshold of auditory steady-state response (ASSR) and auditory brainstem response (ABR), and the correlation between ASSR and behavior hearing threshold (BHT) in infants younger than 6 months old. METHODS: From August 2009 to June 2013, we evaluated 31 newborns (46 ears) who failed to pass the newborn hearing screening tests. The full audiological diagnostic test set included ABR, ASSR, and BHTs. The infant age at diagnosis ranged from 1.10 to 6.00 months (mean, 4.07 months). ABR and ASSR were performed in the same test session, and BHT was defined in the same or a future test session as soon as possible after the ASSR test. Parsons correlation coefficient and linear regression were employed for data analysis. RESULTS: The correlation coefficients between click ABR and 0.5, 1, 2, and 4-kHz ASSRs were 0.35 (p ≤ .05, low), 0.36 (p ≤ .01, moderate), 0.79 (p ＜ .001, high), and 0.80 (p ＜ .001, high), respectively. The correlation coefficients between 0.5, 1, 2, 4 kHz BHT and ASSR were 0.76 (p ＜ .001), 0.76 (p ＜ .001), 0.78 (p ＜ .001), and 0.80 (p ＜ .001). All showed a strong correlation between each frequency of ASSR and BHT (p ＜ .001, all).CONCLUSIONS: ASSR together with click-ABR and BHT is an effective method of evaluating hearing threshold in infants younger than 6 months old.

並列關鍵字

Newborn ； hearing loss ； auditory brainstem response ； auditory steady-state response ； behavioral hearing threshold