新生兒聽力篩檢之合作模式

A Coordinated Model for Newborn Hearing Screening

陳正文(Jeng-Wen Chen) ； 陳培濤(Peir-Taur Chen) ； 邱耀興(Yao-Hsing Chiu) ； 邱昱嘉(Yu-Chia Chiu) ； 劉必筠(Pi-Yun Liu) ； 林秀茵(Hsiu-Yin Lin)

《台灣耳鼻喉頭頸外科雜誌》 40卷2期 (2005/04) Pp. 51-59

https://doi.org/10.6286/2005.40.2.51

摘要

背景：推行全面性新生兒聽力篩檢(newborn hearing screening)是早期診斷先天性聽障及早期進行聽能創建的重要關鍵。篩檢的普及率固然與保險是否給付有關，而增加篩檢的可近性，建立流暢完整的轉介制度也是重要的課題。如何在出生數相對較低的區域或地區醫院充分運用現有資源，在人力物力有限的情形下推行一個有效率且符合成本效益的新生兒聽力篩檢計畫，是本研究進行的主要目的。
方法：本研究由耳鼻喉科與小兒科醫師合作，運用原有人力，分別負責本院高危險群及非高危險群新生兒的聽力篩檢。篩檢儀器使用變頻耳聲傳射(distortion product otoacoustic emission, DPOAE)，採行兩階段篩檢的模式。耳鼻喉科則針對高危險群新生兒，不論其是否通過耳聲傳射聽力篩檢，均安排診斷式聽性腦幹反應(auditory brainstemresponse, ABR)檢查複檢，是本計畫的特色。
結果：自2003年10月至2004年12月間，本院總出生數爲992名，非高危險群新生兒總數爲969名，其中483名(49.8%)接受自費耳聲傳射聽力篩檢，出院前未通過第一階段聽力篩檢者佔7.5%(36/483)。滿月後在小兒科健兒門診有83.3% (30/36)回診接受第二階段聽力篩檢，仍未通過者共17名，扣除6名未接受回診複檢安排的新生兒後，轉介至耳鼻喉科時的轉介率爲3.6%(17/477)。此17例在接受高頻探測音（675Hz或1000Hz）廳阻聽檢及診斷式聽性腦幹反應檢查等複檢後，確定單側及雙側感音性聽力障礙各1名。高危險群新生兒總數爲23名，均轉介至本相妾受耳聲傳射及聽性腦幹反應檢查，共確診單側聽力障礙2名。
結論：本研究證明由小兒科與耳鼻喉科分工合作，運用原有人力，仍可在一般生產數相對較低，無法增加人力成本的區域或地區醫院中推行一個有效率的新生兒聽力篩檢計畫。而將高危險群特別獨立出來，全部接受耳鼻喉科醫師與聽力師耳聲傳射及聽性腦幹反應檢查的設計，則有助於降低一般篩檢計畫中較容易被忽略的「僞陰性」(false negative)問題，增加篩檢的完整性。

關鍵字

全面性新生兒聽力篩檢 ； 聽損危險因子 ； 變頻耳聲傳射 ； 聽性腦幹反應 ； 僞陰性

並列摘要

BACKGROUND: Implementing universal newborn hearing screening is the key to early identification and timely intervention of a child with congenital hearing loss. We presented a coordinated newborn hearing screening program with fine-tuned processes which could run efficiently in a hospital with limited resources.
METHODS: Newborns with hearing loss risk indicators (according to the position statement of the Joint Committee on Infant Hearing, 1994) were screened by an otolaryngologist and an audiologist. Distortion Product Otoacoustic Emission (DPOAE) and Auditory Brainstem Response (ABR) were performed on each high risk baby. Newborns without risk indicators were screened with DPOAE in two stages by pediatric nursing specialists. No extra manpower was employed during this screening program.
RESULTS: 483 non-risk babies were screened by the pediatric department between October 2003 and December 2004. Seventeen babies (3.6%) who failed two stages of DPOAE screening were referred for further testing. Of these, one baby with bilateral hearing loss and one with unilateral hearing loss were ultimately identified and received intervention. Twenty three referred newborns with hearing loss risk indicators were tested with ABR and DPOAE by the otolaryngologist and the audiologist. Two babies were confirmed to have unilateral hearing loss.
CONCLUSIONS: A well coordinated newborn hearing screening program between the otolaryngologist and pediatrician has proven to be effective even in a hospital with low birth numbers and limited resources. A screening tool was the only investment and no extra full-time employee was needed for this screening program. A universal testing of ABR for newborns with hearing loss risk indicators is our way to prevent unwanted false negatives in a newborn hearing screening program.

並列關鍵字

universal newborn hearing screening ； hearing loss risk indicators ； distortion product otoacoustic emission ； auditory brainstemresponse ； false negative