Wideband reflectance in newborns: normative regions and relationship to hearing-screening results.
Wideband reflectance in newborns: normative regions and relationship to hearing-screening results.
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DOI：
10.1097/aud.0b013e3181e40ca7
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发表时间：
2010-10
期刊：
影响因子：
3.7
通讯作者：
Bohning S
中科院分区：
文献类型：
--
作者：
Hunter LL;Feeney MP;Lapsley Miller JA;Jeng PS;Bohning S
在新生儿听力筛查人群中建立宽带中耳反射率的规范性数据，并将测试性能与1 kHz鼓室导抗法进行比较，以预测OAE筛查结果。在两个测试点测量了324名婴儿的宽带中耳反射率（使用0.2至6 kHz的音调和啁啾刺激）、1 kHz鼓室导抗和畸变产物耳声发射（DP）。耳朵分为DP-通过和DP-参考组。在环境压力条件下的音调和啁啾刺激的各个频率区域，以及在各个频率范围内集成的反射面积指数（RAIs），定义了规范的反射率值。受试者工作特征（ROC）分析表明，反射率提供了最好的辨别力的DP状态的频率范围内，涉及2 kHz，和更大的辨别力的DP状态比1 kHz的鼓室导抗。重复测量方差分析（ANOVA）确定，（a）有显着差异的反射率作为DP状态和频率的函数，但不是性别或耳朵;（B）音调和啁啾刺激反射率值基本上是无法区分的，和（c）新生儿从两个地理位置有类似的反射率模式高于1 kHz。出生类型和体重没有贡献的反射率的差异。基于OAE的婴儿听力筛查中的转诊与宽带反射率增加密切相关，表明出生时存在中耳功能障碍。出生后的前4天，随着中耳功能的正常化，反射率显著改善。使用OAE筛查所用的相同设备，可在数秒内获得反射率评分。在第一阶段筛查中具有高反射率评分的新生儿应在几小时至几天内重新筛查，因为大多数中耳问题是暂时的，并且会自发解决。如果反射率和OAE在第二阶段筛查时未通过，建议沿着进行诊断性测试，转诊至耳科医生进行耳部检查。由于永久性听力损失的风险较高，具有正常反射率和OAE屏幕参考结果的新生儿应立即转诊给听力学家进行阈值听觉脑干反应（ABR）诊断测试。
To develop normative data for wideband middle-ear reflectance in a newborn hearing-screening population, and to compare test performance with 1-kHz tympanometry for prediction of OAE screening outcome. Wideband middle-ear reflectance (using both tone and chirp stimuli over 0.2 to 6 kHz), 1-kHz tympanometry, and distortion-product otoacoustic emissions (DPs) were measured in 324 infants at two test sites. Ears were categorized into DP-pass and DP-refer groups. Normative reflectance values were defined over various frequency regions for both tone and chirp stimuli in ambient pressure conditions, and for reflectance area indices (RAIs) integrated over various frequency ranges. Receiver-operating-characteristic (ROC) analyses showed that reflectance provides the best discriminability of DP status in frequency ranges involving 2 kHz, and greater discriminability of DP status than 1-kHz tympanometry. Repeated-measures analyses of variance (ANOVA) established that (a) there were significant differences in reflectance as a function of DP status and frequency, but not sex or ear; (b) tone and chirp stimulus reflectance values are essentially indistinguishable, and (c) newborns from two geographic sites had similar reflectance patterns above 1-kHz. Birth type and weight did not contribute to differences in reflectance. Referrals in OAE-based infant hearing screening were strongly associated with increased wideband reflectance, suggesting middle-ear dysfunction at birth. Reflectance improved significantly over the first 4 days after birth with normalization of middle-ear function. Reflectance scores can be achieved within seconds using the same equipment used for OAE screening. Newborns with high reflectance scores at Stage I screening should be rescreened within a few hours to a few days, as most middle-ear problems are transient and resolve spontaneously. If reflectance and OAE are not passed upon Stage II screening, referral to an otologist for ear examination is suggested along with diagnostic testing. Newborns with normal reflectance and a refer result for the OAE screen should be referred immediately to an audiologist for diagnostic testing with threshold auditory brainstem response (ABR) due to higher risk for permanent hearing loss.