Identification of neonatal hearing impairment: Infants with hearing loss
Identification of neonatal hearing impairment: Infants with hearing loss
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DOI：
10.1097/00003446-200010000-00012
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发表时间：
2000-10-01
期刊：
影响因子：
3.7
通讯作者：
Norton, SJ
中科院分区：
文献类型：
--
作者：
Cone-Wesson, B;Vohr, BR;Norton, SJ
目的：本文描述了作为新生儿听力障碍鉴定(INHI)项目的一部分，被发现听力损失的婴儿的听力学结果和医学状况。此外，还给出了因发育和视力障碍而无法用视觉增强测听(VRA)进行测试的婴儿组的新生儿和母亲的健康变量。设计：INHI项目的总体目标是评估新生儿期给予的听性脑干反应和诱发耳声发射(OAE)测试的测试性能。这些工具是根据婴儿在8到12个月校正年龄时用VRA进行行为测试时的听力进行评估的。对新生儿检查结果、VRA结果、病史信息以及新生儿期和VRA时间之间同时发生的事件的记录进行整理和复习。结果：在2995名接受VRA测试的婴儿中，168名婴儿的听力损失至少有一耳，发生率为5.6%。双侧听力损失66例，发生率为2%，双侧中重度听力损失22例，发生率为0.7%。在这些听力受损的婴儿中，中耳问题的患病率超过50%。从168名听力损失婴儿的较大组中，56名婴儿(86耳)被选为听力损失是由于暂时性中耳病变而更有可能是永久性听力损失的概率较低的婴儿组。这些婴儿用于分析新生儿的测试表现(Norton等人，2000年)。在选择的组中，有30名婴儿双侧至少有轻度损伤，发生率为1%。在轻度、中度、重度和重度听力损失的范围内，耳朵的数量大致相等。对所有接受VRA测试的婴儿和听力损失的婴儿进行了与听力损失相关的风险因素审查。氨基糖苷类药物的治疗史是整个样本中最常见的危险因素；然而，听力正常组和听力受损组的这一危险因素的患病率没有差异。与听力损失发生率最高相关的危险因素是与感音神经性听力损失和其他神经感觉障碍相关的综合征的斑点。67名返回随访的婴儿因严重发育迟缓或视力残疾而无法进行VRA测试。这些婴儿中有许多有极早产和/或极低出生体重的后遗症的病史。结论：本研究中发现的大多数听力损失是轻度的，根据临床病史和鼓室导纳测试，许多轻度和部分中度听力障碍可能是在婴儿早期因中耳积液而获得的。在用于确定新生儿测试成绩的婴儿组中，轻度、中度、重度和重度LASS的数量大致相同。只有一小部分有传统听力损失风险指标的婴儿实际上有听力损失，而有相当数量的听力损失婴儿没有风险指标。这些发现支持需要一个基于普遍新生儿听力筛查的早期识别计划，而不是通过对那些有风险指标的人进行有针对性的测试。
Objective: This article describes the audiologic findings and medical status of infants who were found to have hearing loss, detected as part of the Identification of Neonatal Hearing Impairment (INHI) project. In addition, the neonatal and maternal health variables for the group of infants who could not be tested with visual reinforcement audiometry (VRA) due to developmental and visual disability are presented.Design: The overall goal of the INHI project was to evaluate the test performance of auditory brain stem response and evoked otoacoustic emission (OAE) tests given in the newborn period. These tools were evaluated on the basis of the infants' hearing when tested behaviorally with VRA at 8 to 12 mo corrected age. The neonatal test results, VRA results, medical history information and a record of intercurrent events occurring between the neonatal period and the time of VRA were collated and reviewed. The purpose of this article is to review the characteristics of those infants who were found to have hearing loss.Results: Of 2995 infants who had VRA tests judged to be of good or fair reliability, 168 had a finding of hearing loss far at least one ear, an incidence of 5.6%. Sixty-six infants had bilateral losses, an incidence of 2%, and 22 infants had bilateral hearing losses in the moderate to profound range, an incidence 0.7%. The prevalence of middle ear problems was greater than 50% among these infants with hearing loss. From the larger group of 168 infants with hearing loss, a group of 56 infants (86 ears) was chosen as those with a low probability that the hearing loss was due to transient middle ear pathology and was more likely hearing loss of a permanent nature. These were the infants used for the analyses of neonatal test performance (Norton et al., 2000). In this selected group there were 30 infants with bilateral impairment of at least mild degree, which is an incidence of 1%. There were approximately equal numbers of ears in the mild, moderate, severe and profound range of hearing loss.Risk factors associated with hearing loss were reviewed for the total sample of infants tested with VRA and for those infants with hearing loss. A history of treatment with aminoglycosides was the risk factor most often reported in the entire sample; however, there was no difference in prevalence of this risk factor for the normal-hearing and hearing-impaired groups. The risk factor associated with the highest incidence of hearing loss was stigmata of syndromes associated with sensorineural hearing loss and other neurosensory disorders.Sixty-seven infants who returned for follow-up could not be tested with VRA due to severe developmental delay or visual disability. Many of these infants had medical histories indicating the sequelae of extreme prematurity and/or very low birthweight.Conclusions: Most of the hearing losses found in this study were mild and, based on clinical history and tympanometry tests, many of the mild and some of the moderate impairments may have been acquired in early infancy due to middle ear effusion. In the group of infants used for determination of neonatal test performance there were approximately equal numbers of mild, moderate, severe and profound lasses. Only a small percentage of infants with a conventional risk indicator for hearing loss actually had a hearing loss, and there were a significant number of infants with hearing loss who did not have a risk indicator. These findings support the need for an early identification program based on universal neonatal hearing screening rather than by targeted testing of those with risk indicators.