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目的:对2次听力筛查未通过并伴有听力损失高危因素的婴幼儿进行客观听力评估,总结高危儿听力损失情况及变化特点。方法:对244例(488耳)2次听力筛查未通过或2次筛查结果不一致的婴幼儿采用听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)、鼓室声导抗和镫骨肌反射等客观听力测试。结果:①3次OAE结果间存在一定的波动性,右耳的通过率要高于左耳。②第3次OAE评估通过的184耳中有45耳ABR异常,两项检查的不符合率高达24.5%(45/184);DPOAE不通过的304耳中有20耳ABR正常,不符合率为6.6%(20/304)。③按评估时患儿年龄进行分组,各组中ABR轻度异常比例最高,ABR正常在各组中也有很大的比例。评估年龄<3个月组ABR中度异常率明显高于其他两组(P<0.01),ABR重度异常率在各评估年龄组间差异无统计学意义(P>0.05)。④鼓室导抗曲线以A型为主,在不同程度听力损失婴幼儿中均超过70%(P>0.05),ABR中度异常组B峰检出率明显高于其他组(P<0.05);重度异常组检出1耳C型峰。⑤高危因素分布以高胆红素血症为主(29.5%),远高于其他因素(P<0.05)。结论:具高危因素的婴幼儿听力损失以轻度为主,其听力损失具有一定的波动性。随着年龄增长,有些中度异常有好转的趋势。对高危儿的听力评估需多次检测或结合多种方法方能得出正确结论。
Objective: To evaluate the objective hearing of infants and toddlers who did not pass the hearing screening twice with high risk of hearing loss, and to summarize the hearing loss of high risk children and their changes. Methods: A total of 244 cases (488 ears) of 2 hearing screening failed or 2 times of screening results were inconsistent in infants and young children with auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE) Stapelgia reflex objective hearing test. Results: ① There was a certain fluctuation in the results of the third OAE, and the passing rate of the right ear was higher than that of the left ear. ② There were 45 ear ABR abnormalities in 184 ears through the third OAE evaluation, and the nonconformity rates of the two examinations were as high as 24.5% (45/184). There were 20 ears with normal ABR in 304 ears without DPOAE, 6.6% (20/304). ③ according to the assessment of children age group, the highest proportion of ABR mild abnormalities in each group, ABR normal in each group also has a large proportion. There was no significant difference in ABR rate between the two groups (P> 0.05). There was no significant difference in the ABR rate between the three groups (P> 0.05). (4) The tympanogram was dominated by type A, with more than 70% (P> 0.05) of infants and young children with hearing impairment at different degrees. The positive rate of B peak in moderately abnormal ABR group was significantly higher than that of other groups (P <0.05). Severe abnormalities detected 1 ear C-type peak. ⑤ The distribution of risk factors mainly hyperbilirubinemia (29.5%), much higher than other factors (P <0.05). Conclusion: The hearing loss of infants and young children with high risk factors is mild, and their hearing loss has certain fluctuation. As we age, some moderate abnormalities tend to improve. Hearing assessment of high-risk children need to test multiple times or a combination of methods to get the correct conclusion.