以多頻道聽覺穩定刺激反應預測早產兒之聽力閥值

Abstract

先天性聽力損失的發生率為千分之一到三，有半數以上的個案有先天性聽力損失的危險因子，對於早產兒而言，更容易合併這些危險因子。早期診斷先天性聽力損失的嬰兒並且在出生後的六個月內給予聽語復健，對於這些患者將來的語言發展扮演著重要的角色。為了能夠給予早期的聽語復健，對於言語頻率的聽力閥值評估就佔了重要的角色，本研究的目的是探討多頻道聽覺穩定狀態反應(multi-channel auditory steady state response)是否能夠預測早產兒之聽力閾值。 研究方法 這是一個回溯性研究。於2008年03月到2010年12月出生之早產兒(懷孕週數小於37週)，這些研究對象於矯正年齡6個月之前接受多頻道聽覺穩定狀態反應的檢查和短音腦幹聽性反應(click auditory brainstem response)的檢查，並且得到聽覺穩定狀態反應四個純音頻率(500Hz,1000Hz, 2000Hz, 4000Hz)的閾值和短音腦幹聽性反應的閾值；。而這些受測者年齡介於24到46個月時，接受條件控制遊戲式聽力檢查(conditioned play audiometry)以獲得其純音聽力閾值，我們以線性回歸分析多頻道聽覺穩定狀態反應與條件控制遊戲式聽力檢查的純音聽力閾值的關聯性，以及短音腦幹聽性反應的閾值與條件控制遊戲式聽力檢查的純音聽力閾值的關聯性。 結果 總共有98 位早產兒被收錄在本研究中，但是其中20位的受測者沒有得到後續的條件控制遊戲式聽力檢查閾值，因此只有78位的受測者其聽力檢查結果被分析。多頻道聽覺穩定狀態反應與條件控制遊戲式聽力檢查在500Hz, 1000Hz, 2000Hz, 4000Hz等頻率的閾值的相關係數(correlation coefficient, r) 分別為0.88, 0.92, 0.95 and 0.95。短音腦幹聽性反應閾值與高頻純音(2000Hz, 4000Hz)的平均聽力閾值之線性回歸的相關係數 r為0.92。多頻道聽覺穩定刺激檢查的測量時間，平均69.1±23.2分鐘，腦幹聽性反應的檢查時間為，平均63.3±16.6分鐘，兩組並無統計學上的差異(p=0.113)。 結論 對於早產兒而言，多頻道聽覺穩定狀態反應是一個可靠而且方便的聽力檢查工具。此檢查工具應該可以作為完整聽力評估的一環。

Objective The purpose of this study is to investigate whether multi-channel auditory steady state response (ASSR) is capable of estimating hearing thresholds in preterm neonates Materials and methods This is a retrospective study. Neonates of gestational age less than 37 weeks, born between March 2008 and Dec 2010, were enrolled. Multi-channel auditory steady state response was used to obtain thresholds of 500Hz,1000Hz, 2000Hz and 4000Hz before the corrected age of 6 months. Click auditory brainstem response (cABR) was also used to evaluate the hearing threshold. Conditioned play audiometry was used to obtain the pure-tone thresholds(500Hz,1000Hz, 2000Hz and 4000Hz) of these children when they were between 24 and 46 months old. The correlation between thresholds of ASSR and play audiometry, as well as those of play audiometry and click ABR, were compared. Results Ninety-eight preterm babies were enrolled. Twenty infants were lost during follow-up. Seventy-eight preterm babies fulfilled both examinations. The correlation coefficient (r) of pure tone thresholds of multi-channel ASSR and play audiometry were 0.88, 0.92, 0.95 and 0.95 at 500, 1000, 2000 and 4000 Hz, respectively.The correlation coefficient of click ABR threshold and average threshold of pure tone high frequencies (2000 and 4000 Hz) was 0.92. The average test time of ASSR and ABR was 63.3±16.6 and 69.1±23.2 minutes, respectively. There was no statistical significance between test times of these two groups. Conclusion Multi-channel ASSR is a reliable and convenient audiometric assessment tool in preterm neonate.It can be used as one of the test batteries for preterm neonate audiometric assessment.