Screening sluchu u novorozenců pomocí tranzientně evokovanýchotoakustických emisí

Cílem studie bylo ověřit vyšetření sluchu pomocí tranzientně evokovaných otoakustických emisí (TEOAE) jakometody pro screening poruch sluchu v raném dětském věku a posoudit opodstatněnost screeningu poruch sluchuu celé nebo jen u rizikové populace novorozenců v ČR. Problematika screeningu poruch sluchu u novorozenců jevelice aktuální: uváděná prevalence poruch sluchu je 40 -⁠ 110 na 100 000 živě narozených dětí (1 : 900 -⁠ 1 : 2500).Pro srovnání, incidence hypotyreózy i fenylketonurie je cca 2krát nižší.Soubory a metodika: V období 1997 -⁠ 1999 bylo na neonatologickém pracovišti ve spolupráci s Dětskou ORLklinikou FN Motol vyšetřeno 4790 novorozenců. Novorozenci byli rozděleni na fyziologické (91,7 %, tj. 4391 dětí)a rizikové (8,3 %, tj. 399 dětí). Mezi rizikové jsme zařadili děti s patologickou rodinnou, perinatální či postnatálníanamnézou, tj. novorozence s anamnestickou zátěží poruch sluchu, s porodní hmotností

Klíčová slova:
screening sluchu u novorozenců, otoakustické emise, TEOAE

Screening for Hearing Impairment in Newborns Using Transient Evoked Otoacoustic Emissions

Objective:
Behavioral audiometry is currently accepted as the universal neonatal hearing examination in theCzech Republic. Only in some regional hospitals screening for hearing impairment is done using otoacousticemissions, exclusively aimed at high-risk neonates. This study summarizes the three years experience with regulartransient evoked otoacoustic emissions (TEOAE) screening in neonates.Study design: The prospective study enrolled all neonates (inborn or outborn) admitted to the Dept. ofNeonatology in 1997 -⁠ 1999. TEOAE screening was performed in 4790 neonates. The neonates were divided intotwo groups according to risk factors for hearing impairment (risk positive group n = 399, risk negative group n =4391). Full-term healthy neonates were screened at the age of 2 -⁠ 4 days and preterm infants at the 40thpostconceptional week. First and second repeated tests were done in 4-week intervals. Babies in whom reliable TEOAE were not recorded in the second repeated test were subsequently examined by auditory brainstemresponses (ABR).Results: Prevalence of hearing loss in our study was 1 in 384 (261 in 100,000) in the risk-negative group and 1in 27 (3652 in 100,000) in risk positive newborns. Specificity in the risk-negative group was 0.92 , resp. 0.8 in therisk-positive group. Positive predictive value of the screening was 0.03, resp. 0.17 in the risk group. Hearingimpairment of different magnitude was verified by ABR in 6 babies in each group.Conclusion: There is evidence from population-based surveys that diagnosis and treatment are delayed untilage 1 or 2 years in many children with hearing impairment. TEOAE and ABR are technically highly accuratescreening tests for hearing impairment in newborns. Using these screening methods is essential for early identificationof hearing impairment and for further development of such infants, as well as for further family planningin the affected families.

Key words:
screening for hearing impairment in newborns, otoacoustic emissions, TEOAE

Autoři: Černým. ¹; P. Zoban ¹; D. Groh ²; R. Brabec ¹; J. Vejvalka, KabelkaZ. ^{3 2}; Š. Vejvalková, VlkR. ^{4 1}
Působiště autorů: Novorozenecké oddělení s JIRP, Gynekologicko-porodnická klinika 2. LF UK a Fakultní nemocnice Motol, Praha1 vedoucí doc. MUDr. P. Zoban, CSc. ORL klinika 2. LF UK a Fakultní nemocnice Motol, Praha2 přednosta doc. MUDr. Z. Kabelka Oddělení informačních sys
Vyšlo v časopise: Čes-slov Pediat 2003; (11): 700-704.
Kategorie: Články