868例妇幼机构转诊儿童的听力学特征分析

李悦; 文铖; 程晓华; 于一丁; 王川; 王璟; 傅新星; 刘辉; 刘冬鑫; 黄丽辉

doi:10.13201/j.issn.2096-7993.2023.03.007

868例妇幼机构转诊儿童的听力学特征分析

- 1.
  首都医科大学附属北京同仁医院耳鼻咽喉头颈外科北京市耳鼻咽喉科研究所耳鼻咽喉头颈科学教育部重点实验室(北京，100005)
- 2.
  北京市朝阳区妇幼保健院
- 3.
  首都医科大学附属北京妇产医院儿童保健科
基金项目:
国家自然科学基金面上项目(No：81870730，82071064)；首都卫生发展科研专项(首发2022-2-1092)

详细信息

通讯作者: 黄丽辉，E-mail：huangpub@126.com

中图分类号: R764.43

收稿日期: 2022-11-19

刊出日期: 2023-03-03

Analysis of clinical audiological characteristics in 868 children referred from maternal and child institutions

- 1.
  Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, 100005, China
- 2.
  Maternal and Child Health Care Hospital of Chaoyang District
- 3.
  Department of Children's Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

More Information

Corresponding author: HUANG Lihui, E-mail: huangpub@126.com

Received Date: 19 November 2022

Publish Date: 03 March 2023

摘要

摘要: 目的探讨妇幼机构转诊儿童的临床听力学特点及听力损失高危因素，为进一步完善儿童耳及听力保健工作提供科学依据。方法研究对象为由北京市各妇幼机构转诊至首都医科大学附属北京同仁医院耳科门诊进行听力诊断的儿童共868例，均接受声导抗、听性脑干反应、畸变产物耳声发射等听力学测试。根据儿童确诊年龄分为0~ < 3月组(242例)、3~ < 6月组(328例)、6~ < 12月组(180例)和≥12月组(118例)，对比分析各组听力诊断情况、听力损失程度和性质，以及高危因素与听力损失发生的关系。结果 868例儿童的确诊年龄为(7.13±8.29)个月。确诊听力损失488例(56.22%)，听力正常380例(43.78%)。听力损失792耳，其程度占比由高到低依次为轻度366耳(46.21%)、中度214耳(27.02%)、极重度151耳(19.07%)、重度61耳(7.70%)。0~ < 3月组、3~ < 6月组、6~ < 12月组、≥12月组听力损失程度占比的差异均有统计学意义(P < 0.001)，组间两两比较，轻度占比0~ < 3月组高于其他三组(P < 0.05)，中度占比各组差异无统计学意义(P>0.05)，重度占比≥12月组高于0~ < 3月组(P < 0.05)，极重度占比0~ < 3月组低于其他三组(P < 0.05)。听力损失792耳中，感音神经性占67.42%，传导性和混合性分别占20.71%和11.87%。98例有听力损失高危因素者确诊听力损失58例(59.18%)；高危因素者听力损失发生率由高到低分别为颅面畸形(93.75%)，耳聋家族史/先天性遗传综合征(61.11%)，NICU住院史(46.43%)，其他(20.00%)。结论妇幼机构转诊对轻至中度感音神经性听力损失儿童的早期发现具有重要作用；有颅面畸形、耳聋家族史/先天性遗传综合征、NICU住院史等高危因素者听力损失发生率高，应予以高度重视。
- 妇幼机构 /
- 儿童 /
- 耳及听力保健 /
- 听力损失 /
- 高危因素
Abstract: Objective To investigate the clinical audiological characteristics of children referred from maternal and child institutions and analyze the high risk factors of hearing loss, so as to provide scientific basis for further improvement of children's ear and hearing care.Methods The subjects of this study were 868 children who were referred by maternal and child institutions in Beijing to the otology outpatient of Beijing Tongren Hospital, Capital Medical University for hearing diagnosis. All subjects underwent acoustic immittance, auditory brainstem response, distortion products otoacoustic emission and other audiological tests. Children were divided into groups according to the age of diagnosis: 0- < 3 months group(242 cases), 3- < 6 months group(328 cases), 6- < 12 months group(180 cases), ≥12 months group(118 cases), the results of hearing diagnosis, hearing loss degree and types, the relationship between high risk factors and hearing loss in each group were compared and analyzed.Results The age of diagnosis of 868 children was(7.13±8.29) months. 488 cases with hearing loss accounted for 56.22% and 380 cases with normal hearing accounted for 43.78%. Proportion of different degree of hearing loss of 792 ears from high to low was as follows: mild, 366 ears(46.21%); moderate, 214 ears(27.02%); severe, 151 ears(19.07%); profound, 61 ears(7.70%). There were statistically significant differences in the proportion of different hearing loss degree among 0- < 3 months group, 3- < 6 months group, 6- < 12 months group and ≥12 months group(P < 0.001). Pairwise comparison between groups showed that the proportion of mild hearing loss of 0- < 3 months group was higher than that in the other three groups(P < 0.05), there was no significant difference of moderate hearing loss among all groups(P>0.05), the proportion of severe hearing loss of ≥12 months group was higher than that of 0- < 3 months group(P < 0.05). The proportion of profound hearing loss with 0- < 3 months group was lower than the other three groups(P < 0.05). In 792 ears with hearing loss, sensorineural hearing loss accounted for 67.42%, conductive hearing loss accounted for 20.71% and mixed hearing loss accounted for 11.87%. Among 98 cases with high risk factors for hearing loss, 58 cases(59.18%) were diagnosed with hearing loss. The incidence of hearing loss with high risk factors ranked from high to low was: craniofacial malformation(93.75%), family history/congenital genetic syndrome(61.11%), neonatal intensive care unit(NICU) hospitalization(46.43%) and others(20.00%).Conclusion Referrals from maternal and child institutions play an important role in the early detection of children with mild to moderate sensorineural hearing loss. Children with craniofacial malformation, family history/congenital genetic syndrome, hospitalization history of NICU and other high risk factors have a high incidence of hearing loss and should be attached with great importance.
- maternal and child institutions /
- child /
- ear and hearing care /
- hearing loss /
- high risk factors

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图 1 不同听力损失性质的程度分布

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图 2 不同听力损失程度的性质分布

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表 1 各组听力诊断情况例(%)

组别	例数	正常	听力损失
组别	例数	正常	单侧	双侧	合计
0~ < 3月组	242	113(46.69)	56(23.14)	73(30.17)	129(53.31)
3~ < 6月组	328	161(49.09)	63(19.21)	104(31.71)	167(50.91)
6~ < 12月组	180	75(41.67)	39(21.67)	66(36.67)	105(58.33)
≥12月组	118	31(26.27)¹⁾²⁾³⁾	26(22.03)	61(51.69)	87(73.73)¹⁾²⁾³⁾
合计	868	380(43.78)	184(21.20)	304(35.02)	488(56.22)
与0~ < 3月组比较，¹⁾P < 0.05；与3~ < 6月组比较，²⁾P < 0.05；与6~ < 12月组比较，³⁾P < 0.05。

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表 2 各组听力损失程度比较耳(%)

组别	听力损失总耳数	听力损失程度
组别	听力损失总耳数	轻度	中度	重度	极重度
0~ < 3月组	202	118(58.42)²⁾³⁾	53(26.24)	10(4.95)	21(10.40)²⁾³⁾
3~ < 6月组	271	120(44.28)¹⁾	72(26.57)	18(6.64)	61(22.51)¹⁾
6~ < 12月组	171	73(42.69)¹⁾	50(29.24)	12(7.02)	36(21.05)¹⁾
≥12月组	148	55(37.16)¹⁾	39(26.35)	21(14.19)¹⁾	33(22.30)¹⁾
合计	792	366(46.21)	214(27.02)	61(7.70)	151(19.07)
与0~ < 3月组比较，¹⁾P < 0.05；与3~ < 6月组比较，²⁾P < 0.05；与6~ < 12月组比较，³⁾P < 0.05。

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表 3 各组听力损失性质比较耳(%)

组别	听力损失总耳数	听力损失性质
组别	听力损失总耳数	感音神经性	传导性	混合性
0~ < 3月组	202	129(63.86)	43(21.29)	30(14.85)
3~ < 6月组	271	178(65.68)	59(21.77)	34(12.55)
6~ < 12月组	171	116(67.84)	35(20.47)	20(11.70)
≥12月组	148	111(75.00)	27(18.24)	10(6.76)
合计	792	534(67.42)	164(20.71)	94(11.87)

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表 4 听力损失高危因素儿童听力情况例(%)

高危因素	例数	正常	听力损失程度				听力损失侧别
高危因素	例数	正常	轻度	中度	重度	极重度	单侧	双侧
颅面畸形	32	2(6.25)	6(18.75)	20(62.50)¹⁾³⁾	3(9.38)²⁾	1(3.12)²⁾	20(62.50)	10(31.25)
NICU住院史	28	15(53.57)	11(39.29)	0(0)¹⁾	1(3.57)	1(3.57)	4(14.29)	9(32.14)
耳聋家族史/先天性遗传综合征	18	7(38.89)	3(16.67)	1(5.56)	3(16.67)	4(22.22)²⁾	4(22.22)	7(38.89)
低体重	2	1(50.00)	0(0)	0(0)	0(0)	1(50.00)	0(0)	1(50.00)
高胆红素血症	2	2(100.00)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
病毒感染	2	1(50.00)	0(0)	0(0)	1(50.00)	0(0)	0(0)	1(50.00)
机械通气	1	1(50.00)	0(0)	0(0)	0(0)	0(0)	0(0)	0(0)
多因素	13	11(84.62)	1(7.69)	0(0)	0(0)	1(7.69)	1(7.69)	1(7.69)
合计	98	40(40.82)	21(21.43)	21(21.43)	8(8.16)	8(8.16)	29(29.59)	29(29.59)
与轻度比较，¹⁾P < 0.05；与中度比较，²⁾P < 0.05；与重度比较，³⁾P < 0.05。

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