目的 了解耳声发射(otoacoustic emission,OAE)、自动听性脑电反应(auto auditory brainstem respons,AABR)以及联合筛查的灵敏度、特异度、漏诊率、误诊率。方法 在新生儿出生后3~5 d采用OAE进行听力筛查,筛查未通过者于出生后42 d时进行OAE和AABR联合筛查,联合筛查仍未通过者,转诊至上级医院进行常规脑干诱发电位(auditory brainstem respons,ABR)和声阻抗检查,并对听力障碍进行诊断和分类。OAE和AABR作为并联试验,当两种筛查方法中有一种未通过即判为筛检试验阳性,两种方法均通过判为筛检试验阴性。结果 共完成新生儿OAE和AABR联合筛查1 271例,通过者1 064例,未通过者207例。出生后42 dOAE复筛比OAE初筛灵敏度略有提高;单独使用AABR筛查,灵敏度较低,特异度较高;OAE和AABR联合筛查的灵敏度高于单一方法筛查的灵敏度,漏诊率降低。结论 采用OAE进行新生儿听力筛查存在较高的漏诊率,OAE和AABR联合筛查能够有效的减少漏诊率,因此联合筛查的方法值得推广。

Objective To learn the sensitivity,specificity,the rate of missed diagnosis,misdiagnosis rates of otoacoustic emission (OAE),auto auditory brainstem respons (AABR) and the combined screening. Method OAE hearing screening were carried out in the 3~5 d after birth,each referred infant received OAE joint AABR screening in 42 days after birth.Those who have not passed the combined screening referral to higher hospital for ABR,acoustic impedance examination and the diagnosis and classification of hearing impairment.AABR and OAE as a parallel method of testing,anyone of the two method referred was positive,both of them passed was negative. Results 1 271 newborns received OAE and AABR combined screening,1 064 passed,207 did not pass.The sensitivity of OAE screening in the 42 days after birth was slightly higher;Compared with OAE,AABR screening had a lower sensitivity and higher specificity;Combined screening had improved the sensitivity and reduced the rate of missed diagnosis than a single method of screening. Conclusion Using OAE newborn hearing screening have a higher rate of missed diagnosis,OAE and AABR combined screening can effectively reduce the rate of missed diagnosis,and therefore worthy to be popularized.