老年听力障碍筛查量表在老年性聋调查中的应用与相关性分析

目的　探讨老年听力障碍筛查（h e a r i n g handicap inventory for the elderly-screening,HHIE-S）量表在老年人听力筛查中的应用价值,并分析其敏感性和特 异性。方法　对400例60岁以上老年人进行HHIE-S问卷调查及纯音听阈测试,以纯音测听较好耳的平均听阈,计算听力下降水平,分析HHIE-S在老年人听力筛查中的应用价值;依据世界卫生组织（WHO1997）听力障碍分级标准,并参照美国言语听力协会听力筛查指南标准,将HHIE-S量表得分＞８分定义为存在听力障碍,探讨HHIE-S量表对不同程度听力损失老年人听力筛查的敏感性和特异性及与纯音测听的相关性。结果　HHIE-S量表可以对老年人的听力障碍进行筛查,反映了听力下降对受试者生理和言语交流的影响。①HHIE-S量表敏感性分别是轻度听力损失65.70%、中度听力损失78.40%、重度听力损失98.90%。②HHIE-S量表特异性分别为轻度听力损失94.00%、中度听力损失82.80%、重度听力损失65.60%。③对听力损失阳性预测值分别为轻度98.70%、中度94.80%和重度51.10%;假阳性率分别为轻度6.00%、中度17.20%和重度34.40%;假阴性率分别为轻度34.30%、中度21.60%和重度1.10%。④HHIE-S量表与老年人听力损失程度相关系数分别为0.215、0.586和0.391（P 均<0.001）,有统计学意义。结论　HHIE-S量表简单易行,对于评估听力损失程度具有较高敏感性和特异性,与纯音测听有很好相关性,在老年人听力筛查中具有实 用性和有效性。     

筛选型老年听力障碍量表的研译及其信度和效度评价

目的：研译中文版筛选型老年听力障碍量表（the hearing handicap inventory for the elderly－screen-ing version,HHIE－S）,并检验其信度和效度。方法将英文版 HHIE－S 源量表经过翻译、回译、文化调试等步骤形成中文版 HHIE－S,采用直接采访法,对170例年龄≥65岁听力正常或老年性聋人群进行中文版 HHIE－S量表问卷调查,并进行纯音听阈测试,1～2周后再重复进行一次量表调查。结果研译后的中文版 HHIE－S 量表的10个条目均有较强关联性,量表分为情感和情境2个维度,其 Cronbach’s α系数分别为0．889和0．924,总 Cron-bach’s α系数为0．935;各维度分半信度分别为0．836和0．903,总分半信度为0．836;各条目与维度的重测信度值在0．749至0．921之间,总量表重测信度为0．963。内容效度：各条目与所在维度间相关系数在0．750和0．927之间,与量表总分间的相关系数在0．659和0．878之间。因子分析提取出2个公因子,即情感和情境两个维度,总方差解释率为73．874％。各条目的因子负荷均在0．684和0．871之间,所有条目在相应因子上的因子负荷均＞0．60,与源量表结构一致。量表的两个维度和总分与纯音听阈间呈正相关。结论研译的中文版 HHIE－S 符合汉语语言文化特点,易被老年人群接受;量表的结构稳定,具有较好的信度和效度,可用于老年人听力障碍的初步筛查。     

消息与动态

北京市指定儿童听力诊断中心简介北京市卫生局于2003年9月1日启动了《北京市0-6岁儿童听力筛查、诊断管理办法》。北京市儿童听力筛查工作已经全面展开。北京市卫生局于2003年12月19日公布了北京市首批0-6岁儿童听力诊断定点医疗机构。解放军总医院是首批听力诊断定点医疗机构之一。为此,解放军总医院耳鼻咽喉-头颈外科,解放军耳鼻咽喉科研究所成立了北京市指定儿童听力诊断中心。中心位于耳鼻咽喉科研究所一层,配备了国内标准的声学检查室及听力学检查设备包括纯音测听仪、声导抗测听仪、听性脑干诱发电位、耳声发射、行为测听设备并配备了…     

北京市平谷区儿童轻度听力损失现状调查分析

目的初步了解北京市在校小学生的听力健康状况，获得听力损失的现患率及分布情况，从而为政府决策和社会保障制度的实施提供理论依据。方法采用整群抽样和分层随机抽样相结合的方法，对北京市平谷区第四小学在校学生进行纯音听力测试；并发放问卷，了解学生的基本状况。结果共对997名学生进行了纯音听力测试，初筛阳性人数15名，复筛确诊昕力异常者5名。平谷区第四小学儿童听力残疾初筛阳性率为1．50％，听力损失现患率为5．02‰。结论轻度听力损失儿童是个不容忽视的群体，从多方面进行残疾预防对减少学龄儿童听力损失提高儿童生活质量有现实意义。     

北京市指定儿童听力诊断中心简介

北京市卫生局于2003年9月1日启动了《北京市0-6岁儿童听力筛查、诊断管理办法》。北京市儿童听力筛查工作已经全面展开。北京市卫生局于2003年12月19日公布了北京市首批0-6岁儿童听力诊断定点医疗机构。解放军总医院是首批听力诊断定点医疗机构之一。为此,解放军总医院耳鼻咽喉-头颈外科,解放军耳鼻咽喉科研究所成立了北京市指定儿童听力诊断中心。中心位于耳鼻咽喉科研究所一层,配备了国内标准的声学检查室及听力学检查设备包括纯音测听仪、声导抗测听仪、听性脑干诱发电位、耳声发射、行为测听设备并配备了临床听力师、信息员、技术人员等…     

感音神经性聋患儿的听功能综合评估

目的探讨听力测试组合（ABR＋ASSR＋声场环境中的行为测听）在感音神经性聋患儿残余听力评估中的应用价值。方法48名（96耳）感音神经性聋患儿中能配合纯音测听的患儿19人（38耳）设为PTA组,进行纯音测听及ASSR检测;不能配合纯音测听的患儿29人（58耳）设为BA组,进行声场环境中的行为测听（behavior audiometry,BA）、ABR及ASSR检测。结果①PTA组0．5、1、2、4kHz各频率ASSR反应阈与纯音听阈显著相关（P〈0．01）,各频率相关系数分别为0．75、0．76、0．76、0．83,建立本实验室的ASSR—PTA直线回归方程;②BA组23耳ABR无反应但仍可引出ASSR,而ASSR无反应耳ABR均未能引出;BA组29例患儿中ASSR检测反应较好耳（29耳）在0．5～4kHz四个频率上,ASSR可测得83个反应阈值,行为测听可测得89个反应阈值,综合ASSR和行为测听可以得到96个反应阈值。结论与单项听力测试方法相比,听力测试组合（行为测听＋ABR＋ASSR）能为更小年龄、听力损失更重的患儿进行残余听力的评估,同时能对双侧耳间听力差异、各频率的听力损失程度进行评估,为听力损失病变的定位判断提供参考。     

基于决策树智能算法的2步纯音听力筛查在社区老年人中的应用

目的探索基于决策树智能算法的2步纯音听力筛查在基层医疗单位大范围快速检出中度及以上听力损失者的可行性和科学性。方法对某社区399例老年人进行2步纯音听力筛查(即用0.5 kHz、47 dB HL和2 kHz、42 dB HL两个固定频率和强度的纯音分2步测听)及中文版老年听力障碍筛查量表(Chinese version of the hearing handicap inventory for the elderly screening scale,CHHIE-S)调查,分析筛查出的老年听障者在不同年龄段和性别的分布,以及纯音听力筛查结果与CHHIE-S量表得分的关系,并与既往文献中的结果进行比较。结果使用2步纯音听力筛查对本组老年人中度及以上听力损失的筛出率为29.82%(119/399),除去敏感度误差后,与既往文献报道的用传统标准纯音测听检测社区老年人中度及以上听力损失的检出率(分别为39.32%和39.91%)比较,差异无统计学意义(P=0.052和P=0.594);中度及以上听力损失老年人的检出率随年龄增加而升高(P=0.003),男、女性检出率差异无统计学意义(P=0.067),与文献[年龄χ²=21.89,CI-1.8~19.1;男(34.8%),女(20.5%),CI-0.60~1.23]报道一致;纯音听力筛查结果与CHHIE-S得分显著相关(r=0.218,P<0.001),支持2步纯音听力筛查的内敛效度,与文献报道一致(r=0.392,P<0.001)。结论在具备基本测听设备的条件下,将基于决策树智能算法的2步纯音听力筛查用于常规老年人体检中,可以成为一种科学的、有潜力的在基层社区医疗机构推广应用的老年人听力服务模式。     

中小学生听力筛查量表的编制

目的为我国4～16岁中小学生修订《中小学生听力筛查量表》,为及时发现听力障碍儿童提供可靠的筛查工具。方法采用量表修订的基本程序编制量表,由专家问卷法和Saaty权重计算法对量表进行修订。结果专家意见一致性系数W=0.91236,协调系数经检验后有显著性。专家权威系数Cr=0.72。指标权重一致性指数CI=0.063,所有指标的权重可以接受。随机一致性比率CR=0.043,判断矩阵有满意的一致性。结论该量表的13个指标质量符合量表编制的基本要求,可以进行下一步信度和效度检验。     

少年儿童慢性鼻窦炎患者生活质量量表的编制和检验

目的编制一个评价少年儿童慢性鼻寞炎患者（简称患儿）生活质量的多维测评量表。方法参考国内外生活质量量表，构成患儿生活质量初始量表，对52例患儿进行生活质量的预测试后，进行条目筛选，建立量表，并对量表作信度和效度检验。结果编制的少年儿童慢性鼻寞炎患者生活质量量表（简称量表）分疾病症状、普适性生活质量以及视觉模拟评分3个部分，16个条目。量表的重测信度为0．989，分半信度为0．776，克朗巴赫α系数为0．751。与WHOQOL-BREF总分的Pearson相关系数为0．672，P＜0．01：经因子分析获得的因子结构与量表设计的预想结构一致，具有较好结构效度。量表的信度和效度符合心理测量学要求。结论编制的量表是可信、有效和敏感的，可应用于临床。     

2004年北京市0-6岁儿童听力残疾抽样调查报告

目的通过对北京市学龄前儿童听力残疾的流行现状及致病因素的调查，进一步了解康复需求，为政府职能部门制定耳聋预防及早期干预规划提供理论依据。方法共对28709名0-6岁儿童进行听力筛查，主要采用行为测听法，6个月以下儿童兼做耳声发射。筛查阳性转诊到中国聋儿康复研究中心确诊。结论在参加调查的人数中，筛查阳性者108名，筛查阳性率为3．76‰，依据1987年我国耳聋分级标准，最终诊断听力残疾26人，听力残疾的现患率为0．9‰，假阳性率为75．9％；由于有一名已经确诊听力残疾儿童在听力筛查中漏诊，其听力筛查结果为“通过”，按照Possion分布推算，估计听力残疾总现患率为1．04‰。     

多频听觉稳态反应与40Hz听相关电位对儿童客观听阈评估的比较

目的通过对感音神经性聋患儿的多频听觉稳态反应（multiple frequency auditory steady--state response，MFASSR）测试结果进行分析，并比较其在0．5 kHz处与40 Hz听相关电位（40Hz auditory event related potential，40 Hz AERP）对客观听阈评估的准确性，为MFASSR临床应用提供指导。方法对感音神经性聋儿进行纯音测听、ABR、40 Hz AERP和MFASSR测试。MFASSR与ABR、40 Hz AERP测试均在睡眠状态下进行。按照测试结果分为ABR未引出组与ABR引出组。结果①MFASSR在0．5 kHz处引出率比40 Hz AERP低。②0．5 kHz MFASSR反应阈对纯音听阈的评估较1、2、4 kHz MFASSR反应阈对纯音听阈的评估差。③以纯音听阈为标准，在0．5 kHz处MFASSR与40 Hz AERP对纯音听阈的评估差别具有统计学意义（P=0．001），说明，在0．5 kHz处MFASSR对纯音听阈评估的准确性不如40 Hz AERP。结论MFASSR反应阈对0．5 kHz处纯音听阈的预测需要结合40 Hz AERP来判断。     

Test accuracy and prognostic validity of multiple auditory steady state responses for targeted hearing screening

The test accuracy and prognostic validity of Multiple Auditory Steady State Responses (MSSR) and click Auditory Brainstem Responses (cABR) was compared within the context of a targeted screening protocol. A sample of 508 high-risk babies was first screened using cABR and MSSR (500 and 2000 Hz). All children (failed/ pass) were called back at three to four years of age to determine their hearing status (pure-tone audiometry). Although both methods showed an equally good test performance in the first screen (sensitivity: 100% and specificity: 92-95%), the MSSR may have some potential advantage to identify low-frequency hearing loss. Furthermore, the confirmatory audiometry with MSSR predicted the child hearing status more accurately than the cABR. In conclusion, the MSSR can provide valuable information for the diagnosis and management of infants earlier detected by a screening protocol and further developed might be also useful as a screening test.     

北京某社区老年人群听力水平分布情况及自我认知能力的调查研究*

目的全面了解老年人群中不同听力水平分布情况和老年人对听力的自我认知能力.方法通过问卷调查获得老年人群听力水平自我评估结果,再通过纯音测听检测受试人群听力,评估老年人群对听力水平的自我认知能力.结果接受调查的516例老年人中,听力正常者181人(35.08%),轻度听力损失171人(33.14%),中度听力损失155人(30.04%),重度听力损失9人(1.74%);其中266人(51.55%)对自我的听力水平认知正确,171人(33.14%)自我认知听力水平高于实际水平,79人(15.31%)自我认知听力水平低于实际水平.结论在全身情况基本正常的老年人群中,50%以上的老年人能够正确认知自己的听力状况.     

Auditory steady-state responses to multiple simultaneous stimuli in children with functional or sensorineural hearing loss

The goal of our study was to identify the role of auditory steady-state responses for hearing assessment in patients with functional hearing loss. The study design was to compare auditory steady-state response thresholds and standard pure-tone audiometry thresholds between patients with functional or sensorineural hearing loss. Subjects comprised 16 patients (24 ears) with functional hearing loss and 17 patients (24 ears) with sensorineural hearing loss. Differences and correlations between auditory steady-state response thresholds and standard pure-tone audiometry thresholds at 500, 1,000, 2,000 and 4,000 Hz were evaluated. In children with functional hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds were significantly different at all frequencies and were not significantly correlated. In patients with sensorineural hearing loss, pure-tone audiometry thresholds and auditory steady-state response thresholds did not differ significantly at any frequencies and were significantly correlated. Auditory steady-state responses may have principal role in the assessment of auditory brainstem acuity, particularly at low frequencies in patients with functional hearing loss.     

Conductive hearing loss assessment in children with otitis media with effusion. A comparison of pure tone and BERA results

A comparison between pure-tone audiometry and brainstem electric response audiometry was made in 25 children with a conductive hearing loss due to otitis media with effusion. Pure-tone audiometry, including bone and air-conduction thresholds, was recorded using standard procedures. BERA was used to construct a latency-intensity function and from this the conductive hearing loss could be estimated. For all frequencies except for 2000 Hz a good correlation was found between the conductive loss in the pure-tone audiogram and the conductive loss as estimated by BERA. The moderate correlation for 2000 Hz is due to a 'Carhart'-notch-like phenomenon in the pure-tone audiogram.     

变应性鼻炎对儿童中耳的影响

目的探讨变应性鼻炎对中耳听功能的影响。方法对变应性鼻炎患儿100例和正常儿童50例行耳镜检查、声导抗和纯音听阈的测定。分别对正常儿童组．轻度与中重度变应性鼻炎组的鼓膜异常率、鼓室导抗图异常率、听力损失率、昕阈值进行对比分析,并进行病程与各项观察指标的分析。结果轻度变应性鼻炎组与中重度鼻炎组、中重度鼻炎组与正常儿童组中耳病变和功能异常的发生率相比。差异有统计学意义（P〈O．01）,而轻度变应性鼻炎组与正常儿童组相比,无统计学意义（P〉0．05）;轻度变应性鼻炎组和中重度变应性鼻炎组症状持续时间均与听力损失程度有相关性,病程越长听力损失越重,Spearman相关性检验,r值分别为0．86（P〈0．01）和0．79（P〈O．01）;三组纯音听阈均数经配对t检验,差异均有统计学意义户〈0．01）。结论儿童变应性鼻炎引起的中耳病变和听功能异常发生率较正常儿童显著提高,症状越重。病程越长,发生率越高。     

Evaluation of a hearing screening questionnaire for use with Ecuadorian school-aged children

Objective: The purpose of this study was to evaluate the accuracy of a teacher-administered hearing screening questionnaire to detect hearing loss among first-grade Ecuadorian children in public schools. Design: A cross-sectional design was used to compare screening results from the teacher-administered questionnaire and pure-tone audiometry. Study sample: Children were randomly selected from 117 schools. The study was conducted in two phases to accommodate different school calendars in the country. Data for both screening methods were available for 4616 children. Results: For Phase 1, almost 90% who failed the questionnaire passed audiometry; and, 85% who failed audiometry passed the questionnaire. A revised questionnaire was used for Phase 2 and 70% who failed the questionnaire passed audiometry; and 85% who failed audiometry, passed the questionnaire. Of the 27 children identified in Phase 2 as having hearing loss at the time screening was done, 88.9% failed audiometry, but only 22.2% failed the questionnaire. Conclusions: Because there was little agreement between the questionnaire and the audiometry, it was recommended that the questionnaire not be used to screen Ecuadorian children for hearing loss. The results of this evaluation of the school hearing screening program provided the Ecuadorian government with important information to guide policy decisions.     

Development and evaluation of an audiology app for iPhone/iPad mobile devices

Conclusion: The application described in this study appears to be accurate and valid, thus allowing calculation of a hearing handicap and assessment of the pure-tone air conduction threshold with iPhone/iPad devices. Objective: To develop and evaluate a newly developed professional, computer-based hearing handicap calculator and a manual hearing sensitivity assessment test for the iPhone and iPad (AudCal). Methods: Multi-center prospective non-randomized validation study. One hundred and ten consecutive adult participants underwent two hearing evaluations, a standard audiometry and a pure-tone air conduction test using AudCal with an iOS device. The hearing handicap calculation accuracy was evaluated comparing AudCal vs a web-based calculator. Results: Hearing loss was found in 83 and 84 out of 220 standard audiometries and AudCal hearing tests (Cohen’s Kappa = 0.89). The mean difference between AudCal and standard audiogram thresholds was ?0.21 ± 6.38 dB HL. Excellent reliability and concordance between standard audiometry and the application’s hearing loss assessment test were obtained (Cronbach’s alpha = 0.96; intra-class correlation coefficient = 0.93). AudCal vs a web-based calculator were perfectly correlated (Pearson’s r = 1).     

Clinical trial of BOBCAT: 1st report on the reliability and validity of computerized pure-tone audiometry

Computerized diagnostic audiometry is quickly emerging as a viable productivity tool in the audiology clinic. To date, there has been little reported on its reliability and validity with the hearing-impaired. The 'Battery of Basic Computerized Audiometric Tests' (BOBCAT) is a computer program which puts a wide variety of clinical hearing tests under computer control. The purpose of the present study was to ascertain the reliability and validity of BOBCAT in the measurement of hearing sensitivity. A field study was conducted in a group of 92 workers exposed to noise to measure air- and bone-conduction thresholds. Coefficients of reliability of 0.85 and higher were obtained between air and bone thresholds for both methods of testing; that is, manual and computer-controlled audiometry. The same measurement between manual and computerized air-conduction pure-tone thresholds gave values ranging from 0.93 to 0.98. A principal-components analysis documented content validity of computerized audiometry. These results are interpreted as clear evidence of both reliability and validity of the BOBCAT procedure, with one exception: 6.7% of all observations are showing air-conduction computerized thresholds of -10 dB at one or more frequencies, with no confirmation by manual audiometry. This is attributed to insufficient randomization of intervals between stimuli, a problem which should be taken care of by new versions of the software.     

cis-platinum ototoxicity in children

Despite the recognized ototoxicity of cis-platinum, a clinical outline for the audiologic evaluation of patients receiving this drug has not been clearly defined. In a practical approach to this problem, the audiograms of 48 pediatric patients referred for monitoring during planned cis-platinum therapy were reviewed. Eleven patients tested with auditory brain-stem response (ABR) audiometry demonstrated several limitations of this modality. Fourteen children underwent initial ABR testing followed by at least two pure-tone audiograms. The remaining 23 patients had their hearing evaluated by pure-tone audiometry only. Various factors such as patient age, cis-platinum dosage, and cranial radiation exposure were analyzed for apparent effect. Younger patients tended to be more susceptible to audiologic changes with the administration of cis-platinum. The proportion of patients who demonstrated a hearing loss increased with successive dosing as did the severity of the hearing loss. Prior exposure to cranial radiation was strongly linked to the development of hearing loss following cis-platinum therapy. Guidelines are presented regarding the use of clinical audiometry in the screening of these pediatric oncology patients.