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。

Application and relevance analysis of Hearing Handicap Inventory for the Elderly-Screening in presbycusis survey

OBJECTIVE To investigate the application of Hearing Handicap Inventory for the Elderly-screening(HHIE-S) in hearing screening among elders in rural communities in Beijing. To assess the sensitivity and specificity of the scale. METHODS Four hundred subjects over 60 years old from 10 communities of DaXing district of Beijing were recruited. All the subjects finnished the HHIE-S scale and took the pure tone audiometry, and then were classified into three groups of mild, moderate, and severe deafness according to the average hearing threshold of the ear with less hearing loss by the diagnostic criteria of WHO. Correlation between the pure tone threshold and the HHIE-S scale were examined. According to the audiometric screening guidelines of American Speech-Language-Hearing Associations, a HHIE-S score >8 points indicates hearing impairment. And the sensitivity and specificity of the HHIE-S were examined with this cutoff value. RESULTS 1. The sensitivity of the HHIE-S scale in hearing screening depends on the hearing loss. For the subjects with mild deafness the sensitivity was 65.70%, moderate 78.40%, and severe 98.90%. 2. Respectively, specificity was 94.00%, 82.80%, and 65.60% for mild, moderate, and severe deafness. 3. The positive predictive value was 98.70%, 94.80%, and 51.10% ,respectively;meanwhile, the false positive rate (i.e., the misdiagnosis rate) was 6%, 17.80%, and 34.40%; correspondingly, the false negative rate (i.e., the missed diagnosis) was 34.30%, 21.60% and 1.10%. 4. The correlation coefficients between HHIE-S score and hearing loss were 0.215, 0.586 and 0.391, respectively. (all P<0.001). CONCLUSION HHIE-S scale is simple and easy to practise when screening for hearing loss , with high sensitivity , specificity and good consistency between the score and the pure tone threshold. It is practical and essential for presbycusis survey.